Surgery is the only hope to cure gastric cancer. The aim of surgery is the complete removal of the tumor (UICC RO-resection), which is known to be the only treatment modality proven effective and the most important treatment-related prognostic factor. The type of surgical treatment for gastric cancer is determined by the patient's medicosurgical status and the stage of disease. Improved survival and quality of life(QOL) are the major criteria for the therapeutic strategy. For patients with early gastric cancer, minimal invasive surgery is attempted for the improvement of QOL. Minimal invasive surgery can be performed only when there is no evidence for residual disease, especially in lymphnodes. Therefore, precise prediction and selection of node-negative patients is important for the application of minimal invasive surgery. However, long-term survival data are needed for these new techniques to become more generally accepted. For patients with advanced gastric cancer, aggressive and extended surgical approaches are recommended for the improvement of survival. Distal subtotal gastrectomy is the procedure of choice whenever tumor-free margin can be obtained, with the exception of proximal tumors that can be treated by total gastrectomy. Extended lymphadenectomy should be the choice of lymphadenectomy for experienced surgeons with a low morbidity and mortality. If a surgeon can perform combined resection of adjacent organs safely, it is recommended when a direct invasion is suspicious. Distal pancreatectomy should be avoided unless direct invasion is definite. Splenectomy for the purpose of lymph node dissection is be mandatory, and surgeons should consider preservation of the spleen when there is no definite splenic hilar lymph node enlargement or any direct invasion to the spleen. Cytoreductive surgery with intraperitoneal chemotherapy is a useful and promising procedure for the treatment of peritoneal metastasis. The therapeutic approach should be stratified according to the patient's status, tumor status,and QOL after resection. Above all, the treatment strategy should be specific and tailored to each patient for the improved survival and QOL.
Drug Therapy ; Gastrectomy ; Hope ; Humans ; Lymph Node Excision ; Lymph Nodes ; Mortality ; Neoplasm Metastasis ; Pancreatectomy ; Spleen ; Splenectomy ; Stomach Neoplasms* ; Surgeons

No abstract available.
Adenocarcinoma*

No abstract available.
Neoplasm Metastasis* ; Stomach Neoplasms*

No abstract available.
Drug Therapy* ; Fistula*

No abstract available.
Colorectal Neoplasms*

No abstract available.
Gastrectomy* ; Stomach Neoplasms*

No abstract available.
Colorectal Neoplasms*

Leiomyosarcoma of the inferior vena cava(IVC) is a rare tumor and has a poor prognosis. Recently, newer imaging modalities including ultrasound, computed tomographic scan, magnetic resonance imaging and cavovenography make it possible to detect in its early stage of proression. The best therapeutic management is surgical resection and the effects of postoperative adjuvant therapies on patients' survival are still debatable. We report herein our experience of 45-year-old woman whose leiomyosarcoma of the IVC was successfully resected without reconstruction of the IVC.
Female ; Humans ; Leiomyosarcoma* ; Magnetic Resonance Imaging ; Middle Aged ; Prognosis ; Ultrasonography ; Vena Cava, Inferior*

The detection rate of early gastric cancer has been increasing owing to advances in diagnostic techniques. Several different types of minimally invasive approaches to improve quality of life have been developed for the treatment of EGC due to excellent prognosis of EGC patients. Although minimally invasive surgery for the treatment of EGC has gained its popularity, most surgeons are still performing conventional method of open surgery. Conventional Open surgery for the treatment of early gastric cancer, however, is needed to reduce the invasiveness under the influence of technique in MIS. Surgical treatment of EGC should be decided on a case-by-case basis and each surgeon's method of maximum competency.
Humans ; Prognosis ; Quality of Life ; Stomach Neoplasms

BACKGROUND/AIMS: The usefulness of immunohistochemistry to screen for the microsatellite instability (MSI) phenotype in gastric cancer remains unclear. Moreover, the prognostic value of MSI phenotypes in gastric cancer has been debated. METHODS: The clinicopathologic parameters and survival outcomes of 203 MSI-high (MSI-H) and 261 microsatellite-stable (MSS) advanced gastric cancers (AGCs) were compared. Next, we compared the immunohistochemistry results for hMLH1 and hMSH2 with those of a polymerase chain reaction (PCR)-based method. Kaplan-Meier curves and a Cox proportional hazard regression model were used to conduct survival analyses. RESULTS: The MSI-H AGCs were correlated with older age (p<0.001), female gender (p=0.018), distal location (p<0.001), larger size (p=0.016), and intestinal type (p<0.001). Multivariate analysis revealed that the MSI-H phenotype was an independent favorable factor that was related to overall survival in patients with AGC (p<0.001). Compared with the PCR-based analysis, immunohistochemistry exhibited high sensitivity (91.1%) and specificity (98.5%) in the detection of MSI phenotypes. CONCLUSIONS: MSI-H gastric cancers have distinct clinicopathologic features and better prognoses, which suggests the necessity of MSI analysis in gastric cancer. Immunohistochemistry can be a useful and reliable screening method in the assessment of MSI status in gastric cancer.
Adult ; Aged ; Aged, 80 and over ; Female ; Humans ; Immunohistochemistry/*statistics & numerical data ; Kaplan-Meier Estimate ; Male ; *Microsatellite Instability ; Middle Aged ; Phenotype ; Polymerase Chain Reaction ; Predictive Value of Tests ; Prognosis ; Proportional Hazards Models ; Sensitivity and Specificity ; Sex Factors ; Stomach Neoplasms/*genetics/mortality