No abstract available.
Drug Therapy*

No abstract available.
Drug Therapy* ; Stomach Neoplasms*

No abstract available.
Humans

PURPOSE: We compared patient nutritional status following both total gastrectomy and subtotal gastrectomy in order to identify the effect of the extent of gastric resection on nutritional outcome and to provide methods for improving malnutrition. METHODS: We studied 238 patients with no evidence of recurrent disease following curative surgery for gastric cancer. Among this group, 45 underwent total gastrectomy (TG) and 193 subtotal gastrectomy (SG). The nutritional status was assessed by measuring hemoglobin, serum albumin, iron and vitamin B12, as well as calculating relative body weight, body mass index and percent body fat. RESULTS: Regardless of the extent of gastric resection, most patients revealed a low hemoglobin level and more than 80% of patients demonstrated anemia. Serum iron level was lower in the TG group than in the SG group at one year after surgery (p=0.027), and 80.0% of the TG group revealed a low serum iron level (less than 65 ug/mL) as compared to 25.6% of the SG group at three years after surgery (p=0.001). Serum vitamin B12 level of the TG group was lower than that of the SG group. There was a tendency of lower relative body weight, lower body mass index and lower percent body fat in the TG group than in the SG group. CONCLUSION: Periodic nutritional assessment is recommended following gastrectomy and nutrients including iron and vitamin B12 must be supplemented when indicated.
Stomach Neoplasms

PURPOSE: We evaluated the clinical implication of Resection A surgery retrospectively to identify whether quality of surgery can be used as a selection factor for adjuvant therapy in patients with gastric cancer. METHODS: Prognosis of 902 patients with gastric cancer who underwent Resection A surgery was evaluated. RESULTS: Among all discharged patients, 77 patients (8.5%) died of recurrent disease, 55 patients (6.1%) died without recurrent disease. Five-year survival rate of all discharged patients was 91.6% and 10-year survival rate 87.1%. Statistically significant prognostic factors were depth of invasion (P<0.001), lymph node metastasis (P<0.001), stage (P<0.001), tumor location (P=0.036) and size (P=0.001), extent of gastric resection (P<0.001), and chemotherapy (P<0.001) on univariate analyses. However, depth of invasion (P=0.001), lymph node metastasis (P<0.001), and total gastrectomy (P<0.001) emerged as statistically significant poor prognostic factor on a multivariate analysis. Adjuvant chemotherapy did not increase the survival rate of patients after Resection A surgery, even in patients with stage II disease. CONCLUSION: In selecting the patients for adjuvant therapy, both the stage of gastric cancer and the quality of surgery should be considered.
Chemotherapy, Adjuvant ; Gastrectomy ; Humans ; Lymph Nodes ; Multivariate Analysis ; Neoplasm Metastasis ; Prognosis ; Retrospective Studies ; Stomach Neoplasms ; Survival Rate

PURPOSE: We have preoperatively and postoperatively investigated the characteristics of anemia in patients with gastric cancer in order to provide optimal medical care for the patients. MATERIALS AND METHODS: Preoperative hemoglobin, serum iron, serum ferritin, serum vitamin B12, and serum folic acid were measured for 321 patients with gastric cancer. These were measured again for 287 patients 6 months postoperatively. RESULTS: Ninety-four patients (29.3%) had preoperative anemia. Preoperative hemoglobin, serum iron, and serum vitamin B12 levels were higher in the patients with early gastric cancer than in patients with advanced gastric cancer. Preoperative hemoglobin, serum iron, and serum ferritin levels were higher in male patients than in female patients. The patients who had preoperative anemia showed a high probability of having postoperative anemia (P<0.001), and the patients who had low serum ferritin levels preoperatively showed a high probability of having low serum ferritin levels and iron deficiency anemia postoperatively (P<0.001). CONCLUSION: Preoperative ferritin deficiency should be improved by iron supplement, even though the patient may not be anemic at that time. Periodic postoperative measurements of the hemoglobin, serum iron, serum ferritin, serum vitamin B12, and serum folic acid levels are highly recommended because postgastrectomy anemia is not rare. Finally, if any low hemoglobin, serum iron, serum ferritin, serum vitamin B12, or serum folic acid levels are found, they should be treated in an appropriate way.
Anemia* ; Anemia, Iron-Deficiency ; Female ; Ferritins ; Folic Acid ; Gastrectomy ; Humans ; Iron ; Male ; Stomach Neoplasms* ; Vitamin B 12

BACKGROUND: To clarify the clinical significance of CEA and CA19-9 in patients with gastric cancer, we evaluated the correlation between tissue expression, the peripheral and the portal levels of these tumor markers, and ten clinicopathological factors, as well as the prognosis. METHODS: Surgical specimens from 40 patients with gastric cancer were examined by using immunohistochemical staining with anti-CEA and anti-CA19-9 monoclonal antibodies. Serum levels of CEA and CA19-9 in the portal and the peripheral blood were measured by using immunoradiometric assays. RESULTS: Positive values of the portal venous CEA were more common in patients with lymph-node metastasis, distant metastasis, and lymphatic invasion than in those without these factors. Curative surgery was performed in 50.5% of the patients with high portal CEA levels and in 90.6% of the patients with low portal CEA levels. Positive values of the peripheral venous CEA were significantly higher in cases with lymph-node metastasis. The positive rate of CA19-9 immunohistochemistry was significantly higher in patients with distant metastasis and in non-curative surgery. The positive rate of peripheral venous CA19-9 was higher in cases with distant metastasis. The three-year survival rate of patients with negative tissue CEA was significantly higher than that of patients with a positive result. The peripheral venous levels of CEA and CA19-9 reflected the portal venous levels accurately. CONCLUSIONS: These results suggest that immunohistochemical examination of CEA in patients with gastric cancer is useful for the evaluation of the biological aggressiveness and progression of the disease and can be used for making a prognosis.
Antibodies, Monoclonal ; Biomarkers, Tumor ; Humans ; Immunohistochemistry ; Immunoradiometric Assay ; Neoplasm Metastasis ; Prognosis ; Stomach Neoplasms* ; Survival Rate

PURPOSE: The aim of this study was to evaluate chronological change of quality of life after surgery in patients with gastric cancer during one year postoperatively. MATERIALS AND METHODS: Quality of life data were obtained from 272 gastric cancer patients who underwent curative gastrectomy between September 2008 and February 2011 at the Kyungpook National University Hospital. The Korean versions of the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire Core (QLQ) 30 with gastric cancer-specific module, the EORTC QLQ-STO22 were used to assess quality of life. All patients had no evidence of recurrence or metastasis during the first postoperative year. Patients were asked to complete the questionnaire, by themselves preoperatively, 3-, 6-, 9-, and 12-months postoperatively. RESULTS: Physical functioning score and role functioning score significantly decreased at first 3 months after surgery and the significant differences were noticed until 12 months after surgery. Emotional functioning score started with the lowest score before surgery and significant improvement was shown 6 months after surgery. Most symptom scores and STO-22 scores were highest at 3 months after surgery and gradually decreased, thereafter. Eating restriction, anxiety, taste, body image scores was highest at 3 months after surgery without significant decrease afterwards. CONCLUSIONS: Most scales worsened after surgery and gradually recovered afterwards with some differences in rate of recovery. However the scales did not fully recover by 1 year period. Further follow-up after 1 year would be helpful in determining which scales are permanently damaged and which are just taking longer time to recover.
Anxiety ; Body Image ; Eating ; Follow-Up Studies ; Gastrectomy ; Humans ; Neoplasm Metastasis ; Quality of Life ; Recurrence ; Stomach Neoplasms ; Weights and Measures ; Surveys and Questionnaires

The para-aortic lymph nodes are the most distal resectable intra-abdominal nodes, to which most lymphatic channels from the stomach converge. Metastasis of gastric cancer to these nodes is regarded as a distant metastasis, and the patient's prognosis is known to be dismal. The purposes of this study are to identify the frequency of metastasis in the para-aortic lymph nodes and to evaluate the therapeutic effect of dissection of these nodes in gastric cancer. Macroscopically identified para-aortic lymph nodes from the left renal vein to the aortic bifurcation were dissected during operation in 173 patients, from among all the patients who underwent surgery for gastric cancer at Kyungpook National University Hospital from 1990 to 1994. Metastases in the para-aortic lymph nodes were found in 26 cases (15%). The frequency of para-aortic lymph node metastasis increased significantly with increasing tumor size and Borrmann type. Neither the tumor location, the depth of invasion, nor the histologic type affected the frequency of metastasis. There were two operative mortalities (1.2%). Twenty-six patients (15%) remained hospitalized for more than 3 weeks postoperatively. There seemed to be a higher incidence of postoperative morbidity in patients with positive para-aortic lymph nodes than in patients with negative nodes, but this difference was not statistically significant. The five-year survival rate of patients with para-aortic lymph node metastasis was 14.4%. Among the patients with para-aortic lymph node metastasis, skip metastasis was found in 11 cases (42%). There seemed to be some survival advantage in patients with skip metastasis, as compared to the positive n3 cases. However, this was not a statistically significant difference. Dissection of the para-aortic lymph nodes did not cause any significant disadvantage in postoperative mortality and morbidity. However, it could not prevent peritoneal seeding or hematogenous metastasis. Based on these data, dissection of the para-aortic lymph nodes seems to have little therapeutic effect, but provides information for accurate staging.
Gyeongsangbuk-do ; Humans ; Incidence ; Lymph Node Excision* ; Lymph Nodes* ; Mortality ; Neoplasm Metastasis ; Prognosis ; Renal Veins ; Stomach ; Stomach Neoplasms* ; Survival Rate

PURPOSE: The aim of this study was to compare the clinicopathological characteristics and postoperative prognosis of two age groups with gastric cancer in order to establish the proper treatment strategy in these groups of patients. MATENRIALS AND METHODS: Among patients with gastric cancer who underwent a gastrectomy between 1990 and 1996 at the Department of Surgery, Kyungpook National University, the clinicopathological characteristics, including the postoperative survival, of patients younger than 40-years old were compared with those of patients over 69-years old. RESULTS: During that period 1,125 gastric cancer patients underwent a gastrectomy. Among them, 111 patients (9.9%) were less than 40-years old, and 96 patients (8.5%) were over 69-years old. In the young group, 79 patients (71.2%) had a poorly differentiated adenocarcinoma, and 59 patients from the elderly group (61.5%) had a well- or moderately differentiated adenocarcinoma (P<0.05). Curative surgery was performed for 88 (79.3%) patients in the young group and 78 (81.3%) patients in the elderly group. This difference was not statistically significant. There was no statistically significant difference in the 5-year survival rates between the young and the elderly (66.3% vs. 47.2%) groups, but the 5-year survival rate of the young group was significantly higher than that of the elderly group after a curative resection (83.2% vs. 53.3%; P<0.05). Also the 5-year survival rate of the elderly group was significantly higher than that of the young group after a non-curative resection (20.4% vs. 4.6%; P<0.05). CONCLUSION: For young patients, more efforts are needed to detect gastric cancer in its early stages so that a curative surgery can be performed. However, for the elderly, surgical treatment is recommended at any stage because of the relatively high survival rate, even after non-curative surgery.
Adenocarcinoma ; Adult ; Aged ; Gastrectomy ; Gyeongsangbuk-do ; Humans ; Prognosis ; Stomach Neoplasms ; Survival Rate