No abstract available.
Drug Therapy* ; Stomach Neoplasms*

No abstract available.
Drug Therapy*

No abstract available.
Humans

PURPOSE: There is no established treatment-related prognostic factor for gastric cancer except a curative tumor resection. This study was done to clarify the prognostic value of early postoperative intraperitoneal chemotherapy (EPIC) in patients with serosa-positive gastric cancer. MATERIALS AND METHODS: We analyzed retrospectively the postoperative survival data of 209 patients with serosa- positive gastric cancer treated by surgery and chemotherapy. The survival period for patients was calculated from the date of resection until cancer-related death or the last date of follow-up; Kaplan-Meier survival curves were plotted and compared by using the log-rank test. A multivariate analysis was done by using the Cox proportional hazards model. RESULTS: Statistically significant differences in survival rates were noted based on gender, depth of invasion, lymph node metastasis, distant metastasis, stage, location of tumor, macroscopic type, extent of gastric resection, curability of surgery, and adjuvant chemotherapy. Five-year survival rates of patients who received EPIC and systemic chemotherapy were 49 per cent and 25 per cent, respectively (P=0.009). A multivariate analysis revealed that invasion of an adjacent organ, lymph node metastasis, total gastrectomy, and palliative surgery were poor independent prognostic factors. Also, EPIC had a marginal prognostic value (P=0.056). CONCLUSION: Perioperative intraperitoneal chemotherapy can possibly be one of the independent prognostic indicators in case of serosa-positive gastric cancer.
Chemotherapy, Adjuvant ; Drug Therapy* ; Follow-Up Studies ; Gastrectomy ; Humans ; Kaplan-Meier Estimate ; Lymph Nodes ; Multivariate Analysis ; Neoplasm Metastasis ; Palliative Care ; Proportional Hazards Models ; Retrospective Studies ; Stomach Neoplasms* ; Survival Rate

PURPOSE: In general, surgical resection has been accepted as the primary treatment for resectable stage IV gastric cancer as the survival can be improved over that of non-resectional therapy, although the main prognostic factors are invasion to adjacent organs, involvement of distant lymph nodes, hepatic metastasis and peritoneal dissemination. However, there is a lack of proper criteria or surgical resection in these patients, so it is unclear which patients will benefit from a resection. METHODS: Overall, 498 patients underwent surgery, 314 had a gastrectomy, extended lymph node dissection, with or without co-resection or early postoperative intraperitoneal chemotherapy (resection group), and 184 had non-resectional surgery (non-resection group). The mean survival durations were compared with the Student's t-test. In 310 patients with a single factor, the cumulative survival rates were calculated by the Kaplan-Meier method and compared using the log-rank test. The efficacy of early postoperative intraperitoneal chemotherapy (EPIC) was also evaluated. RESULTS: In patients with one and two factors, the mean survival durations of the resection group were significantly longer than those of the non-resection group (21.4+/-23.3 months vs. 5.9+/-4.8 months; P<0.001, 13.8+/-17.5 months vs. 6.5+/-6.6 months; P=0.003, respectively). The mean survival durations with T factor were 17.4+/-18.2 and 6.3+/-4.7 months in the resection and non-resection groups, respectively (P=0.007). The mean survival durations with N factor, P factor and N&P factors were also significantly longer in resection than the non-resection group (19.2+/-21.1 months vs. 4.6+/-3.1 months; P<0.001, 26.4+/-27.4 months vs. 6.1+/-5.3 months; P<0.001, and 20.0+/-27.1 months vs. 5.7+/-5.1 months; P=0.024, respectively). The five-year survival rates of the patients with single factor were 10.9 and 0% in the resection and non-resection groups, respectively (P<0.001). The five-year survival rates of the patients with P factor were 28.9% and 9.7% in the resection and EPIC and resection only groups, respectively (P=0.0254). CONCLUSION: A survival benefit can be obtained by a surgical resection in patients with a single factor involvement, with the exception of hepatic metastasis, and with two factors involvement composed of distant lymph nodes involvement and peritoneal dissemination.
Drug Therapy ; Gastrectomy ; Humans ; Lymph Node Excision ; Lymph Nodes ; Neoplasm Metastasis ; Stomach Neoplasms* ; Survival Rate

BACKGROUND: The aim of this study is to show the effectiveness and the safety of laparoscopic surgery for the treatment of complicated duodenal ulcers. METHODS: From September 1994 to July 1997, 30 hemodynamically stable patients underwent laparoscopic surgery for the treatment of complicated duodenal ulcers, including 13 free perforations, 12 obstructions and 5 intractabilities. Operations consisted of a truncal vagotomy with a drainage procedure, a proximal gastric vagotomy (posterior truncal vagotomy with anterior seromyotomy) and simple closure of the perforation in 16, 9, 5 cases, respectively. In the beginning of this study, congo-red tests were attempted in 12 patients, intraoperatively in 7 and postoperatively in 5, to assess the reliability of a laparoscopic vagotomy. Long-term follow up was evaluated using by modified Visik criteria. RESULTS: The mean operation time was 150 (80-230) minutes. Oral intake resumed on the third postoperative day. The mean hospital stay was 8.4 days. There was one intraoperative open conversion. In another case, a distal subtotal gastrectomy followed due to persistent postoperative gastric stasis. Six of 7 intraoperative congo red tests showed black-to-red discoloration of the gastric mucosa, which meant reduced gastric acidity. However, in the postoperative group, only 2 of 5 cases did. The mean follow-up period was 21 (3-38) months. There were 2 recurrent ulcers. One was on the duodenum; the other was a marginal ulcer. CONCLUSIONS: Laparoscopic surgery for the treatment of complicated duodenal ulcers is technically feasible, effective, and safe.
Congo Red* ; Congo* ; Drainage ; Duodenal Ulcer* ; Duodenum ; Follow-Up Studies ; Gastrectomy ; Gastric Acid ; Gastric Mucosa ; Gastroparesis ; Humans ; Laparoscopy ; Length of Stay ; Peptic Ulcer ; Ulcer ; Vagotomy* ; Vagotomy, Proximal Gastric ; Vagotomy, Truncal

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

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: Alpha-fetoprotein (AFP) is widely accepted as a useful tumor marker for diagnosis of hepatocellular carcinomas. On rare occasions, however, an abnormal elevation of serum AFP also has been reported in an adenocarcinoma of the gastrointestinal tract. We evaluated the influence of preoperative abnormal elevation of serum AFP (AFP positivity) on the prognosis of resectable gastric cancers. MATENRIALS AND METHODS: 812 gastric cancer patients, who were investigated for serum AFP before their operations and who underwent gastric resections with D2 or more extended lymph node dissection, were enrolled in the study. The survival rates were calculated by using the Kaplan-Meier method and were compared by using the log-rank test. A multivariate analysis was performed using the Cox proportional hazards model. RESULTS: Fifty patients (6.2%) were AFP positive (10.1~4322.6 ng/ml). The survival rate of the AFP positive group was significantly lower than that of the AFP negative group ( 46.6% vs. 67.0%; P=0.0002). The depth of tumor invasion, the degree of regional lymph node metastasis, distant metastases, the TNM stage, the gross type, differentiation, the extent of gastric resection, and the curability of the surgery also significantly influenced survival. Multivariate analysis revealed that the depth of tumor invasion, the degree of regional lymph node metastasis, the curability of the surgery, and AFP positivity were independent prognostic indicators. CONCLUSION: Preoperative serum AFP can be used as an independent prognostic factor of resectable gastric cancer.
Adenocarcinoma ; alpha-Fetoproteins ; Carcinoma, Hepatocellular ; Diagnosis ; Fetal Proteins* ; Gastrointestinal Tract ; Humans ; Lymph Node Excision ; Lymph Nodes ; Multivariate Analysis ; Neoplasm Metastasis ; Prognosis ; Proportional Hazards Models ; 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