No abstract available.
Drug Therapy*

No abstract available.
Drug Therapy* ; Stomach Neoplasms*

No abstract available.
Humans

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

PURPOSE: We evaluated the socio-personal and clinical factors that can affect preoperative quality of life to determine how to improve preoperative quality of life in patients with gastric cancer. MATERIALS AND METHODS: The preoperative quality of life data of 200 patients (68 females and 132 males; mean age 58.9+/-12.6 years) with gastric cancer were analyzed according to socio-personal and clinical factors. The Korean versions of the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire Core (QLQ) 30 and the EORTC QLQ-STO22, a gastric cancer-specific module, were used to assess quality of life. Patients were asked to complete the questionnaire preoperatively by themselves. RESULTS: Patients with a higher academic background and stage I disease tended to have higher global health status scores. Highly educated younger men had better physical functioning scores. Highly educated and well-nourished patients with stage I cancer had higher role functioning scores. Married patients had better emotional scores. The symptom scales were affected by sex, age, education level, nutrition, and cancer stage. CONCLUSIONS: Preoperative quality of life in patients with gastric cancer can be improved by nutritional support and treatment of symptoms caused by disease progression. Psychological support may be helpful for patients with a poor quality of life.
Disease Progression ; Education ; Female ; Health Records, Personal ; Humans ; Male ; Nutritional Support ; Preoperative Period ; Quality of Life* ; Stomach Neoplasms* ; Weights and Measures ; Surveys and Questionnaires

PURPOSE: The macroscopic findings of tumors are not always identical with the microscopic findings. This study investigated the oncologic implications of macroscopic serosal invasion in advanced gastric cancer to find out how to improve the accuracy for the depth of invasion assessed by the surgeon during an operation. MATERIALS AND METHODS: The medical records of 789 patients with advanced gastric cancer who underwent a gastrectomy at Kyungpook National University Hospital between 1995 and 1999 were reviewed. The prognoses and the recurrence patterns were analyzed according to macroscopic serosal invasion and microscopic serosal invasion, and the clinico-pathological factors of cT3/ss cancers were compared with those of cT3/se cancers. RESULTS: Difference of survival rates according to macroscopic serosal invasion and microscopic serosal invasion revealed statistically significant. Recurrence rates were similar in patients with macroscopic and microscopic serosal invasion (42.2% and 41.4%, respectively). Peritoneal recurrence rates were also similar (19.8% and 21.9%, respectively). The sensitivity and the specificity of macroscopic assessment of serosal invasion were 70.3% and 77.8%, respectively. On univariate and multivariate analyses, Borrmann type I/II cancers and the absence of distant metastases revealed the risk factors for overestimating of serosal invasion. CONCLUSION: Macroscopic serosal invasion assessed by a surgeon intraoperatively can be used to give a prognosis and to predict the recurrence pattern precisely, although there is a risk for overestimation when the tumor is a Borrmann type I/II cancer or the tumor has no distant metastases.
Gastrectomy ; Gyeongsangbuk-do ; Humans ; Medical Records ; Multivariate Analysis ; Neoplasm Metastasis ; Prognosis ; Recurrence ; Risk Factors ; Sensitivity and Specificity ; Stomach Neoplasms* ; Survival Rate

PURPOSE: We compared the quality of life (QOL) and nutritional outcomes following both Billroth I (BI) and Billroth II (BII) reconstructions after a subtotal gastrectomy in order to identify which reconstruction would produce a better QOL and nutritional outcomes and to provide better follow-up management. MATENRIALS AND METHODS: We studied 273 patients without evidence of recurrent disease following a curative distal subtotal gastrectomy for gastric cancer. Among them, 135 underwent a BI reconstruction and 138 a BII reconstruction. The nutritional status was assessed by using levels of hemoglobin, serum albumin, iron, and vitamin B12 and by calculating the relative body weight, the body mass index, and the percentage of body fat. The QOL was measured by using the Troidl score and by treatment-specific symptoms based on the criteria, somewhat modified by the authors, of Korenaga and others. RESULTS: There was no significant difference in QOL between the BI and the BII groups. More than half of the patients revealed anemia, regardless of the type of reconstruction. The serum vitamin B12 level of the BII group was lower than that of the BI group. The BII group showed a tendency toward lower hemoglobin levels and serum iron concentrations than the BI group did. CONCLUSION: The quality of life was not impaired in most patients after either a BI or a BII reconstruction. However, both resulted in iron deficiency anemia, although the incidence was higher after a BII reconstruction. The patient's serum iron and vitamin B12 should be measured periodically and these must be administered if the measurements reveal a below normal range.
Adipose Tissue ; Anemia ; Anemia, Iron-Deficiency ; Body Mass Index ; Body Weight ; Follow-Up Studies ; Gastrectomy ; Gastroenterostomy* ; Humans ; Incidence ; Iron ; Nutritional Status ; Quality of Life* ; Reference Values ; Serum Albumin ; Stomach Neoplasms ; Vitamin B 12

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

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

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