No abstract available.
Drug Therapy*

No abstract available.
Drug Therapy* ; Stomach Neoplasms*

No abstract available.
Humans

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

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: Recurrence of gastric cancer is not infrequent even though the surgery was curative. The main purpose of this study was to evaluate the relationships between the clinicopathological factors and the recurrence patterns to develop the strategies for the adjuvant treatment. METHODS: We followed the postoperative courses of 578 patients with gastric cancer who underwent curative surgery at the Department of Surgery, Kyungpook National University Hospital from 1990 to 1994. RESULTS: One hundred and forty patients (24.2%) died of a recurrence of the gastric cancer, and 40 (6.9%) died without recurrent disease. The most frequent mode of recurrence was peritoneal seeding (40.0%), followed by hematogenous recurrence (29.2%) and local recurrence (25.0%). The incidence of peritoneal recurrence was significantly higher in subgroups of patients with serosal invasion (47.2% and 17.2%; p=0.011) and with poorly differentiated tumors (47.4% and 27.3%; p=0.002). The incidence of hematogenous recurrence was significantly higher in subgroups of patients without serosal invasion (41.4% and 25.3%; p=0.011) and with well or moderately differentiated tumors (47.7% and 18.4%; p=0.002). The recurrence rates according to the lymph node dissection and postoperative systemic chemotherapy were not significantly different. CONCLUSION: In patients with serosal invasion or with poorly differentiated tumors, an effort to prevent peritoneal recurrence is needed. And in patients with well or moderately differentiated tumors, an effort to prevent hematogenous recurrence is also needed.
Drug Therapy ; Gastrectomy ; Gyeongsangbuk-do ; Humans ; Incidence ; Lymph Node Excision ; Recurrence* ; Stomach Neoplasms*

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: 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

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