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Advanced Gastric Cancer That Was Curatively Resected 78 Months after Being Diagnosed: Report of a Case.

Hae Jung SON ; Moon Won YOO ; Seong Ho KONG ; Hye Seong AHN ; In Kyu LEE ; Woo Ho KIM ; Hyuk Joon LEE ; Han Kwang YANG

Journal of the Korean Gastric Cancer Association.2010;10(1):40-44. doi:10.5230/jkgca.2010.10.1.40

The natural history of gastric cancer is unclear. We report here on a rare case of advanced gastric cancer for which we performed curative gastrectomy 78 months after the diagnosis. A 74-year-old woman with epigastric pain underwent esophagogastroscopy in January, 2000 and she was diagnosed with advanced gastric cancer. Suspicious omental cake was noted on CT. After refusing all kinds of treatment, she underwent a follow up CT scan on September, 2002, which no longer suggested omental cake. She once again refused treatment, but she visited the hospital in June, 2006 due to severe epigastric pain and a decreased oral intake. Abdominal CT showed no distant metastasis, and so radical subtotal gastrectomy with regional lymph node dissection was performed in July, 2006 and the TNM stage was T2bN1M0 (stage II)
Aged ; Female ; Follow-Up Studies ; Gastrectomy ; Humans ; Lymph Node Excision ; Natural History ; Neoplasm Metastasis ; Stomach Neoplasms

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Quality of Life of Long-term Survivors after a Subtotal or a Total Gastrectomy for Gastric Cancer.

Seung Soo LEE ; Sung Won HAN ; Hyeyeon JEONG ; Jyewon SONG ; Ho Young CHUNG ; Wansik YU

Journal of the Korean Gastric Cancer Association.2010;10(1):34-39. doi:10.5230/jkgca.2010.10.1.34

PURPOSE: The aim of this study was to compare quality of life of long-term survivors after a subtotal or a total gastrectomy for gastric cancer. MATERIALS AND METHODS: The European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30 questionnaire and QLQ-STO22 questionnaire were used to assess quality of life of 166 patients on their 5th annual follow-ups after gastrectomy for gastric cancer. One hundred twenty-six patients underwent a subtotal gastrectomy and 40 patients a total gastrectomy. RESULTS: The subtotal gastrectomy group revealed a trend to have better quality of life in functional scales (physical, role, emotional, cognitive and social), fatigue, pain, dyspnea, diarrhea and financial difficulties. The total gastrectomy group showed a trend to have better quality of life in the global health status and quality of life, nausea and vomiting, insomnia, appetite loss and constipation. In all scales of the EORTC QLQ-STO22, the subtotal gastrectomy group had a trend to have better quality of life. However these did not reach the statistical significance. CONCLUSION: Surgeons may not limit the extent of resection concerning long-lasting poor quality of life. Oncologically sound resection is recommended.
Appetite ; Constipation ; Diarrhea ; Dyspnea ; Fatigue ; Follow-Up Studies ; Gastrectomy ; Humans ; Nausea ; Quality of Life ; Surveys and Questionnaires ; Sleep Initiation and Maintenance Disorders ; Stomach Neoplasms ; Survivors ; Vomiting ; Weights and Measures

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Totally Laparoscopic Total Gastrectomy for Early Gastric Cancer: An Initial Experience.

Jeong Seon LEE ; Han Hong LEE ; Jin Jo KIM ; Seung Man PARK

Journal of the Korean Gastric Cancer Association.2010;10(1):26-33. doi:10.5230/jkgca.2010.10.1.26

PURPOSE: We wanted to evaluate the technical feasibility and safety of totally laparoscopic total gastrectomy (TLTG) for treating early gastric cancer. MATERIALS AND METHODS: The medical records of 11 consecutive patients who underwent TLTG after being diagnosed with early gastric cancer at Incheon St. Mary's Hospital, The Catholic University of Korea from February 2005 to September 2009 were retrospectively reviewed and their clinicopathologic characteristics and the surgical results were investigated. RESULTS: The mean operation time was 385.6+/-94.1 minutes, the mean time for creating an intracorporeal anastomosis was 97.5+/-60.0 minutes and the mean number of the harvested lymph nodes was 46.6+/-15.4. The mean number of days after operation until starting a liquid diet was the 6.15+/-7.6th postoperative day and the mean hospital stay after surgery was 14.2+/-11.9 days. There was no case of open conversion, but there were 2 cases of intraoperative complication and 3 cases of postoperative complication. There was one case of postoperative mortality. The patient suffered from thrombocytopenia of an unknown cause, which was refractory to platelet transfusion, on 4th postoperative day and the patient died of intraabdominal bleeding on the 6th postoperative day. CONCLUSION: TLTG was a technically feasible and relatively safe procedure. However, a long time for creating the intracoproeal anastomosis and a long operation time are still problems to be solved.
Diet ; Gastrectomy ; Hemorrhage ; Humans ; Intraoperative Complications ; Korea ; Length of Stay ; Lymph Nodes ; Medical Records ; Platelet Transfusion ; Postoperative Complications ; Retrospective Studies ; Stomach Neoplasms ; Thrombocytopenia

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Comparison of the Nutritional Status and the Acute Inflammatory Reaction between Laparoscopy-assisted Distal Gastrectomy and Conventional Open Distal Gastrectomy for Early Gastric Cancer.

Hyun Dong CHAE

Journal of the Korean Gastric Cancer Association.2010;10(1):19-25. doi:10.5230/jkgca.2010.10.1.19

PURPOSE: Laparoscopy-assisted gastrectomy (LAG) is gaining wider acceptance as a minimally invasive treatment for early gastric cancer, but the safety, efficacy and clinical benefits of this type of surgery are still unclear. The purpose of this study is to compare laparoscopy-assisted gastrectomy (LADG) and conventional open distal gastrectomy (CODG) for early gastric cancer (EGC) according to the changes of the postoperative nutritional status and acute inflammatory reaction. MATERIALS AND METHODS: Eighty seven patients with EGC and who underwent a LADG between March 2006 and May 2009 at Daegu Catholic University Hospital, was enrolled. Over the same period, we enrolled 30 patients who underwent CODG and they were confirmed to have EGC from their pathology. The clinico-pathological features and serologic parameters were evaluated from the medical records and then retrospectively analyzed. RESULTS: There were no differences in the preoperative white blood cell (WBC), C-reactive protein (CRP) level, albumin level, the T4/T8 ratio and the other clinical data between the two groups. The total WBC counts gradually increased and they were significant lower at the 1st and 3rd postoperative days in the LADG group than that in the CODG group (P=0.001 and 0.008, respectively). The postoperative CRP levels were significantly lower at postoperative 5th day in the LADG group (P<0.001). The postoperative albumin and T4/T8 ratio gradually decreased, and the T4/T8 ratio was significantly higher at the 3rd postoperative day in the LADG group compared to that in the CODG group (P=0.003). CONCLUSION: This study demonstrates that the LADG has less of an influence on an acute inflammatory reaction than does CODG. Therefore, it is one of the safe and feasible procedures for the treatment of early gastric cancer.
C-Reactive Protein ; Gastrectomy ; Humans ; Leukocytes ; Medical Records ; Nutritional Status ; Retrospective Studies ; Stomach Neoplasms

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Omental Infarction Following Laparoscopy-assisted Gastrectomy (LAG) for Gastric Cancer.

Min Chan KIM ; Ghap Joong JUNG ; Jong Young OH

Journal of the Korean Gastric Cancer Association.2010;10(1):13-18. doi:10.5230/jkgca.2010.10.1.13

PURPOSE: Omental infarction (OI) following laparoscopy-assisted gastrectomy (LAG) for gastric cancer could become more common in the future because the indications for LAG are expected to expand. The aim of this study was to determine the clinical characteristics of OI following LAG. MATERIALS AND METHODS: Three hundred ninety patients who underwent LAG for T1 or T2 gastric cancer from April 2003 to November 2007 were enrolled. OI was diagnosed by two radiologists using the patients' abdominal 16 row-detector CT scans. The clinicopathologic characteristics were retrospectively evaluated in the omental infarction (OI) group and the non-omental infarction (non-OI) group using the gastric cancer database of Dong-A University Medical Center and the medical records. RESULTS: Nine omental infarctions (2.3%) of 390 LAGs were diagnosed. All the OIs could be discriminated from omental metastasis on the initial or follow up CT images. The location of the omental infarctions was on the epigastrium in 3 patients and in the left upper quadrant in 3 patients. The mean size of the OIs was 4.1 cm. Most patients with OI had no signs or symptoms. The body mass index of the OI group was higher than that of the non-OI group (P=0230), and OI was more common in patients who underwent total gastrectomy than in the patients who underwent subtotal gastrectomy (P=0.0011). CONCLUSION: Laparoscopy-assisted gastrectomy (LAG) with partial omentectomy for gastric cancer can be a cause of secondary OI. Omental infarction after LAG has different clinical characteristics and CT findings that those of other omental infarctions or postoperative omental metastases. Further multicenter study will be needed to evaluate in detail the clinical features of omental infarction after LAG.
Academic Medical Centers ; Body Mass Index ; Follow-Up Studies ; Gastrectomy ; Humans ; Infarction ; Neoplasm Metastasis ; Retrospective Studies ; Stomach Neoplasms

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Changes of the Preoperative and Postoperative Nutritional Statuses in Patients with Gastric Cancer and Assessment of the Nutritional Factors That Are Correlated with Short-Term Postoperative Complications.

Cheong Ah OH ; Dae Hoon KIM ; Seung Jong OH ; Min Gew CHOI ; Jae Hyung NOH ; Tae Sung SOHN ; Sung KIM ; Jae Moon BAE

Journal of the Korean Gastric Cancer Association.2010;10(1):5-12. doi:10.5230/jkgca.2010.10.1.5

PURPOSE: The aim of this study was to evaluate the preoperative and postoperative nutritional statuses of patients with gastric cancer and to investigate the nutritional factors that are correlated with perioperative complications. MATERIALS AND METHODS: From January 2008 to Jun 2008, 669 patients who underwent curative gastrectomy were enrolled in a retrospective study. To evaluate the changes of their nutritional status preoperatively and postoperatively, we measured the total lymphocyte count, the serum albumin, the body weight change and the BMI. The nutritional factors correlated with short-term postoperative complications were analyzed. RESULTS: The total lymphocyte count and serum albumin decreased from the first preoperative day to the 5th day after operation, but they tended to increase and approach the normal range 6 months after operation. The only factor correlated with the short-term postoperative complications (defined as the ones that occurred for 30 days) was the serum albumin checked on the 5th day after operation. CONCLUSION: Low serum albumin on the 5th day after operation was correlated with postoperative short-term complications. Serum albumin can be the preoperative statistical parameter that can predict the occurrence of postoperative complications.
Body Weight Changes ; Gastrectomy ; Humans ; Lymphocyte Count ; Nutrition Assessment ; Nutritional Status ; Postoperative Complications ; Reference Values ; Retrospective Studies ; Serum Albumin ; Stomach Neoplasms

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Treatment of Gastric Epithelial Dysplasia That Is Diagnosed by Endoscopic Biopsy.

Eun Young KIM ; Jin Jo KIM ; Byung Wuk KIM ; Seung Man PARK

Journal of the Korean Gastric Cancer Association.2010;10(1):1-4. doi:10.5230/jkgca.2010.10.1.1

PURPOSE: Gastric epithelial dysplasia (GED) was defined as "unequivocally neoplastic epithelium that may be associated with or give rise to invasive adenocarcinoma" and GED also represents a direct precursor of intestinal type adenocarcinoma of the stomach. The recommended treatment guidelines for GED in the medical literature are endoscopic mucosal resection (EMR) or surgery for high grade dysplasia (HGD) and annual endoscopic surveillance with biopsy for low grade dysplasia (LGD) The aim of this study was to determine the treatment plan for GED that is diagnosed by endoscopic biopsy. MATERIALS AND METHODS: We enrolled 148 patients who were treated by endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD) for GED: there were 63 patients with HGD and 85 patients with LGD and all of them were diagnosed by endoscopic biopsy from January 2006 to December 2008. The results of the final histopathologic reports after EMR or ESD were compared with the results of the endoscopic biopsies. RESULTS: The final histopathologic results of the 148 patients with GED showed 49 (33.1%) patients with adenocarcinoma, 40 (27.0%) patients with HGD and 59 (39.9%) patients with LGD. Among the 63 patients with HGD, 34 (54.0%) patients had adenocarcinoma, 20 (31.7%) patients had HGD and 9 (14.3%) patients had LGD. For the 85 patients with LGD, 15 (17.6%) patients had adenocarcinoma, 20 (23.5%) patients had HGD and 50 (58.8%) patients had LGD. CONCLUSION: Complete resection, including EMR or ESD, is needed for patients with GED diagnosed by endoscopic biopsy and they have HGD. For patients with LGD, EMR or ESD may be needed in addition to endoscopic surveillance with biopsy for making the correct diagnosis and proper treatment because of the possibility of adenocarcinoma.
Adenocarcinoma ; Biopsy ; Epithelium ; Humans ; Stomach

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Correlation between Infiltrations of Tumor-associated Macrophages, Mast Cells, and Dendritic Cells with Clinicopathologic Factors in Advanced Gastric Cancer.

Seung Bum LEE ; Kyong Chon CHI

Journal of the Korean Gastric Cancer Association.2005;5(3):206-212. doi:10.5230/jkgca.2005.5.3.206

PURPOSE: Angiogenesis has a critical role in tumor proliferation, invasion, and metastasis. In gastric cancer, tumor- associated macrophages and mast cells produce angiogenic factors such as VEGF, that inhibit the functional maturation of dendritic cells. The aim of this study is to identify tumor-associated macrophages, mast cells, dendritic cell infiltrations, and microvessel densities (MVD) to investigate the relationship between them and the prognosis for gastric-cancer patients. MATERIALS AND METHODS: The subjects were 79 patients selected from those who had undergone a curative gastric resection for stomach cancer. With them, Immuno-histochemical staining was done using CD34 for the MVD, CD68 antigen for macrophages, and S-100 protein for dendritic cells, and toluidine blue staining was done for mast cells. RESULTS: Macrophage infiltration showed a statistically significant positive correlation with histologic differentiation and a negative correlation with invasion depth, nodal metastasis, and stage. S-100 (+) dendritic cells and mast cells had no significant correlations with histologic differentiation, invasion depth, nodal metastasis, distant metastasis, stage, and MVD. As survival, no statistically significant differences were seen between the variables. CONCLUSION: Tumor-associated macrophages should be evaluated as possible prognostic markers in gastric-cancer patients.
Angiogenesis Inducing Agents ; Dendritic Cells* ; Humans ; Macrophages* ; Mast Cells* ; Microvessels ; Neoplasm Metastasis ; Prognosis ; S100 Proteins ; Stomach Neoplasms* ; Tolonium Chloride ; Vascular Endothelial Growth Factor A

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Expression Pattern of KLF4 in Korean Gastric Cancers.

Jae Hwi SONG ; Yong Gu CHO ; Chang Jae KIM ; Cho Hyun PARK ; Su Young KIM ; Suk Woo NAM ; Sug Hyung LEE ; Nam Jin YOO ; Jung Young LEE ; Won Sang PARK

Journal of the Korean Gastric Cancer Association.2005;5(3):200-205. doi:10.5230/jkgca.2005.5.3.200

PURPOSE: KLF4, a member of the KLF family, is a zinc finger tumor suppressor protein that is critical for gastric epithelial homeostasis. Our aim was to determine whether the altered expression of KLF4 might be associated with gastric cancer development and, if so, to determine to which pathologic parameter it is linked. MATERIALS AND METHODS: For the construction of the gastric cancer tissue microarray, 84 paraffin-embedded tissues containing gastric cancer areas were cored 3 times and transferred to the recipient master block. The expression pattern of KLF4 was examined on tissue microarray slides by using immunohistochemistry and was compared with pathologic parameters, including histologic type, depth of invasion, lymph node metastasis, and peritoneal dissemination. RESULTS: The KLF4 protein was expressed in cytoplasm and nucleus of superficial and foveolar epithelial cells in the normal gastric mucosa. We found markedly reduced or loss of KLF4 expression in 43 (51.2%) of the 84 gastric cancer tissues. There was no significant correlation between KLF4 expression and pathologic parameters, including histologic type, depth of invasion, lymph node metastasis and peritoneal dissemination. CONCLUSION: Our findings suggest that altered expression of KLF4 may contribute to abnormal regulation of gastrointestinal epithelial cell growth and differentiation and to the development of Korean gastric cancer, as an early event.
Apoptosis ; Cytoplasm ; Epithelial Cells ; Gastric Mucosa ; Homeostasis ; Humans ; Immunohistochemistry ; Lymph Nodes ; Neoplasm Metastasis ; Stomach Neoplasms* ; Zinc Fingers

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Suppression of Helicobacter pylori-induced Angiogenesis by a Gastric Proton Pump Inhibitor.

Sung Ho JIN ; Hwa Young LEE ; Dong Kyu KIM ; Yong Kwan CHO ; Ki Baik HAHM ; Sang Uk HAN

Journal of the Korean Gastric Cancer Association.2005;5(3):191-199. doi:10.5230/jkgca.2005.5.3.191

BACKGROUND: Though infections of Helicobacter pylori (H. pylori) are closely associated with activation of host angiogenesis, the underlying mechanisms, as well as the strategy for its prevention, have not been identified. Here, we investigated a causal role of H. pylori infection in angiogenesis of gastric mucosa and a potent inhibitory effect of a gastric proton pump inhibitor (PPI) on the gastropathy. MATERIALS AND METHODS: A comparative analysis of CD 34 expression in tissues obtained from 20 H. pylori-associated gastritis and 18 H. pylori-negative gastritis patients was performed. Expression of HIF-1alpha and VEGF were tested by using RT-PCR. To evaluate the direct effect of H. pylori infection on differentiation of endothelial HUVEC cells, we carried out an in vitro angiogenesis assay. RESULTS: H. pylori-associated gastritis tissues showed significantly higher density of CD34+ blood vessels than did H. pylori-negative gastritis tissues, and the levels were well correlated with expressions of HIF-1alpha. Conditioned media from H. pylori-infected gastric mucosal cells stimulated a tubular formation of HUVEC cells. We also found a significant inhibitory effect of PPI, an agent frequently used for H. pylori eradication, on H. pylori-induced angiogenesis. This drug effectively inhibited the phosphorylation of MAP kinase ERK1/2, which is a principal signal for H. pylori-induced angiogenesis. CONCLUSION: The fact that PPIs can down-regulate H. pylori-induced angiogenesis suggest that anti-angiogenic treatment using PPI may be a preventive approach for H. pylori-associated carcinogenesis.
Blood Vessels ; Carcinogenesis ; Culture Media, Conditioned ; Gastric Mucosa ; Gastritis ; Helicobacter pylori ; Helicobacter* ; Human Umbilical Vein Endothelial Cells ; Humans ; Phosphorylation ; Phosphotransferases ; Proton Pumps* ; Protons* ; Stomach Neoplasms ; Vascular Endothelial Growth Factor A

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