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Preoperative Evaluation and Anesthesia.

Yong Seok OH

Journal of the Korean Gastric Cancer Association.2002;2(3):117-122. doi:10.5230/jkgca.2002.2.3.117

No abstract available.
Anesthesia*

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Surgery for Cancer Arising at an Anastomotic Site after Radical Total Gastrctomy.

Ho Young YOON ; Sang Hoon LEE ; Choong Bai KIM

Journal of the Korean Gastric Cancer Association.2007;7(3):174-179. doi:10.5230/jkgca.2007.7.3.174

The survival of patients with gastric cancer is improved by early diagnosis and surgical treatment. However, there is no established treatment for locally recurrent cancer or cancer arising at an anastomotic site after total gastrectomy; further, most surgeons are reluctant to resect this type of cancer because of frequent systemic metastasis and there are few competent surgeons who have the skill to perform such an operation. We have experienced recurrent cancer at an anastomotic site after total gastrectomy: one patient had recurrent cancer and two patients had metachronous cancer. All these patients were operated on and the patients were discharged without any complications. All of them are alive at the time of this report. In some cases, good results could be expected for operating on recurrent cancer of an anastomotic site after previous total gastrectomy. So, we present here our experience along with a review of literatures.
Early Diagnosis ; Gastrectomy ; Humans ; Neoplasm Metastasis ; Stomach Neoplasms

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The Immunological Effect of Mistletoe Extract on Gastric Cancer Patients.

Sung Woo YANG ; Dong Gue SHIN ; Il Myung KIM ; Seong Min YOON ; Yong Jik LEE ; Su Hak HEO ; Tae Hee KIM

Journal of the Korean Gastric Cancer Association.2007;7(3):167-173. doi:10.5230/jkgca.2007.7.3.167

PURPOSE: Mistletoe (Viscum album L.) extract is one of the most widely used agents in alternative cancer therapeutic regimens in Europe. This study was conducted to determine the effect of mistletoe extract on immune function in gastric cancer patients. MATERIALS AND METHODS: Ten patients that had undergone a curative gastrectomy were enrolled in the prospective study. ABNOBAviscum Q(R) was injected subcutaneously three times a week from postoperative-day 7 to week 16 with an increasing dose. All of the patients simultaneously received chemotheraphy with mitomycin, oral 5-FU and a cisplatin regimen. The WBC count, differential count, lymphocyte/WBC ratio and the level of cytokines (IL-1beta, IL-2, IL-6, IFN-gamma, TNF-alpha) were checked in the peripheral blood preoperatively, at postoperative week 8 and at postoperative week 16. RESULTS: The WBC and neutrophil counts significantly decreased after treatment on week 8 and week 16 (P=0.001), but the total eosinophil count was slightly increased (P=0.15). The total lymphocyte count also decreased during treatment but the lymphocyte/WBC ratio was slightly increased without statistical significance (P=0.91). The cytokine levels did not significantly change during treatment. CONCLUSION: It is somewhat difficult to determine the direct effect of mistletoe therapy on immune function as the effect may be compromised by the concurrent chemotherapy. It can be assumed that the slightly increased lymphocyte/WBC ratio and eosinophil count may be a result of the immunomodulatory effect of the mistletoe extract.
Cisplatin ; Cytokines ; Drug Therapy ; Eosinophils ; Europe ; Fluorouracil ; Gastrectomy ; Humans ; Interleukin-2 ; Interleukin-6 ; Lymphocyte Count ; Mistletoe* ; Mitomycin ; Neutrophils ; Prospective Studies ; Stomach Neoplasms*

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The Results of the ATP Based Chemotherapy Response Assay in Gastric Cancer Tissues.

Je Hyung LEE

Journal of the Korean Gastric Cancer Association.2007;7(3):160-166. doi:10.5230/jkgca.2007.7.3.160

PURPOSE: Recently, chemosensitivity tests have become widely used for the selection of effective drugs in gastric cancer patients. In this study, a chemosensitivity test was performed to select agents to increase the effectiveness of adjuvant chemotherapy. MATERIALS AND METHODS: Chemosensitivity testing was performed in 81 gastric cancer patients that received a gastrectomy at the Yeungnam University Hospital. An ATP (adenosine triphosphate) based chemotherapy response assay was used. Clinicopatholgical factors such as sex, age, expression of tumor markers (CEA and CA19-9 levels), location of the tumor, morphology of advanced cancer, histological type, cell differentiation, depth of invasion, Lauren classification, Ming classification, lymphatic invasion, vascular invasion, neural invasion, lymph node metastasis and TNM stage were used to correlate the chemosensitivity and clinicopathological factors. RESULTS: The most effective antitumor agents in gastric cancer patients were (in order of effectiveness) 5-FU, Epirubicin, Irinotecan and Oxaliplatin in our series. The chemosensitivity test showed a significant difference in susceptibility according to clinicopathological factors. CONCLUSION: Further studies on multidrug therapy are needed to evaluate synergistic effects of drugs. Therefore, for effective chemotherapy, it is more efficacious to select a chemosensitive drug than continue to use the same drug regimen.
Adenosine Triphosphate* ; Antineoplastic Agents ; Cell Differentiation ; Chemotherapy, Adjuvant ; Classification ; Drug Therapy* ; Epirubicin ; Fluorouracil ; Gastrectomy ; Humans ; Lymph Nodes ; Neoplasm Metastasis ; Stomach Neoplasms* ; Biomarkers, Tumor

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Morbidity of Laparoscopic Assisted Gastrectomy for Early Gastric Cancer.

Ji Eun CHOI ; Oh JEONG ; Jeong Hwan YOOK ; Kab Jung KIM ; Jung Tack LIM ; Sung Tae OH ; Gun Choon PARK ; Byung Sik KIM

Journal of the Korean Gastric Cancer Association.2007;7(3):152-159. doi:10.5230/jkgca.2007.7.3.152

PURPOSE: Recently, the use of laparoscopic assisted gastrectomy for early gastric cancer has been on the increase and the procedure has been quickly adopted by clincians. However, there are few reports regarding the safety and risk of this type of surgery. The aim of this study is to evaluate the morbidity and to verify the safety of laparoscopic assisted gastrectomy for early gastric cancer. MATERIALS AND METHODS: A total of 376 patients that had undergone laparoscopic assisted gastrectomy for early gastric cancer between April 2004 and December 2006 were reviewed retrospectively. The clinicopathological characteristics, operative complications, and factors related to complications were evaluated. RESULTS: The overall operative morbidity and mortality rates were 10.6% and 0%, intraoperative morbidity was 1.1% (4 of 376 patients) and post operative morbidity was 9.6% (36 of 376 patients). Most complications required no surgery except for an intestinal obstruction in two cases. Multivariate analysis of risk factors related to operative morbidity determined that age was an independent factor associated with morbidity (P=0.021). CONCLUSION: The complication rate of laparoscopic assisted gastrectomy is low and most complications can be managed by conservative methods rather than with surgery. There were no specific predicting factors for complications except old age. Laparoscopy is a technically feasible and acceptable surgical modality for early gastric cancer.
Gastrectomy* ; Humans ; Intestinal Obstruction ; Laparoscopy ; Mortality ; Multivariate Analysis ; Retrospective Studies ; Risk Factors ; Stomach Neoplasms*

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Pledget as a Useful Substitute for a Knot in Intracorporeal Continuous Gastrointestinal Suturing.

Jin Jo KIM ; Kyo Young SONG ; Sung Keun KIM ; Kyong Hwa JUN ; Hyung Min CHIN ; Wook KIM ; Hae Myung JEON ; Cho Hyun PARK ; Seung Man PARK ; Keun Woo LIM ; Woo Bae PARK ; Seung Nam KIM

Journal of the Korean Gastric Cancer Association.2007;7(3):146-151. doi:10.5230/jkgca.2007.7.3.146

PURPOSE: Pledget is a PTFE felt that is usually used for suture reinforcement in cardiovascular surgery. In order to minimize the difficulty in intracorporeal continuous gastrointestinal suturing by reducing the number of tied knots, we have used pledget as substitute for a knot (pledget suturing). MATERIALS AND METHODS: Thirty-two consecutive patients who underwent totally laparoscopic uncut Roux-en-Y gastrojejunostomy after distal gastrectomy in our institution were enrolled in this study, and the patients were divided into three groups according to the method of intracorporeal anastomosis. Basically, intracorporeal anastomosis was performed by several firings of linear staplers; however, the entry holes for the stapler at the jejunojejunostomy and the gastrojejunostomy were closed by pledget suturing in group A (8 patients), the entry hole for the stapler at jejunojejunostomy was closed by conventional suturing in group B (8 patients), and all of the entry holes for the stapler were closed by stapling in group C (16 patients). The surgical outcomes of each group were compared to each other. RESULTS: The anastomotic time in group A was not longer than in group B, although there were more sutures used in group A, but it was longer than in group C. The number of stapler cartridges used in group A was the smallest among the three groups. In group B, there were two cases of a break of suture material during anastomosis, there were no such cases in group A. There was no complication related to anastomosis in all of the groups. CONCLUSION: Pledget was found to be useful for minimizing the difficulty in intracoproreal continuous gastrointestinal suturing and reducing the number of stapler cartilages used in intracorporeal anastomosis.
Cartilage ; Fires ; Gastrectomy ; Gastric Bypass ; Humans ; Polytetrafluoroethylene ; Sutures

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Comparison of an Uncut Roux-en-Y Gastrojejunostomy with a Billroth I Gastroduodenostomy after Totally Laproscopic Distal Gastrectomy.

Jin Jo KIM ; Sung Keun KIM ; Kyong Hwa JUN ; Kyo Young SONG ; Hyung Min CHIN ; Wook KIM ; Hae Myung JEON ; Cho Hyun PARK ; Seung Man PARK ; Keun Woo LIM ; Woo Bae PARK ; Seung Nam KIM

Journal of the Korean Gastric Cancer Association.2007;7(3):139-145. doi:10.5230/jkgca.2007.7.3.139

PURPOSE: An uncut Roux-en-Y gastrojejunostomy has been known to be effective in preventing bile reflux gastritis in the remnant stomach and the Roux stasis syndrome. MATERIALS AND METHODS: To evaluate the usefulness of a totally laparoscopic uncut Roux-en-Y gastrojejunostomy (TLuRYGJ) after a distal gastrectomy, we reviewed the medical records of 19 consecutive patients that underwent a TLuRYGJ at our institution, and 11 consecutive patients who underwent a totally laparoscopic Billroth I gastrectomy (TLB-I) during the same period. RESULTS: Postoperative gastrointestinal symptoms related to the postgastrectomy syndrome and the Visick classification at six months after surgery were not different in the two groups; however, there was no case of symptomatic bile reflux gastritis and only one case of delayed gastric empting, for which medication was required, in the TLuRYGJ group. The endoscopic findings of the remnant stomach for bile reflux gastritis at six months after surgery were better in the TLuRYGJ group than in the TLB-I group. CONCLUSION: A TLuRYGJ was found to be effective in preventing bile reflux gastritis and the Roux stasis syndrome.
Bile Reflux ; Classification ; Gastrectomy* ; Gastric Bypass* ; Gastric Stump ; Gastritis ; Gastroenterostomy* ; Humans ; Laparoscopy ; Medical Records ; Postgastrectomy Syndromes

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Clinical Usefulness of a Totally Laparoscopic Gastrectomy.

Jin Jo KIM ; Sung Keun KIM ; Kyong Hwa JUN ; Han Chul KANG ; Kyo Young SONG ; Hyung Min CHIN ; Wook KIM ; Hae Myung JEON ; Cho Hyun PARK ; Seung Man PARK ; Keun Woo LIM ; Woo Bae PARK ; Seung Nam KIM

Journal of the Korean Gastric Cancer Association.2007;7(3):132-138. doi:10.5230/jkgca.2007.7.3.132

PURPOSE: In Korea, the number of laparoscopy-assisted distal gastrectomies for early gastric cancer patients has been on the increase. Although minimally invasive surgery is more beneficial, no reported case of a total laparoscopic gastrectomy has been reported because of difficulty with intracorporeal anastomosis. This study attempts, through our experience, to determine the safety and feasibility of a total laparoscopic gastrectomy with various types of intracorporeal anastomosis using laparoscopic linears stapler in treating early gastric carcinomas. MATERIALS AND METHODS: We investigated the surgical results and clinicopatholgical characteristics of 81 patients that underwent a totally laparoscopic distal gastrectomy at our department between June 2004 and May 2007. The intracorporeal anastomoses were performed by using laparoscopic linear staplers. RESULTS: The mean operative time was 287 minutes, the mean anastomotic time was 40 minutes, and the mean number of laparoscopic linear staplers used for an operation was 7.5. The mean time to the first flatus, the first food intake, and discharge from hospital was 2.9, 3.6, and 10.3 days respectively. There were 11 cases of postoperative complications, but no case of postoperative mortality or conversion to an open procedure. In 75 patients with an adenocarcinoma, the mean number of lymph nodes harvested was 38.1 and the stage distribution was as follows: stage I, 72 patients; stage II, 2 patients; stage IV, 1 patient. During the mean follow-up period of 14 months, 5 patients died of other causes and there were no cases of cancer recurrence. CONCLUSION: A total laparoscopic gastrectomy with intracorporeal anastomosis by using a laparoscopic linear stapler was found to be safe and feasible. We were able to obtain acceptable surgical outcomes in terms of minimal invasiveness.
Adenocarcinoma ; Conversion to Open Surgery ; Eating ; Flatulence ; Follow-Up Studies ; Gastrectomy* ; Humans ; Korea ; Laparoscopy ; Lymph Nodes ; Mortality ; Operative Time ; Postoperative Complications ; Recurrence ; Stomach Neoplasms ; Surgical Procedures, Minimally Invasive

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Prognostic Factors of Advanced Gastric Cancer Patients without Lymph Node Metastasis.

Sang Yoon KANG ; Se Won KIM ; Sun Kyo SONG ; Sang Woon KIM

Journal of the Korean Gastric Cancer Association.2007;7(3):124-131. doi:10.5230/jkgca.2007.7.3.124

PURPOSE: This study was conducted to identify prognostic factors in gastric cancer without lymph node metastasis and to specifiy which prognostic factors can be available in detail according to the depth of invasion. MATERIALS AND METHODS: This retrospective study was based on the medial records of 268 gastric cancer patients who received resectional therapy from 1990 to 1999. The patients who revealed pT2NOMO, pT3NOMO, pT4NOMO on postoperative pathologic reports were enrolled. The survival rate was analyzed according to clinicopathologic and therapeutic factors. RESULTS: According to the depth of invasion, the number of patients with pT2a, pT2b, pT3 and pT4 were 86 (32.1%), 56 (20.9%), 108 (40.3%), and 18 (6.7%) respectively. Age, depth of invasion, histological type, Borrmann type, and Lauren classification were statistically significant in the univariate analysis, and the age, the depth of invasion, and Lauren classification were independent prognostic factors identified by multivariate analysis. On multivariate analysis of subgroups according to the depth of invasion, the independent prognostic factors were age, Borrmann type, and Lauren classification in pT2, and age, Lauren classification , and vascular invasion in pT3. The prognostic factors of pT4 patients could not be analyzed due to limited sample size. CONCLUSION: In advanced gastric cancer patients without lymph node metastasis, age, the depth of invasion, and Lauren classification should be checked to predict prognosis. In patients with pT2 lesion among the above patients, the Borrmann type should be added in check-list.
Classification ; Humans ; Lymph Nodes* ; Multivariate Analysis ; Neoplasm Metastasis* ; Prognosis ; Retrospective Studies ; Sample Size ; Stomach Neoplasms* ; Survival Rate

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Clinicopathological Features and Prognostic Factors for Patients with Clinical T4 Gastric Cancer that Underwent Combined Resection of Invaded Organs.

Gun Young BYUN ; Joong Min PARK ; Ho Il KIM ; Jong Han KIM ; Sung Soo PARK ; Seong Ju KIM ; Young Jae MOK ; Chong Suk KIM

Journal of the Korean Gastric Cancer Association.2007;7(3):117-123. doi:10.5230/jkgca.2007.7.3.117

PURPOSE: The surgical treatment of gastric cancer that invades adjacent organs is a radical gastrectomy with combined resection including the adjacent organs or a palliative operation by performing either a gastrojejunostomy or gastrectomy. However, since it is impossible to determine the exact stage of the cancer, either T or N, in the case of palliative surgery, it is inappropriate to predict patient prognosis. This study analyzes the prognoses for patients whose final TNM stages are determined by a combined resection performed due to macroscopical infiltration into the adjacent organs. MATERIALS AND METHODS: Of 2,452 patients that underwent surgery for gastric cancer at our hospital from 1983 to 2002, we evaluated 102 patients where a combined resection was performed because direct infiltration into the adjacent organs was discovered. RESULTS: Univariate analysis showed that the survival rate differed by the depth of invasion into the gastric walls, the degree of lymph node metastasis, distant metastasis, pathological TNM stage, surgical curability, the location of tumor, and histological differentiation. By multivariate analysis, it was found that the surgical curability, the location of the tumor and the degree of lymph node metastasis were independent prognostic factors. CONCLUSION: It is suggested that even when infiltration into adjacent organs is suspected, radical surgery should be performed as to allow a prediction of prognosis through an exact determination of disease stage, and to improve the survival rate.
Gastrectomy ; Gastric Bypass ; Humans ; Lymph Nodes ; Multivariate Analysis ; Neoplasm Metastasis ; Palliative Care ; Prognosis ; Stomach Neoplasms* ; Survival Rate

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