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Kyong Hwa JUN ; Ji Han JUNG ; Hyung Min CHIN ; Wook KIM ; Cho Hyun PARK ; Hae Myung JEON ; Seung Man PARK ; Keun Woo LIM ; Woo Bae PARK ; Seung Nam KIM

Journal of the Korean Gastric Cancer Association.2008;8(1):47-52. doi:10.5230/jkgca.2008.8.1.47

The majority of choriocarcinomas occur in the uterus as gestational malignant tumors. Rarely, a choriocarcinoma appears in the gastrointestinal tract, and the tumor is assumed to arise from a different histogenetic origin as compared to tumors of other sites. A primary gastric choriocarcinoma is a rare aggressive, widely metastatic malignant tumor, and has a poor prognosis. Reported here is a case of a 69-year-old woman with a primary gastric choriocarcinoma who presented with melena, epigastric pain, and was diagnosed with a poorly differentiated adenocarcinoma based on a preoperative endoscopic biopsy. Gastrectomy with lymph node dissection, followed by postoperative chemotherapy, is the treatment of choice. Therefore, in the case of a poorly differentiated adenocarcinoma with a bleeding tendency, a meticulous examination with the suspicion of a choriocarcinoma should be undertaken.
Adenocarcinoma ; Aged ; Biopsy ; Choriocarcinoma ; Female ; Gastrectomy ; Gastrointestinal Tract ; Hemorrhage ; Humans ; Lymph Node Excision ; Melena ; Pregnancy ; Prognosis ; Uterus

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Modified FOLFOX-6 Chemotherapy for Recurrent or Inoperable Gastric Cancer Patients.

Sung Bae JEE ; Jae Hyun HAN ; Hoon HUH ; Kyo Young SONG ; Hyung Min CHIN ; Wook KIM ; Cho Hyun PARK ; Seung Man PARK ; Seung Nam KIM ; Hae Myung JEON

Journal of the Korean Gastric Cancer Association.2008;8(1):40-46. doi:10.5230/jkgca.2008.8.1.40

PURPOSE: We wanted to evaluate the efficacy and toxicity of modified FOLFOX-6 chemotherapy for treating recurrent or inoperable gastric cancer patients. MATERIALS AND METHODS: From April 2006 to August 2007, 35 patients with recurrent gastric cancer after curative resection and 43 patients with inoperable gastric cancer underwent chemotherapy, and the results were retrospectively investigated. RESULTS: 78 patients were assessable for response and toxicity, and they underwent an average of 7.1 cycles of chemotherapy. The response was evaluated according to the RECIST criteria. 11 partial responses (14.1%), 35 cases of stable disease (44.9%), and 32 cases of progressive disease (41%) were observed. The median time to progression was 6 months, and the average overall survival was 13 months. CTCAE grade 1 or 2 anemia (52.6%) was the most prevalent toxicity. Other common toxicities included thrombocytopenia (17.9%) and peripheral neuropathy (30.8%). There were 13 changes in the chemotherapy regimen to S1-cisplatin due to disease progression, but only an average of 1.76 cycles of S1-cisplatin were delivered due to severe toxicities and poor compliance. CONCLUSION: Acceptable efficacy and toxicity were seen as 59% of the patients showed non-progression, and no grade 3 or 4 toxicities were observed. In conclusion, the modified FOLFOX-6 chemotherapy is considered to be the proper 1st-line choice as a palliative treatment for recurrent or inoperable gastric cancer patients.
Anemia ; Disease Progression ; Humans ; Organoplatinum Compounds ; Palliative Care ; Peripheral Nervous System Diseases ; Retrospective Studies ; Stomach Neoplasms ; Thrombocytopenia

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Efficacy and Safety of Intraveous Iron Sucrose in the Perioperatively Anemic Patients of Gastrectomy.

Moon Won YOO ; Jae Jin CHO ; In Kyu LEE ; Hye Seong AHN ; Sang Ho JEONG ; Hyuk Joon LEE ; Hyung Ho KIM ; Kuhn Uk LEE ; Han Kwang YANG

Journal of the Korean Gastric Cancer Association.2008;8(1):35-39. doi:10.5230/jkgca.2008.8.1.35

PURPOSE: This study was aimed to evaluate the efficacy and safety of of intravenous iron sucrose (Venoferrum(R)) for treating the perioperative anemic gastrectomy patients. MATERIALS AND METHODS: From September 2006 to February 2007 at Seoul National University Hospital, the gastrectomy patients who displayed perioperative anemia (7.0 g/dl < or = hemoglobin levels (Hb) < 11.0 g/dl) and who were admitted or visited the outpatient clinic of the Department of surgery, were divided into two groups. The preoperative (< or = 2~3 weeks before gastrectomy) or postoperative (> or = 1 month after gastrectomy) patients without evidence of acute bleeding were included into Group 1. The immediate postoperative (< 1 month after gastrectomy) patients with stable vital signs were included into Group 2. The age, gender, diagnosis, Hb, hematocrit (Hct), mean corpuscular volume (MCV), serum ferritin (SF), total iron binding capacity (TIBC), serum iron and reticulocyte counts (RC) were evaluated before and after intravenous iron sucrose administration. The adverse effects of drugs were investigated. RESULTS: The number of patients of group 1 and group 2 was 79 and 46, respectively. In group 1, there was a statistically significant difference in the Hb, Hct, MCV, SF, RC and TIBC with each mean change of 1.3 g/dl, 4.1%, 3.1fl, 195 ng/ml, 0.2% and -86.4 ug/dl, respectively. In group 2, there was a statistically significant difference in the Hb, Hct, MCV, SF and RC with each mean change of 1.8 g/dl, 6.1%, 3.4fl, 260 ng/ml and 0.3%, respectively. Two patients (1.6%) suffered local thrombophlebitis as an adverse effect. CONCLUSION: Intravenous iron sucrose for the perioperative anemia of gastrectomy patients was efficacious in the short period without significant adverse effects.
Ambulatory Care Facilities ; Anemia ; Erythrocyte Indices ; Ferric Compounds ; Ferritins ; Gastrectomy ; Glucaric Acid ; Hematocrit ; Hemoglobins ; Hemorrhage ; Humans ; Iron ; Reticulocyte Count ; Sucrose ; Thrombophlebitis ; Vital Signs

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Laparoscopic Assisted Total Gastrectomy (LATG) with Extracorporeal Anastomosis and using Circular Stapler for Middle or Upper Early Gastric Carcinoma: Reviews of Single Surgeon's Experience of 48 Consecutive Patients.

Oh CHEONG ; Byung Sik KIM ; Jeong Hwan YOOK ; Sung Tae OH ; Jeong taek LIM ; Kab jung KIM ; Ji eun CHOI ; Gun chun PARK

Journal of the Korean Gastric Cancer Association.2008;8(1):27-34. doi:10.5230/jkgca.2008.8.1.27

PURPOSE: Many recent studies have reported on the feasibility and usefulness of laparoscopy assisted distal gastrectomy (LADG) for treating early gastric cancer. On the other hand, there has been few reports about laparoscopy assisted total gastrectomy (LATG) because upper located gastric cancer is relatively rare and the surgical technique is more difficult than that for LADG, We now present our procedure and results of performingLATG for the gastric cancer located in the upper or middle portion of the stomach. MATERIALS AND METHODS: From Jan 2005 to Sep 2007, 96 patients underwent LATG by four surgeons at the Asan Medical Center, Seoul, Korea. Among them, 48 consecutive patients who were operated on by asingle surgeon were analyzed with respect to the clinicopathological features, the surgical results and the postoperative courses with using the prospectively collected laparoscopy surgery data. RESULTS: There was no conversion to open surgery during LATG. For all the reconstructions, Roux-en Y esophago- jejunostomy and D1+beta lymphadenectomy were the standard procedures. The mean operation time was 212+/-67 minutes. The mean total number of retrieved lymph nodes was 28.9+/-10.54 (range: 12~64) and all the patients had a clear proximal resection margin in their final pathologic reports. The mean time to passing gas, first oral feeding and discharge from the hospital was 2.98, 3.67 and 7.08 days, respectively. There were 5 surgical complications and 2 non-surgical complications for 5 (10.4%) patients, and there was no mortality. None of the patients needed operation because of complications and they recovered with conservative treatments. The mean operation time remained constant after 20 cases and so a learning curve was present. The morbidity rate was not different between the two periods, but the postoperative course was significantly better after the learning curve. Analysis of the factors contributing to the postoperative morbidity, with using logistic regression analysis, showed that the BMI is the only contributing factor forpostoperative complications (P=0.029, HR=2.513, 95% CI=1.097-5.755). Conclusions: LATG with regional lymph node dissection for upper and middle early gastric cancer is considered to be a safe, feasible method that showed an excellent postoperative course and acceptable morbidity. BMI should be considered in the patient selection at the beginning period because of the impact of the BMI on the postoperative morbidity.
Body Mass Index ; Conversion to Open Surgery ; Gastrectomy ; Hand ; Humans ; Jejunostomy ; Korea ; Laparoscopy ; Learning Curve ; Logistic Models ; Lymph Node Excision ; Lymph Nodes ; Patient Selection ; Prospective Studies ; Stomach Neoplasms

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The Early Experience with a Laparoscopy-assisted Pylorus-preserving Gastrectomy: A Comparison with a Laparoscopy-assisted Distal Gastrectomy with Billroth-I Reconstruction.

Jong Ik PARK ; Sung Ho JIN ; Ho Yoon BANG ; Gi Bong CHAE ; Nam Sun PAIK ; Nan Mo MOON ; Jong Inn LEE

Journal of the Korean Gastric Cancer Association.2008;8(1):20-26. doi:10.5230/jkgca.2008.8.1.20

PURPOSE: Pylorus-preserving gastrectomy (PPG), which retains pyloric ring and gastric function, has been accepted as a function-preserving procedure for early gastric cancer for the prevention of postgastrectomy syndrome. This study was compared laparoscopy-assisted pylorus-preerving gastrectomy (LAPPG) with laparoscopy-assisted distal gastrectomy with Billroth-I reconstruction (LADGB I). MATERIALS AND METHODS: Between November 2006 and September 2007, 39 patients with early gastric cancer underwent laparoscopy-assisted gastrectomy in the Department of Surgery at Korea Cancer Center Hospital. 9 of these patients underwent LAPPG and 18 underwent LADGBI. When LAPPG was underwent, we preserved the pyloric branch, hepatic branch, and celiac branch of the vagus nerve, the infrapyloric artery, and the right gastric artery and performed D1+beta lymphadenectomy to the exclusion of suprapyloric lymph node dissection. The distal stomach was resected while retaining a 2.5~3.0 cm pyloric cuff and maintaining a 3.0~4.0 cm distal margin for the resection. RESULTS: The mean age for patients who underwent LAPPG and LADGBI were 59.9+/-9.4 year-old and 64.1+/-10.0 year-old, respectively. The sex ratio was 1.3:1.0 (male 5, female 4) in the LAPPG group and 2.6:1.0 (male 13, female 5) in the LADGBI group. Mean total number of dissected lymph nodes (28.3+/-11.9 versus 28.1+/-8.9), operation time (269.0+/-34.4 versus 236.3+/-39.6 minutes), estimated blood loss (191.1+/-85.7 versus 218.3+/-150.6 ml), time to first flatus (3.6+/-0.9 versus 3.5+/-0.8 days), time to start of diet (5.1+/-0.9 versus 5.1+/-1.7 days), and postoperative hospital stay (10.1+/-4.0 versus 9.2+/-3.0 days) were not found significant differences (P>0.05). The postoperative complications were 1 patient with gastric stasis and 1 patient with wound seroma in LAPPG group and 1 patient with left lateral segment infarct of liver in the LADGB I group. CONCLUSION: Patients treated by LAPPG showed a comparable quality of surgical operation compared with those treated by LADGBI. LAPPG has an important role in the surgical management of early gastric cancer in terms of quality of postoperative life. Randomized controlled studies should be undertaken to analyze the optimal survival and long-term outcomes of this operative procedure.
Arteries ; Diet ; Female ; Flatulence ; Gastrectomy ; Gastroparesis ; Humans ; Korea ; Length of Stay ; Liver ; Lymph Node Excision ; Lymph Nodes ; Postgastrectomy Syndromes ; Postoperative Complications ; Seroma ; Sex Ratio ; Stomach ; Stomach Neoplasms ; Vagus Nerve

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Survival Rates after Operation for Gastric Cancer: Fifteen-year Experience at a Korea Cancer Center Hospital.

Jong Ik PARK ; Sung Ho JIN ; Ho Yoon BANG ; Nam Sun PAIK ; Nan Mo MOON ; Jong Inn LEE

Journal of the Korean Gastric Cancer Association.2008;8(1):9-19. doi:10.5230/jkgca.2008.8.1.9

PURPOSE: Gastric cancer is the most common malignant tumor in Korea. We reviewed the cases at our institution to identify the survival rates and clarify the prognostic factors of patients with gastric cancer. MATERIALS AND METHODS: We conducted a retrospective study of 6,918 patients who had received a diagnosis of gastric cancer, and they underwent surgery at Korea Cancer Center Hospital during a 15-year period from 1991 to 2005. RESULTS: The overall 5-year survival rate was 66.8%. The univariate analysis revealed that age, location of tumor, gross type of tumor, the histology according to the WHO classification, the Lauren classification, depth of invasion (T stage), lymph node metastasis (N stage), distant metastasis (M stage), the type of surgery, the UICC TNM stage, postoperative complications, adjuvant chemotherapy, lymphatic invasion, venous invasion and perineural invasion were the significantly different factors of the survival rates. The multivariate analysis revealed that age , Borrmann type 4, the histology according to the WHO classification, depth of invasion (T stage), lymph node metastasis (N stage), distant metastasis (M stage), the type of surgery, UICC TNM stage, postoperative complications, adjuvant chemotherapy and lymphatic invasion were the independent prognostic factors. CONCLUSION: We have shown a statistically significant association between the survival rates after operation for gastric cancer and the clinicopathologic factors. Early diagnosis of gastric cancer, appropriate surgeryand adjuvant therapy might improve the quality of life and the survival rates of gastric cancer patients.
Chemotherapy, Adjuvant ; Early Diagnosis ; Humans ; Korea ; Lymph Nodes ; Multivariate Analysis ; Neoplasm Metastasis ; Postoperative Complications ; Quality of Life ; Retrospective Studies ; Stomach Neoplasms ; Survival Rate

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Extended Approach of EMR/ESD in Stomach Cancer: CON.

Hwoon Yong JUNG

Journal of the Korean Gastric Cancer Association.2008;8(1):5-8. doi:10.5230/jkgca.2008.8.1.5

No abstract available.
Stomach

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Extended Approach of EMR (ESD) in Stomach Cancer: Pro.

Joo Young CHO ; Weon Young CHO ; Tae Hee LEE

Journal of the Korean Gastric Cancer Association.2008;8(1):1-4. doi:10.5230/jkgca.2008.8.1.1

No abstract available.
Stomach

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Perforated Early Gastric Cancer: A case report.

Moon Soo LEE ; Sung Yong KIM ; Sang Hyun OH ; Man Kyu CHAE ; Il Kwon CHUNG ; Moo Jun BAEK ; Kyung Kyu PARK ; Chang Ho KIM ; Moo Sik CHO

Journal of the Korean Gastric Cancer Association.2001;1(1):64-67. doi:10.5230/jkgca.2001.1.1.64

An exceedingly rare case of perforated early gastric cancer is reported. A 68-year-old man developed peritonitis due to perforation of early gastric cancer. An emergency radical operation was performed and was followed by an uneventful recovery. Histologic examination of the surgical specimen showed type III early gastric cancer composed of a signet ring cell carcinoma. Five years after surgery, the patients was alive with no evidence of tumor recurrence. The rarity of this complication in early gastric cancer is discussed, and a review of the literature is presented.
Aged ; Carcinoma, Signet Ring Cell ; Emergencies ; Humans ; Peritonitis ; Recurrence ; Stomach Neoplasms*

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Clinical Analysis of MALT Lymphoma in the Stomach.

Kwang Yeol PAIK ; Jae Hyung NOH ; Jin Seok HEO ; Tae Sung SOHN ; Seong Ho CHOI ; Jae Won JOH ; Yong Il KIM

Journal of the Korean Gastric Cancer Association.2001;1(1):60-63. doi:10.5230/jkgca.2001.1.1.60

PURPOSE: The aim of this study was to analyze the clinical and the histopathological characteristics of mucosa associated lymphoid tissue (MALT) lymphomas in the stomach. MATENRIALS AND METHODS: We retrospectively reviewed the medical records of 22 patients who had been treated at Samsung Medical Center from Jan. 1995 to Sep. 2000 and who had been pathologically proven to have a MALT lymphoma. The factors we analyzed were operative procedure, tumor stage, and histopathological characteristics. RESULTS: Of 3658 patients with a gastric malignancy, 22 patients proved to have a MALT lymphoma (0.6%). There were 7 men and 15 women whose ages ranged from 25 years to 70 years (mean, 48.8 years). Forteen cases were located in the antrum, 4 (18%) in the body and 4 (18%) in the fundus or the high body. Nineteen of these patients were managed with total gastrectomy and splenectomy and 3 with radical subtotal gastrectomy. Histopathologically the tumor was limited to the mucosa in 3 patients (13.6%), to the submucosa in 13 (59.1%) and extended to the muscularis propria in 6 (27.3%). Lymph node involvement was seen in 12 patients (54.6%). There was no splenic or hepatic involvement. Bone marrow involvement was not seen in any patients. H. pylori was identified in 11 patients (50%). During the mean follow-up period of 32.7 months, there were no reports of tumor recurrence or death. CONCLUSION: MALT lymphomas rarely disseminate by the time of diagnosis and rarely involve the bone marrow. Lymph node involvement is relatively high and a total gastrectomy is effective in managing patients with a MALT lymphoma.
Bone Marrow ; Diagnosis ; Female ; Follow-Up Studies ; Gastrectomy ; Humans ; Lymph Nodes ; Lymphoid Tissue ; Lymphoma ; Lymphoma, B-Cell, Marginal Zone* ; Male ; Medical Records ; Mucous Membrane ; Recurrence ; Retrospective Studies ; Splenectomy ; Stomach* ; Surgical Procedures, Operative

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