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A Case of Advanced Gastric Cancer with Para-Aortic Lymph Node Metastasis from Co-Occurring Prostate Cancer.

Miyeong PARK ; Sang Ho JEONG ; Young Joon LEE ; Ji Ho PARK ; Sang Kyung CHOI ; Soon Chan HONG ; Eun Jung JUNG ; Young tae JU ; Chi Young JEONG ; Jeong Hee LEE ; Woo Song HA

Journal of Gastric Cancer.2017;17(1):93-97. doi:10.5230/jgc.2017.17.e10

An 84-year-old man was diagnosed with two synchronous adenocarcinomas, a Borrmann type IV advanced gastric adenocarcinoma in his antrum and a well-differentiated Borrmann type I carcinoma on the anterior wall of the higher body of his stomach. Pre-operatively, computed tomography of the abdomen revealed the presence of advanced gastric cancer with peri-gastric and para-aortic lymph node (LN) metastasis. He planned for palliative total gastrectomy owing to the risk of obstruction by the antral lesion. We performed a frozen biopsy of a para-aortic LN during surgery and found that the origin of the para-aortic LN metastasis was from undiagnosed prostate cancer. Thus, we performed radical total gastrectomy and D2 LN dissection. Post-operatively, his total prostate-specific antigen levels were high (227 ng/mL) and he was discharged 8 days after surgery without any complications.
Abdomen ; Adenocarcinoma ; Aged, 80 and over ; Biopsy ; Gastrectomy ; Humans ; Lymph Nodes* ; Lymphatic Metastasis ; Neoplasm Metastasis* ; Prostate* ; Prostate-Specific Antigen ; Prostatic Neoplasms* ; Stomach ; Stomach Neoplasms*

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Erratum: Anthropometric Study of the Stomach.

Eun Gyeong LEE ; Tae Han KIM ; Yeon Ju HUH ; Yun Suhk SUH ; Hye Sung AHN ; Seong Ho KONG ; Hyuk Joon LEE ; Woo Ho KIM ; Han Kwang YANG

Journal of Gastric Cancer.2017;17(3):282-282. doi:10.5230/jgc.2017.17.e24

The authors found out that this article was omitted “Funding section” for grant support.

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Plexiform Angiomyxoid Myofibroblastic Tumor of the Stomach: a Rare Case.

Su Mi KIM ; Ji Yeong AN ; Min Gew CHOI ; Jun Ho LEE ; Tae Sung SOHN ; Kyung Mee KIM ; Sung KIM ; Jae Moon BAE

Journal of Gastric Cancer.2017;17(3):277-281. doi:10.5230/jgc.2017.17.e22

Plexiform angiomyxoid myofibroblastic tumor (PAMT) of the stomach is a very rare mesenchymal tumor of the gastrointestinal tract. We report a case of asymptomatic gastric PAMT that was pathologically confirmed after surgical resection. The tumor had a multinodular plexiform growth pattern, bland-looking spindle cells, and an Alcian blue-positive myxoid stromal matrix rich in small blood vessels. Immunohistochemistry analysis revealed that the tumor cells of the PAMT were positive for smooth muscle actin (SMA) and negative for c-kit, CD34, S-100 protein, epithelial membrane antigen (EMA), and desmin. PAMT should be differentiated from other submucosal tumors of the stomach by immunohistochemical findings. Considering the benign features of this tumor, observation without resection may be an option for the treatment of PAMT if the tumor is asymptomatic.
Actins ; Blood Vessels ; Desmin ; Gastrointestinal Tract ; Immunohistochemistry ; Mucin-1 ; Muscle, Smooth ; Myofibroblasts* ; S100 Proteins ; Stomach*

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Two-Layer Hand-Sewn Esophagojejunostomy in Totally Laparoscopic Total Gastrectomy for Gastric Cancer.

Enrique NORERO ; Rodrigo MUÑOZ ; Marco CERONI ; Manuel MANZOR ; Fernando CROVARI ; Mauricio GABRIELLI

Journal of Gastric Cancer.2017;17(3):267-276. doi:10.5230/jgc.2017.17.e26

PURPOSE: Different esophagojejunostomy (EJ) reconstruction methods are used after totally laparoscopic total gastrectomy (TLTG), and none is considered a standard technique. This report describes a 2-layer hand-sewn EJ technique during TLTG; we also evaluated postoperative morbidity associated with this technique. MATERIALS AND METHODS: This retrospective cohort study included all consecutive patients who underwent TLTG for gastric cancer (GC) from 2012 to 2016 at 2 affiliated teaching hospitals. All participating surgeons performed standardized intracorporeal 2-layer hand-sewn EJ. RESULTS: We included 51 patients who underwent TLTG for GC and standardized EJ anastomosis. Twenty-seven (53%) were male, and the median age was 60 (36–87) years. The average operative time was 337±71 minutes and intraoperative bleeding was 160±107 mL. There were no open conversions related to EJ. Postoperative morbidity was observed in 9 (17.0%) patients. There was no postoperative mortality. EJ leakage was observed in 2 patients (3.8%) and 1 patient (1.9%) developed EJ stenosis. Patients with leakage were managed non-operatively and the patient with stenosis required endoscopic dilation. The median length of hospital stay was 8 (6–29) days. CONCLUSIONS: Two-layer hand-sewn EJ during TLTG for GC is a feasible and safe technique. This method avoids a laparotomy for reconstruction and the disadvantages associated with laparoscopic introduction of mechanical staplers for EJ, and provides an alternative for alimentary tract reconstruction after TLTG.
Cohort Studies ; Constriction, Pathologic ; Gastrectomy* ; Hemorrhage ; Hospitals, Teaching ; Humans ; Laparoscopy ; Laparotomy ; Length of Stay ; Male ; Methods ; Mortality ; Operative Time ; Retrospective Studies ; Stomach Neoplasms* ; Surgeons

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A Novel Roux-en-Y Reconstruction Involving the Use of Two Circular Staplers after Distal Subtotal Gastrectomy for Gastric Cancer.

Hoon HUR ; Chang Wook AHN ; Cheul Su BYUN ; Ho Jung SHIN ; Young Bae KIM ; Sang Yong SON ; Sang Uk HAN

Journal of Gastric Cancer.2017;17(3):255-266. doi:10.5230/jgc.2017.17.e32

PURPOSE: Although Roux-en-Y (R-Y) reconstruction after distal gastrectomy has several advantages, such as prevention of bile reflux into the remnant stomach, it is rarely used because of the technical difficulty. This prospective randomized clinical trial aimed to show the efficacy of a novel method of R-Y reconstruction involving the use of 2 circular staplers by comparing this novel method to Billroth-I (B-I) reconstruction. MATERIALS AND METHODS: A total of 118 patients were randomly allocated into the R-Y (59 patients) and B-I reconstruction (59 patients) groups. R-Y anastomosis was performed using two circular staplers and no hand sewing. The primary end-point of this clinical trial was the reflux of bile into the remnant stomach evaluated using endoscopic and histological findings at 6 months after surgery. RESULTS: No significant differences in clinicopathological findings were observed between the 2 groups. Although anastomosis time was significantly longer for the patients of the R-Y group (P<0.001), no difference was detected between the 2 groups in terms of the total surgery duration (P=0.112). Endoscopic findings showed a significant reduction of bile reflux in the remnant stomach in the R-Y group (P<0.001), and the histological findings showed that reflux gastritis was more significant in the B-I group than in the R-Y group (P=0.026). CONCLUSIONS: The results of this randomized controlled clinical trial showed that compared with B-I reconstruction, R-Y reconstruction using circular staplers is a safe and feasible procedure. This clinical trial study was registered at www.ClinicalTrials.gov (registration No. NCT01142271).
Bile ; Bile Reflux ; Gastrectomy* ; Gastric Stump ; Gastritis ; Hand ; Humans ; Methods ; Prospective Studies ; Stomach Neoplasms*

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Does Hospital Volume Really Affect the Surgical and Oncological Outcomes of Gastric Cancer in Korea?.

Eun Young KIM ; Kyo Young SONG ; Junhyun LEE

Journal of Gastric Cancer.2017;17(3):246-254. doi:10.5230/jgc.2017.17.e31

PURPOSE: The significance of hospital volume remains inconsistent and controversial. In particular, few studies have examined whether hospital volume is associated with the outcome of gastrectomy for gastric cancer in East Asia. This study examined the effect of hospital volume on the short-term surgical and long-term oncological outcomes of patients undergoing curative gastrectomy for gastric cancer. MATERIALS AND METHODS: Between 2009 and 2011, 1,561 patients underwent curative gastrectomy for gastric cancer at Seoul St. Mary's Hospital (n=1,322) and Bucheon St. Mary's Hospital (n=239). We defined Seoul St. Mary's Hospital as a high-volume center and Bucheon St. Mary's Hospital as a low-volume center. RESULTS: The extent of resection, rate of combined resection, tumor stage, operating time, and hospital stay did not differ significantly between the 2 hospitals. In addition, the hospital volume was not significantly associated with the 30-day morbidity and mortality. When the overall and disease-free survival rates of the patients were stratified according to stage, hospital volume was not significantly associated with prognosis at any stage. CONCLUSIONS: Hospital volume might not be a decisive factor with respect to the surgical and oncological outcomes of patients if well-trained surgeons perform gastrectomy for gastric cancer.
Disease-Free Survival ; Far East ; Gastrectomy ; Gyeonggi-do ; Health Facility Size ; Humans ; Korea* ; Length of Stay ; Mortality ; Prognosis ; Seoul ; Stomach Neoplasms* ; Surgeons

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Perigastric Lymph Node Metastasis from Papillary Thyroid Carcinoma in a Patient with Early Gastric Cancer: The First Case Report.

Gui Ae JEONG ; Hyung Chul KIM ; Hee Kyung KIM ; Gyu Seok CHO

Journal of Gastric Cancer.2014;14(3):215-219. doi:10.5230/jgc.2014.14.3.215

Distant metastasis from papillary thyroid carcinoma (PTC), particularly from papillary thyroid microcarcinoma, is rare. We present a case of perigastric lymph node metastasis from PTC in a patient with early gastric cancer and breast cancer. During post-surgical follow-up for breast cancer, a 56-year-old woman was diagnosed incidentally with early gastric cancer and synchronous left thyroid cancer. Therefore, laparoscopic distal gastrectomy with lymph node dissection and left thyroidectomy were performed. On the basis of the pathologic findings of the surgical specimens, the patient was diagnosed to have papillary thyroid microcarcinoma with perigastric lymph node metastasis and early gastric cancer with mucosal invasion. Finally, on the basis of immunohistochemical staining with galectin-3, the diagnosis of perigastric lymph node metastasis from PTC was made. When a patient has multiple primary malignancies with lymph node metastasis, careful pathologic examination of the surgical specimen is necessary; immunohistochemical staining may be helpful in determining the primary origin of lymph node metastasis.
Breast Neoplasms ; Diagnosis ; Female ; Follow-Up Studies ; Galectin 3 ; Gastrectomy ; Humans ; Lymph Node Excision ; Lymph Nodes* ; Middle Aged ; Neoplasm Metastasis* ; Stomach Neoplasms* ; Thyroid Gland ; Thyroid Neoplasms* ; Thyroidectomy

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Concurrent Robot-Assisted Distal Gastrectomy and Partial Nephrectomy for Synchronous Early Gastric Cancer and Renal Cell Carcinoma: An Initial Experience.

Jieun KIM ; Su Mi KIM ; Jeong Eun SEO ; Min Gew CHOI ; Jun Ho LEE ; Tae Sung SOHN ; Sung KIM ; Jae Moon BAE ; Seong Il SEO

Journal of Gastric Cancer.2014;14(3):211-214. doi:10.5230/jgc.2014.14.3.211

We report our experience of a concurrent robot assisted distal gastrectomy and partial nephrectomy for synchronous early gastric cancer and renal cell carcinoma. A 55-year-old female patient was diagnosed with early gastric cancer on screening endoscopy. Abdominal computed tomography showed an incidental right renal cell carcinoma. Robot assisted distal gastrectomy was performed, followed by partial nephrectomy. The final pathological examination showed signet ring cell carcinoma within the lamina propria and renal cell carcinoma with negative resection margins. The patient showed no evidence of recurrence at 6-months. A robot-assisted combined operation could be a treatment option for early stages of synchronous malignancies.
Carcinoma, Renal Cell* ; Carcinoma, Signet Ring Cell ; Endoscopy ; Female ; Gastrectomy* ; Humans ; Mass Screening ; Middle Aged ; Mucous Membrane ; Nephrectomy* ; Recurrence ; Robotics ; Stomach Neoplasms* ; Surgical Procedures, Minimally Invasive

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Endoscopic and Laparoscopic Full-Thickness Resection of Endophytic Gastric Submucosal Tumors Very Close to the Esophagogastric Junction.

Oh Kyoung KWON ; Wansik YU

Journal of Gastric Cancer.2015;15(4):278-285. doi:10.5230/jgc.2015.15.4.278

PURPOSE: Gastric submucosal tumors (SMTs) located very close to the esophagogastric junction (EGJ) are a challenge for gastric surgeons. Therefore, this study reports on the experience of using endoscopic and laparoscopic full-thickness resection (ELFR) with laparoscopic two-layer suturing in such tumors. MATERIALS AND METHODS: Six patients with gastric SMTs very close to the EGJ underwent ELFR with laparoscopic two-layer suturing at Kyungpook National University Medical Center. With the patient under general anesthesia, the lesser curvature and posterior aspect adjacent to the EGJ were meticulously dissected and visualized using a laparoscopic approach. A partially circumferential full-thickness incision at the distal margin of the tumor was then made using an endoscopic approach under laparoscopic guidance. The SMT was resected using laparoscopic ultrasonic shears, and the gastric wall was closed using two-layer suturing. Thereafter, the patency and any leakage were checked through endoscopy. RESULTS: All the ELFR procedures with laparoscopic two-layer suturing were performed successfully without an open conversion. The mean operation time was 139.2+/-30.9 minutes and the blood loss was too minimal to be measured. The tumors from four patients were leiomyomas, while the tumors from the other two patients were gastrointestinal stromal tumors with clear resection margins. All the patients started oral intake on the third postoperative day. There was no morbidity or mortality. The mean hospital stay was 7.7+/-0.8 days. CONCLUSIONS: ELFR with laparoscopic two-layer suturing is a safe treatment option for patients with an SMT close to the EGJ, as major resection of the stomach is avoided.
Academic Medical Centers ; Anesthesia, General ; Endoscopy ; Esophagogastric Junction* ; Gastrointestinal Stromal Tumors ; Gyeongsangbuk-do ; Humans ; Leiomyoma ; Length of Stay ; Mortality ; Stomach ; Ultrasonics

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Beginner Surgeon's Initial Experience with Distal Subtotal Gastrectomy for Gastric Cancer Using a Minimally Invasive Approach.

Yung Hun YOU ; Yoo Min KIM ; Dae Ho AHN

Journal of Gastric Cancer.2015;15(4):270-277. doi:10.5230/jgc.2015.15.4.270

PURPOSE: Minimally invasive gastrectomy (MIG), including laparoscopic distal subtotal gastrectomy (LDG) and robotic distal subtotal gastrectomy (RDG), is performed for gastric cancer, and requires a learning period. However, there are few reports regarding MIG by a beginner surgeon trained in MIG for gastric cancer during surgical residency and fellowship. The aim of this study was to report our initial experience with MIG, LDG, and RDG by a trained beginner surgeon. MATERIALS AND METHODS: Between January 2014 and February 2015, a total of 36 patients (20 LDGs and 16 RDGs) underwent MIG by a beginner surgeon during the learning period, and 13 underwent open distal subtotal gastrectomy (ODG) by an experienced surgeon in Bundang CHA Medical Center. Demographic characteristics, operative findings, and short-term outcomes were evaluated for the groups. RESULTS: MIG was safely performed without open conversion in all patients and there was no mortality in either group. There was no significant difference between the groups in demographic factors except for body mass index. There were significant differences in extent of lymph node dissection (LND) (D2 LND: ODG 8.3% vs. MIG 55.6%, P=0.004) and mean operative time (ODG 178.8 minutes vs. MIG 254.7 minutes, P<0.001). The serial changes in postoperative hemoglobin level (P=0.464) and white blood cell count (P=0.644) did not show significant differences between the groups. There were no significant differences in morbidity. CONCLUSIONS: This study showed that the operative and short-term outcomes of MIG for gastric cancer by a trained beginner surgeon were comparable with those of ODG performed by an experienced surgeon.
Body Mass Index ; Demography ; Fellowships and Scholarships ; Gastrectomy* ; Humans ; Internship and Residency ; Laparoscopy ; Learning ; Leukocyte Count ; Lymph Node Excision ; Mortality ; Operative Time ; Robotics ; Stomach Neoplasms* ; Surgical Procedures, Minimally Invasive

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