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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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Nomogram Estimating the Probability of Intraabdominal Abscesses after Gastrectomy in Patients with Gastric Cancer.

Bang Wool EOM ; Jungnam JOO ; Young Woo KIM ; Boram PARK ; Hong Man YOON ; Keun Won RYU ; Soo Jin KIM

Journal of Gastric Cancer.2015;15(4):262-269. doi:10.5230/jgc.2015.15.4.262

PURPOSE: Intraabdominal abscess is one of the most common reasons for re-hospitalization after gastrectomy. This study aimed to develop a model for estimating the probability of intraabdominal abscesses that can be used during the postoperative period. MATERIALS AND METHODS: We retrospectively reviewed the clinicopathological data of 1,564 patients who underwent gastrectomy for gastric cancer between 2010 and 2012. Twenty-six related markers were analyzed, and multivariate logistic regression analysis was used to develop the probability estimation model for intraabdominal abscess. Internal validation using a bootstrap approach was employed to correct for bias, and the model was then validated using an independent dataset comprising of patients who underwent gastrectomy between January 2008 and March 2010. Discrimination and calibration abilities were checked in both datasets. RESULTS: The incidence of intraabdominal abscess in the development set was 7.80% (122/1,564). The surgical approach, operating time, pathologic N classification, body temperature, white blood cell count, C-reactive protein level, glucose level, and change in the hemoglobin level were significant predictors of intraabdominal abscess in the multivariate analysis. The probability estimation model that was developed on the basis of these results showed good discrimination and calibration abilities (concordance index=0.828, Hosmer-Lemeshow chi-statistic P=0.274). Finally, we combined both datasets to produce a nomogram that estimates the probability of intraabdominal abscess. CONCLUSIONS: This nomogram can be useful for identifying patients at a high risk of intraabdominal abscess. Patients at a high risk may benefit from further evaluation or treatment before discharge.
Abdominal Abscess ; Abscess* ; Bias (Epidemiology) ; Body Temperature ; C-Reactive Protein ; Calibration ; Classification ; Dataset ; Discrimination (Psychology) ; Gastrectomy* ; Glucose ; Humans ; Incidence ; Leukocyte Count ; Logistic Models ; Multivariate Analysis ; Nomograms* ; Postoperative Complications ; Postoperative Period ; Retrospective Studies ; Stomach Neoplasms*

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Effect of Carrot Intake in the Prevention of Gastric Cancer: A Meta-Analysis.

Hossein FALLAHZADEH ; Ali JALALI ; Mahdieh MOMAYYEZI ; Soheila BAZM

Journal of Gastric Cancer.2015;15(4):256-261. doi:10.5230/jgc.2015.15.4.256

PURPOSE: Gastric cancer is the third leading cause of cancer-related mortality, with the incidence and mortality being higher in men than in women. Various studies have shown that eating carrots may play a major role in the prevention of gastric cancer. We conducted a meta-analysis to determine the relationship between carrot consumption and gastric cancer. MATERIALS AND METHODS: We searched multiple databases including PubMed, Cochrane Library, Scopus, ScienceDirect, and Persian databases like Scientific Information Database (SID) and IranMedx. The following search terms were used: stomach or gastric, neoplasm or cancer, carcinoma or tumor, and carrot. Statistical analyses were performed using Comprehensive Meta Analysis/2.0 software. RESULTS: We retrieved 81 articles by searching the databases. After considering the inclusion and exclusion criteria, 5 articles were included in this study. The odds ratio (OR) obtained by fixed effects model showed that a 26% reduction in the risk of gastric cancer has been associated with the consumption of carrots) OR=0.74; 95% confidence interval=0.68~0.81; P<0.0001). According to funnel graph, the results showed that the possibility of a publication bias does not exist in this study. CONCLUSIONS: The findings of this study showed an inverse relationship between the consumption of carrots and the risk of gastric cancer.
Daucus carota* ; Eating ; Female ; Humans ; Incidence ; Male ; Mortality ; Odds Ratio ; Publication Bias ; Stomach ; Stomach Neoplasms*

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Helicobacter pylori Eradication Reduces the Metachronous Recurrence of Gastric Neoplasms by Attenuating the Precancerous Process.

Da Hyun JUNG ; Jie Hyun KIM ; Yong Chan LEE ; Sang Kil LEE ; Sung Kwan SHIN ; Jun Chul PARK ; Hyun Soo CHUNG ; Hyunki KIM ; Hoguen KIM ; Yong Hoon KIM ; Jae Jun PARK ; Young Hoon YOUN ; Hyojin PARK

Journal of Gastric Cancer.2015;15(4):246-255. doi:10.5230/jgc.2015.15.4.246

PURPOSE: The importance of Helicobacter pylori eradication after endoscopic resection (ER) of gastric neoplasms remains controversial. In this study, we clarified the importance of H. pylori eradication for metachronous lesions after ER. MATERIALS AND METHODS: This study included 3,882 patients with gastric neoplasms who underwent ER. We included patients infected with H. pylori who received eradication therapy. Among them, 34 patients with metachronous lesions after ER and 102 age- and sex-matched patients (nonmetachronous group) were enrolled. Background mucosal pathologies such as atrophy and intestinal metaplasia (IM) were evaluated endoscopically. The expression levels of CDX1, CDX2, Sonic hedgehog (SHH), and SOX2 were evaluated based on H. pylori eradication and the development of metachronous lesions. RESULTS: The eradication failure rate was higher in the metachronous group than in the nonmetachronous group (P=0.036). Open-type atrophy (P=0.003) and moderate-to-severe IM (P=0.001) occurred more frequently in the metachronous group. In patients with an initial diagnosis of dysplasia, the eradication failure rate was higher in the metachronous group than in the nonmetachronous group (P=0.002). In addition, open-type atrophy was more frequent in the metachronous group (P=0.047). In patients with an initial diagnosis of carcinoma, moderate-to-severe IM occurred more frequently in the metachronous group (P=0.003); however, the eradication failure rate was not significantly different between the two groups. SHH and SOX2 expression was increased, and CDX2 expression was decreased in the nonmetachronous group after eradication (P<0.05). CONCLUSIONS: Open-type atrophy, moderate-to-severe IM, and H. pylori eradication failure were significantly associated with metachronous lesions. However, eradication failure was significantly associated with dysplasia, but not carcinoma, in the metachronous group. Thus, H. pylori eradication may play an important role in preventing metachronous lesions after ER for precancerous lesions before carcinomatous transformation.
Atrophy ; Diagnosis ; Hedgehogs ; Helicobacter pylori* ; Helicobacter* ; Humans ; Metaplasia ; Pathology ; Recurrence* ; Stomach Neoplasms*

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Time-Dependent Effects of Prognostic Factors in Advanced Gastric Cancer Patients.

Jin Ok KWON ; Sung Ho JIN ; Jae Seok MIN ; Min Suk KIM ; Hae Won LEE ; Sunhoo PARK ; Hang Jong YU ; Ho Yoon BANG ; Jong Inn LEE

Journal of Gastric Cancer.2015;15(4):238-245. doi:10.5230/jgc.2015.15.4.238

PURPOSE: This study aimed to identify time-dependent prognostic factors and demonstrate the time-dependent effects of important prognostic factors in patients with advanced gastric cancer (AGC). MATERIALS AND METHODS: We retrospectively evaluated 3,653 patients with AGC who underwent curative standard gastrectomy between 1991 and 2005 at the Korea Cancer Center Hospital. Multivariate survival analysis with Cox proportional hazards regression was used in the analysis. A non-proportionality test based on the Schoenfeld residuals (also known as partial residuals) was performed, and scaled Schoenfeld residuals were plotted over time for each covariate. RESULTS: The multivariate analysis revealed that sex, depth of invasion, metastatic lymph node (LN) ratio, tumor size, and chemotherapy were time-dependent covariates violating the proportional hazards assumption. The prognostic effects (i.e., log of hazard ratio [LHR]) of the time-dependent covariates changed over time during follow-up, and the effects generally diminished with low slope (e.g., depth of invasion and tumor size), with gentle slope (e.g., metastatic LN ratio), or with steep slope (e.g., chemotherapy). Meanwhile, the LHR functions of some covariates (e.g., sex) crossed the zero reference line from positive (i.e., bad prognosis) to negative (i.e., good prognosis). CONCLUSIONS: The time-dependent effects of the prognostic factors of AGC are clearly demonstrated in this study. We can suggest that time-dependent effects are not an uncommon phenomenon among prognostic factors of AGC.
Follow-Up Studies ; Gastrectomy ; Humans ; Korea ; Lymphatic Metastasis ; Lymph Nodes ; Multivariate Analysis ; Prognosis ; Proportional Hazards Models ; Retrospective Studies ; Stomach Neoplasms*

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Oncologic Safety of Laparoscopic Wedge Resection with Gastrotomy for Gastric Gastrointestinal Stromal Tumor: Comparison with Conventional Laparoscopic Wedge Resection.

Sejin LEE ; You Na KIM ; Taeil SON ; Hyoung Il KIM ; Jae Ho CHEONG ; Woo Jin HYUNG ; Sung Hoon NOH

Journal of Gastric Cancer.2015;15(4):231-237. doi:10.5230/jgc.2015.15.4.231

PURPOSE: Various laparoscopic wedge resection (LWR) techniques requiring gastrotomy for gastrointestinal stromal tumors (GISTs) of the stomach have been applied to facilitate tumor resection and preserve the remnant gastric volume. However, there is the possibility of cancer cell dissemination during these procedures. The aim of this study was to assess the oncologic safety of LWR with gastrotomy (LWR-G) compared to LWR without luminal exposure. MATERIALS AND METHODS: Clinicopathologic and operative results of 193 patients who underwent LWR for gastric GIST were retrospectively analyzed from 2003 to 2013. We stratified the patients into two groups: LWR-G and LWR without gastrotomy (LWR-C). Clinicopathologic features, short-term outcomes, and long-term outcomes were compared. RESULTS: A total of 26 patients underwent LWR-G, and 167 patients underwent LWR-C. The LWR-G group showed significantly more anterior wall-located (n=10, 38.5%), intraluminal (n=20, 76.9%), and ulcerative (n=13, 50.0%) tumors than the LWR-C group (n=33, 19.8%; n=96, 57.5%; n=46, 27.5%, respectively). Postoperative short-term outcomes did not differ between the two groups. When tumor staging was compared, no statistical difference was noted. There was no recurrence in the LWR-G group, while 2 patients in the LWR-C group experienced recurrence. The two recurrences in the LWR-C group were found in the liver and in the remnant stomach at 63 and 12 months after the operation, respectively. No gastric GIST-related death was recorded in any group during the study period. CONCLUSIONS: LWR-G for gastric GIST is an oncologically safe procedure even for masses with ulcerations.
Gastric Stump ; Gastrointestinal Stromal Tumors* ; Humans ; Laparoscopy ; Liver ; Neoplasm Staging ; Phenobarbital ; Recurrence ; Retrospective Studies ; Stomach ; Stomach Neoplasms ; Ulcer

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Association between Chemotherapy-Response Assays and Subsets of Tumor-Infiltrating Lymphocytes in Gastric Cancer: A Pilot Study.

Jee Youn LEE ; Taeil SON ; Jae Ho CHEONG ; Woo Jin HYUNG ; Sung Hoon NOH ; Choong Bai KIM ; Chung Gyu PARK ; Hyoung Il KIM

Journal of Gastric Cancer.2015;15(4):223-230. doi:10.5230/jgc.2015.15.4.223

PURPOSE: The purpose of this pilot study was to evaluate the association between adenosine triphosphate-based chemotherapy response assays (ATP-CRAs) and subsets of tumor infiltrating lymphocytes (TILs) in gastric cancer. MATERIALS AND METHODS: In total, 15 gastric cancer tissue samples were obtained from gastrectomies performed between February 2007 and January 2011. Chemotherapy response assays were performed on tumor cells from these samples using 11 chemotherapeutic agents, including etoposide, doxorubicin, epirubicin, mitomycin, 5-fluorouracil (5-FU), oxaliplatin, irinotecan, docetaxel, paclitaxel, methotrexate, and cisplatin. TILs in the tissue samples were evaluated using antibodies specific for CD3, CD4, CD8, Foxp3, and Granzyme B. RESULTS: The highest cancer cell death rates were induced by etoposide (44.8%), 5-FU (43.1%), and mitomycin (39.9%). Samples from 10 patients who were treated with 5-FU were divided into 5-FU-sensitive and -insensitive groups according to median cell death rate. No difference was observed in survival between the two groups (P=0.216). Only two patients were treated with a chemotherapeutic agent determined by an ATP-CRA and there was no significant difference in overall survival compared with that of patients treated with their physician's choice of chemotherapeutic agent (P=0.105). However, a high number of CD3 TILs was a favorable prognostic factor (P=0.008). Pearson's correlation analyses showed no association between cancer cell death rates in response to chemotherapeutic agents and subsets of TILs. CONCLUSIONS: Cancer cell death rates in response to specific chemotherapeutic agents were not significantly associated with the distribution of TIL subsets.
Adenosine ; Adenosine Triphosphate ; Antibodies ; Cell Death ; Cisplatin ; Doxorubicin ; Drug Screening Assays, Antitumor ; Drug Therapy ; Epirubicin ; Etoposide ; Fluorouracil ; Gastrectomy ; Granzymes ; Humans ; Lymphocytes, Tumor-Infiltrating* ; Methotrexate ; Mitomycin ; Paclitaxel ; Pilot Projects* ; Stomach Neoplasms*

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