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Recent Evolution of Surgical Treatment for Gastric Cancer in Korea.

Ji Yeong AN ; Jae Ho CHEONG ; Woo Jin HYUNG ; Sung Hoon NOH

Journal of Gastric Cancer.2011;11(1):1-6. doi:10.5230/jgc.2011.11.1.1

Gastric cancer is the most common malignancy and the incidence is steadily increasing in Korea. The principal treatment modality for gastric cancer is surgical extirpation of tumor along with draining lymph nodes. Gastrectomy with D2 lymph node dissection has been well established as a standard of surgery and improved the survival of gastric cancer patients. Recently, technological advances are drastically reshaping the landscape of surgical treatment of gastric cancer. One of the most notable trends is that minimal access surgery becomes dominating the treatment of early stage diseases. For advanced diseases, the standard access surgery is considered a reference treatment. Although there is a pilot study underway to evaluate the feasibility of the application of minimal access surgery to advanced gastric cancer (AGC), the evidence for oncological safety is not yet provided sufficiently. Based on the recent randomized controlled trials, the extent of surgery for AGC has re-defined as para-aortic lymph node dissection dose not add any survival benefit while increasing surgery-related morbidities. In addition, it is now accepted as a standard operation omitting unnecessary procedures such as splenectomy and/or distal pancreatectomy for prophylactic lymph node dissection. Conceptual and technical innovation has contributed to decreasing morbidity and mortality without impairing oncological safety. All these recent advances in the field of gastric cancer surgery would be concluded in maximizing therapeutic index for gastric cancer while improving quality of life.
Gastrectomy ; Humans ; Incidence ; Korea ; Lymph Node Excision ; Lymph Nodes ; Pancreatectomy ; Quality of Life ; Splenectomy ; Stomach Neoplasms ; Unnecessary Procedures

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Early Gastric Cancer with Signet Ring Cell Histology Remained Unresected for 53 Months.

Seung Soo LEE ; Seung Wan RYU ; In Ho KIM ; Soo Sang SOHN

Journal of Gastric Cancer.2011;11(3):189-193. doi:10.5230/jgc.2011.11.3.189

The natural course of untreated patients with signet ring cell carcinoma of the stomach remains poorly understood while assumptions have been made to distinguish it from other types of gastric cancer. A 74-year-old Korean woman was diagnosed with early gastric cancer with signet ring cell histology and refused surgery. A satellite lesion was identified 46 months after the initial diagnosis. The patient finally agreed to undergo distal subtotal gastrectomy 53 months following the initial diagnosis. Postoperative histological examination of both lesions confirmed signet ring cell carcinoma associated with submucosal invasion. There was no evidence of lymph node metastasis.
Aged ; Carcinoma, Signet Ring Cell ; Disease Progression ; Female ; Gastrectomy ; Humans ; Lymph Nodes ; Neoplasm Metastasis ; Stomach ; Stomach Neoplasms

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Acute Gastric Necrosis Due to Gastric Outlet Obstruction Accompanied with Gastric Cancer and Trichophytobezoar.

Dosang LEE ; Kiyoung SUNG ; Jun Hyun LEE

Journal of Gastric Cancer.2011;11(3):185-188. doi:10.5230/jgc.2011.11.3.185

Gastric necrosis due to gastric outlet obstruction is a very rare condition, but it might be fatal if missed or if diagnosis is delayed. Our patient was a 73-year-old male complaining of abdominal pain, distension and dyspnea for 1 day. In plain radiography and computed tomography, a markedly distended stomach and decreased enhancement at the gastric wall were noted. He underwent explo-laparotomy, and near-total gastric mucosal necrosis accompanied by sludge from the soaked laver was noted. A total gastrectomy with esophagojejunostomy was performed, and he recovered without sequelae. Final pathologic examination revealed advanced gastric cancer at the antrum with near-total gastric mucosal necrosis.
Abdominal Pain ; Aged ; Dyspnea ; Gastrectomy ; Gastric Outlet Obstruction ; Humans ; Male ; Necrosis ; Sewage ; Stomach ; Stomach Neoplasms

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An Effect of Letrozole on Gastric Cancer?.

Ahmed EL HADI ; Hazem AL-MOMANI ; Paul EDWARDS

Journal of Gastric Cancer.2011;11(3):180-184. doi:10.5230/jgc.2011.11.3.180

Letrozole is a drug used in the treatment of postmenopausal women with breast and ovarian tumours. There is no evidence in the literature indicating its use in treating gastric cancer. We present a 68 year old lady admitted from the emergency department with weight loss, malaise and anaemia. Investigations confirmed the presence of two different primary tumours in the left breast and the stomach. Following that this patient with oestrogen receptor positive breast cancer and oestrogen receptor negative gastric cancer was treated with letrozole for her breast cancer followed by a gastric resection. Independent histology by two pathologists pre-operatively diagnosed gastric adenocarcinoma. Post-operatively, independent analysis of the resected stomach, omentum and lymph nodes revealed no evidence of gastric cancer. Therefore we conclude that there is a possibility of letrozole having an effect on gastric cancer. Further studies are needed.
Adenocarcinoma ; Breast ; Breast Neoplasms ; Emergencies ; Female ; Humans ; Lymph Nodes ; Nitriles ; Omentum ; Remission, Spontaneous ; Stomach ; Stomach Neoplasms ; Triazoles ; Weight Loss

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Role of 18F-fluoro-2-deoxyglucose Positron Emission Tomography in Gastric GIST: Predicting Malignant Potential Pre-operatively.

Jeon Woo PARK ; Chang Ho CHO ; Duck Su JEONG ; Hyun Dong CHAE

Journal of Gastric Cancer.2011;11(3):173-179. doi:10.5230/jgc.2011.11.3.173

PURPOSE: It is difficult to obtain biopsies from gastrointestinal stromal tumors (GISTs) prior to surgery because GISTs are submucoal tumors, despite being the most common nonepithelial neoplasms of the gastrointestinal tract. Unlike anatomic imaging techniques, PET-CT, which is a molecular imaging tool, can be a useful technique for assessing tumor activity and predicting the malignant potential of certain tumors. Thus, we aimed to evaluate the usefulness of PET-CT as a pre-operative prognostic factor for GISTs by analyzing the correlation between the existing post-operative prognostic factors and the maximum SUV uptake (SUVmax) of pre-operative 18F-fluoro-2-deoxyglucose (FDG) PET-CT. MATERIALS AND METHODS: The study was conducted on 26 patients who were diagnosed with gastric GISTs and underwent surgery after being examined with pre-operative FDG PET-CT. An analysis of the correlation bewteen (i) NIH risk classfication and the Ki-67 proliferation index, which are post-operative prognostic factors, and (ii) the SUVmax of PET-CT, which is a pre-operative prognostic factor, was performed. RESULTS: There were significant correlations between (i) SUVmax and (ii) Ki-67 index, tumor size, mitotic count, and NIH risk group (r=0.854, 0.888, 0.791, and 0.756, respectively). The optimal cut-off value for SUVmax was 3.94 between "low-risk malignancy" and "high-risk malignancy" groups. The sensitivity and specificity of SUVmax for predicting the risk of malignancy were 85.7% and 94.7%, respectively. CONCLUSIONS: The SUVmax of PET-CT is associated with Ki-67 index, tumor size, mitotic count, and NIH classification. Therefore, it is believed that PET-CT is a relatively safe, non-invasive diagnostic tool for assessing malignant potential pre-operatively.
Biopsy ; Electrons ; Gastrointestinal Stromal Tumors ; Gastrointestinal Tract ; Humans ; Molecular Imaging ; Positron-Emission Tomography ; Sensitivity and Specificity

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Clinical Outcomes according to Primary Treatment in Gastric Cancer Patients with Peritoneal Seeding.

Jung Min BAE ; Kyoung Joon YEO ; Se Won KIM ; Sang Woon KIM ; Sun Kyo SONG

Journal of Gastric Cancer.2011;11(3):167-172. doi:10.5230/jgc.2011.11.3.167

PURPOSE: Peritoneal seeding of gastric cancer is known to have a poor prognosis. With the diagnosis of peritoneal seeding, there is no effective treatment modality. Gastrectomy with chemotherapy or primary chemotherapy is basically one of major options for this condition. This study was conducted to compare the clinical outcomes of these treatments and to identify the better way to improve the prognosis of patients with peritoneal seeding. MATERIALS AND METHODS: Between 2001 and 2007, gastric cancer patients with peritoneal seeding by preoperative or intraoperative diagnosis were reviewed retrospectively. The enrolled patients were divided as primary gastrectomy and primary chemotherapy group. Clinicopathologic characteristics and clinical outcomes of groups were analyzed and compared. RESULTS: Fifty-four patients were enrolled. 21 patients belonged to the group of primary gastrectomy and 33 patients were to the primary chemotherapy group. Among 33 patients of the primary chemotherapy group, 17 patients were received only chemotherapy and 16 patients were received gastrectomy due to the good responses of primary chemotherapy. The 3 years survival rates were 14% in primary gastrectomy group, 55% in patients who received gastrectomy after primary chemotherapy, and 0% in patients with primary chemotherapy only. CONCLUSIONS: Although this study had many limitations, some valuable information was produced. In terms of survival benefits for the gastric cancer patients with peritoneal seeding, primary gastrectomy and additional gastrectomy after primary chemotherapy revealed the better clinical outcomes. But, prospective randomized clinical study and multi-center study are should be performed to decide proper treatment for gastric cancer patients with peritoneal seeding.
Gastrectomy ; Humans ; Prognosis ; Retrospective Studies ; Seeds ; Stomach Neoplasms ; Survival Rate

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Clinical Outcomes of Gastrectomy after Incomplete EMR/ESD.

Hye Jeong LEE ; You Jin JANG ; Jong Han KIM ; Sung Soo PARK ; Seung Heum PARK ; Jong Jae PARK ; Seung Joo KIM ; Chong Suk KIM ; Young Jae MOK

Journal of Gastric Cancer.2011;11(3):162-166. doi:10.5230/jgc.2011.11.3.162

PURPOSE: Endoscopic resection is widely accepted as standard treatment for early gastric cancer (EGC) without lymph node metastasis. The procedure is minimally invasive, safe, and convenient. However, surgery is sometimes needed after endoscopic mucosal resection/endoscopic submucosal dissection endoscopic mucosal resection (EMR)/endoscopic submucosal dissection (ESD) due to perforation, bleeding, or incomplete resection. We evaluated the role of surgery after incomplete resection. MATERIALS AND METHODS: We retrospectively studied 29 patients with gastric cancer who underwent a gastrectomy after incomplete EMR/ESD from 2006 to 2010 at Korea University Hospital. RESULTS: There were 13 incomplete resection cases, seven bleeding cases, three metachronous lesion cases, three recurrence cases, two perforation cases, and one lymphatic invasion case. Among the incomplete resection cases, a positive vertical margin was found in 10, a positive lateral margin in two, and a positive vertical and lateral margin in one case. Most cases (9/13) were diagnosed as mucosal tumors by endoscopic ultrasonography, but only three cases were confirmed as mucosal tumors on final pathology. The positive residual tumor rate was two of 13. The lymph node metastasis rate was three of 13. All lymph node metastasis cases were submucosal tumors with positive lymphatic invasion and no residual tumor in the gastrectomy specimen. No cases of recurrence were observed after curative resection. CONCLUSIONS: A gastrectomy is required for patients with incomplete resection following EMR/ESD due to the risk of residual tumor and lymph node metastasis.
Endosonography ; Gastrectomy ; Hemorrhage ; Humans ; Korea ; Lymph Nodes ; Neoplasm Metastasis ; Neoplasm, Residual ; Recurrence ; Retrospective Studies ; Stomach Neoplasms

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Frozen Section Biopsy to Evaluation of Obscure Lateral Resection Margins during Gastric Endoscopic Submucosal Dissection for Early Gastric Cancer.

Eun Jung KANG ; Joo Young CHO ; Tae Hee LEE ; So Young JIN ; Won Young CHO ; Jin Hyun BOK ; Hyun Gun KIM ; Jin Oh KIM ; Joon Seong LEE ; Il Hyun LEE

Journal of Gastric Cancer.2011;11(3):155-161. doi:10.5230/jgc.2011.11.3.155

PURPOSE: To determine the diagnostic utility of a frozen section biopsy in patients undergoing endoscopic submucosal dissection (ESD) for early gastric neoplasms with obscure margins even with chromoendoscopy using acetic acid and indigo carmine (AI chromoendoscopy). MATERIALS AND METHODS: The lateral spread of early gastric neoplasms was unclear even following AI chromoendoscopy in 38 patients who underwent ESD between June 2007 and May 2011. Frozen section biopsies were obtained by agreement of the degree of lateral spread between two endoscopists. Thus, frozen section biopsies were obtained from 23 patients (FBx group) and not in the other 15 patients (AI group). RESULTS: No significant differences were observed for size, histology, invasive depth, and location of lesions between the AI and FBx groups. No false positive or false negative results were observed in the frozen section diagnoses. Adenocarcinoma was revealed in three patients and tubular adenoma in one, thereby changing the delineation of lesion extent and achieving free lateral margins. The rates of free lateral resection margins and curative resection were significantly higher in the FBx group than those in the AI group. CONCLUSIONS: Frozen section biopsy can help endoscopists perform more safe and accurate ESD in patients with early gastric neoplasm.
Acetic Acid ; Adenocarcinoma ; Adenoma ; Biopsy ; Frozen Sections ; Humans ; Indigo Carmine ; Indoles ; Stomach Neoplasms

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Endoscopic Treatment for Early Gastric Cancer.

Sang Gyun KIM

Journal of Gastric Cancer.2011;11(3):146-154. doi:10.5230/jgc.2011.11.3.146

Endoscopic resection has been accepted as a curative modality for early gastric cancer (EGC). Since conventional endoscopic mucosal resection (EMR) has been introduced, many improvements in endoscopic accessories and techniques have been achieved. Recently, endoscopic submucosal dissection (ESD) using various electrosurgical knives has been performed for complete resection of EGC and enables complete resection of EGC, which is difficult to completely resect in the era of conventional EMR. Currently, ESD is accepted as the standard method for endoscopic resection of EGC in indicated cases. In this review, the history of endoscopic treatment for EGC, overall ESD procedures, and indications and clinical results of endoscopic treatment will be presented.
Stomach Neoplasms

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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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