To explore the differences in biological characteristics for the small gastrointestinal stromal tumors and the incidence of complications and recurrence between the traditional surgical treatment and endoscopic treatment.
 Methods: We collected the relevant clinical and pathological data from patients who were diagnosed as gastrointestinal stromal tumors with the diameter less than 2 cm by the Department of Pathology of Xiangya Hospital from January 2009 to December 2015. The complications and recurrence after the surgical treatment were analyzed.
 Results: In patients with small gastrointestinal stromal tumors, the proportion of female was higher than that of male (male:female=1:1.69). The median age for patient with this disease was 49 years old and it was more common in middle-aged and elderly. Most lesions were found in the stomach, followed by the esophagus and the small intestine. The small gastrointestinal stromal tumors occurred in the colon and rectum were rare. There was 60.3% (47/78) patients with abdominal pain, 7.7% (6/78) patients with hematochezia or melena, and 98.7% (78/79) with small gastrointestinal stromal tumors' mitotic count ≤5/50 HPF. The positive rates for CD, CD34, DOG-1, actin-smooth, and S-100 were 98.7%, 86.1%, 82.3%, 31.6%, and 24.1%, respectively. Three patients occurred surgical complications, 2 suffered recurrence during the follow-up. There was no significant difference in the incidence of complications and recurrence between the traditional surgical treatment and endoscopic treatment (P>0.05).
 Conclusion: Small gastrointestinal stromal tumors' malignant potential is low, and the recurrence and metastasis rate is low. Its biological behavior tends to be benign. The traditional surgical treatment and endoscopic treatment are both safe and effective for small gastrointestinal stromal tumor. Endoscopic treatment has the advantages in lower cost, shorter hospitalization time, and small trauma. Therefore, endoscopic treatment could be the first choice for small GIST resection under the condition of mature endoscopic technology.
Aged ; Endoscopy, Gastrointestinal ; Female ; Gastrointestinal Hemorrhage ; etiology ; Gastrointestinal Neoplasms ; complications ; pathology ; surgery ; Gastrointestinal Stromal Tumors ; complications ; pathology ; surgery ; Humans ; Incidence ; Male ; Middle Aged ; Neoplasm Recurrence, Local ; Postoperative Complications ; epidemiology ; Retrospective Studies ; Tumor Burden

Gastric stump cancer was initially defined as a carcinoma of the stomach occurring more than 5 years after surgery for gastric or duodenal benign disease. In recent years, as the number of total gastrectomy for benign disease has gradually decreased and the gastric cancer detection and operation rate have annually increased, residual recurrence of primary gastric cancer more than 10 years after gastric cancer surgery has also been considered as gastric stump cancer. The incidence of gastric stump cancer is increasing annually. The epidemiological characteristics of this form of cancer are also developing, and they show a higher incidence in males compared to females. The incidence has been affected following digestive tract reconstruction, and the risk increases in patients who undergo Billroth II( reconstruction. The interval of onset is related to the benign and malignant condition of primary disease, and the incidence increases after 10 years of early gastric cancer surgery. Lymph node metastasis pattern in gastric stump cancer is different from that in primary gastric cancer as the primary operation may destroy normal lymph flow. Many factors are known to cause gastric stump cancer, mainly duodenal gastric reflux, Helicobacter pylori infection, and gastric mucosal barrier dysfunction; however, the mechanism is not clear. It is expected to reduce the incidence of gastric stump cancer by taking precautionary measures against different inducements, which also has some guiding significance for the treatment and prognosis of gastric cancer.
Female ; Gastrectomy ; Gastric Stump ; pathology ; surgery ; Gastroenterostomy ; Humans ; Incidence ; Male ; Neoplasm Recurrence, Local ; Risk Factors ; Stomach Neoplasms ; epidemiology ; etiology ; surgery

OBJECTIVE: To evaluate the recurrence rates and patterns of failure in patients with stage I endometrial carcinoma after surgical staging without adjuvant therapy. METHODS: Medical records of 229 patients with stage I endometrial carcinoma, treated with surgery alone between 2002 and 2010 at Siriraj Hospital were retrospectively reviewed. The primary objective of this study was recurrence rates. The secondary objectives were patterns of failure, disease-free survival, overall survival, and prognostic factors related to outcomes. RESULTS: During median follow-up time of 53.3 months, 11 recurrences (4.8%) occurred with a median time to recurrence of 21.2 months (range, 7.7 to 77.8 months). Vaginal recurrence was the most common pattern of failure (8/11 patients, 72.7%). Other recurrences were pelvic, abdominal and multiple metastases. Factors that appeared to be prognostic factors on univariate analyses were age and having high intermediate risk (HIR) (Gynecologic Oncology Group [GOG] 99 criteria), none of which showed significance in multivariate analysis. The recurrence rates were higher in the patients with HIR criteria (22.2% vs. 4.1%, p=0.013) or patients with stage IB, grade 2 endometrioid carcinoma (9.4% vs. 4.3%, p=0.199). Five-year disease-free survival and 5-year overall survival were 93.9% (95% CI, 89.9 to 5.86) and 99.5% (95% CI, 97.0 to 99.9), respectively. CONCLUSION: The patients with low risk stage I endometrial carcinoma had excellent outcomes with surgery alone. Our study showed that no single factor was demonstrated to be an independent predictor for recurrence.
Adult ; Aged ; Aged, 80 and over ; Endometrial Neoplasms/mortality/pathology/*surgery ; Female ; Humans ; Middle Aged ; Neoplasm Recurrence, Local/epidemiology ; Neoplasm Staging ; Treatment Outcome

INTRODUCTIONMinimally invasive hepatectomy (MIH) for patients with hepatocellular carcinoma (HCC) is technically challenging, especially with large posteriorly located tumours or background of liver cirrhosis. This is a case-control study comparing the long-term oncological safety of HCC patients who underwent MIH and open hepatectomy (OH). Most of these patients have liver cirrhosis compared to other studies.

MATERIALS AND METHODSSixty patients were divided into 2 groups, 30 underwent MIH and 30 underwent OH for HCC resection. The patients in both groups were matched for extent of tumour resection, age and cirrhosis status. Patient characteristics, risk factors of HCC and all oncological data were studied.

RESULTSNegative resection margins were achieved in 97% of patients in both groups. The mean blood loss during surgery was significantly lower in the MIH group compared to the OH group (361 mL vs 740 mL; 95% CI, 222.2, 734.9; P = 0.04). Hospitalisation is significantly shorter in MIH group (7 days vs 11 days; 95% CI, 6.9, 12.2,; P = 0.04). Eight patients (27%) in the MIH group and 13 patients (43%) in the OH group developed HCC recurrence (P = 0.17). One, 3 and 5 years disease-free survival between MIH and OH groups are 76% vs 55%, 58% vs 47%, and 58% vs 39% respectively (P = 0.18). One, 3 and 5 years overall survival between MIH and OH groups are 93% vs 78%, 89% vs 70%, and 59% vs 65% respectively (P = 0.41).

CONCLUSIONMIH is a safe and feasible curative treatment option for HCC with similar oncological outcomes compared to OH. MIH can be safely performed to remove tumours larger than 5 cm, in cirrhotic liver, as well as centrally and posterior located tumours. In addition, MIH patients have significant shorter hospitalisation and intraoperative blood loss.

Blood Loss, Surgical ; Carcinoma, Hepatocellular ; complications ; pathology ; surgery ; Case-Control Studies ; Disease-Free Survival ; Hepatectomy ; methods ; Humans ; Laparoscopy ; Length of Stay ; Liver Cirrhosis ; complications ; Liver Neoplasms ; complications ; pathology ; surgery ; Margins of Excision ; Minimally Invasive Surgical Procedures ; methods ; Neoplasm Recurrence, Local ; epidemiology ; Tumor Burden

PURPOSE: The aim of this study was to identify risk factors influencing permanent stomas after low anterior resection with temporary stomas for rectal cancer. MATERIALS AND METHODS: A total of 2528 consecutive rectal cancer patients who had undergone low anterior resection were retrospectively reviewed. Risk factors for permanent stomas were evaluated among these patients. RESULTS: Among 2528 cases of rectal cancer, a total of 231 patients had a temporary diverting stoma. Among these cases, 217 (93.9%) received a stoma reversal. The median period between primary surgery and stoma reversal was 7.5 months. The temporary and permanent stoma groups consisted of 203 and 28 patients, respectively. Multivariate analysis showed that independent risk factors for permanent stomas were anastomotic-related complications (p=0.001) and local recurrence (p=0.001). The 5-year overall survival for the temporary and permanent stoma groups were 87.0% and 70.5%, respectively (p<0.001). CONCLUSION: Rectal cancer patients who have temporary stomas after low anterior resection with local recurrence and anastomotic-related complications may be at increased risk for permanent stoma.
Adenocarcinoma/pathology/*surgery ; Adult ; Aged ; Aged, 80 and over ; Female ; Follow-Up Studies ; Humans ; Ileostomy/*statistics & numerical data ; Incidence ; Male ; Middle Aged ; Multivariate Analysis ; Neoplasm Recurrence, Local ; Postoperative Complications/epidemiology ; Rectal Neoplasms/pathology/*surgery ; Republic of Korea/epidemiology ; Retrospective Studies ; Risk Factors ; Surgical Stomas/*statistics & numerical data ; Treatment Outcome

PURPOSE: The aim of this study was to identify risk factors influencing permanent stomas after low anterior resection with temporary stomas for rectal cancer. MATERIALS AND METHODS: A total of 2528 consecutive rectal cancer patients who had undergone low anterior resection were retrospectively reviewed. Risk factors for permanent stomas were evaluated among these patients. RESULTS: Among 2528 cases of rectal cancer, a total of 231 patients had a temporary diverting stoma. Among these cases, 217 (93.9%) received a stoma reversal. The median period between primary surgery and stoma reversal was 7.5 months. The temporary and permanent stoma groups consisted of 203 and 28 patients, respectively. Multivariate analysis showed that independent risk factors for permanent stomas were anastomotic-related complications (p=0.001) and local recurrence (p=0.001). The 5-year overall survival for the temporary and permanent stoma groups were 87.0% and 70.5%, respectively (p<0.001). CONCLUSION: Rectal cancer patients who have temporary stomas after low anterior resection with local recurrence and anastomotic-related complications may be at increased risk for permanent stoma.
Adenocarcinoma/pathology/*surgery ; Adult ; Aged ; Aged, 80 and over ; Female ; Follow-Up Studies ; Humans ; Ileostomy/*statistics & numerical data ; Incidence ; Male ; Middle Aged ; Multivariate Analysis ; Neoplasm Recurrence, Local ; Postoperative Complications/epidemiology ; Rectal Neoplasms/pathology/*surgery ; Republic of Korea/epidemiology ; Retrospective Studies ; Risk Factors ; Surgical Stomas/*statistics & numerical data ; Treatment Outcome

BACKGROUND/AIMS: Endoscopic resection (ER) of superficial esophageal neoplasm (SEN) is a technically difficult procedure. We investigated the clinical outcomes of ER for SEN to determine its feasibility and effectiveness. METHODS: Subjects who underwent ER for SEN at Asan Medical Center between December 1996 and December 2010 were eligible. The clinical features of patients and tumors, histopathological characteristics, adverse events, ER results and survival were investigated. RESULTS: A total of 129 patients underwent ER for 147 SENs. En bloc resection (EnR) was performed in 118 lesions (80.3%). Complete resection (CR) was accomplished in 128 lesions (86.5%), and curative resection (CuR) was performed in 118 lesions (79.7%). The EnR, CR, and CuR rates were significantly greater in the endoscopic submucosal dissection group when compared to those in the endoscopic resection group. Adverse events occurred in 22 patients (17.1%), including bleeding (n=2, 1.6%), perforation (n=12, 9.3%), and stricture (n=8, 6.2%). Local tumor recurrence occurred in 2.0% of patients during a median follow-up of 34.8 months. The 5-year overall and disease-specific survival rates were 94.0% and 97.5%, respectively. CONCLUSIONS: ER is a feasible and effective method for the treatment of SEN as indicated by favorable clinical outcomes.
Aged ; Aged, 80 and over ; Disease-Free Survival ; Dissection/*adverse effects/methods ; Esophageal Neoplasms/pathology/*surgery ; Esophageal Perforation/epidemiology/etiology ; Esophageal Stenosis/epidemiology/etiology ; Esophagoscopy/*adverse effects/methods ; Female ; Gastric Mucosa/surgery ; Humans ; Male ; Middle Aged ; Neoplasm Recurrence, Local/epidemiology ; Postoperative Hemorrhage/epidemiology/etiology ; Retrospective Studies ; Treatment Outcome

BACKGROUND/AIMS: Follicular thyroid carcinoma (FTC) and Hurthle cell carcinoma (HCC) of the thyroid are relatively uncommon thyroid malignancies in iodine-sufficient areas. In this study we evaluated the clinical behavior, prognostic factors and treatment outcomes of FTC and HCC in Korea. METHODS: This multicenter study included 483 patients with FTC and 80 patients with HCC who underwent an initial surgery between 1995 and 2006 in one of the four tertiary referral hospitals in Korea. We evaluated clinicopathological factors associated with distant metastases and recurrence during a median of 6 years of follow-up. RESULTS: HCC patients were significantly older (49 years vs. 43 years; p < 0.001) and had more lymphovascular invasions (22% vs. 14%; p = 0.03) compared with FTC patients. Distant metastases were confirmed in 40 patients (8%) in the FTC group and in two patients (3%) in the HCC group (p = 0.07). Distant metastases were significantly associated with older age, widely invasive cancer and extrathyroidal invasion. Only 14 patients (3%) had recurrent disease and there was no significant difference between FTC and HCC groups (p = 0.38). Recurrence was associated with larger tumor size and cervical lymph node metastasis. CONCLUSIONS: HCC patients were older and had more lymphovascular invasions than FTC patients. However, FTC and HCC patients had similar initial clinicopathological features. Older age, wide invasiveness and extrathyroidal invasion were independent risk factors for predicting distant metastases in FTC and HCC patients.
Adenocarcinoma, Follicular/*epidemiology/secondary/surgery ; Adult ; Age Factors ; *Diet ; Female ; Humans ; *Iodine ; Lymphatic Metastasis ; Male ; Middle Aged ; Neoplasm Recurrence, Local ; *Nutritional Status ; Republic of Korea/epidemiology ; Retrospective Studies ; Risk Factors ; Tertiary Care Centers ; Thyroid Neoplasms/*epidemiology/pathology/surgery ; Thyroidectomy ; Time Factors ; Treatment Outcome

BACKGROUNDc-Myc, EZH2 and p27 were defined to modulate the behavior of prostate cancer with pro-tumoral or anti-tumoral effects and had ability in predicting prostate cancer progression, but the research of their co-expression value of prognosis is rarely. This study aimed to investigate the prognostic value of combining tri-marker together in patients with intermediate-risk prostate cancer after surgery.

METHODSExpression levels of c-Myc, EZH2 and p27 in 129 patients with intermediate-risk prostate cancer were assessed using immunohistochemistry in a semi-quantitative manner. The expression profiles of these three markers were analyzed and investigated for association with biochemical recurrence.

RESULTSIn all, fifty of 129 cases experienced biochemical recurrence during a median follow-up time of 31 months (range, 6 - 60 months). Of these relapse patients, one case without and 10 cases with any single positive marker were observed; 39 cases were detected with any two or all three positive markers (22 cases with any two and 17 cases with all three positive markers). Survival analysis showed that patients with over-expression of c-Myc or EZH2, and lower expression of p27 manifested significantly higher biochemical recurrence rates. Subsequent multivariate analysis revealed that c-Myc, EZH2 and p27 expression statuses showed potential in predicting relapse, respectively. Notably, combining three markers together as a "composite index" (0 or 1, vs. 2 or 3 positive markers) provided powerful prognostic value (HR 6.57, 95% CI 3.02 - 14.31, P < 0.001). There was a significant difference between the patient subgroups with 0 or 1 and those with 2 or 3 positive markers expression statuses, and tri-marker composite index was an independent risk factor for predicting relapse in patients with intermediate-risk prostate cancer after surgery.

CONCLUSIONComposite index of c-Myc, EZH2, and p27 can be valued as powerful prognosis parameter for intermediate-risk prostate cancer patients after the surgery, and postoperative adjuvant therapy can be adopted accordingly.

Cyclin-Dependent Kinase Inhibitor p27 ; analysis ; Enhancer of Zeste Homolog 2 Protein ; Humans ; Immunohistochemistry ; Male ; Middle Aged ; Neoplasm Recurrence, Local ; epidemiology ; Neoplasm Staging ; Polycomb Repressive Complex 2 ; analysis ; Prognosis ; Prostatic Neoplasms ; chemistry ; mortality ; pathology ; surgery ; Proto-Oncogene Proteins c-myc ; analysis

OBJECTIVETo discuss clinical effects of surgical treatment for desmoplastic fibroma of bone.

METHODSBetween June 2000 and June 2010, 15 cases of desmoplastic fibroma were treated by surgical operation including 4 males and 7 females with an average age of 39 years old (ranged from 18 to 64 years old). The site of tumor was proximal femur in 4 cases, distal femur in 3, distal tibia in 2, proximal humerus in 1, distal humerus in 1, scapula in 1, pelvic in 2, manubrium of sternum in 1. The simple intralesional curettage was performed in 1 case. The other 14 cases were divided into two groups, 7 cases had an aggressive curettage with inactivation and the last 7 cases had a wide resection. Recurrence condition were observed after operation. The function was valuated in two groups after the operation according to Enneking's standard.

RESULTSThe mean duration of follow-up was 56 months (ranged, 18 to 132 months). Two cases recurred, but no metastasis. The patient with simple intralesional curettage recurreed, 1 of the 7 patients with a wide resection recurred. The recurrence rate was 13.3% (2/15). There was no recurrence in the group with an aggressive curettage with inactivation. According to Enneking's standard, Enneking scoring was 21.6 +/- 3.8 in the group with a wide resection and 28.3 +/- 1.3 in another group, The results were excellent in 2 cases and good in 5 in the group with a wide resection, excellent in 7 in the other group.

CONCLUSIONThe aggressive curettage with inactivation has better functional recovery than the wide resection,and it should be chosen when the lesion is small or located in an area where reconstruction is difficult.

Adolescent ; Adult ; Bone Neoplasms ; pathology ; surgery ; Female ; Fibroma, Desmoplastic ; pathology ; surgery ; Humans ; Male ; Middle Aged ; Neoplasm Recurrence, Local ; epidemiology ; Young Adult