• Journal of Gastric Cancer
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• 제21권2호
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• pp.179-190
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• 2021

Purpose: Reduced port laparoscopic distal gastrectomy (RPLDG) using 3 ports is less invasive than conventional laparoscopic distal gastrectomy (CLDG) using 5 ports. Although RPLDG performed by expert surgeons is safe and feasible, novice surgeons have difficulty performing this procedure. This study evaluated the surgical outcomes and feasibility of RPLDG performed by a novice surgeon. Materials and Methods: The records of 136 patients who underwent laparoscopic distal gastrectomy for gastric cancer performed by a single novice surgeon between May 2016 and December 2018 were retrospectively reviewed. Among these 136 patients, 52 underwent RPLDG and 84 underwent CLDG. The clinicopathological characteristics, operative outcomes, and short-term postoperative outcomes of the 2 groups were compared. Results: The percentage of women was significantly higher in the RPLDG group than in the CLDG group (48.1% vs. 31%; P=0.045), but other baseline characteristics did not differ significantly between the groups. Billroth II anastomosis was performed significantly more frequent (90.4% vs. 73.8%, P=0.015) and operation time was significantly shorter (207.1±43.3 min vs. 225.5±44.6 min, P=0.020) in the RPLDG group than in the CLDG group. The time to first flatus, postoperative pain score, length of postoperative hospital stay, and incidence and severity of complications did not differ significantly between the groups. Analysis of the learning curve based on the operation time showed that performing RPLDG on 20-30 patients was required to achieve technical proficiency. Conclusions: RPLDG is a safe and feasible surgical procedure for the treatment of gastric cancer, even when performed by a novice surgeon.

• Journal of Chest Surgery
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• 제9권1호
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• pp.69-72
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• 1976

This is to report a case of bronchgenic cyst. While most of the bronchogenic cysts reported in the literature so far were located either in the lung parechym or in the mediastinum near the tracheal bifurcation or main bronchi. the cyst presenting in this study was originated in the wall of the esophagus and was reported to be very rare. The cystic tumor was found accidentally by X-ray fluoroscopic examination of the esophagus and stomach in the patient with gastric hemorrhage. X-ray study revealed that the cystic tumor was oval in shape and located in the left posterolateral wall of the esophagus in the thoracic lower third. Two surgical operations, gastrectomy for gastric hemorrhage and the resection of the cystic tumor, were carried out separately. Gastrectomy including the removal of prepyloric ulcer by the Billroth II type procedure was performed in regular fashion, and the cystic tumor was resected radically without any injury of the mucous membrane of the esophagus. The cyst removed appeared to be filled with mucinous material, and histological examination identified the tumor as a bronchogenic cyst with ciliated epithelial internal lining. Postperative course of the patient was uneventful.

• Journal of Gastric Cancer
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• 제21권3호
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• pp.221-235
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• 2021

Purpose: The Korean Gastric Cancer Association (KGCA) has been conducting nationwide surveys on patients with surgically treated gastric cancer, every 5 years, since 1995. This study details the results of the survey conducted in 2019. Materials and Methods: This survey was conducted from March to December 2020 using a standardized case report form, which was sent to every member of the KGCA via e-mail. We collected data on 54 items, including patient demographics, tumor characteristics, surgical procedures, and surgical outcomes. We compared the results of the 2019 survey with previous surveys. Results: Data of 14,076 cases were collected from 68 institutions. The mean patient age was 62.9 years and the proportion of patients who were aged ≥71 years increased from 9.1% in 1995 to 28.8% in 2019. The proportion of upper-third tumors steadily increased from 11.2% in 1995 to 20.9% in 2019 and that of early gastric cancer increased from 57.7% in 2009 to 63.6% in 2019. Regarding operative procedures, a total laparoscopic approach was used in more than half of the cases (55.1%) in 2019. The most common anastomotic method was the Billroth II procedure (45.0%) after distal gastrectomy and double tract reconstruction (81.2%) after proximal gastrectomy in 2019. The postoperative mortality rate was 1.0%, and the overall postoperative complication rate was 14.5%. Conclusions: The results of the 2019 nationwide survey demonstrate the current status of gastric cancer treatment in Korea. This information will provide a basis for gastric cancer research in the future.

• Journal of Chest Surgery
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• 제16권3호
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• pp.386-390
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• 1983

One case of surgically treated sliding esophageal hiatal hernia associated with bleeding gastric ulcer is presented. The patient was 73 years-old woman who had suffered from epigastric heartburn, indigestion, and melena since 3 months prior to admission. Esophageal hiatal hernia was suspected on the simple chest film and the diagnosis was confirmed by tetralogic barium study of the gastrointestinal tract. Hematemesis and melena were persisted so emergent thoracotomy and abdominal exploration were undertaken. Repair of hiatal hernia by constricting suture around relaxed esophageal hiatus was made and plication sutures were Inserted between esophagogastric junction and median arcuate ligament of diaphragm. Concomittently, subtotal gastrectomy with Billroth II procedure was performed to removal of large bleeding ulcer on the lesser curvature of the stomach antrum. Postoperative course was uneventful.

• Journal of Gastric Cancer
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• 제7권4호
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• pp.228-236
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• 2007

목적: 위암의 위절제술 후, 생체전기 임피던스법을 이용하여 1년 동안 체성분 변화를 알아봄으로써 위절제술에 따른 영양, 생리학적 연구의 기초 자료로 활용하고자 하였다. 대상 및 방법: 2003년 11월부터 2004년 11월까지 위암으로 근치적 위절제술을 시행 받고, 본 연구에 사전 동의를 해준 98명을 대상으로 생체 전기 임피던스법(Inbody 4.0, Biospace, Korea)을 이용하여 간단한 임상적 지표에 따른 변화를 알아보았다. 결과: 체중은 술 후 1개월까지 6.7%, 6개월까지 9.4%의 감소를 보인다(P<0.01). 제지방량은 4개월까지 4.9%의 감소를 보이고 이후에는 변화하지 않았다(P<0.01). 체지방량과 내장지방은 6개월 동안 24.3%, 14.1%의 감소를 보였다(P<0.01). 여자가 남자에 비해 체중, 제지방량, 내장지방의 감소가 많았다(P<0.05). 병기 III-IV기 환자가 I-II기에 비해 부종지수가 높게 나타났다(P<0.05). Billroth I, III Esophagoje-junostomy에 따른 유의한 차이는 체지방량으로 12개월 때 감소비율이 각각 27.6%, 22.1%, 41.2%이었다(P<0.05). 결론: 위절제 후의 부족한 영양 섭취와 체중 감소의 개선은 삶의 질과 관계되므로 영양, 생리학적 연구의 관심이 필요하다. 체성분 분석에 있어서 생체전기 임피던스법은 유용하게 사용될 수가 있었고 본 결과가 향후 위 절제와 관련된 영양생리학적 연구에 응용되기를 희망한다.

• Journal of Gastric Cancer
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• 제21권4호
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• pp.325-334
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• 2021

Purpose: Although dumping symptoms are thought to involve postprandial glycemic changes, postprandial glycemic variability without dumping symptoms remains poorly understood due to the lack of a method that allows the easy and continuous measurement of blood glucose levels. Materials and Methods: Patients having undergone distal gastrectomy with Billroth-I (DG-BI) or Roux-en-Y reconstruction (DG-RY), total gastrectomy with RY (TG-RY) and pylorus preserving gastrectomy (PPG) for gastric cancer 3 months to 3 years prior, diagnosed as pathological stage I or II, were prospectively enrolled from March 2018 to January 2020. The interstitial tissue glycemic levels were measured every 15 min, up to 14 days by continuous glucose monitoring. Moreover, using a diary recording the diet and symptoms, asymptomatic glucose profiles without sugar supplementation within 3 h postprandially were compared among the four procedures. Results: A total of 40 patients were enrolled, 10 patients for each of the four procedures. There were 47 glucose profiles with DG-BI, 46 profiles with DG-RY, 38 profiles with TG-RY, and 46 profiles with PPG. PPG showed the slowest increase with a subsequent gradual decrease in glucose fluctuations, without hyperglycemia or hypoglycemia, among the four procedures. In contrast, TG-RY and DG-RY showed spike-like glycemic variability, sharp rises during meals, and rapid drops. The glucose profiles of DG-BI were milder than those of RY. Conclusions: The asymptomatic glycemic changes after meals differ among the types of surgical procedures for gastric cancer. Given the mild glycemic fluctuations in PPG and the glucose spikes in TG-RY and DG-RY, pylorus preservation and physiological reconstruction without changes in food pathways may optimize postprandial glucose profiles after gastrectomy.

• Journal of Gastric Cancer
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• 제11권4호
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• pp.239-242
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• 2011

A debate is currently ongoing about whether a large gastrointestinal stromal tumor (GIST) should be treated by the laparoscopic approach because of the increased risk of tumor rupture during manipulation of the tumor with laparoscopic instruments and the resultant peritoneal tumor dissemination. Herein, we report a case of a large GIST of the stomach which was successfully treated by the laparoscopic approach. A 57 year old female patient visited our institution complaining of postprandial epigastric discomfort. An esophagogastroduodenoscopy and an abdominal computed tomography scan revealed a $10{\times}8$ cm sized submucosal tumor at the greater curvature side of the gastric antrum. The patient underwent laparoscopic distal gastrectomy with intracorporeal Billroth-II reconstruction without any breakage of the tumor. Her postoperative course was uneventful and she was discharged on the 7th postoperative day. Even a large GIST of the stomach can safely be treated by the laparoscopic approach when it is performed with proper techniques by an experienced surgeon.

• Journal of Gastric Cancer
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• 제1권3호
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• pp.144-149
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• 2001

Purpose: Gastric stump cancer is defined as a cancer that develops in the stomach after a resection in cases of non-malignant or malignant gastric disease. The interval between the gastrectomy and the detection of gastric stump cancer must be over 5 years. Since duodenogastric reflux gastritis is a precancerous condition and one of the most important factors inducing gastric stump cancer, we compared the bile-acid content of gastric juice between gastric stump cancer patients and controls. Materials and Methods: To evaluate retrospectively the surgical treatment of patients with gastric stump cancer, we reviewed the cases histories of 1016 stomach cancer patients who had been operated on at the Department of General Surgery, Kosin University Gospel Hospital, between 1995 and 1998. The gastric juice was collected during the operations on the gastric stump cancer patients by using a needle puncture of the fundus of the stomach and during the endoscopic examinations of the control subjects. The samples were analyzed for various bile acids (gas chromatography/mass spectrometry). Results: The 6 gastric stump cancer cases accounted for $0.6\%$ of all gastric cancer patients; 5 patients were first operated on for a peptic ulcer and the remaining one for an adenocarcinoma of the stomach. All of the cases were men. The reconstruction method after the initial gastrectomy was a Billroth II in all cases. The sites of the gastric stump cancer were the anastomotic sitein 2 patients, the upper body in 2, the fundus in 1 and the cardia in 1. The operative methods were 3 total gastrectomies, 2 subtotal gastrectomies with Roux en Y anastomosis, and 1 partial gastrectomy with lymph node dissection and had a curative intention in all patients. All of the patients were still surviving at the time of this report. The gastric juices of 4 gastric stump patients showed significantly higher contents of cholic acid ($36.42{\mu}g/ml$) compared to the gastric juices of 35 control subjects ($36.42{\mu}g/ml$)(p$\leq0.0001$). Chenodeoxycholic acid and lithocholic acid were not significantly different. Conclusion: The gastric juice of gastric stump cancer patients contained a significantly higher cholic acid content. At the time of the initial gastrectomy, an operative method that prevents duodenogastric reflux may prevent or minimize the development of gastric stump cancer, and more aggressive surgical treatment may improve survival.

• 대한영상의학회지
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• 제85권3호
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• pp.661-667
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• 2024

들장관증후군은 위장 재건술을 동반한 위절제술 후 발생하는 드문 합병증이다. 이 질환은 담관염, 췌장염, 복막염을 동반한 십이지장 천공과 같은 치명적인 상태에 이를 수 있어서, 즉각적인 감압 치료가 필요하다. 담관 확장이 없는 들장관증후군 환자를 위한 대체 감압 치료법으로 경담낭 십이지장 배액술을 시행한 두 건의 증례를 보고하고자 한다. Billroth II 문합술과 위원위절제술을 시행한 2명의 환자가 상복부 통증과 구토를 주소로 응급실에 내원하였다. 컴퓨터단층촬영에서 급성 췌장염을 동반한 들장관증후군으로 진단되었다. 담관 확장이 없어 담도를 통한 접근이 어려워, 경담낭 접근을 통해 담낭관을 통과한 후 들장관을 감압하기 위한 십이지장 배액 카테터를 설치하였다. 환자들은 배액술 시행 후 각각 2주와 1개월째에 추가적인 수술적 치료 없이 퇴원하였다.

• Journal of Gastric Cancer
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• 제7권4호
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• pp.213-218
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• 2007

목적: 조기위암 수술에 복강경 적용의 용이성 및 종양학적 안정성에 대해서는 많은 연구가 아루어지고 있으나, 복 강경 적용의 또 다른 목적인 '삶와 질' 향상에 대한 연구 는 아직 미흡한 현실이다. 이에 저자들은 위암 수술에 복강경 적용이 '삶의 질' 향상에 미치는 장기적 영향을 평가 하고자 본 연구를 고안하였다. 대상 및 방법: 2003년 1월부터 2004년 12월까지만 2년간 순천향대학병원 외과에서 위 절제 수술 후 위암 1기로 진단된 154명의 환자들을 대상으로 수술 후 1년 이상 경과한 시점에서 설문조사를 시행하였다. EORTC OLQ-C30(3판)과 EORTC QLQ-ST022 한글판을 이용하여 한 명의 전문 간호사에 의해 외래 방문 시 직접 면담 혹은 전화 상담을 통해 설문조사를 시행했으며, 통계처리는 SPSS 12.0 for Windows를 이용하였다. 결과: 전체 대상 환자 154명 중 86명에서 설문 조사가 이루어져 58%의 응답률을 보였으며, 86명(개복군: 57명, 복강경군: 29명)의 평균 연령은 55세였고, 남자가 60명 여자가 26명으로 남녀 비는 2.3 : 1 이었다. 개복 군의 종양 크기는 평균 2.42 cm로 복강경군의 평균 종양 크기 1.8 cm에 비해 유의하게 크기가 컸으며(P=0.003), 평균 획득 림프절 수도 개복 군에서 36개로 유의하게 더 많았다(P=0.000). 그 외 종양관련 인자인 원발암와 침윤도, 림프절 전이 및 TNM 병기에 있어서 양 군 간에 차이는 없었다. 전반적인 건강 상태와 관련된 2 항목의 평균 점수는 개복 군이 57 (${\pm}20.6$), 복강경 군이 60.3 (${\pm}20.4$)으로 양 군 간에 유의한 차이는 없었으며, 기능과 관련된 15 항목과 증상과 관련된 13항목에 있어서도 양군 간에 유의한 차이는 없었다. EORTC QLQ-STO22를 이용한 '삶의 질' 비교 결과 개복군의 평균 점수는 94.5 (${\pm}97.3$), 복강경군은 68.9 (${\pm}64.9$)로 개복군에서 전반적으로 불편한 증상을 많이 호소하였으나 통계학적인 차이는 없었다. 결론: EORTC QLQ-C30 (3판)과 EORTC QLQ-STO22 한글판을 이용한 설문조사 결과 장기적인 측면에서 위 절제술에 복 강경 적용이 환자의 '삶의 질' 향상에 영향을 미치지 못했다.