• Journal of Gastric Cancer
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• 제1권3호
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• pp.150-154
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• 2001

Purpose: Multiple early gastric cancers were found in $6.9\∼11.7\%$ of patients with early gastric cancer. The goal of this study was to clarify the clinicopathologic features of and to investigate treatment strategy for multiple early gastric cancer. Materials and Methods: Of 967 patients with an gastric adenocarcinoma who were treated by surgical resection during the period of $1993\∼1998$ at the Department of Surgery, Korea University College of Medicine, 267 patients had early gastric cancer. A retrospective analysis of the clinicopathologic differences between the main and the accessory lesions in multiple early gastric cancer was carried out. A comparative analysis was also conducted between solitary early gastric cancer and multiple early gastric cancer. Results: Of 267 patients with early gastric cancer, multiple early gastric cancers were found in 12 patients ($4.5\%$), including 10 men and 2 women. Eleven patients with multiple early gastric cancer had one accessory lesion and 1 patient had 2 accessory lesions. Of the 13 accessory lesions, 7 ($53.8\%$) were located in the same region as the main lesion. The most frequent combination of macroscopic types for the main lesion and the accessory lesion were depressed and depressed types (6 cases, $46.1\%$). The most frequent histologic type of main lesion was a well differentiated adenocarcinoma in 7 ($58.3\%$) of the 12 cases; the accessory lesion was also well differentiated in 4 of those 7 cases. Of the 13 accessory lesions, 4 ($30.8\%$) had been overlooked preoperatively; most of them were located in the lower third of the stomach and were IIb or IIc type and measured less than 1 cm in diameter. Lymph node metastasis was detected in 1 patient ($8.3\%$). The clinicopathologic features of multiple early gastric cancer were not different from those of solitary early gastric cancer. Conclusion: In multiple early gastric cancer, the main and the accessory lesions showed similar differentiation, and lymph node metastasis was less frequent than in solitary early gastric cancer. Therefore, limited procedures, including endoscopic mucosal resection, may be indicated if each lesion of the multiple early gastric cancer fits the criteria for treatment strategy.

• Journal of Gastric Cancer
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• 제16권1호
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• pp.34-42
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• 2016

Purpose: Early gastric cancer cases that are estimated to meet indications for treatment before endoscopic submucosal resection are often revealed to be out-of-indication after the treatment. We investigated the short-term treatment outcomes in patients with early gastric cancer according to the pretreatment clinical endoscopic submucosal resection indications. Materials and Methods: We retrospectively reviewed the medical records of patients with early gastric cancer that met the pretreatment endoscopic submucosal resection indications, from 2004 to 2011. Curative resection rate and proportion of out-of-indication cases were compared according to the pre-endoscopic submucosal resection indications. Pre-endoscopic submucosal resection factors associated with out-of-indication in the final pathological examination were analyzed. Results: Of 756 cases, 660 had absolute and 96 had expanded pre-endoscopic submucosal resection indications. The curative resection rate was significantly lower in the patients with expanded indications (64.6%) than in those with absolute indications (81.7%; P<0.001). The cases with expanded indications (30.2%) were revealed to be out-of-indication more frequently than the cases with absolute indications (13.8%; P<0.001). Age of >65 years, tumor size of >2 cm, tumor location in the upper-third segment of the stomach, and undifferentiated histological type in pre-endoscopic submucosal resection evaluations were significant risk factors for out-of-indication after endoscopic submucosal resection. Conclusions: Non-curative resection due to out-of-indication occurred in approximately one-third of the early gastric cancer cases that clinically met the expanded indications before endoscopic submucosal resection. The possibility of additional surgery should be empha-sized for patients with early gastric cancers that clinically meet the expanded indications.

• Journal of Gastric Cancer
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• 제23권1호
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• pp.159-170
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• 2023

Maintaining the postoperative quality of life (QOL) while ensuring curability without overtreatment is important in the treatment of early gastric cancer. Postoperative QOL is anticipated to be maintained through minimally invasive function-preserving gastrectomy in early gastric cancer. The concept of the sentinel lymph node (SN) basin is essential to maintain the curability of early gastric cancer using minimally invasive function-preserving gastrectomy. However, additional resection after surgery is difficult to perform in gastric cancer. Thus, the SN basin theory is important. Recently, a multicenter randomized phase III trial in South Korea (SENORITA trial) proved that laparoscopic sentinel node navigation surgery (LSNNS) for stomach preservation results in better postoperative QOL compared with standard gastrectomy in patients with early gastric cancer. LSNNS contributes to patients' QOL based on the concept that curability is not impaired. A multicenter nonrandomized phase III trial is ongoing in Japan, and oncologic safety is expected to be demonstrated. LSNNS has been established as a treatment option for selected patients with early gastric cancer, and its application will become widespread in the future.

• Journal of Gastric Cancer
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• 제12권3호
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• pp.164-172
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• 2012

Purpose: The purpose of this study is to investigate the prognostic significance of tumor size for 5-year survival rate in patients with gastric cancer. Materials and Methods: A total of 1,697 patients with gastric cancer, who underwent potentially curative gastrectomy, were evaluated. Patients were divided into 4 groups as follows, according to the median size of early and advanced gastric cancer, respectively: small early gastric cancer (tumor size ${\leq}3$ cm), large early gastric cancer (tumor size >3 cm), small advanced gastric cancer (tumor size ${\leq}$ 6 cm), and large advanced gastric cancer (tumor size >6 cm). The prognostic value of tumor size for 5-year survival rate was investigated. Results: In a univariate analysis, tumor size is a significant prognostic factor in advanced gastric cancer, but not in early gastric cancer. Multivariate analysis showed that tumor size is an independent prognostic factor for 5-year survival rate in advanced gastric cancer (P=0.003, hazard ratio=1.372, 95% confidence interval=1.115~1.690). When advanced gastric cancer is subdivided into 2 groups, according to serosa invasion: Group 1; serosa negative (T2 and T3, 7th AJCC), and Group 2; serosa positive (T4a and T4b, 7th AJCC), tumor size is an independent prognostic factor in Group 1 (P=0.011, hazard ratio=1.810, 95% confidence interval=1.149~2.852) and in Group 2 (P=0.033, hazard ratio=1.288, 95% confidence interval=1.020~1.627), respectively. Conclusions: Tumor size is an independent prognostic factor in advanced gastric cancer irrespective of the serosa invasion, but not in early gastric cancer.

• Journal of Gastric Cancer
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• 제9권3호
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• pp.71-77
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• 2009

내시경 절제술은 림프절 전이의 위험도가 낮은 조기위암에 대한 근치적 국소 치료로 받아들여지고 있다. 최근 조기위암의 림프절 전이에 대한 연구결과들과 내시경 수기 및 부속기구의 발전에 기초하여 내시경 절제의 적용 범위는 확대되는 추세이다. 현재 조기위암의 내시경 절제의 확대 적응증으로는 궤양이 동반되지 않는 경우의 점막암이나, 궤양이 동반된 3 cm 이하의 점막암, 궤양이 없는 3 cm 이하의 미분화 점막암, 3 cm 이하의 궤양을 동반하지 않은 분화가 좋은 미세점막하암으로 림프혈관 침범이 없는 경우이다. 이 중 미분화암은 분화가 좋은 암과 비교하여 다른 생물학적 행태를 가진다는 관점에서 내시경 절제의 확대 적응증으로 포함하는 것에 있어 논란이 있는 상태이다. 따라서, 본 종설에서는 미분화 조기위암의 생물학적 행태와 내시경 절제술 결과에 기초하여 미분화 조기위암에서의 내시경 절제술 적용에 관하여 논해보고자 한다.

• Journal of Gastric Cancer
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• 제1권2호
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• pp.119-123
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• 2001

Purpose: The prognosis of operated early gastric cancer is quite excellent and the 5-year survival rate shows to be over $90\%$. The less extensive treatment has been considered to be attractive. However, lymph node metastasis remains a main risk factor for recurrence of early gastric cancer. The author performed this study in order to determine which clinicopathologic factors of early gastric cancer influence lymph node metastasis and recurrence. Materials and Methods: A retrospective study was conducted on 222 patients with early gastric cancer who had been treated by gastrectomy combined with D2 or more extended lymph node dissection between January 1991 and December 1997 at the Department of Surgery, Kyunghee University Hospital. Results: Lymph node metastasis was observed in 26 patients ($11.7\%$), and the depth of tumor invasion and tumor size among clinicopathologic factors affected lymph node metastasis. The 5-year recurrence rate was $4.4\%$, and it was revealed that lymph node metastasis and depth of tumor invasion had a greater effect on recurrence than other clinicopathologic factors. Conclusion: The high risk factors of early gastric cancer in recurrence were submucosal tumor invasion, tumor size more than 2 cm, and lymph node metastasis. Patients of early gastric cancer with such high risk factors should undergo radical gastric resection than limited surgery. (J Korean Gastric Cancer Assoc 2001;1:119-123)

• Journal of Gastric Cancer
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• 제1권4호
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• pp.197-201
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• 2001

Purpose: There are variants of gastric cancer assoclated with predominantly peritoneal spread of with haematogenous metastases. Perioperative intraperitoneal chemotherapy as an adjuvant to surgery is considered as a rational therapeutic modality to prevent peritoneal spread. We evaluated the influence of early postoperative intraperitoneal chemotherapy on the prognosis of resectable advanced gastric cancer. Materials and Methods: From 1990 to 1995, 246 patients with biopsy proven advanced gastric cancer were enrolled in the study. Among them 123 patients received early postoperative intraperitoneal mitomycin C and 5-fluorouracil. The survival rate was calculated using by the Kaplan-Meier method and was compared using the log-rank test according to 13 clinico-pathologic factors. Multivariate analysis was performed with the Coxproportional hazards model. Results: Gastric resection plusearly postoperative intraperitoneal chemotherapy showed an improved survival rate as compared to surgery alone ($54.1\%\;versus\;40.3\%;$ P=0.0325). Depth of tumor invasion, degree of regional lymph vode metastasis, distant metastasis, tumor size, tumor location, extent of gastric resection, and curability of surgery significantly influenced survival. When a multivariate analysis was performed, depth of tumor invasion, lymph node metastasis, early postoperative intraperitoneal chemotherapy, curability of surgery, and extent of gastric resection emerged as the statistically significant and independent prognostic factors. Conlusion: Early postoperative intraperitoneal chemotherapy is one of the independent prognostic indicators of resectable advanced gastric cancer.

• Journal of Gastric Cancer
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• 제22권3호
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• pp.169-183
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• 2022

Gastric cancer is prevalent in Korea and ranked as the third most common cancer in 2019, followed by lung and thyroid cancers. The National Cancer Screening Program (NCSP) for gastric cancer has been implemented in adults aged ≥ 40 since 1999 and involves endoscopic screening every 2 years. The beneficial effects of the current NCSP on early cancer detection, cost-effectiveness, and mortality reduction are evident. However, the screening program results in a large socioeconomic burden and the consumption of medical resources, as it focuses solely on secondary prevention (early detection) rather than primary prevention of cancer. Helicobacter pylori is defined as a group I carcinogen by the International Agency for Research on Cancer. Hence, its eradication has been suggested as an important primary gastric cancer prevention strategy. Well-designed randomized controlled trials involving high-risk groups (post-endoscopic resection of early gastric cancer and family history of gastric cancer) and long-term follow-up studies in the general population have provided high-quality evidence regarding the effects of H. pylori eradication on gastric cancer prevention. In this review, we discussed the evidences for a possible modification of the current gastric cancer secondary prevention strategy by introducing primary prevention through H. pylori eradication. Areas for future research to optimize primary prevention strategies were also suggested.

• 지역사회간호학회지
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• 제10권2호
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• pp.362-371
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• 1999

This study was conducted to explore the relationship between locus of control and health belief. the life style of gastric cancer patients. The subjects of this study were 40 of the early gastric cancer and 90 of the advanced gastric cancer who first visiting patient to general surgery out patient department of Chungnam University Hospital for operation. The data was collected with structured questionnaire from July. 1998 to Feb. 1999 The tool were Moon's Health Belief Scale and Multiple Locus of Control of Wallston. Wallston, DeVellis. The data was analysed by SAS program using frequency, $X^2$-test, Pearson's correlation coefficient, ANOVA. Scheffe-test, t-test. The results were as follows 1. 30.8% of subjects were early gastric cancer anf 69.2% were advanced gastric cancer. The subject knowing about diagnosis was 83.1%. 16.9% did'nt know about diagnosis. 2. The correlationship between Health belief and Locus of control of subjects was not supported. 3. There was statistically no difference of life style between early and advanced gastric cancer patients. 4. There were statistically significant differences in perceived sensitivity according to weight. educational level. and birth order, in perceived barrier according to educational level. and in perceived severity according to occupation among demographic characteristics of study subjects. From above results. health professional has to educate general population to detect gastric cancer early to improve survival rate because early gastric cancer is high in survival rate, and to prevent recurrence and to maintain continuing healthy status. In the future, gastroscopy also has to expand to detect early. For there was no difference in life style between early and advanced gastric cancer. carcinogen related to diet should be emphasized through education. The perceived benefit among health belief model was not supported in this study therefore further study and comparison between gastric cancer and normal population are needed.

• Journal of Gastric Cancer
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• 제10권2호
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• pp.49-54
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• 2010

Endoscopic resection is now accepted as curative treatment modalities for early gastric cancer without lymph node metastasis. However, based on large-scaled data about the risk of lymph node metastasis in early gastric cancer and as a result of the technical development of endoscopic devices, it was suggested that the criteria for endoscopic resection should be extended. According to the treatment guidelines for gastric cancer in Japan, the extended indications include the following: differentiated-type mucosal cancer without ulceration and greater than 2 cm in diameter, differentiated-type mucosal cancer with ulceration and up to 3 cm in diameter, undifferentiated-type mucosal cancer without ulceration and up to 2 cm in diameter, and, in the absence of lymphovascular invasion, a tumor not deeper than submucosal level 1 (less than $500\;{\mu}m$). In this review, we discuss the evidence of the application of expanded endoscopic indication based on analysis of biologic behavior and data of endoscopic resection.