• Journal of Gastric Cancer
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• v.8 no.4
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• pp.225-231
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• 2008

Purpose: Laparoscopic gastric resection (LGR) is increasingly being used instead of open gastric resection (OGR) as the standard surgical treatment for gastric submucosal tumors. Yet there are few reports on which technique shows better postoperative outcomes. This study was performed to compare these two treatment modalities for gastric submucosal tumors by evaluating the postoperative outcomes. We also provide an analysis of the learning curve for LGR. Materials and Methods: Between 2003.4 and 2008.8, 103 patients with a gastric submucosal tumor underwent either LGR (N=78) or OGR (n=25). A retrospective review was performed on a prospectively obtained database of 103 patients. We reviewed the data with regard to the operative time, the blood loss during the operation, the time to the first soft diet, the postoperative hospital stay, the tumor size and the tumor location. Results: The clinicopatholgic and tumor characteristics of the patients were similar for both groups. There was no open conversion in the LGR group. The mean operation time and the bleeding loss were not different between the LGR group and the OWR group. The time to first soft diet (3.27 vs. 6.16 days, P<0.001) and the length of the postoperative hospital stay (7.37 vs. 8.88 days, P=0.002) were shorter in the LGR group compared to the OGR group. The tumor size was bigger in the OGR group than that in the LGR group (6.44 vs. 3.65 cm, P<0.001). When performing laparoscopic gastric resection of gastric SMT, the surgeon was able to decrease the operation time and bleeding loss with gaining more experience. We separated the total cases into 3 periods to compare the operation time, the bleeding losses and the complications. The third period showed the shortest operation time, the least bleeding loss and the fewest complications. Conclusion: LGR for treating a gastric submucosal tumor was superior to OGR in terms of the postoperative outcomes. An operator needs some experience to perform a complete laparoscopic gastric resection. Laparoscopic resection could be considered the first-line treatment for gastric submucosal tumors.

• Journal of Gastric Cancer
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• v.8 no.4
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• pp.250-255
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• 2008

Purpose: The purpose of this study was to assess the diagnostic value of 18F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) for detecting the lymph node (LN) metastasis of gastric cancer. Materials and Methods: 119 patients (M : F=89 : 30; mean age: 64) with gastric cancer were referred for preoperative FDG-PET/CT scanning and spiral enhanced abdominal pelvic CT from June 2006 to July 2008, and these were the subjects of our study. All the patients underwent curative radical gastrectomy and lymph node dissection. A final diagnosis was made for all the patients by the histology of the surgical specimens. Results: Both PET/CT and enhanced CT showed similar sensitivity for detecting regional lymph node metastasis (32.6% vs 39.5%, respectively). PET/CT was more accurate than enhanced CT for detecting regional lymph node metastasis (67.2% vs 63.0%, respectively), and PET/CT showed better specificity (86.8% vs 76.3, respectively) and a better positive predictive value (PPV) (58.3% vs 48.6%, respectively). PET/CT showed better specificity (98.0% vs 88.2%, respectively) and accuracy (79.4% vs 73.9%, respectively) than enhanced CT for detecting early gastric cancer. PET/CT showed better specificity (64.0% vs 52.0%, respectively), a better PPV (60.9% vs 57.1%), a better negative predictive value (NPV) (48.5% vs 46.4%, respectively) and better accuracy (53.6% vs 51.8%, respectively) than enhanced CT for detecting advanced gastric cancer. Conclusion: FDG-PET/CT is more usefulness than enhanced CT for making the preoperative diagnosis of regional LN metastases from gastric cancers.

• Journal of Gastric Cancer
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• v.8 no.4
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• pp.169-175
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• 2008

Purpose: The main target of 5-fluorouracil (5-FU) is thymidylate synthase (TS). A high TS expression has been identified as promoting resistance to 5-FU. For colorectal cancers, the response to 5-FU based adjuvant chemotherapy is different according to the microsatellite instability (MSI) status. The reports on the relationship between MSI and the TS expression in colorectal cancer have been inconsistent. No data is available for gastric cancer regarding the relationship between MSI and the TS expression. Therefore, we studied the relationship between MSI and the TS expression in gastric cancer. Materials and Methods: Ninety-nine consecutive patients who underwent radical gastrectomy for gastric cancer from January 2004 to May 2006 at Bundang CHA hospital were studied. MSI was assessed for five markers (BAT25, BAT26, D2S123, D5S346, and D17S250) by PCR and with using an ABI prism 3100 Genetic analyzer. The TS expression was analyzed by immunohistochemistry with using mouse anti-thymidylate synthase monoclonal antibody to the TS 106 clone. Results: Out of the ninety-nine patients, MSS/MSI-L was detected in 92 (92.1%) cases and 7 cases (7.1%) were MSI-H. A negative TS expression was found in 46 (46.5%) cases, a low TS expression was found in 33 (33.3%) and a high TS expression was found in 20 (20.2%). Out of 92 MSS/MSI-L patients, the number of patients with negative, low and high TS expressions were 46 (50%), 30 (32.6%) and 16 (17.4%), respectively. Out of the 7 MSI-H patients, the number of patients with negative, low and high TS expressions were 0 (0%), 3 (42.9%) and 4 (57.1%), respectively. The relationship between MSI-H and a high TS expression was statistically significant. Conclusion: Gastric cancer with MSI-H showed higher levels of a TS expression compared to the gastric cancer with MSS/MSI-L.

• Journal of Gastric Cancer
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• v.7 no.3
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• pp.146-151
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• 2007

Purpose: Pledget is a PTFE felt that is usually used for suture reinforcement in cardiovascular surgery. In order to minimize the difficulty in intracorporeal continuous gastrointestinal suturing by reducing the number of tied knots, we have used pledget as substitute for a knot (pledget suturing). Materials and Methods: Thirty-two consecutive patients who underwent totally laparoscopic uncut Roux-en-Y gastrojejunostomy after distal gastrectomy in our institution were enrolled in this study, and the patients were divided into three groups according to the method of intracorporeal anastomosis. Basically, intracorporeal anastomosis was performed by several firings of linear staplers; however, the entry holes for the stapler at the jejunojejunostomy and the gastrojejunostomy were closed by pledget suturing in group A (8 patients), the entry hole for the stapler at jejunojejunostomy was closed by conventional suturing in group B (8 patients), and all of the entry holes for the stapler were closed by stapling in group C (16 patients). The surgical outcomes of each group were compared to each other. Results: The anastomotic time in group A was not longer than in group B, although there were more sutures used in group A, but it was longer than in group C. The number of stapler cartridges used in group A was the smallest among the three groups. In group B, there were two cases of a break of suture material during anastomosis, there were no such cases in group A. There was no complication related to anastomosis in all of the groups. Conclusion: Pledget was found to be useful for minimizing the difficulty in intracoproreal continuous gastrointestinal suturing and reducing the number of stapler cartilages used in intracorporeal anastomosis.

• Journal of Chest Surgery
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• v.31 no.9
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• pp.884-892
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• 1998

Background: The gastroepiploic artery is not only an alternative graft but also may be considered an important primary graft for coronary revascularization. However, the long-term patency of the gastroepiploic arterial graft is yet to be determined and the incidence of perioperative spasm and long-term patency of a coronary graft may be affected by the properties of the graft response to certain vasoactive substances. The reactivity of the gastroepiploic artery to vasoactive substances has not been studied extensively and the results of the studies are contradictory. Material and Method: This study was designed to test the reactivity of human gastroepiploic artery to four constrictors and four relaxants. The middle sections of the human gastroepiploic arteries were collected from the patients undergoing gastrectomy and the arterial rings with intact endothelium were suspended in organ baths for isometric tension recording. Result: Epinephrine, norepinephrine, and potassium chloride induced the maximum constriction to higher forces (7.0$\pm$1.1g, 6.6$\pm$0.9g, and 6.5$\pm$1.1g) than 5-hydroxytryptamine did (3.8$\pm$1.7g, p<0.05). Nitroprusside and histamine induced almost full relaxation in the gastroepiploic arteries preconstricted with norepinephrine. There was no significant difference between two relaxants regarding maximum relaxation force. Acetylcholine induced the maximum relaxation to weaker force when compared with nitroprusside and histamine (p<0.05), and isoproterenol was the weakest of the relaxants (p<0.05 compared with acetylcholine). Conclusion: The gastroepiploic artery has a strong capacity of endothelium-dependent relaxation which could have an important influence on long-term patency. The gastroepiploic artery exhibits a potent contractility to catecholamines and the enhanced contractility may facilitate vasospasm in the presence of high circulating levels of catecholamines. Nitroprusside, a potent relaxant in gastroepiploic artery, might be beneficial for the treatment of gastroepiploic arterial graft spasm. The gastroepiploic arterial graft with intact endothelium may respond weakly to beta-adrenoceptor agonist and 5-hydroxytryptamine.

• Radiation Oncology Journal
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• v.9 no.2
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• pp.249-252
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• 1991

A Retrospective study to analyze the failure pattern in locally advanced stomach cancer, treated with radical surgery and post-op chemotherapy was perfomed. Among 107 patients who underwent radical gastrectomy in Asan Medical Center between June 1989 and August 1990. there were 20 stage II(T2NO, T2N1) and 87 stage III(T3N1, T3N2) and 91 patients were eligible for study. 57 patients treated with 6 cycles of postop adjuvant chemotherapy. Among 57 patients treated with postop adjuvant chemotherapy, local failure occurred in $21\%$ and distant failure in $12\%$. Among 34 patients who were not treated with postop chemotherapy, local failure occurred in $24\%$ and distant failure in $26\%$. Among 29 failures including 13 locoregional, 9 distant metastasis and 7 locoregional and distant metastasis, 11 cases recurred in the anastomotic site, 3 in the gastric bed,7 in the regional lymph nodes and peritoneal seeding occurred in 6 cases. The true incidences of gastric bed, nodal and peritoneal failures may be higher in the longer follow-up or reoperative or autopsy series. Our data sugest that postop chemocherapy is beneficial by reducing distant failure rate. Our data suggest that postop chemocherapy is beneficial by reducing distant failure rate. Postop adjuvant locoregional radiotherapy in addition to the systemic adjuvant therapy may reduce the local failure rate and potentially benefit in at least $20\%$ of patients who developed the local failure only.

• Journal of Gastric Cancer
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• v.5 no.2
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• pp.89-94
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• 2005

Purpose: Early gastric cancer (EGC) has an excellent prognosis compared to advanced gastric cancer. The 5-year survival rate for EGC now exceeds $90\%$, and EGC is recognized as a curable malignancy. The important prognostic factor in EGC is the status of lymph-node metastasis. Despite conserving surgery being suggested for EGC at present, it is of vital importance to select a surgical method appropriate to each individual case. This retrospective study was undertaken to clarify clinicopathologic features and factors related to lymph-node metastasis in submucosal gastric cancer in order to determine an appropriate therapy. Materials and Methods: This study analyzed the clinicopathologic features for 279 patients with a submucosal gastric carcinoma (Group I) and compared with those of patients with mucosal (Group II) or muscularis proprial gastric carcinoma (Group III). All patients were operated on from 1981 to 1999 at Chonnam University Hospital. There were no statistically significant differences among the groups with respect to age, gender, tumor location, hepatic metastasis, or peritoneal dissemination. Results: Positive lymph node metastasis was found in 47 ($16.8\%$) of the 279 patients with a submucosal gastric carcinoma. The incidence of lymph-node metastasis was significantly higher in patients with a submucosal gastric carcinoma than in patients with a mucosal gastric carcinoma ($16.8\%\;vs.\;3.9\%\;$; P<0.01). Therefore, depth of invasion was a significant factor affecting in lymph-node metastasis. The 5-year survival rates were $88.6\%$ for patients in Group I, $95.2\%$ for patients in Group II, and $72.7\%$ for patients in Group III (P<0.01 for Group I vs. Group II; Group I vs. Group III). In patients with a submucosal gastric carcinoma, the survival rate with positive lymph nodes was significantly poorer than that of patients without lymph-node metastasis ($87.3\%\;vs.\;94.2\%$; P<0.01). Conclusion: Gastrectomy with D2 lymph node dissection is an appropriate operative procedure for patients with a submucosal gastric carcinoma.