• Journal of Gastric Cancer
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• v.7 no.1
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• pp.42-46
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• 2007

Usually in the subtotal gastrectomy, the left and the right gastric arteries, as well as the left and the right gastroepiploic arteries are ligated. Thus, to avoid a blue stomach surgeons preserve the spleen and the short gastric arteries. When a radical subtotal gastrectomy with splenectomy is performed, meticulous caution is necessary; otherwise, the subtotal gastrectomy might have to be changed to a total gastrectomy to prevent a blue stomach. We report the case of a 67-year-old woman who had distal stomach cancer with a splenic solitary mass, for which splenic meatastasis could be excluded. We planned and performed a laparoscopy-assisted radical subtotal gastrectomy with splenectomy as the diagnostic and therapeutic option. In this case, to avoid a remnant stomach infarction or total gastrectomy we saved the left gastric artery and vein with clearing perivascular soft tissue, lymphatics, and lymph nodes. Thus the radical therapeutic goal was reached, and serious complications were avoided.

• Journal of Gastric Cancer
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• v.12 no.1
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• pp.18-25
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• 2012

Purpose: Recently, laparoscopy-assisted gastrectomy (LAG) has been widely accepted modality for early gastric cancer in Korea. The indication of LAG may be extended in an experienced institution. In our institution, the first case of laparoscopy-assisted gastrectomy (LAG) for gastric cancer was performed in May 1998. We retrospectively reviewed the long-term oncologic outcomes over 12 years to clarify the feasibility of LAG for gastric cancer. Materials and Methods: The authors retrospectively analyzed 753 patients who underwent LAG for gastric cancer, from May 1998 to August 2010. We reviewed clinicopathological features, postoperative outcomes, mortality and morbidity, recurrence, and survival of LAG for gastric cancer. Results: During the time period, 3,039 operations for gastric cancer were performed. Among them, 753 cases were done by LAG (24.8%). There were 69 cases of total gastrectomy, 682 subtotal gastrectomies, and 2 proximal gastrectomies. According to TNM stage, 8 patients were in stage 0, 619 in stage I, 88 in stage II, and 38 in stage III. The operation-related complications occurred in 77 cases (10.2%). Median follow-up period was 56.2 months (range 0.7~165.6 months). Twenty-five patients (3.3%) developed recurrence, during the follow-up period. The overall 5-year and disease free survival rates were 97.1% and 96.3%, respectively. Conclusions: The number of postoperative complications and survival rates of our series were comparable to the results from that of other reports. The authors consider LAG to be a feasible alternative for the treatment of early gastric cancer. However, rationale for laparoscopic surgery in advanced gastric cancer has yet to be determined.

• Journal of Gastric Cancer
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• v.10 no.1
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• pp.13-18
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• 2010

Purpose: Omental infarction (OI) following laparoscopy-assisted gastrectomy (LAG) for gastric cancer could become more common in the future because the indications for LAG are expected to expand. The aim of this study was to determine the clinical characteristics of OI following LAG. Materials and Methods: Three hundred ninety patients who underwent LAG for T1 or T2 gastric cancer from April 2003 to November 2007 were enrolled. OI was diagnosed by two radiologists using the patients' abdominal 16 row-detector CT scans. The clinicopathologic characteristics were retrospectively evaluated in the omental infarction (OI) group and the non-omental infarction (non-OI) group using the gastric cancer database of Dong-A University Medical Center and the medical record. Results: Nine omental infarctions (2.3%) of 390 LAGs were diagnosed. All the OIs could be discriminated from omental metastasis on the initial or follow up CT images. The location of the omental infarctions was on the epigastrium in 3 patients and in the left upper quadrant in 3 patients. The mean size of the OIs was 4.1 cm. Most patients with OI had no signs or symptoms. The body mass index of the OI group was higher than that of the non-OI group (P=0230), and OI was more common in patients who underwent total gastrectomy than in the patients who underwent subtotal gastrectomy (P=0.0011). Conclusion: Laparoscopy-assisted gastrectomy (LAG) with partial omentectomy for gastric cancer can be a cause of secondary OI. Omental infarction after LAG has different clinical characteristics and CT findings that those of other omental infarctions or postoperative omental metastases. Further multicenter study will be needed to evaluate in detail the clinical features of omental infarction after LAG.