• Journal of Gastric Cancer
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• 제11권1호
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• pp.31-37
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• 2011

Purpose: We performed this study to evaluate the clinical presentation as well as the proper surgical intervention for ovarian metastasis from gastric cancers and these tumors were identified during postoperative follow-up. This will help establish the optimal strategy for improving the survival of patients with this entity. Materials and Methods: 22 patients (3.2%) with ovarian metastasis were noted when performing a retrospective chart review of (693) females patients who had undergone a resection for gastric cancer between 1981 and 2008. The covariates used for the survival analysis were the patient age at the time of ovarian relapse, the size of the tumor, the initial TNM stage of the gastric cancer, the interval to metastasis and the presence of gross residual disease after treatment for Krukenberg tumor. The cumulative survival curves for the patient groups were calculated with the Kaplan-Meier method and they were compared by means of the Log-Rank test. Results: The average age of the patients was 48.6 years (range: 24 to 78 years) and the average survival time of the 22 patients was 18.8 months (the estimated 3-year survival rate was 15.8%) with a range of 2 to 59 months after the diagnosis of Krukenberg tumor. The survival rate for patients without gross residual disease was longer than that of the patients with gross residual disease (P=0.0003). In contrast, patient age, the size of ovarian tumor, the initial stage of gastric adenocarcinoma, the interval to metastasis and adjuvant chemotherapy were not prognostic indicators for survival after the development of ovarian metastasis. Conclusions: Early diagnosis and complete resection are the only possible hope to improve survival. As the 3-year survival rate after resection of Krukenberg tumor is 15.8%, it seems worthwhile to consider performing tumorectomy as the second cytoreduction.

• Journal of Gastric Cancer
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• 제16권2호
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• pp.120-124
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• 2016

Primary squamous cell carcinoma (SCC) of the stomach is a very rare disease. However, the pathogenesis, clinical characteristics, and prognosis of gastric SCC are controversial and remain to be elucidated. Herein, we report a case of primary gastric SCC of the remnant stomach after subtotal gastrectomy. A 65-year-old man was admitted to our hospital due to epigastric discomfort and dizziness. He had undergone subtotal gastrectomy 40 years previously for gastric ulcer perforation. Endoscopy revealed a normal esophagus and a large mass in the remnant stomach. Abdominal computed tomography revealed enhanced wall thickening of the anastomotic site and suspected metachronous gastric cancer. Endoscopic biopsy revealed SCC. Total gastrectomy was performed with Roux-en-Y esophagojejunostomy. A 10-cm tumor was located at the remnant stomach just proximal to the previous area of anastomosis. Pathologic examination showed well-differentiated SCC extended into the subserosa without lymph node involvement (T3N0M0). The patient received adjuvant systemic chemotherapy with 6 cycles of 5-FU and cisplatin regimen, and he is still alive at the 54-month follow-up. According to the treatment principles of gastric cancer, early detection and radical surgical resection can improve the prognosis.

• Journal of Gastric Cancer
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• 제16권3호
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• pp.152-160
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• 2016

Purpose: Endoscopic diagnosis of gastric cancer (GC) that emerges after eradication of Helicobacter pylori may be affected by unique morphological changes. Using comprehensive endoscopic imaging, which can reveal biological alterations in gastric mucosa after eradication, previous studies demonstrated that Congo red chromoendoscopy (CRE) might clearly show an acid non-secretory area (ANA) with malignant potential, while autofluorescence imaging (AFI) without drug injection or dyeing may achieve early detection or prediction of GC. We aimed to determine whether AFI might be an alternative to CRE for identification of high-risk areas of gastric carcinogenesis after eradication. Materials and Methods: We included 27 sequential patients with metachronous GC detected during endoscopic surveillance for a mean of 82.8 months after curative endoscopic resection for primary GC and eradication. After their H. pylori infection status was evaluated by clinical interviews and $^{13}C$-urea breath tests, the consistency in the extension of corpus atrophy (e.g., open-type or closed-type atrophy) between AFI and CRE was investigated as a primary endpoint. Results: Inconsistencies in atrophic extension between AFI and CRE were observed in 6 of 27 patients, although CRE revealed all GC cases in the ANA. Interobserver and intraobserver agreements in the evaluation of atrophic extension by AFI were significantly less than those for CRE. Conclusions: We demonstrated that AFI findings might be less reliable for the evaluation of gastric mucosa with malignant potential after eradication than CRE findings. Therefore, special attention should be paid when we clinically evaluate AFI findings of background gastric mucosa after eradication (University Hospital Medical Information Network Center registration number: UMIN000020849).

• Journal of Gastric Cancer
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• 제11권3호
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• pp.162-166
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• 2011

Purpose: Endoscopic resection is widely accepted as standard treatment for early gastric cancer (EGC) without lymph node metastasis. The procedure is minimally invasive, safe, and convenient. However, surgery is sometimes needed after endoscopic mucosal resection (EMR)/endoscopic submucosal dissection (ESD) due to perforation, bleeding, or incomplete resection. We evaluated the role of surgery after incomplete resection. Materials and Methods: We retrospectively studied 29 patients with gastric cancer who underwent a gastrectomy after incomplete EMR/ESD from 2006 to 2010 at Korea University Hospital. Results: There were 13 incomplete resection cases, seven bleeding cases, three metachronous lesion cases, three recurrence cases, two perforation cases, and one lymphatic invasion case. Among the incomplete resection cases, a positive vertical margin was found in 10, a positive lateral margin in two, and a positive vertical and lateral margin in one case. Most cases (9/13) were diagnosed as mucosal tumors by endoscopic ultrasonography, but only three cases were confirmed as mucosal tumors on final pathology. The positive residual tumor rate was two of 13. The lymph node metastasis rate was three of 13. All lymph node metastasis cases were submucosal tumors with positive lymphatic invasion and no residual tumor in the gastrectomy specimen. No cases of recurrence were observed after curative resection. Conclusions: A gastrectomy is required for patients with incomplete resection following EMR/ESD due to the risk of residual tumor and lymph node metastasis.

• Journal of Digestive Cancer Research
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• 제5권1호
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• pp.44-49
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• 2017

Background: 최근 제안된 조기위암에 대한 미세침습 치료법은 내시경점막하박리술(endoscopic submucosal dissection, ESD)혹은 종양 부위를 전층 절제(endoscopic full-thickness gastric resection, EFTGR)을 통해 위 절제를 최소화하고 동시에 복강경을 통해 감시림프절 절제(sentinel lymph node dissection, SLND)를 시행함으로써 그 가능성을 제시했었고, 이들을 각각 ESN (endoscopic submucosal dissection with laparoscopic sentinel lymph node dissection), Hybrid-NOTES (endoscopic full-thickness gastric resection with laparoscopic sentinel lymph node dissection)라고 명명하였다. 본 고에서는 림프절 전이 위험성이 높은 조기위암에 대해 이 두 치료법을 시행받은 환자들의 장기 추적 결과를 평가하고자 한다. Methods: 이 후향적 연구는 2009년 1월부터 2013년 5월 중에 ESN 혹은 Hybrid-NOTES를 시행받은 환자들이 포함되었다. Results: 총 42명의 환자들이 연구에 포함되었고, ESN 21명, Hybrid-NOTES 21명이 각각 등록되었다. ESN을 시행받은 21명 중 4명, Hybrid-NOTES를 시행받은 5명은 이 미세침습수술 후 추가 수술을 받아야 했다. 아직까지 이 수술 후 사망 환자는 없지만 ESN을 시행받은 1명의 환자에서 림프절 전이가 발견되어 항암치료를 받고 있다. Conclusion: 조기위암의 미세침습 수술인 ESN 혹은 Hybrid-NOTES는 좋은 장기 추적 결과를 보여주었다. 이 방법들은 향후 림프절 전이 위험성이 높은 조기위암에서 ESD와 gastrectomy 사이에 속한 환자들에게 좋은 치료법이 될 수 있을 거라고 생각된다.

• Journal of Digestive Cancer Research
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• 제3권1호
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• pp.35-38
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• 2015

2008년 9월 조기 위암으로 내시경점막하박리술을 시행받은 과거력이 있는 62세 남자가 2010년 10월 시행한 상부위장관내시경 검사상 중부식도에 병변이 관찰되었다. 루골 색소 내시경상 염색이 잘 되지 않고, 확대내시경상에서 신생혈관이 관찰되며, 파괴된 혈관들이 연결되는 상피유두내혈관 루프상점막근층을 침범한 양상(IPCL-V3)이 관찰되었다. 초음파내시경 검사상 점막에 국한된 소견으로 보여, 조기 식도암으로 진단하에 내시경점막하박리술을 시행받았다. 이후 최종 조직 검사상 침범깊이는 점막층 M2 부위까지 침범한 소견이 관찰되고 D2-40 양성으로 림프절 전이 위험성이 높아 추가로 항암방사선 동시요법을 시행하였고, 이후 재발없이 지내다가 2013년 3월 중부식도에 이소성 병변으로 고분화 이형성이 발견되어 내시경점막절제술 및 광역동 치료를 시행받았다. 이 환자에서와 같이 조기 식도암에서 내시경점 막하박리술 시행 후 항암방사선 동시요법을 시행하는 것도 효과적인 치료 방법이 될 수 있다. 추후 전향적 연구가 필요할 것으로 생각된다.