• Journal of Gastric Cancer
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• v.18 no.2
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• pp.152-160
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• 2018

Purpose: Totally laparoscopic gastrectomy (TLG) for advanced gastric cancer (AGC) is a technically and oncologically challenging procedure for surgeons. This study aimed to compare the oncologic feasibility and technical safety of TLG for AGC versus early gastric cancer (EGC). Materials and Methods: Between 2011 and 2016, 535 patients (EGC, 375; AGC, 160) underwent curative TLG for gastric cancer. Clinicopathologic characteristics and surgical outcomes of both patient groups were analyzed and compared. Results: Patients with AGC required a longer operation time and experienced more intraoperative blood loss than those with EGC did. However, patients from both the AGC and EGC groups demonstrated similar short-term surgical outcomes such as postoperative morbidity (14.4% vs. 13.3%, P=0.626), mortality (0% vs. 0.5%, P=0.879), time-to-first oral intake (2.7 days for both groups, P=0.830), and postoperative hospital stay (10.2 days vs. 10.1 days, P=0.886). D2 lymph node dissection could be achieved in the AGC group (95%), with an adequate number of lymph nodes being dissected ($36.0{\pm}14.9$). In the AGC group, the 3-year overall and disease-free survival rates were 80.5% and 73.7%, respectively. Conclusions: TLG is as safe and effective for AGC as it is for EGC.

• Journal of Gastric Cancer
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• v.16 no.4
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• pp.254-259
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• 2016

Purpose: Owing to increased life expectancy, the number of elderly patients with gastric cancer has increased. This study aimed to identify the outcomes of gastric cancer patients aged 80 years or older through comparison of their clinicopathological characteristics, surgical outcomes, and oncologic outcomes. Materials and Methods: Between January 2006 and December 2013, the records of 478 patients who underwent surgery for gastric cancer were retrospectively evaluated. Patients were divided into two groups: patients <80 years old (n=446) and patients ${\geq}80$ years old (n=32). Results: There were no significant differences in sex, body mass index, length of hospital stay, duration of surgery, depth of invasion, nodal metastasis, histologic type, or tumor size between the two groups. However, significant differences were found for the American Society of Anesthesiologist score and the serum albumin level between the two groups. Postoperative morbidity, mortality, disease-free survival, and recurrence rate did not differ between curatively resected patients in the two groups. Conclusions: In elderly patients with gastric cancer, active treatment including radical gastrectomy is necessary.

• Korea Journal of Hospital Management
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• v.9 no.3
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• pp.128-142
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• 2004

To evaluate the effects of critical pathway on the length of hospital stay, the cost and quality of care provided to gastrectomy patients in a tertiary care academic medical center. The basic research design is a retrospective case-control comparative study. 470 patients of gastrectomy were included in the study; 180 before pathway development (control), 163 right after pathway implementation (path group I) and 127 one year after pathway implementation (path groupII). 476 patients of modified radical mastectomy were also analyzed to examine whether the reduction of the length of hospital stay is from the hospital-wide trend or due to the critical pathway. Death after operation, ICU stay, unplanned re-operation, readmission after discharge, the length of hospital stay and cost were analyzed. 2-test, one-way ANOVA, Bonferroni and Turkey's test were used for statistical analysis. (1) There were no significant differences in patient clinical conditions and no sign of deterioration of quality from critical pathway. (2) The length of hospital stay was 13.0 days in control group, 12.2 days in path group I and 10.0 days (p<0.01) in path groupII. (3) The total costs during the hospital stay were reduced. However the cost per day was significantly increased from reduction of hospital stay (358,488won in control, 366,017won in path group I and 413,220won (p<0.01) in path groupII). Critical pathway reduced the length of hospital stay, total hospital costs and resource utilization without harming quality of patient care.

• Journal of Gastric Cancer
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• v.17 no.2
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• pp.154-161
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• 2017

Purpose: This study aimed to investigate the correlation between multiple early gastric cancer (MEGC) and multiple primary malignancies during the follow-up of patients with gastrectomy. Materials and Methods: The number of primary tumors detected in other organs after gastrectomy for early gastric cancer (EGC) has been increasing because of improved survival and surveillance programs. A total of 3,129 patients underwent radical gastrectomy for treatment of EGC at Samsung Medical Center from January 2000 to December 2005. Of these, 3,057 patients were selected and their medical records were retrospectively analyzed. Results: Among the 3,057 patients, 148 (4.8%) had MEGC, 84.5% were male, 57.4% were over 60 years old, 42.6% had a macroscopic type EGC IIb main lesion, and 68.9% had well-differentiated tumors with a significantly high incidence of MEGC. There were no differences between patients with solitary early gastric cancer (SEGC) and those with MEGC with regard to overall survival or recurrence-free survival, but MEGC was an independent risk factor for metachronous primary malignancies in other organs (P=0.004, hazard ratio [HR]=2.444). Conclusions: MEGC is not a risk factor for poor prognosis after curative gastrectomy, but it is a risk factor for metachronous primary malignancies in other organs during postoperative follow-up; therefore, careful surveillance is needed.

• Journal of Gastric Cancer
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• v.16 no.2
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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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• v.7 no.3
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• pp.174-179
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• 2007

The survival of patients with gastric cancer is improved by early diagnosis and surgical treatment. However, there is no established treatment for locally recurrent cancer or cancer arising at an anastomotic site after total gastrectomy; further, most surgeons are reluctant to resect this type of cancer because of frequent systemic metastasis and there are few competent surgeons who have the skill to perform such an operation. We have experienced recurrent cancer at an anastomotic site after total gastrectomy: one patient had recurrent cancer and two patients had metachronous cancer. All these patients were operated on and the patients were discharged without any complications. All of them are alive at the time of this report. In some cases, good results could be expected for operating on recurrent cancer of an anastomotic site after previous total gastrectomy. So, we present here our experience along with a review of literatures.

• Journal of Gastric Cancer
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• v.9 no.4
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• pp.223-230
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• 2009

Purpose: Circular stapled gastrectomy has been the favored procedure with its feasibility and the shortened operative time, but anastomotic leakage, stenosis and bleeding have been reported as problems. The aim of this study was to identify what can be done to supplement the safety of this technique by examining the potential complications of performing circular stapled gastrojejunosomy after radical subtotal gastrectomy. Materials and Methods: As subjects, this study selected 1,391 patients who underwent gastrojejunostomy after radical subtotal gastrectomy because of gastric cancer at our Department of Surgery from Jan. 1998 to Dec. 2007. The patients were divided into Group I (n=479) who underwent hand-sewn gastrojejunostomy, Group II (n=48) who underwent linear stapled gastrojejunostomy and Group III (n=864) who underwent circular stapled gastrojejunostomy. Group III was re-divided into two subgroups on the basis of the point of time that a visual check was intraoperatively performed at the anastomotic site: Group III-A (n=198) before and Group III-B (n=666) after. The characteristics and complications of the patients were then compared. Results: For the comparison of the complications between Group I, Group II and Group III, anastomotic leakage was found in 7 cases (1.5%) in Group I, in 1 case (2.0%) in Group II and in 10 case (1.2%) in Group III, and anastomotic stenosis were found in 4 cases (0.8%) in Group I, 1 case (2.0%) in Group II and 5 case (0.6%) in Group III. Anastomotic bleeding was found in 32 cases (6.7%) in Group I, in 5 cases (10.4%) in Group II and in 67 cases (7.7%) in Group III. For the comparison of complications between Group III-A and Group III-B, anastomotic bleeding was found in 57 cases (28.8%) in Group III-A and 10 cases (1.5%) in Group III-B and the difference was statistically significant (P=0.037). Conclusion: Circular stapled gastrojejunostomy after radical subtotal gastrectomy is recommended because of the safety and feasibility of this technique, but bleeding at the anastomotic site may be the critical issue. In conclusion, direct inspection for bleeding at the anastomotic site during the operation will improve the safety of performing circular stapler anastomosis.

• Journal of Gastric Cancer
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• v.20 no.2
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• pp.202-211
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• 2020

Purpose: This study was to investigate the prognostic significance of the preoperative fibrinogen and systemic inflammation response index (F-SIRI) in a Chinese cohort of resectable gastric cancer. Materials and Methods: Baseline characteristics, preoperative fibrinogen levels and peripheral neutrophil, monocyte, and lymphocyte counts were retrospectively reviewed in 240 patients who underwent radical gastrectomy. The optimal cut-off values for fibrinogen and SIRI were defined as 4.0 g/L and 1.2. Then patients with hyperfibrinogenemia (≥4.0 g/L) and high SIRI (≥1.2) were assigned with an F-SIRI of 2 (both of these hematological abnormalities), 1 (one of these abnormalities), and 0 (neither abnormality), respectively. The prognostic value was examined by univariate and multivariate survival analysis. Results: Preoperative F-SIRI was significantly correlated with tumor size, fibrinogen level, and adjuvant chemotherapy. Whereas there was no significant difference in age, gender, tumor location or other characteristics between groups. In addition, high preoperative F-SIRI was significantly associated with worse disease-free survival (DFS) (hazard ratio [HR], 2.299; 95% confidence interval [CI], 1.482-3.566; P<0.001) and overall survival (OS) (HR, 2.461; 95% CI, 1.584-3.824; P<0.001) by univariate survival analysis. Moreover, it remained an independent predictor for impaired DFS (HR, 2.023; 95% CI, 1.273-3.215; P=0.003) and OS (HR, 2.341; 95% CI, 1.480-3.705; P<0.001) in multivariate Cox regression analysis. Conclusions: Preoperative F-SIRI could serve as a significantly prognostic marker for long-term survival in Chinese patients who underwent radical gastrectomy.

• Journal of Gastric Cancer
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• v.4 no.3
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• pp.186-191
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• 2004

Primary small-cell carcinomas of the stomach are rare and aggressive malignancies with poor survival rates. Preoperative diagnosis is difficult and a standard treatment is not yet established. We have recently experienced two cases of a primary small-cell carcinoma of the stomach. The first case was a 65-year-old man with epigastric soreness. Endoscopic biopsy showed an adenocarcinoma. He underwent a radical subtotal gastrectomy with D2 lymph-node dissection. Pathology revealed a collision tumor of a smallcell carcinoma and an adenocarcinoma with submucosal invasion and with metastasis in 20 out of 48 lymph nodes (T1N3M0). The second case was a 64-year-old man with epigastric soreness. Endoscopic biopsy revealed a small-cell carcinoma. There was no evidence of a primary tumor in the lung. A radical subtotal gastrectomy with D2 lymph-node dissection was performed. Pathology showed a pure smallcell carcinoma with proper muscle invasion and with metastasis in 1 out of 36 lymph nodes (T2aN1M0).

• Journal of Gastric Cancer
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• v.2 no.1
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• pp.20-25
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• 2002

Purpose: Chylous ascites is an accumulation of lymphatic fluid within the peritoneal cavity due to trauma or to an obstruction on the lymphatic system. Postoperative chylous ascites is a rare complication of abdominal surgery. It is frequently reported after retroperitoneal dissections and results in high morbidity and mortality. However, there have been few report of such a complication following a radical gastrectomy. Therefore, we review the clinical analysis and treatment of chylous ascites based on our experience. Materials and Methods: From July 1992 to June 2001, we treated 13 cases of chylous ascites after operations for gastric cancer. We reviewed medical charts of those patients retrospectively. Results: The incidence of chylous ascites after operations for gastric cancer was $0.83\%$ (13/1552). The mean time from ingestion of a meal after the operation to the development of symptoms was 2 days (range: $1\∼6$ days). Conservative treatment by fasting, total parenteral nutrition (TPN), and repeated paracentesis was successful in all patients. The mean time from diagnosis to complete resolution was 25 days (range: $2\∼105$ days). Conclusion: Chylous ascites should be considered in any patient with a typical milky color of drainage who has recently undergone radical gastrectomy. Treatment with fasting, TPN, and repeated paracentesis usually is successful.