• Journal of Gastric Cancer
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• v.10 no.4
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• pp.226-233
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• 2010

Purpose: In resectable gastric cancer, choice regarding the extent of resection depends on tumor size, location, and distance from resection margin. However, there remains controversy for choice of resection for tumors in the middle third of the stomach. This study investigated patients who underwent gastrectomy in order to analyze the differences between total gastrectomy (TG) and subtotal gastrectomy (STG). Materials and Methods: From 2000 to 2006, 125 patients with a tumor in the middle third of the stomach underwent radical gastric resection at EUMC. We retrospectively conducted comparative analysis for the differences in clinicopathological characteristics and prognosis between TG and STG. Results: The average tumor size was 6.7 cm for TG, and 4.1 cm for STG. The number of metastatic lymph nodes were 13.3 for TG, and 3.7 for STG. Patients with more advanced cancer were more likely to receive TG. The 5-year survival rate for TG was lower (38.1%) than STG (69.0%). However, if tumor stages were stratified, there was no significant difference in the survival rate. Histologically, for the undifferentiated type of cancer (Stage 1, 2), the 5-year survival rate of STG was higher (88.1%) than TG (75.0%). Conclusions: Comparing patients with tumors in the middle third of the stomach who underwent TG and STG, there was no statistically significant difference in the 5-year survival rate. If stages were stratified, the clinicopathological characteristic becomes a key factor in deciding the prognosis, rather than the choice of resection. Thus if the radical resection margin can be obtained for a tumor in the middle third of the stomach, STG is considered instead of TG.

• Journal of Gastric Cancer
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• v.16 no.2
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• pp.63-71
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• 2016

Pylorus-preserving gastrectomy (PPG) is a function-preserving surgery for the treatment of early gastric cancer (EGC), aiming to decrease the complication rate and improve postoperative quality of life. According to the Japanese gastric cancer treatment guidelines, PPG can be performed for cT1N0M0 gastric cancer located in the middle-third of the stomach, at least 4.0 cm away from the pylorus. Although the length of the antral cuff gradually increased, from 1.5 cm during the initial use of the procedure to 3.0 cm currently, its optimal length still remains unclear. Standard procedures for the preservation of pyloric function, infra-pyloric vessels, and hepatic branch of the vagus nerve, make PPG technically more difficult and raise concerns about incomplete lymph node dissection. The short- and long-term oncological and survival outcomes of PPG were comparable to those for distal gastrectomy, but with several advantages such as a lower incidence of dumping syndrome, bile reflux, and gallstone formation, and improved nutritional status. Gastric stasis, a typical complication of PPG, can be effectively treated by balloon dilatation and stent insertion. Robot-assisted pylorus-preserving gastrectomy is feasible for EGC in the middle-third of the stomach in terms of the short-term clinical outcome. However, any benefits over laparoscopy-assisted PPG (LAPPG) from the patient's perspective have not yet been proven. An ongoing Korean multicenter randomized controlled trial (KLASS-04), which compares LAPPG and laparoscopy-assisted distal gastrectomy for EGC in the middle-third of the stomach, may provide more clear evidence about the advantages and oncologic safety of PPG.

• Journal of Gastric Cancer
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• v.19 no.4
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• pp.417-426
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• 2019

Purpose: Although an increased incidence of gallbladder (GB) stone formation after gastrectomy has been reported, its etiology remains uncertain. The goal of this study was to explore the incidence of gallstone formation after gastrectomy in gastric cancer patients and investigate the risk factors therein. Materials and Methods: Medical records of patients who underwent curative gastrectomy, performed by a single surgeon between August 2012 and December 2015 at the Asan Medical Center, were retrospectively reviewed. Baseline characteristics and surgical outcomes, including GB stone gallstone formation after gastrectomy, were analyzed. Results: Of 561 patients included in the study, 36 presented with GB stone formation after gastrectomy for gastric cancer. The incidence of gallstone formation was 6.4%. The mean interval between gallstone formation and gastrectomy was 21.9 months. In multivariate analyses, the incidence of gallstone formation increased in patients 63 years or older, with greater than 6.2 kg weight loss in the first 6 months after the procedure, a preoperative serum total bilirubin level greater than 0.5 mg/dL, and in patients who did not receive adjuvant chemotherapy. Conclusions: This study presented risk factors for GB stone formation after gastric cancer surgery, and special attention should be afforded to patients with such risk factors.

• Journal of Gastric Cancer
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• v.16 no.4
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• pp.247-253
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• 2016

Purpose: The aim of this study was to establish an anthropometric reference of the stomach for gastric cancer surgery and a modeling formula to predict stomach length. Materials and Methods: Data were retrieved for 851 patients who underwent total gastrectomy at the Seoul National University Hospital between 2008 and 2013. Clinicopathological data and measurements from a formalin-fixed specimen were reviewed. The lengths (cm) of the greater curvature (GC) and lesser curvature (LC) were measured. Anthropometric data of the stomach were compared according to age, body weight, height (cm), and body mass index. To predict stomach length, two multiple regression analyses were performed. Results: The mean lengths of the GC and LC were $22.2{\pm}3.1cm$ and $16.3{\pm}2.6cm$, respectively. The men's GC length was significantly greater than the women's ($22.4{\pm}3.1cm$ vs. $21.2{\pm}2.9cm$, P=0.003). Patients aged >70 years showed significantly longer LC than those aged <50 years ($16.9{\pm}2.9cm$ vs. $15.9{\pm}2.4cm$, P=0.002). Patients with body weights >70 kg showed significantly longer GC than those with body weights <55 kg ($23.0{\pm}2.9cm$ vs. $21.4{\pm}3.2cm$, P<0.001). In the predicted models, 4.11% of the GC was accounted for by age and weight; and 4.94% of the LC, by age, sex, height, and weight. Conclusions: Sex, age, height, and body weight were associated with the length of the LC, while sex and body weight were the only factors that were associated with the length of the GC. However, the prediction model was not sufficiently strong.

• Journal of Preventive Medicine and Public Health
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• v.33 no.1
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• pp.25-30
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• 2000

Objectives : This study was performed to evaluate the effect of stage shift according to screening of stomach cancer. Methods : Total 840 cases of stomach cancer patients, undergone a surgical operation at Department of Surgery, Kangnam St. Mary's Hospital, The Catholic University of Korea from Jan. 1989 to Dec. 1995, were reviewed by stomach cancer working sheet, and classified as asymptomatic and symptomatic group based on the presence of subjective symptoms on their hospital visit. Their histopathologic stages were analysed. We compared the histopathologic stages of asymptomatic stomach cancer patients with those of symptomatic patients. Results : From the total of 840 patients, asymptomatic patients group comprised 28 cases (3.3%). Proportion of asymptomatic patients tended to increase from 1.9% in 1990, 0.9% in 1991 to 8.6% in 1995. Proportions of asymptomatic patients by stages were 78.6% (stage I), 3.6% (stage III), 17.9% (stage IV) and that of symptomatic patients by stages were 38.2% (stage I), 16.5% (stage II), 24.8% (stage III), 19.1% (stage IV). In less than 40 years old, 50.5% of symptomatic patients were diagnosed as stage I. With increment of ages, proportions of stage I were makedly decreased. It was significantly different between proportion of early gastric cancer in asymptomatic patients (60.1%) and that in symptomatic patients (25.0%). Conclusions : We confirmed stage shift according to screening of stomach cancer. And proportion of early gastric cancer in asymptomatic patients was higher than that in symptomatic patients. This results suggest that screening of gastric cancer be important to reduce mortality and if be indirectly started from 40 years old.

• Journal of Gastric Cancer
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• v.14 no.3
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• pp.215-219
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• 2014

Distant metastasis from papillary thyroid carcinoma (PTC), particularly from papillary thyroid microcarcinoma, is rare. We present a case of perigastric lymph node metastasis from PTC in a patient with early gastric cancer and breast cancer. During post-surgical follow-up for breast cancer, a 56-year-old woman was diagnosed incidentally with early gastric cancer and synchronous left thyroid cancer. Therefore, laparoscopic distal gastrectomy with lymph node dissection and left thyroidectomy were performed. On the basis of the pathologic findings of the surgical specimens, the patient was diagnosed to have papillary thyroid microcarcinoma with perigastric lymph node metastasis and early gastric cancer with mucosal invasion. Finally, on the basis of immunohistochemical staining with galectin-3, the diagnosis of perigastric lymph node metastasis from PTC was made. When a patient has multiple primary malignancies with lymph node metastasis, careful pathologic examination of the surgical specimen is necessary; immunohistochemical staining may be helpful in determining the primary origin of lymph node metastasis.

• Tuberculosis and Respiratory Diseases
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• v.51 no.4
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• pp.386-389
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• 2001

An endobronchial metastasis is defined as a subsegmental or a more proximal central bronchial metastasis of a nonpulmonary neoplasm in the bronchoscopically visible range. However, the frequencies of endobronchial metastasis range from 2 to 50% of pulmonary metastases from extrathoracic neoplasms by a different definition of an endobronchial metastasis. Primary neoplasms of an endobronchial metastasis including breast cancer, colon cancer, renal cell carcinoma, and ovarian cancer are relatively common. However, an endobronchial metastasis arising from thyroid cancer, parotid gland tumor, bone tumor, bladder cancer, and stomach cancer has only rarely been reported in the literature. Here we report a case of an endobrochial metastases from a hepatocellular carcinoma.

• Journal of Gastric Cancer
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• v.17 no.2
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• pp.180-185
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• 2017

Despite the decreasing incidence and mortality from gastric cancer, it remains a major health problem worldwide. Ninety percent of cases are adenocarcinomas. Here, we report a case of gastric adenocarcinoma developed after successful treatment of prior primary gastric diffuse large B-cell lymphoma (DLBCL). Our patient was an elderly man with primary gastric DLBCL in whom complete remission was achieved after R-CHOP (cyclophosphamide, adriamycin, vincristine, prednisolone plus rituximab) chemotherapy. Helicobacter pylori infection persisted despite adequate treatment leading to sustained chronic gastritis. The mean time to diagnose metachronous gastric carcinoma was seven years. We believe that a combination of many risk factors, of which chronic H. pylori infection the most important, led to the development of gastric carcinoma following primary gastric lymphoma. In summary, patients who have been successfully treated for primary gastric lymphoma should be followed up at regular short intervals. H. pylori infection should be diagnosed promptly and treated aggressively.

• Health Policy and Management
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• v.33 no.2
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• pp.129-140
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• 2023

Background: This study aims to compare the burden of disease in Korea with other Organization for Economic Cooperation and Development (OECD) countries using the OECD health statistics from 1985 to 2020. Methods: We analyzed potential years of life lost (YLL) per 100,000 population using the Positive value for relative comparison (PARC) index, trend test, and average annual percentage change (AAPC) with logistic regression analysis. Results: The relative disease burden was good for many diseases, but the disease burden was severe for a few diseases in Korea. Diseases with a high relative burden of disease in Korea are as follows; intentional self-harm (YLL2020 575.6, AAPCYLL 2.6%; PARC2020 -1.000, AAPCPARC -15.8%), malignant neoplasms of the liver (YLL2020 136.6, AAPCYLL -3.9%; PARC2020 -1.000, AAPCPARC 0.0%), malignant neoplasms of the stomach (YLL2020 9.0, AAPCYLL 3.2%; PARC2020 -0.556, AAPCPARC -22.9%), Parkinson's disease (YLL2020 575.6, AAPCYLL 2.6%; PARC2020 -1.000, AAPCPARC -15.8%). Conclusion: Diseases with a high burden of disease are needed to be prioritized in the planning and execution of healthcare policies that can contribute to the efficient use of healthcare resources.

• Journal of Gastric Cancer
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• v.16 no.3
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• pp.200-206
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• 2016

In Korea, proximal gastrectomy has recently attracted attention as a better choice of function-preserving surgery for proximal early gastric cancer than total gastrectomy. Of the various strategies to overcome reflux symptoms from remnant stomach, double tract reconstruction not only reduces the incidence of anastomosis-related complications, but is also sufficiently reproducible as a laparoscopic procedure. Catching up with the recent rise of single-port laparoscopic surgeries, we performed a pure single-port laparoscopic proximal gastrectomy with DTR. This procedure was designed by merging the function-preserving concept of proximal gastrectomy with single-port laparoscopic total gastrectomy.