• Journal of Gastric Cancer
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• v.5 no.4 s.20
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• pp.252-259
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• 2005

To clarify the clinicopathologic features of small-cell carcinomas (SCC) of the stomach, we reviewed three cases of surgically treated SCC. The first case was a pure SCC, with severe pancreatic invasion and peritoneal seeding. A gastro-jejunostomy was performed. Postoperative chemotherapy was performed with CDDP and VP-16 (8 cycles) but showed disease progression (PD); a consecutive chemotherapy with CDDP and irinotencan (2 cycles) also showed PD. A third line with CDDP, VP16, ifosfamide, and mesna was followed by a 4th line (CDDP and Taxol). The male patient died with liver metastasis and peritoneal seeding 14 months after the operation. The second case was a SCC mixed with a poorly differentiated adenocarcinoma. Profound lymphadenopathy and liver metastasis were found. Two cycles of preoperative chemotherapy with TS-1 and CDDP were performed, which showed nearly complete remission for lymphadenopathy and partial response for the primary tumor site and liver metastatic lesion. A total gastrectomy and extended lymphadenectomy was performed. There were no viable cancer cells in 35 retrieved lymph nodes. Postoperative chemotherapy using the same regimen was performed for 4 cycles. Enlarged liver metastasis was found at the follow-up CT scan, so a posterior segmentectomy of liver was performed. After liver surgery, the chemotherapy regimen was changed to irinotecan and cisplatin. This male patient has been in good health for the f4 months since gastric surgery. The third case was a pure SCC, and a subtotal gastrectomy was performed curatively. That male patient received 5 cycles of TS-1 and is still in good health 14 months after operation.

• Tuberculosis and Respiratory Diseases
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• v.61 no.3
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• pp.279-284
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• 2006

A multiple primary malignant tumor is a disease mainly encountered in the of the older age groups. Attempts should be made to rule out a second primary malignant neoplasm in the elderly patients with unusual signs and symptoms. We encountered a case of a 67-year-old male with triple primary malignant tumors of the stomach, larynx, and lung. The patient had been treated with a subtotal gastrectomy for early gastric cancer in 1991 and a Laser laryngectomy for the laryngeal squamous cell carcinoma in 2003. In 2005, lung cancer was found with the biopsy revealing an adenosquamous carcinoma. Systemic chemotherapy was performed.

• Journal of Gastric Cancer
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• v.2 no.3
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• pp.157-162
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• 2002

Purpose: The prognosis of stage IV gastric cancer is very grave. However, some of these patients survive long periods after surgery. This study was undertaken to investigate various clinico-pathological profiles related to the prognosis for these long-term survivors. Materials and Methods: One hundred fifty-five patients with stage IV gastric cancer who underwent a gastric resection from 1992 to 1997 at Hanyang University Hospital were evaluated. Thirty-three patients who survived more than 5 years after surgery were designated as long-term survivors (LTS); on the other hand, one hundred twenty-two patients who died within 5 years after surgery were named as short-term survivors (STS). Results: The rate of the patients with T4, preoperative serum level of CA19-9 greater than 37 U/g protein, and peritoneal dissemination was lower for the LTS than in for the STS (P=0.002, P=0.045, and P=0.0000, respectively). Tumors were smaller (7.3 cm vs. 8.9 cm, P=0.030) and metastatic lymph node were fewer (19.7 vs. 28.8, P=0.019) for the LTS than for the STS. Curative surgery ($\76\%\;vs.\;\46\%$, P=0.002) and a subtotal gastrectomy ($\76\%\;vs.\;46\%$, P=0.026) were performed more frequently for the LTS than for the STS. From a univariate survival analysis, depth of invasion, distant metastasis, extent of gastric resection, postoperative chemotherapy, and curability were statistically significant factors. From a multivariate survival analysis, curability, depth of invasion, and extent of gastric resection were independent prognostic factors. Conclusions: If feasible, we have to exert our efforts to achieve curative surgery although the tumor is considered to be a stage IV gastric cancer. Thereafter, multi-modality treatments including chemotherapy can be considered to improve the prognosis.

• The Korean Journal of Pain
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• v.11 no.1
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• pp.41-46
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• 1998

Background: Preoperative analgesia may prevent nociceptive inputs generated during surgery from sensitizing central neurons and therefore may preempt postoperative pain. Although preemptive analgesia has shown to decrease postinjury pain in animals, studies in human are not consistent. We studied whether epidural morphine injection before surgical incision could affect postoperative pain and analgesic demands, compared with injection after removal of specimen. Methods: Forty patients scheduled for radical subtotal gastrectomy were randomly assigned to one of two groups for prospective study in a double-blind manner. Group 1 received an epidural injection of 3 mg of morphine in 8 ml of 0.9% saline before surgical incision, and Group 2 after removal of specimen. Postoperative pain relief was provided with I.V. patient controlled analgesia (PCA) system. Numerical rating scales for pain and mood, Prince Henry Hospital scores for pain, cumulative PCA analgesic consumptions, and incidence of side effects were assessed at 2, 6, 12, 24, 48 hours after operation. Results: Cumulative PCA analgesic consumption in group 1 was significantly less than in group 2 at 2, 6 hours after surgery. Pain scores and the incidence of side effects were similar in both groups. Conclusions: Preoperative analgesia with epidural morphine showed little difference in patient controlled analgesic consumption after upper abdominal surgery compaired to intraoperative morphine.

• Journal of Gastric Cancer
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• v.12 no.1
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• pp.43-45
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• 2012

Mesenteric pseudocyst is rare. This term is used to describe the abdominal cystic mass, without the origin of abdominal organ. We presented a case of mesenteric pseudocyst of the small bowel in a 70-year-old man. Esophago-gastro-duodenoscopy showed a 3.5 cm sized excavated lesion on the posterior wall of angle. Endocopic biopsy confirmed a histologic diagnosis of the poorly differentiated adenocarcinoma, which includes the signet ring cell component. Abdominal computed tomography scan showed a focal mucosal enhancement in the posterior wall of angle of the stomach, a 2.4 cm sized enhancing mass on the distal small bowel loop, without distant metastases or ascites in rectal shelf, and multiple gallbladder stones. The patient underwent subtotal gastrectomy with gastroduodenostomy, segmental resection of the small bowel, and cholecystectomy. The final pathological diagnosis was mesenteric pseudocyst. This is the first case report describing incidentally detected mesenteric pseudocyst of the small bowel in gastric cancer patients.

• Journal of Yeungnam Medical Science
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• v.2 no.1
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• pp.39-44
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• 1985

To assess the effect of post-operative pain control of upper abdominal surgery through lumbar epidural narcotic injection, the 3rd or 4th lumbar epidural puncture was done, and were injected 1mg, of morphine (Group I) or 10mg, of demerol (Group II) mixed with 10ml of normal saline into the epidural space, after operation of the cholecystectomy in 10patients and antrectomy and vagotomy, subtotal or total gastrectomy in 10patients. Time interval of the post-operative analgesic effect between morphine and demerol groups were compared. The results of this study were as follows: 1. In the group I, average analgesic duration was 29.4 hours. 2. In the group II, average analgesic duration was 4.0 hours. It is concluded that post-operative pain control of upper abdominal surgery through the lumbar epidural narcotic injection was effective, and morphine injection was more effective than demerol.

• The Korean Journal of Pain
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• v.20 no.2
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• pp.123-129
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• 2007

Background: Postoperative pruritus following the administration of epidural narcotics is a very common and undesirable side effect. Therefore, we evaluated the use of a combination of naloxone and sufentanil via patient controlled epidural analgesia to determine if the incidence of pruritus was decreased when compared to the use of sufentanil alone. Methods: Patients scheduled for subtotal gastrectomy under general anesthesia were enrolled in a prospective, double-blinded and randomized trial. All patients received a $20{\mu}g$ epidural bolus of sufentanil in 5 ml of 0.2% ropivacaine. Following administration of the epidural, patients in the sufentanyl group (S) received a continuous epidural comprised of sufentanil ($0.75{\mu}g/ml$) in 0.2% ropivacaine, whereas patients in the naloxone group (N) received an epidural infusion comprised of naloxone ($4{\mu}g/ml$) and sufentanil ($0.75{\mu}g/ml$) in 0.2% ropivacaine. The infusion rate, demand dose and lockout interval were 5 ml/hr, 0.5 ml and 15 minutes respectively. Next, the occurrence of postoperative analgesia and side effects were evaluated by blinded observers. Results: The incidence of pruritus (47.4% versus 20.0%, P = 0.013) and nausea (42 .1 % versus 20.0%, P = 0.043) were lower in group N than in group S. In addition, there were no significant differences observed in the visual analogue scale, the incidence of vomiting or the incidence of sedation. Furthermore, epidural infusion of naloxone at $0.25-0.4{\mu}g/kg/hr$ did not affect the requirement for postoperative sufentanil. Conclusions: Epidural naloxone reduces epidural sufentanil induced pruritus and nausea without reversing its analgesic effects.

• Korean Journal of Clinical Oncology
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• v.14 no.2
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• pp.120-127
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• 2018

Purpose: The purpose of this study was to determine the immunologic role of lymph node (LN) and stage migration by assessing LN count and metastatic LN count. Methods: A total of 2,117 patients with gastric adenocarcinoma located in the body and antrum who underwent distal/subtotal gastrectomy with D2 LN dissection between January 1, 1998 and December 31, 2008 were enrolled. LN count and number of metastases were determined in the N1 tier (area of D1 dissection) and N2 tier (area of D2 dissection). The lower and upper quartiles of LN counts in the same pN stage were grouped to compare the prognosis and LN positivity according to the LN tier. Results: Stage migration from N1 tier to N2 tier occurred in 3.2% of cases. The 5-year disease-specific survival rates of the upper and lower LN count groups within the N1 tier were 91.0% and 86.7% (P=0.01), respectively. LN positivity in the N2 tier of the lower LN count group was higher than that of the upper LN count group (14.1% vs. 8.2%, P<0.01). Stage migration in the N2 tier of the lower LN count group was also higher than that of the upper LN count group (4.6% vs. 1.8%, P<0.01). Conclusion: The lower LN count group had a decreased survival rate compared to that of the upper LN count group, suggesting that perigastric LN has an immunological defense role in weakening the disseminating power of metastatic tumor cells, as indicated by the LN count.

• Journal of Digestive Cancer Research
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• v.4 no.2
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• pp.122-126
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• 2016

Leptomeningeal carcinomatosis occurs in approximately 5% of patients with cancer. The most common cancers involving the leptomeninges are breast, lung cancer and melanoma. However, gastric adenocarcinoma has been rarely reported with leptomeningeal carcinomatosis. The presenting manifestations are usually headache, visual disturbances and seizures. We report a case of leptomeningeal metastasis that presented as a gastric cancer. A 75-year old man was transferred to our hospital for further evaluation and treatment after being diagnosed with adenocarcinoma through endoscopic biopsy during a regular health examination. An abdominal computed tomography (CT) showed AGC, stage IA (cT1N0M0), while an endoscopic examination showed AGC, Borrmann type 2. The patient is currently under observation after undergoing radical subtotal gastrectomy with gastroduodenostomy and subsequent administration of oral chemotherapeutic agents. As an abdominal CT response assessment performed after surgery revealed new metastasis to the liver, the patient received palliative chemotherapy as recurrence was suspected. After receiving chemotherapy in the order of DP (Cisplatin + Docetaxel), FOLFIRI (5-FU + Leucovorin + Irinotecan), an abdominal CT response assessment showed complete response. Since decreased mentality maintained throughout the follow up period based on outpatient clinic, brain MRI was performed and revealed multiple leptomeningeal metastasis. The Patient died 2 days after the diagnosis.

• Journal of the Korean Society of Radiology
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• v.81 no.4
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• pp.933-938
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• 2020

Brachiocephalic venous aneurysm (BVA) development is an extremely rare, particularly as a primary vascular disorder. BVAs may be misinterpreted as lymphadenopathies owing to the variable degrees of enhancement seen in imaging studies, especially among patients with underlying malignancy. We report a BVA that mimicked lymph node metastasis on CT in a 60-year-old female who had undergone subtotal gastrectomy for stomach cancer. After follow-up chest CT with different bolus times and Doppler ultrasonography, a venous aneurysm originating from the brachiocephalic vein was diagnosed. We emphasize that, to make an accurate diagnosis, physicians should be aware of the potential diagnostic pitfalls and have a high index of suspicion for BVA when encountering certain lesions in the cervical area.