[Show abstract][Hide abstract] ABSTRACT: This study aimed to compare the outcomes of endoscopic submucosal dissection (ESD) and gastrectomy based on the two sets of indications for ESD, namely guideline criteria (GC) and expanded criteria (EC).
[Show abstract][Hide abstract] ABSTRACT: The oncologic outcomes of laparoscopy-assisted gastrectomy for the treatment of gastric cancer have not been evaluated. The aim of this study is to validate the efficacy and safety of laparoscopic gastrectomy for gastric cancer in terms of long-term survival, morbidity, and mortality retrospectively.
The study group comprised 2,976 patients who were treated with curative intent either by laparoscopic gastrectomy (1,477 patients) or open gastrectomy (1,499 patients) between April 1998 and December 2005. The long-term 5-year actual survival analysis in case-control and case-matched population was conducted using the Kaplan-Meier method. The morbidity and mortality and learning curves were evaluated.
In the case-control study, the overall survival, disease-specific survival, and recurrence-free survival (median follow-up period, 70.8 months) were not statistically different at each cancer stage with the exception of an increased overall survival rate for patients with stage IA cancer treated via laparoscopy (laparoscopic group; 95.3%, open group: 90.3%; P < .001). After matching using a propensity scoring system, the overall survival, disease-specific survival, and recurrence-free survival rates were not statistically different at each stage. The morbidity of the case-matched group was 15.1% in the open group and 12.5% in the laparoscopic group, which also had no statistical significance (P = .184). The mortality rate was also not statistically significant (0.3% in the open group and 0.5% in the laparoscopic group; P = 1.000). The mean learning curve was 42.
The long-term oncologic outcomes of laparoscopic gastrectomy for patients with gastric cancer were comparable to those of open gastrectomy in a large-scale, multicenter, retrospective clinical study.
Journal of Clinical Oncology 01/2014; · 18.04 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Despite the initial absolute or relative contraindication of laparoscopic surgery during pregnancy, in the last decade, laparoscopic appendectomy (LA) has been performed in pregnant women. But few studies compare the outcomes of LA compared with open appendectomy (OA). We investigated clinical outcomes to evaluate the safety and efficacy of LA compared with OA in pregnant women.
We recruited consecutive pregnant patients with a diagnosis of acute appendicitis who were undergoing LA or OA between May 2007 and August 2011 into the study.
Sixty-one patients (22 LA and 39 OA) enrolled in our study. There were no significant differences in duration of surgery, postoperative complication rate and obstetric and fetal outcomes, including incidence of preterm labour, delivery type, gestation age at delivery, birth weight and APGAR scores between the 2 groups. However, the LA group had shorter time to first flatus (2.4 ± 0.4 d v. 4.0 ± 1.7 d, p = 0.034), earlier time to oral intake (2.3 ± 1.6 d v. 4.1 ± 1.9 d, p = 0.023) and shorter postoperative hospital stay (4.2 ± 2.9 d v. 6.9 ± 3.7 d, p = 0.043) than the OA group.
Laparoscopic appendectomy is a clinically safe and effective procedure in all trimesters of pregnancy and should be considered as a standard treatment alternative to OA. Further evaluation including prospective randomized clinical trials comparing LA with OA are needed to confirm our results.
Canadian journal of surgery. Journal canadien de chirurgie 10/2013; 56(5):341-6. · 1.63 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: A randomized controlled trial to evaluate the long-term outcomes of laparoscopic distal gastrectomy for gastric cancer is currently ongoing in Korea. Patients with cT1N0M0-cT2aN0M0 (American Joint Committee on Cancer, 6th edition) distal gastric cancer were randomized to receive either laparoscopic or open distal gastrectomy. For surgical quality control, the surgeons participating in this trial had to have performed at least 50 cases each of laparoscopy-assisted distal gastrectomy and open distal gastrectomy and their institutions should have performed more than 80 cases each of both procedures each year. Fifteen surgeons from 12 institutions recruited 1,415 patients. The primary endpoint is overall survival. The secondary endpoints are disease-free survival, morbidity, mortality, quality of life, inflammatory and immune responses, and cost-effectiveness (ClinicalTrials.gov ID: NCT00452751).
Journal of the Korean Surgical Society 02/2013; 84(2):123-30. · 0.21 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: A 53-year-old woman was diagnosed with gastrointestinal stromal tumor (GIST) of the stomach. Computed tomography (CT) revealed a huge mass (12 cm in diameter), likely to invade pancreas and spleen. In the operation field, the tumor was in an unresectable state. The patient was then started on imatinib therapy for 4 months. On follow-up imaging studies, the tumor almost disappeared. We performed total gastrectomy and splenectomy upon which two small-sized residual tumors were found on microscopy. In this paper, we describe a case of clinicopathologic change in unresectable GIST after neoadjuvant imatinib mesylate.
Journal of the Korean Surgical Society. 02/2012; 82(2):120-4.
[Show abstract][Hide abstract] ABSTRACT: A 54 year old man was referred to our hospital with gastric cancer. The patient had a history of splenectomy and a left nephrectomy as a result of a traffic accident 15 years earlier. The endoscopic findings were advanced gastric cancer at the lower body of the stomach. Abdominal ultrasonography (USG) and magnetic resonance imaging demonstrated a metastatic nodule in the S2 segment of the liver. Eventually, the clinical stage was determined to be cT2cN1cM1 and a radical distal gastrectomy, lateral segmentectomy of the liver were performed. The histopathology findings confirmed the diagnosis of intrahepatic splenosis, omental splenosis. Hepatic splenosis is not rare in patients with a history of splenic trauma or splenectomy. Nevertheless, this is the first report describing a patient with gastric cancer and intrahepatic splenosis that was misinterpreted as a liver metastatic nodule. Intra-operative USG guided fine needle aspiration should be considered to avoid unnecessary liver resections in patients with a suspicious hepatic metastasis.
[Show abstract][Hide abstract] ABSTRACT: Although a novel technique for the performance of intestinal sutureless anastomosis using a compression device has recently been investigated, it has not yet received widespread acceptance. We performed a multicenter prospective randomized trial in order to determine the clinical efficacy of the NiTi Hand CAC 30, a type of compression anastomosis clip (CAC), for jejunojejunostomy in gastric cancer surgery.
Forty-seven patients from 6 institutions, who were diagnosed with gastric adenocarcinoma, were enrolled; these patients were randomized to a CAC group and a hand-sewn (control) group. Three patients dropped out for various reasons, and results for 44 patients were finally analyzed. The CAC group consisted of 20 patients, and there were 24 patients in the control group.
Anastomosis time, the primary endpoint of this trial, was shorter in the CAC group than in the control group (P < 0.001). However, total operation times (P = 0.055) did not differ. All reconstructions were completed by Roux-en-Y anastomosis, and the complication rates of the two groups did not differ (P = 0.908); however, jejunojejunostomy leakage occurred in two patients in the CAC group.
Our prospective multicenter clinical trial showed that the use of the NiTi Hand CAC™ 30 for jejunojejunostomy in gastric cancer surgery was feasible and could reduce anastomosis time. However, considering that there were two cases of leakage, extended use of the NiTi Hand CAC™ 30 should be carefully applied.
Gastric Cancer 02/2011; 14(2):124-9. · 3.99 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Since Kalloo and colleagues first reported the feasibility and safety of a peroral transgastric approach in the porcine model in 2004, various groups have reported more complex natural orifice transluminal endoscopic surgery (NOTES) procedures, such as the cholecystectomy, splenectomy and liver biopsy, in the porcine model. Natural orifice access to the abdominal cavity, such as transgastric, transvesical, transcolonic, and transvaginal, has been described. Although a novel, minimally invasive approach to the abdominal cavity is a peroral endoscopic transgastric approach, there are still some challenging issues, such as the risk of infection and leakage, and the method of gastric closure. Hybrid-NOTES is an ideal first step in humans. Human hybrid transvaginal access has been used for years by many surgeons for diagnostic and therapeutic purposes. Here, we report a transvaginal flexible endoscopic appendectomy, with a 5-mm umbilical port using ultrasonic scissors in a 74-year-old woman with acute appendicitis.
Journal of the Korean Society of Coloproctology 12/2010; 26(6):429-32.
[Show abstract][Hide abstract] ABSTRACT: Since reconstruction after laparoscopy-assisted distal gastrectomy (LADG) is performed through a small minilaparotomy window, the clinical course and complication rate are influenced by clinical technical expertise and experience. The aim of this study was to compare postoperative complications and survival rates of Billroth I and Billroth II reconstructions after LADG.
We retrospectively collected data from 1,259 patients who underwent LADG performed by ten surgeons at ten hospitals between April 1998 and December 2005. Patients were classified into two groups according to reconstruction method used: the Billroth I group (n=875) and the Billroth II group (n=384). Patient and tumor characteristics, operative details, and postoperative complications were analyzed.
Billroth II reconstruction was performed on obese patients (p=0.003) and patients with more advanced tumors (p<0.001). Billroth I reconstruction was performed more frequently in the lower portion of the stomach (p<0.001) and yielded shorter operating times. The postoperative complication rate was 11.4% in the Billroth I group, which was lower than that in the Billroth II group (16.9%) (p=0.011). However, the differences in the major complication rates were not statistically significant (p=0.263). Of the intra-abdominal complications, intraluminal or intraperitoneal bleeding was the most frequent complication in the Billroth I group and duodenal stump leakage was the most frequent in the Billroth II group. The postoperative mortality rate did not show a statistically significant difference.
Both Billroth I and Billroth II techniques are feasible and safe reconstruction methods after LADG for gastric cancer. To reduce major complication rates, surgeons should pay attention to bleeding in Billroth I reconstruction and stump leakage in Billroth II reconstruction.
[Show abstract][Hide abstract] ABSTRACT: Duodenal gastrointestinal stromal tumors (GISTs) are uncommon and relatively small subset of GISTs whose optimal surgical procedure has not been well defined. We conducted this study to present the surgical experience in our institution and to analyze the postoperative outcome of duodenal GISTs.
A retrospective clinicopathologic analysis was performed for nine duodenal GIST patients who underwent surgery from May 2001 to April 2009. The median follow-up period was 22 months (range: 13-61 months).
A total of nine patients (six males/three females) with a median age of 52 years (range: 45-73 years) were treated. The most common presentation was abdominal pain (45%), and the second portion of duodenum (45%) was most common dominant site. All of the patients underwent limited resection: there were seven wedge resections with primary closures (five open/two laparoscopic) and two segmental resections with end-to-end duodenojejunostomies. The median tumor size was 3.5 cm (range: 1.9-5.5 cm), and the mitotic count was less than fivemitoses/50 high power fields (HPF) in all cases. None patients had neoadjuvant or adjuvant therapy. All of the patients were alive and disease-free.
We obtained excellent disease-free survival following limited resection with clear margins. Limited resection should be considered a treatment option for duodenal GIST.
Journal of Gastrointestinal Surgery 02/2010; 14(5):880-3. · 2.36 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The risk of recurrence and recurrence patterns after laparoscopy-assisted gastrectomy for gastric cancer remain unclear. The objective of this study is to assess recurrence and its timing, patterns, and risk factors following laparoscopy-assisted gastrectomy from multicenter data.
A retrospective multicenter study was performed using data from 1,485 patients who had undergone laparoscopy-assisted gastrectomy for gastric cancer at ten institutions from 1998 to 2005. Recurrence and its timing and patterns were reviewed. Univariate and multivariate analyses were performed to identify risk factors for recurrence.
Excluding 68 patients (9 postoperative mortalities, 1 synchronous distant metastasis, 2 nonadenocarcinomas, and 56 losses to follow-up), 50 of 1,417 patients (3.5%) had recurrences. Incidence of recurrence was 1.6% (19/1186) in early gastric cancer and 13.4% (31/231) in advanced gastric cancer. Recurrence occurred in 34 of 50 patients (68.0%) within 2 years of surgery, and in 45 of 50 patients (90.0%) within 3 years. The recurrence pattern was hematogenous in 17 patients (34.0%), peritoneal in 11 (22.0%), locoregional in 10 (20.0%), distant lymph nodes in 2 (4.0%), and mixed in 10 (20.0%). Advanced T-classification and lymph node metastases were risk factors for recurrence.
Laparoscopy-assisted gastrectomy showed satisfactory long-term oncologic outcomes similar to those of open surgery. The study provides additional evidence suggesting that laparoscopy-assisted gastrectomy is a good alternative to open gastrectomy in patients with gastric cancer of relatively early stage, although results of a randomized controlled trial and more long-term follow-up are needed to provide conclusive evidence.
Annals of Surgical Oncology 02/2010; 17(7):1777-86. · 4.12 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The aim of this study was to evaluate the safety of this trial with respect to morbidity and mortality.
Laparoscopic-assisted distal gastrectomy (LADG) is rapidly gaining popularity. However, there is limited evidence regarding its oncologic safety. We therefore conducted a phase III multicenter, prospective, randomized study comparing LADG with open gastrectomy (ODG).
Patient eligibility criteria were pathologically-proven adenocarcinoma, 20 to 80 years of age, preoperative stage I, no history of other cancer, chemotherapy, or radiotherapy. The primary end point was to determine whether there is a difference in overall survival between 2 groups. The morbidity and mortality were compared to evaluate the safety of this trial. The time was decided on the hypothesis that the morbidity of this trial was not significantly different from that of previous reports on open gastric cancer surgeries (17%-20%). This study is registered at ClinicalTrials.gov and carries the following ID number: NCT00452751.
A total of 342 patients were randomized (LADG, 179 patients; ODG, 161 patients) between January 1, 2006 and July 19, 2007. There were no significant differences between the 2 groups in age, gender, and comorbidities. The postoperative complication rates of the LADG and ODG groups were 10.5% (17/179) and 14.7% (24/163), respectively (P = 0.137). Reoperations were required in 3 cases each group. The postoperative mortality was 1.1% (2/179) and 0% (0/163) in the LADG and ODG groups (P = 0.497), respectively.
There was no significance difference in the morbidity and mortality between the 2 groups. Therefore, we conclude that this trial is safe and is thus ongoing.
Annals of surgery 02/2010; 251(3):417-20. · 7.90 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The aim of this study was to assess the safety and short-term value of laparoscopic gastrectomy in the elderly with gastric cancer compared with a younger cohort.
Data on all patients with gastric cancer undergoing laparoscopic gastrectomy at ten institutions in Korea between May 1998 and December 2005 were collected. Patients under the age of 45 years and those undergoing total gastrectomy, proximal gastrectomy and pylorus-preserving gastrectomy were excluded. An analysis of clinicopathological data for patients aged 45-69 years (average-age group) and those aged 70 years or more (elderly group) was undertaken.
Co-morbidity was more common and postoperative hospital stay was longer in elderly patients. Pre-existing pulmonary and cardiovascular disease in the elderly contributed to respiratory dysfunction and intraperitoneal complications respectively. Tumour size and location, stage, methods of reconstruction and the number of combined operations were similar in the two groups. There were no significant differences in postoperative morbidity or mortality.
Although elderly patients had greater co-morbidity, laparoscopic gastrectomy was a safe treatment for gastric cancer in this age group.
British Journal of Surgery 11/2009; 96(12):1437-42. · 4.84 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The purpose of this study was to evaluate the impact of comorbidities on the surgical outcomes in laparoscopy-assisted distal gastrectomy (LADG).
Although laparoscopic gastrectomy is less invasive than conventional open surgery, surgeons are still concerned with surgical outcomes associated with comorbidity.
We retrospectively collected data on 1324 patients who underwent LADG between April 1998 and December 2005 by 10 surgeons in 10 hospitals. After excluding 87 patients who had an unusual medical history or surgical methods, 1237 patients were enrolled for analysis to evaluate the effect of comorbidities on the surgical outcomes.
Seven patients (0.6%) died during their hospitalization, and postoperative complications occurred in 162 (13.1%) of 1237 patients. According to univariate analysis, gender, number of comorbidities, reconstruction type, and the surgeon's experience in laparoscopy-assisted gastrectomy (LAG) were related to postoperative local complications; age and comorbidity were related to systemic complications; and comorbidity was the only variable related to hospital mortality. Comorbidity was a predictive risk factor for local complications (odds ratio (OR): 1.79) and systemic complications (OR: 2.89) in multivariate analysis. The patients with pulmonary comorbidity were related to most types of immediate postoperative complications compared with other comorbidities.
Our study suggests that comorbidities of patients could be a predictive risk factor for surgical complication after LADG. Therefore, patients with early gastric cancer having comorbidity should be considered for one of the limited surgeries. In addition, surgeons should carefully assess patients with comorbidities with full perioperative attention.
Annals of surgery 12/2008; 248(5):793-9. · 7.90 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To clarify optimal treatment guidelines for residual or local recurrence after endoscopic resection (ER).
Eighty-six patients underwent gastrectomy due to incomplete ER and local recurrence after ER. The pathological findings of ER and gastrectomy specimens were analyzed.
The cause of gastrectomy was categorized into five groups; submucosal (sm) invasion without margin involvement, positive margin, margin not evaluable, high risk of lymph node metastasis and local recurrence after ER. According to the pathological findings of gastrectomy specimens, remnant cancer and lymph node metastases were found in 56 (65.1%) and in 5 patients (5.8%), respectively. At 10 gastrectomy specimens which were sm invasion without margin involvement, the scattered residual cancer cells were found around the ulcer scar in 2 (20%) patients. In 11 of 44 margin involvement specimens, no residual cancer or lymph node metastasis was found. In patients with local recurrence, mean duration from ER to surgery was 14.8 months, and 19% of patients were found to have sm or deeper depth of invasion.
Gastrectomy with lymph node dissection should be performed in patients with sm invasion with or without margin involvement. However, minimal approach other than gastrectomy could further be applied to selected patients.
Journal of Surgical Oncology 07/2008; 98(1):6-10. · 2.64 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: BackgroundThe aim of this multicenter retrospective study was to establish background data for future randomized clinical trial comparing
open and laparoscopy-assisted gastrectomies (LAGs). We sought to evaluate the technical feasibility of LAG by determining
the morbidity and mortality and identifying corresponding predictive factors.
Patients and MethodsA retrospective multicenter study was carried out in Korea on 1,485 patients in who, LAG had been attempted for gastric cancer
under the care of ten surgeons, at ten institutions, during the period spanning May 1998 to December 2005. Patient characteristics,
operative outcomes, and postoperative morbidities and mortalities were analyzed.
ResultsOverall morbidity and mortality rates were 14.0% and 0.6%, respectively. Complications included: wound problem (4.2%, n=62), intraluminal bleeding (1.3%, n=20), intra-abdominal abscess or fluid collection (1.3%, n=19), anastomotic leakage (1.3%, n=18), and intra-abdominal bleeding (1.3%, n=18). By using multivariate analysis we found that the two most important risk factors associated with postoperative complications
were presence of comorbidity in the patient and lack of experience on the part of the surgeon.
ConclusionLAG is a technically feasible, safe, and effective method for treating patients with gastric cancer. Extra caution in patients
with comorbidities, and dedication to improving surgical proficiency in LAG, may decrease the risk of complications. Through
this study, we have established the inclusion criteria for LAG. For our multicenter, prospective, randomized trials (NCT00452751),
potential patients should have an American Society of Anesthesiology (ASA) score of less than 3, and surgeons performing the
procedures should have experience with more than 50 cases of LAG.
Annals of Surgical Oncology 01/2008; 15(10):2692-2700. · 4.12 Impact Factor