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ABSTRACT: Abstract Background: Construction of an esophagojejunostomy is a major concern in totally laparoscopic total gastrectomy (TLTG). Use of a circular stapler can be technically challenging in laparoscopic procedures. We aimed to introduce our modified techniques and to assess the early outcomes following TLTG with side-to-side esophagojejunostomy using a linear stapler in patients with gastric cancer. Subjects and Methods: From December 2010 to June 2011, 27 patients who underwent TLTG for gastric cancer were retrospectively reviewed. Their clinicopathologic characteristics, surgical time, hospital stay, morbidity, and mortality were analyzed. Results: The mean age of patients was 59.1 years, and the average body mass index was 24.6 kg/m(2). The mean operating time was 126.2 minutes, and the hospital stay averaged 8.1 days. No conversion to open laparotomy was required. There were 2 luminal bleeding cases and 1 intra-abdominal bleeding case, but all were successfully managed with conservative treatment only. No patient experienced reoperation, anastomosis leakage, stricture, duodenal stump leakage, or wound problems. Conclusions: Our TLTG with side-to-side esophagojejunostomy method can be a feasible and safe option for patients with gastric cancer.
Journal of Laparoendoscopic & Advanced Surgical Techniques 10/2012; · 1.40 Impact Factor
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ABSTRACT: BACKGROUND: Mistletoe (Viscum album L.) extracts are widely used in complementary cancer therapy. Aim of this study was to evaluate safety and efficacy of a standardized mistletoe extract (abnobaVISCUM(R) Quercus, aVQ) in patients with gastric cancerPatients and Methods32 operated gastric cancer patients (stage Ib or II) who were waiting for oral chemotherapy with the 5-FU prodrug doxifluridine were randomized 1:1 to receive additional therapy with aVQ or no additional therapy. aVQ was injected subcutaneously three times per week from postoperative day 7 to week 24 in increasing doses. EORTC QLQ-C30 and -STO22 Quality of Life questionnaire, differential blood count, liver function tests, various cytokine levels (tumor necrosis factor (TNF)-alpha, interleukin (IL)-2), CD 16+/CD56+ and CD 19+ lymphocytes were analyzed at baseline and 8, 16 and 24 weeks later. RESULTS: Global health status (p <0.01), leukocyte- and eosinophil counts (p <=0.01) increased significantly in the treatment group compared to the control group. Diarrhea was less frequently reported (7% vs. 50%, p=0.014) in the intervention group. There was no significant treatment effect on levels of TNF-alpha, IL-2, CD16+/CD56+ and CD 19+ lymphocytes and liver function tests measured by ANOVA. CONCLUSION: Additional treatment with aVQ is safe and was associated with improved QoL of gastric cancer patients. ClinicalTrials.Gov Registration number NCT01401075.
BMC Complementary and Alternative Medicine 10/2012; 12(1):172. · 2.24 Impact Factor
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ABSTRACT: Multiple early gastric cancers (MEGCs) may be easily missed on preoperative gastroscopy because the lesions are predominantly small and flat. This may increase the risks of gastric remnant lesions and recurrence. We aimed to define high-risk group of MEGC and suggest proper management of missed lesion after partial gastrectomy.
A total of 117 patients with MEGCs and 2182 with solitary EGC who underwent gastrectomy between 2008 and 2010 were retrospectively analyzed to determine their clinicopathologic characteristics. We also assessed their family history, the presence of Helicobacter pylori infection, and of precancerous lesions; and the results of microsatellite instability and immunohistochemical staining of the primary (largest) lesion for p53, human epidermal growth factor receptor [HER1], and HER2 were also reviewed.
MEGCs occurred more frequently in elderly males and in patients with adenoma, atrophic gastritis, or a family history of gastric cancer. These patients had more favorable pathologic findings, including less deep invasion, better differentiation, more intestinal type, and less frequent lymphovascular/perineural invasion than patients with solitary EGCs. The mean size of MEGCs was smaller (2.44 cm vs 3.36 cm) but there was no difference in the number of metastatic lymph nodes. Most accessory lesions were confined to the mucosal layer, with their average diameter was 1.82 cm.
A careful preoperative gastroscopy should be performed in patients at high risk of MEGCs and more cautious postoperative endoscopic surveillance of the remnant stomach is required. For missed foci on remnant stomach, endoscopic resection can be a good option if it meets the criteria.
Surgical Oncology 09/2012; 21(4):269-73. · 2.44 Impact Factor
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Jae Ho Jeong,
Min-Hee Ryu,
Baek-Yeol Ryoo,
Sung Sook Lee,
Inkeun Park,
Sang Hong Lee, Kab Choong Kim,
Jeong Hwan Yook,
Sung Tae Oh,
Byung Sik Kim,
Yoon-Koo Kang
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ABSTRACT: Adjuvant chemotherapy with S-1 was proven to be effective in Japanese patients with advanced gastric cancer curatively resected with D2 lymph node dissection.
We retrospectively evaluated the medical records of 305 patients with stage II, III or IV (M0) gastric cancer who had received adjuvant S-1 chemotherapy following curative gastrectomy with D2 lymph node dissection between October 2007 and December 2009. Adjuvant S-1 was administered at a dose of 40 mg/m(2) twice daily for 4 weeks followed by 2 weeks of rest, every 6 weeks for eight cycles.
Of the 305 patients, 248 (81.3 %) and 198 (64.9 %) completed four and eight cycles of adjuvant chemotherapy, respectively. The most common reasons for discontinuing treatment prior to the planned eight cycles were adverse events (n = 47, 15.4 %) and tumor recurrence (n = 28, 9.2 %). Sixty-five (21.3 %) patients required dose reduction due to adverse events. The most common grade 3/4 toxicities were neutropenia (n = 39, 12.8 %), diarrhea (n = 15, 4.9 %). Multivariate analysis showed that total gastrectomy [odds ratio (OR) 2.44; 95 % confidence interval (CI) 1.29-4.62, p = 0.006] was an independent risk factor for grade 3/4 hematologic toxicities, and age > 65 years (OR 2.60; 95 % CI 1.34-5.07, p = 0.005) was an independent risk factor for grade 3 non-hematologic toxicities.
Adjuvant chemotherapy with S-1 for 1 year is safe and feasible in Korean patients. Age > 65 years and total gastrectomy are independent risk factors for severe adverse events caused by adjuvant S-1 chemotherapy.
Cancer Chemotherapy and Pharmacology 08/2012; 70(4):523-9. · 2.83 Impact Factor
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ABSTRACT: Single-incision laparoscopic surgery is becoming a more widely accepted surgical approach. However, the feasibility and safety of single-incision laparoscopic cholecystectomy (SILC) are yet to be established. The present study compared outcomes following the use of SILC or conventional laparoscopic cholecystectomy (CLC) on patients with gallbladder disease.
The study involved 190 symptomatic gallbladder disease patients treated between March 2009 and February 2011. Ninety-six patients underwent SILC, and 94 patients underwent CLC. Clinical and surgical outcomes were compared.
The SILC and CLC groups were similar in terms of age, gender ratio, body mass index, and diagnoses. The two groups were also found to be similar in terms of postoperative clinical course and complications. The SILC group had a longer operation time, less postoperative pain, and a shorter hospital stay than the CLC group (P<.05 for all variables).
SILC using the OCTO port system (Darim Corp., Korea) was as safe and feasible as CLC. Additionally, SILC is less invasive and more comfortable for patients than CLC.
Journal of Laparoendoscopic & Advanced Surgical Techniques 04/2012; 22(5):443-7. · 1.40 Impact Factor
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Jeong Hoon Lee,
Kee Don Choi,
Mi-Young Kim,
Kwi-Sook Choi,
Do Hoon Kim,
Young Soo Park, Kab Choong Kim,
Ho June Song,
Gin Hyug Lee,
Hwoon-Yong Jung,
Jeong Hwan Yook,
Byung Sik Kim,
Yoon-Koo Kang,
Jin-Ho Kim
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ABSTRACT: Preoperative pathologic diagnosis of a gastric subepithelial tumor (SET) may improve clinical decision making. However, the clinical impact of EUS-guided Trucut biopsy (EUS-TCB) data on decision making in patients with a gastric SET has not been assessed.
To evaluate the impact of EUS-TCB information on the clinical management of patients with a gastric SET.
Retrospective review of prospectively collected data.
Tertiary referral center.
Sixty-five patients with gastric SETs 2 cm or larger in diameter.
EUS-TCB.
The number of patients for whom treatment plans were changed because of EUS-TCB results.
Nine SETs were not punctured by the TCB needle because of technical problems, and we were unable to obtain adequate subepithelial tissue from 19 SETs. Treatment plans were changed for 18 of 65 patients (27.7%). The changes were avoiding unnecessary resection (7 benign SETs ≥ 3 cm in diameter), scheduling for definitive treatment (6 GI stromal tumors and 1 carcinoid tumor), and modifying the surgical field (3 large GI stromal tumors and 1 carcinoma). When we assessed treatment plans relative to tumor location, we found that avoiding unnecessary resection was associated with the presence of cardiac SETs.
Retrospective study with a small number of patients.
EUS-TCB changed or influenced management decisions in 18 of 65 patients (27.7%) with gastric SETs. Patients could receive proper and tailored surgery, medical treatment, or surveillance according to size and location of SETs with EUS-TCB.
Gastrointestinal endoscopy 08/2011; 74(5):1010-8. · 6.71 Impact Factor
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ABSTRACT: Totally laparoscopic distal gastrectomy (TLDG) has several advantages over laparoscopic-assisted distal gastrectomy (LADG), including a shorter incision, less pain, and earlier recovery. We compared the feasibility and early surgical outcomes of TLDG and LADG in patients with gastric cancer.
Between September 2008 and December 2009, 180 patients with gastric cancer underwent TLDG with intracorporeal gastroduodenostomy using linear staplers; and between January 2006 and December 2009, 268 patients with gastric cancer underwent LADG with extracorporeal gastroduodenostomy using circular staplers. Clinical features and early surgical outcomes were compared between the two groups.
There were no between-group differences in postoperative clinical course and complications. Postoperative pain and the amount of pain killer administered were significantly lower (P<.05 each), and postoperative scars were smaller in the TLDG group.
TLDG with intracorporeal gastroduodenostomy is as safe and feasible as LADG for patients with gastric cancer. Moreover, TLDG is less invasive and more comfortable for patients than LADG.
Journal of Laparoendoscopic & Advanced Surgical Techniques 06/2011; 21(5):387-91. · 1.40 Impact Factor
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Mi-Young Kim,
Young Soo Park,
Kee Don Choi,
Jeong Hoon Lee,
Kwi-Sook Choi,
Do Hoon Kim,
Ho June Song,
Gin Hyug Lee,
Hwoon-Yong Jung,
Jin-Ho Kim,
Sung-Cheol Yun, Kab Choong Kim,
Jeong Hwan Yook,
Sung Tae Oh,
Byung Sik Kim,
Min-Hee Ryu,
Yoon-Koo Kang
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ABSTRACT: To evaluate the recurrence predicting factors of small gastric gastrointestinal stromal tumors (GISTs) through the long-term follow-up after surgical/endoscopic resection.
Although small gastric GISTs are known to have a low risk of recurrence after complete resection, the prognostic factors are not well known.
The study retrospectively analyzed the records of 136 patients with primary gastric GISTs of 5 cm or less without metastasis who underwent surgical/endoscopic resection between March 1997 and December 2008 at the Asan Medical Center, and who were followed-up for at least 3 months after resection. Specimens were assessed for tumor size, mitotic index, and microscopic resection margin. Specimen sections were immunohistochemically stained to determine the levels of expression of the cell cycle proteins p53, p16(INK4), pRb, cyclin D1, and Ki-67. DNA was extracted from high-risk tumors to analyze for KIT mutations.
Among 136 patients, 5 (3.7%) patients with tumors with a high mitotic index showed recurrence at a median 23 months post resection. None of 14 patients with microscopic positive resection margins showed recurrence during a median follow-up time of 32 months. A high mitotic index was a predictor of recurrence (P<0.001), but that tumor size, method of resection, or margin status were not. In addition, abnormal p53 expression was found to be associated with recurrence (P=0.004). All assessable high-risk tumors had a KIT exon 11 mutation.
Predictors of recurrence of gastric GISTs of 5 cm or less were a high mitotic index and abnormal p53 expression. A positive microscopic resection margin was not associated with recurrence.
Journal of clinical gastroenterology 05/2011; 46(2):130-7. · 2.21 Impact Factor
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ABSTRACT: Recent advances in molecular targeted therapy have identified HER2 as an important target for anti-cancer therapy in gastric cancer (GC). Although the clinical relevance and prognostic significance of HER2 in breast cancer has been well acknowledged, it remains controversial in GC.
HER2 expression was investigated in two independent series of GC by immunohistochemical staining. One series corresponded to 1,414 cases of whole-tissue sections and the other corresponded to 595 cases of tissue microarrays (TMAs). Results were compared and correlated with clinicopathologic parameters.
HER2-positivity was detected in 12.3% of whole-tissue sections and 17% of TMAs. Among samples scored 3+, 90.1% stained ≥50% of the tumor area, but only 40.9% in score 2+ cases stained ≥50% of the tumor area. In whole-tissue sections, HER2-positivity was correlated with age (P = 0.002), histological type (differentiated or intestinal, P < 0.001), lymphovascular invasion (P = 0.005), and lymph node metastasis (P = 0.009). In TMAs, HER2-positivity was correlated only with age (P = 0.003) and histological type (P < 0.001). Multivariate analyses of the differentiated GC subgroup revealed that HER2-positivity was an independent poor prognostic factor (P = 0.042). The cases with HER2-positive in ≥50% of the tumor area showed worse prognosis than those of <50% (P = 0.021).
Despite discrepancies in the results from whole-tissue sections and TMAs, HER2 overexpression was positively correlated with aggressive biological behavior and was an independent poor prognostic factor for recurrence in differentiated GCs. Therefore, HER2-positive GCs should be considered for adjuvant trastuzumab therapy.
Annals of Surgical Oncology 04/2011; 18(10):2833-40. · 4.17 Impact Factor
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ABSTRACT: Gastric endocrine tumors are usually classified as 3 types of well-differentiated endocrine tumors (typical carcinoids or carcinoids) and poorly differentiated carcinomas (neuroendocrine carcinomas [NECs]).
From 1993 to 2008, 97 patients (73 men and 24 women) were diagnosed with gastric neuroendocrine tumors at the Asan Medical Center.
Of the 45 patients with typical carcinoids, 37 underwent surgery (eg, endoscopic resection). Of the 52 patients with NECs, 43 underwent surgery (eg, radical gastrectomy). One patient died of recurrence of the typical carcinoids, whereas 26 patients with NECs died of related diseases (P < .05). The rates of survival and recurrence did not significantly differ by type of typical carcinoid (P > .05).
Regardless of the type, carcinoids that are not yet advanced can be effectively treated with minimal endoscopic or laparoscopic surgery. However, all NECs and advanced carcinoids should be treated with radical gastrectomy.
American journal of surgery 04/2010; 200(3):328-33. · 2.36 Impact Factor
