Chang Hak Yoo

HER-2/neu amplification is an independent prognostic factor in gastric cancer.

The HER-2/neu protein is intimately involved with normal cell proliferation and tissue growth and is extensively homologous and related to the epidermal growth factor receptor. HER-2/neu protein expression has been most intensively studied in the context of breast carcinoma, in which its amplification and overexpression correlate with the overall course of disease, and with a poor prognosis, and constitute a predictive factor of poor response to chemotherapy and endocrine therapy. In this study, we investigated the relationship between the expression of HER-2/neu and the clinicopathological characteristics of tumors, including survival. This study was performed with a view toward the future introduction of Herceptin therapy for gastric cancer patients. HER-2/neu overexpression and gene amplification was examined with semiquantitative standardized immunohistochemical staining, chromogenic in situ hybridization (CISH), and fluorescence in situ hybridization (FISH) in 182 gastric cancer patients who underwent curative surgery at the Kangbuk Samsung Hospital. Twenty-nine (15.9%) of 182 patients expressed the HER-2/neu protein by immunohistochemistry. HER-2/neu gene amplification was detected in seven patients by CISH and FISH. Intestinal-type cancers exhibited higher rates of HER-2/neu amplification than did diffuse-type cancers (P < 0.05). Tumors with HER-2/neu amplification were associated with poor mean survival rates (922 vs 3243 days) and 5-year survival rates (21.4% vs 63.0%; P < 0.05). Age, TNM stage, and amplification of HER-2/neu were found to be independently related to survival by multivariate analysis. HER-2/neu amplification may constitute an independent prognostic factor in gastric cancer patients, and patients exhibiting HER-2/neu amplification might constitute potential candidates for new adjuvant therapies which involve the use of humanized monoclonal antibodies.

Nasogastric Decompression is not Necessary in Operations for Gastric Cancer: Prospective Randomised Trial

OBJECTIVE To assess the need for routine nasogastric decompression after extensive resections in patients with gastric cancer. DESIGN Prospective randomised study. SETTING University hospital, Korea. SUBJECTS Over a 1-year period (July 1999-July 200), 136 patients with gastric cancer who underwent radical gastrectomy with D2 or more lymph node dissection. INTERVENTIONS Randomised to have nasogastric decompression (n = 69) or not (n = 67). MAIN OUTCOME MEASURES Postoperative course, morbidity, and mortality. RESULTS Time to passage of first flatus, time to taking liquid diet, length of operation, and postoperative hospital stay were all significantly shorter in the no decompression group. Two patients in each group required subsequent nasogastric decompression. There were no significant differences between the two groups concerning the presence of postoperative fever, nausea, vomiting, anastomotic leaks, or pulmonary or wound complications. No patients died. CONCLUSIONS Routine nasogastric decompression is not necessary in elective operations for gastric cancer.

Proximal Gastrectomy Reconstructed by Jejunal Pouch Interposition for Upper Third Gastric Cancer: Prospective Randomized Study

Proximal gastrectomy with jejunal pouch interposition (PGJP) has been advocated as an alternative operation for upper third gastric cancer. However, there has been no prospective randomized trial comparing PGJP with total gastrectomy with Roux-en-Y esophagojejunostomy (TGRY). The aim of this study was to compare the short- and medium-term results of PGJP and TGRY in a randomized clinical trial. Fifty-one patients with upper third gastric cancer were randomized to either PGJP (n = 25) or TGRY (n = 26). Outcome measures were postoperative complications, nutritional status assessed by serum nutritional parameters, and postgastrectomy symptoms. There were no significant differences in operating time, hospital stay, and postoperative complications. Blood loss was significantly less in the PGJP group (P = 0.036). Nineteen patients (73%) in the TGRY group had one or more postgastrectomy symptoms, which was significantly more frequent than in the PGJP group (32%; P = 0.012). There were also significant differences between the two groups with regard to food intake, weight recovery, hemoglobin, and serum vitamin B12 levels in favor of PGJP. In conclusion, proximal gastrectomy with jejunal pouch interposition for upper third gastric cancer is safe, and is associated with a greater reduction in postgastrectomy symptoms and better nutritional status compared with conventional total gastrectomy.

Long-term Results of Proximal and Total Gastrectomy for Adenocarcinoma of the Upper Third of the Stomach

PURPOSE The choice of surgical strategy for patients with adenocarcinoma of the upper one third of the stomach is controversial. This study was performed to analyze the surgical results of a 11-year experience with these lesions. MATERIALS AND METHODS From January 1990 to December 2000, 259 patients with upper third gastric cancer underwent proximal gastrectomy (n=74) or total gastrectomy (n=185) through an abdominal approach. Morbidity, mortality, recurrence patterns, and survival were compared between these two groups retrospectively. RESULTS There were no significant differences in general complication and mortality rates between the two groups. However, the incidences of reflux esophagitis (16.2%) and anastomotic stricture (35.1%) were more common in the proximal gastrectomy group compared with the total gastrectomy group (0.5 and 8.1%). Regarding the main patterns of recurrence, local recurrence was dominant in the proximal gastrectomy group, whereas distant recurrence was dominant in the total gastrectomy group. Five-year overall survival (54.8 versus 47.8%) and survival according to tumor stage were no different between the groups. Multivariate analysis showed that the extent of resection was not an independent prognostic factor. CONCLUSION The extent of resection for upper third gastric cancer did not appear to affect long-term outcome. However, proximal gastrectomy is associated with an increased risk of reflux esophagitis, anastomotic stricture, and local recurrence.

Impact of delayed laparoscopic cholecystectomy after percutaneous transhepatic gallbladder drainage for patients with complicated acute cholecystitis.

Laparoscopic cholecystectomy (LC) for complicated acute cholecystitis is associated with high rates of complications and conversion to open cholecystectomy. Percutaneous transhepatic gallbladder drainage (PTGBD) is a safe and effective treatment for acute inflammation of the gallbladder. This study was a retrospective analysis of patients who underwent an LC with or without PTGBD for complicated acute cholecystitis at our hospital between January 2002 and January 2007. Patients were classified into 3 groups: group 1, patients who underwent an LC without preoperative PTGBD (n=60); group 2, patients who underwent an early scheduled LC within 7 days of PTGBD (n=35); and group 3, patients in whom the LC was delayed for a mean of 19.9 days (range, 14 to 39 d) after PTGBD (n=38). The conversion rate to open cholecystectomy and the postoperative complication rate were lower in group 3 than in group 1 (P<0.05). Elective delayed LC after PTGBD may lower the conversion and complication rates of patients with complicated acute cholecystitis.

Laparoscopic-assisted total gastrectomy versus open total gastrectomy for upper and middle gastric cancer in short-term and long-term outcomes.

Purpose: In recent years, laparoscopy-assisted distal gastrectomy has become the recognized procedure for treatment of early gastric cancer because of improved cosmesis and reduced postoperative pain. However, there are a few reports of laparoscopic-assisted total gastrectomy (LATG) performed for gastric cancer in the upper third or middle third stomach due to the difficulties of surgical techniques and the safety of oncologic short-term and long-term outcomes. Methods: Between January 2006 and December 2009, 84 patients with upper third or middle third gastric cancer underwent LATG or conventional open total gastrectomy (OTG). Of these patients, 34 patients underwent LATG and they were compared with patients who underwent OTG regarding short-term and long-term outcome. Results: The proximal margins (P=0.343) and distal margins (P=0.685) did not differ between the LATG and OTG groups. Postoperative morbidity occurred in 8 (16.0%) OTG and 6 (17.6%) LATG cases and postoperative mortality occurred 2 (4.0%) and 0 (0.0%) cases of OTG and LATG, respectively. Recurrence occurred in 8 (16.0%) cases and 1 (2.9%) case in the OTG and LATG group, respectively (P=0.077). The 5-year survival rate in the OTG group was 77.5% and in the LATG was 93.2% with no significant difference (P=0.082). Conclusions: Our results confirm that LATG with extended lymphadenectomy for middle or upper early and locally advanced gastric cancer can achieve a radical oncologic resection equivalent to that of OTG. In addition, LATG is a feasible and safe procedure, and has several advantages over conventional OTG.

Predictive value of preoperative serum CEA, CA19-9 and CA125 levels for peritoneal metastasis in patients with gastric carcinoma.

PURPOSE Peritoneal metastasis is a crucial factor for the prognosis in gastric cancer, but its diagnosis is difficult before laparotomy. This study analyzed the usefulness of diagnostic imaging and various tumor markers in the detection of peritoneal metastasis in gastric cancer. MATERIALS AND METHODS The sera from 768 patients with gastric cancer were measured for CEA, CA19-9 and CA125 levels using a commercial immunoradiometric assay. All the patients underwent diagnostic imaging with computed tomography (CT) and ultrasound (US) before laparotomy. RESULTS Preoperative levels of CEA, CA19-9 and CA125 were above the cut-off levels in 15.4%, 8.7% and 5.7% of all cases, respectively. Eighty-eight patients were diagnosed with peritoneal metastasis by laparotomy. CT and US revealed peritoneal dissemination in 15 of 88 patients (17%). Among the three tumor markers, CA19-9 and CA125 showed similar detection rates of peritoneal metastasis (37.5% and 38.6%, respectively). In particular, the serum CA125 levels showed the best sensitivity (38.6%), specificity (98.4%), and diagnostic accuracy (91.5%), and the highest odd ratio (24.46, 95% CI: 11.17 approximately 53.57) for predicting peritoneal metastasis among the markers tested. CEA did not add significant predictive information (p=0.471). CONCLUSION Preoperative serum CA19-9 and CA125 levels may provide a predictable value in determining peritoneal metastasis in patients with gastric cancer.

Radiofrequency ablation for metachronous hepatic metastases from gastric cancer.

The objective of this study was to evaluate the results of radiofrequency ablation (RFA) for the treatment of metachronous hepatic metastases from gastric adenocarcinoma. Between January 2000 and February 2008, we retrospectively reviewed 7 cases for which RFA was performed for treating metachronous hepatic metastases after resection of the primary gastric adenocarcinoma. The median period between curative gastrectomy and metachronous hepatic metastasis was 14 months (range: 6 to 48 mo). The median survival of the patients was 11.0 months (range: 5.5 to 39.2) after the first detection of hepatic metastases and 10.0 months (range: 5 to 38.2) after the first RFA. Hepatic metastases recurred 3 to 21 months after RFA in all patients. A second RFA was performed for a single recurrent hepatic metastasis in 1 patient and this patient survived more than 3 years without recurrence until the time of this study. In conclusion, the efficacy of RFA alone for metachronous hepatic metastases from gastric adenocarcinoma was disappointing due to multiple intrahepatic recurrences. Combination therapy such as systemic chemotherapy or hepatic arterial infusion chemotherapy adjuvant to RFA would more reasonable for treating hepatic metastases from gastric cancer.

Prognostic factors associated with long-term survival and recurrence in pancreatic adenocarcinoma.

BACKGROUND/AIMS It is very important to determine the prognostic factors for pancreatic adenocarcinoma when choosing surgical and conservative management strategies. In this study, we identified prognostic factors for survival and recurrence in patients with histologically proven pancreatic adenocarcinoma. METHODOLOGY Between January 2003 and December 2009, 82 patients with histologically proven pancreatic adenocarcinoma were considered for this study. Follow-up consisted of personal contact with patients or review of electronic medical records at this center and was terminated on December 31, 2011 or upon the patients death. RESULTS Overall survival rates of all patients at 1, 3, and 5 years were 51.9, 21.6 and 16.0%. Preoperative jaundice was the only independent prognostic factor for total pancreatic cancer patients, while N stage and perineural invasion in pathological findings was identified as an independent prognostic factor for survival of patients with surgical resection. Chemotherapy was the only independent prognostic factor for survival of patients who underwent palliative surgical bypass. CONCLUSIONS Preoperative jaundice in any patients, lymph node metastasis, perineural invasion in patients with surgical resection, and chemotherapy in patients undergoing palliative surgical bypass are important prognostic factors for survival of pancreatic cancer.

Impact of chronologic age in the elderly with gastric cancer

Purpose Although the incidence of gastric cancer has declined in the general population, it is the second most frequent cause of death due to malignancy in the world with its incidence in the elderly increasing as a result of increased life expectancy. This present study tried to find the optimal treatment for patients aged 75 years or older with gastric cancer through comparison of the clinicopathological characteristics, surgical outcomes, and identifying prognostic factors of survival. Methods Elderly patients who underwent gastric resection for gastric cancer from January, 1999 to February, 2009 (n = 470) were divided into two groups: very elderly patients, 75 years or older (n = 95), and younger elderly patients, between 65 and 74 years old (n = 365). Results Distinct characteristics of very elderly patients included more frequent underlying disease, deeper invasion, and more frequent lymph node metastasis. There were significant differences in overall survival between the two groups at stages III-B and IV. However, postoperative hospital stays, postoperative morbidity, mortality and early stage did not differ between curatively resected patients in the two groups. Conclusion Due to improved postoperative care, gastrectomy of gastric cancer is the treatment of choice in very elderly patients. Therefore, early diagnosis through regular medical screening and curative gastrectomy with lymph node dissection should be performed in very elderly gastric cancer patients.