Chong Suk Kim

Surgical Outcomes for Gastric Cancer in the Upper Third of the Stomach

IntroductionThe proportion of gastric cancers affecting the upper third of the stomach has been increasing. At our surgical service we perform total and proximal gastrectomy for this condition. The purpose of this study was to investigate the surgical outcome of the two operative procedures and determine an optimal surgical approach.MethodsData from 147 patients who underwent resection for gastric cancer affecting the proximal one-third of the stomach were retrospectively analyzed. The patients were classified into a total gastrectomy (TG) group or a proximal gastrectomy (PG) group, and the clinicopathologic characteristics and surgical results were compared. We analyzed survival rates using Kaplan-Meier methods and made comparisons using a log-rank test across the same stage of the gastric cancer.ResultsFrom 1992 to 2000, a total of 104 total gastrectomies and 43 proximal gastrectomies for gastric cancer affecting the upper one-third of the stomach were performed. Our investigation revealed significantly different clinicopathologic characteristics in Borrmann type, length of the resection margin, degree of lymph node dissection, and lymph node stage. During the procedure, a combined resection of other organs was performed in 30 TG and 27 PG patients. Postoperative complications developed in 15 TG and 22 PG patients. The cancer recurrence rate was 4.8% for the TG group and 39.5% for the PG group; it was highest when the length of the proximal resection margin was < 1 cm. When we compared 5-year survival rates between the two groups, each at the same cancer stage, a significant difference was noted for stage III and IV gastric cancers.ConclusionsProximal gastrectomy may be performed during the early stage of proximal gastric cancer; but because of the high frequency of complications and cancer recurrence, an additional procedure should be expected afterward. When the cancer stage is advanced, total gastrectomy should be performed with sufficient length of the proximal resection margin.

Expression of estrogen receptors in gastric cancer and their clinical significance.

The male predominance of gastric cancer suggests that female sex hormones may have a protective effect against gastric cancer. We evaluated the expression of estrogen receptors in gastric cancer tissue and cells and the clinical significance of ER‐β expression in gastric cancer.

Gastric cancer histology: clinicopathologic characteristics and prognostic value.

Gastric cancer can be divided into two major histologic categories, that is, differentiated and undifferentiated types. In the present study, we sought to clarify the prognoses and clinicopathologic characteristics of signet ring cell carcinoma and mucinous carcinoma, both of which are mucin‐producing tumors of the undifferentiated type.

Incidence and Long-term Outcome of Young Patients With Gastric Carcinoma According to Sex Does Hormonal Status Affect Prognosis?

BACKGROUND We investigated the clinicopathological features and evaluated the prognostic impact of age and sex on patients with gastric cancer. DESIGN Retrospective study from 1993 to 2000. SETTING Korea University Medical Center. PATIENTS A total of 1299 patients with gastric cancer were divided into young (n = 175 [13.5%]) and older (n = 1124 [86.5%]) groups with an age cutoff of 40 years. MAIN OUTCOME MEASURES Clinicopathological characteristics were investigated and survival analysis was performed according to sex for each age group. RESULTS Tumor differentiation was significantly different between the 2 age groups. Among male patients, the young group had more undifferentiated tumors than the older group (P < .001) but, in female patients, both differentiation (P < .001) and operative methods (P = .008) were significantly different between the young and older groups. In male patients, the 10-year survival rate of the young group was higher (62.5%) than that of the older group (44.6%) (P = .03). Although it was not statistically significant, the survival rate of the older female group was higher than that of the young group (56.2% vs 51.9%). On multivariate analysis, tumor stage (P < .001) and sex (P = .042) were proved to be independent prognostic factors. CONCLUSIONS Only tumor differentiation was an important difference between the 2 age groups, and prognosis was not affected by age. However, when sex was added to age as a factor, the older male and young female groups had an unfavorable prognosis. Therefore, we propose that sex hormones such as estrogens contribute to the survival differences, and further studies are needed to confirm this possibility.

Clinical Significance of Immunohistochemically-Identified Lymphatic and/or Blood Vessel Tumor Invasion in Gastric Cancer

BACKGROUND Tumor invasion and lymph node metastasis are significant prognostic factors for gastric cancer, and lymphatic and vascular tumor invasion are also significant risk factors for gastric cancer recurrence. Recently, the immunohistochemical detection of lymphatic and blood vessel tumor invasion (LBVI) has been shown to have a higher sensitivity and specificity than hematoxylin-eosin staining methods. MATERIALS AND METHODS One hundred forty-nine gastric cancer patients who underwent curative resection at Korea University Hospital between November 2003 and December 2006 served as the study subjects. Lymphatic vessel invasion was evaluated by immunostaining with the new selective marker, D2-40, and blood vessel invasion was assessed with anti-CD31 antibody. Patients were divided according to the presence of LBVI, clinicopathologic factors were compared, and postoperative surgical outcomes were analyzed. RESULTS LBVI was present in 66 patients (44.3%). LBVI was significantly correlated with depth of tumor invasion (P < 0.001), lymph node stage (P < 0.001), and lymph node micrometastasis (P = 0.013). Cancer recurrence was more common in the LBVI group (P = 0.007), and peritoneal seeding was the most prevalent type of recurrence (P = 0.028). Univariate analysis showed tumor size, depth of tumor invasion, lymph node stage, and LBVI to have a significant impact on survival. Based on multivariate analysis, however, depth of tumor invasion and lymph node stage were correlated with survival. CONCLUSION Immunohistochemical demonstration of LBVI is an additional prognostic marker, and provides useful information for planning treatment strategies in gastric cancer patients.

Expression of Liver–Intestine Cadherin and Its Correlation with Lymph Node Metastasis in Gastric Cancer: Can It Predict N Stage Preoperatively?

BackgroundReliable method to predict lymph node metastasis is not yet available. In the present study, therefore, we examined LI-cadherin expression in human gastric cancer and attempted to find its relationship with clinicopathologic data, especially with lymph node metastasis. We also analyzed the expression in preoperative biopsy specimen to uncover its possibility of prognostication for lymph node metastasis.MethodsThe paired preoperative endoscopic biopsy and postoperative resected specimens from 208 patients who had surgically been treated for gastric cancer were retrospectively analyzed immunohistochemically for expression of LI-cadherin.ResultsThere were 47 (22.6%) and 161 (77.4%) tumors which had positive and negative LI-cadherin expression, respectively. LI-cadherin expression was significantly correlated with tumor histology and lymph node metastasis: Furthermore, reduced expression of LI-cadherin was closely associated with tumor progression and lymph node metastasis in human gastric carcinoma. LI-cadherin expressions in both resected tumor and preoperative endoscopic tissues were found to be independent factors associated with lymph node metastasis.ConclusionsThere is a close association between reduced expression of LI-cadherin and lymph node metastasis in human gastric cancer. Immunohistochemical study of LI-cadherin is relatively simple compared to sentinel node navigation surgery, and it could be a practical prediction method for lymph node metastasis in patients with this malignancy.

Advanced Gastric Cancer in the Middle One-third of the Stomach: Should Surgenos Perform Total Gastrectomy?

To determine which optimal surgical procedure for middle‐third advanced gastric cancer (AGC) based on comparative study of the long‐term prognosis between total gastrectomy (TG) and distal gastrectomy (DG).

Surgical outcomes and prognostic factors for T4 gastric cancers.

PURPOSE In locally advanced gastric carcinomas that have invaded adjacent organs, the prognosis is poor. When combined resections are performed in T4 gastric cancers, a high morbidity rate is reported and it is inconclusive as to whether or not there is an improvement in the survival rate. We investigated surgical outcomes and analysed the prognostic factors for T4 gastric cancers. PATIENTS AND METHODS Between January 1992 and December 2000, 132 patients underwent surgery for T4 gastric cancer; they were divided into three groups: combined resections in group I, gastrectomy alone in group II, and resections not performed but palliative gastrojejunostomy or intraperitoneal chemotherapy in group III. Surgical outcomes and clinicopathologic factors were compared and prognostic factors were evaluated. RESULTS Among the three groups, statistically significantly different factors were tumour location, Borrmann type, tumour size, distant metastasis and peritoneal metastasis. The most commonly resected organ was the transverse colon, and 14 post-operative morbidities developed. In the multivariate analysis, the treatment group and curability were proved to be independent prognostic factors. CONCLUSION In patients with T4 gastric carcinoma, an aggressive surgical approach can be beneficial when curative resection is performed. If curative resection is not possible, palliative resection can be performed for a better quality of life.

Clinical Outcomes of Gastrectomy after Incomplete EMR/ESD

Purpose Endoscopic resection is widely accepted as standard treatment for early gastric cancer (EGC) without lymph node metastasis. The procedure is minimally invasive, safe, and convenient. However, surgery is sometimes needed after endoscopic mucosal resection/endoscopic submucosal dissection endoscopic mucosal resection (EMR)/endoscopic submucosal dissection (ESD) due to perforation, bleeding, or incomplete resection. We evaluated the role of surgery after incomplete resection. Materials and Methods We retrospectively studied 29 patients with gastric cancer who underwent a gastrectomy after incomplete EMR/ESD from 2006 to 2010 at Korea University Hospital. Results There were 13 incomplete resection cases, seven bleeding cases, three metachronous lesion cases, three recurrence cases, two perforation cases, and one lymphatic invasion case. Among the incomplete resection cases, a positive vertical margin was found in 10, a positive lateral margin in two, and a positive vertical and lateral margin in one case. Most cases (9/13) were diagnosed as mucosal tumors by endoscopic ultrasonography, but only three cases were confirmed as mucosal tumors on final pathology. The positive residual tumor rate was two of 13. The lymph node metastasis rate was three of 13. All lymph node metastasis cases were submucosal tumors with positive lymphatic invasion and no residual tumor in the gastrectomy specimen. No cases of recurrence were observed after curative resection. Conclusions A gastrectomy is required for patients with incomplete resection following EMR/ESD due to the risk of residual tumor and lymph node metastasis.

Primary Squamous Cell Carcinoma of the Stomach That Developed with Menetrier's Disease

Primary squamous cell carcinoma (SCC) of the stomach is an exceedingly rare disease [1]. The pathogenesis of this neoplasm remains rather obscure, and its etiology and the prognosis are controversial. Gastric cancer, mainly adenocarcinoma, occasionally arises from Menetrier’s disease, and this has generally been described as hypertrophic gastropathy [2]. To the best of our knowledge, we report here on the first case of primary gastric SCC associated with Menetrier’s disease.