Han Mo Yoo

Negative impact of leakage on survival of patients undergoing curative resection for advanced gastric cancer.

Leakage has been shown to adversely affect survival in patients undergoing surgery for gastrointestinal malignancies. However, the effect of leakage following radical gastrectomy in patients with gastric cancer remains unclear.

Intragastric approach for submucosal tumors located near the Z-line: A hybrid laparoscopic and endoscopic technique

The present study was designed to evaluate the feasibility and impact of the “intragastric” approach to laparoscopic wedge resection as a surgical option for the treatment of suspected small sized gastric submucosal tumors (SMTs) located at the level of Z‐line.

Long-term outcomes and survival after laparoscopy-assisted distal gastrectomy for gastric cancer: three-year survival analysis of a single-center experience in Korea.

Laparoscopy‐assisted distal gastrectomy (LADG) has been established as an alternative treatment for early gastric cancer (EGC) because of excellent short‐term results. However, only a few reports have considered the long‐term outcomes of LADG. In this study, we investigated the 3‐year outcome and survival of patients who underwent LADG.

Short-term outcomes of laparoscopic versus open total gastrectomy: a matched-cohort study.

BACKGROUND This study was designed to compare short-term laparoscopic total gastrectomy (LTG) with open total gastrectomy (OTG) outcomes in gastric cancer. METHODS Seventy patients who underwent total gastrectomy via LTG or OTG were included. All cases were matched for stage, age, and sex by means of statistically generated selection of all gastrectomies performed during the same period. RESULTS Although the operation time was not longer for LTG, the time required for esophagojejunostomy was significantly longer in LTG than in OTG (43 vs 14 min, P < .05). The incidence of anastomotic complications was higher in the LTG group as well. CONCLUSIONS Postoperative complications such as anastomotic leakage and stenosis were observed more frequently in LTG. To improve the safety of esophagojejunostomy in LTG, technical innovations should be pursued.

Use of laparoscopy as an alternative to computed tomography (CT) and positron emission tomography (PET) scans for the detection of recurrence in patients with gastric cancer: a pilot study

BackgroundThis study aimed to evaluate laparoscopy as a diagnostic method for detecting recurrence in patients with advanced gastric cancer.MethodsDiagnostic laparoscopy was performed for 12 patients with insufficient evidence of intraabdominal gastric cancer recurrence by computed tomography or positron emission tomography. By comparing laparoscopic observations with conventional radiologic results, the diagnostic accuracy of laparoscopy was assessed.ResultsIn 11 (92%) of 12 cases of recurrence not diagnosed by imaging studies, laparoscopic examination confirmed the case as a recurrence. Using diagnostic laparoscopy, retroperitoneal lymph node recurrence was confirmed in two patients, peritoneal seeding nodules in five patients, and recurrent masses invading the mesocolon in two patients. Two patients had no definitive recurrence grossly but were confirmed as recurrence cases by washing cytology during the laparoscopic procedure. One patient had a duodenal stump recurrence. No patients experienced operation-related morbidity.ConclusionLaparoscopy is a safe and feasible method for detecting recurrence with acceptable accuracy. This approach provides more accurate information than conventional imaging methods.

Conditional survival analysis in Korean patients with gastric cancer undergoing curative gastrectomy.

BackgroundConditional survival (CS) measures the probability that patients will survive an additional number of years given that they have already survived for a certain period of time.MethodsIn total, 2935 gastric cancer patients who had undergone curative gastrectomy between 1995 and 2011 were enrolled. The Cox proportional hazard regression model was used to evaluate the factors associated with overall survival (OS). Three-year CS estimates at ‘t’ years after surgery were calculated as follows: CS(t) = S(t + 3)/S(t).ResultsThe 1-, 2-, 3-, 4- and 5-year OS rates of the 2935 patients were 96.6 %, 92.0 %, 88.7 %, 85.6 and 82.7 %, respectively. The probability of surviving an additional 3 years on the condition of having already survived 1, 2, 3, 4 and 5 years after surgery were 88.6 %, 89.9 %, 91.0 %, 92.2 % and 93.2 %, respectively. Patients with a higher risk at baseline showed a greater increase in CS over time.ConclusionsCS estimates provide important information about dynamic prognostic changes over time for Korean gastric cancer patients, and as such, can be used to guide long-term follow-up strategies.

Morbidity and mortality after non-curative gastrectomy for gastric cancer in elderly patients

This study examined the surgical outcome of non‐curative resection in elderly patients with gastric cancer.

Roux-en-Y gastrojejunostomy after totally laparoscopic distal gastrectomy: comparison with Billorth II reconstruction.

Purpose: The purpose of this study was to compare Roux-en-Y (R-Y) reconstruction with Billroth-II (B-II) reconstruction after a totally laparoscopic distal gastrectomy (TLDG). Methods: Eighty-one consecutive TLDG procedures were performed by a single surgeon and subsequently examined. Postoperative outcomes, clinicopathologic features, and postoperative endoscopic findings between the 2 groups were evaluated and compared. Results: The mean operation time was not significantly higher in the R-Y than in the B-II group (P=0.396). Postoperative hospital stay was longer in the R-Y than in the B-II group (P=0.037). The severities of gastritis and bile reflux were reduced significantly in the R-Y group as compared with that in the B-II group (P<0.001). There was no significant difference in the amount of residual food between the 2 groups. Conclusions: R-Y reconstruction after TLDG appears to be a safe and feasible procedure, and is associated with a reduced severity of gastritis and bile reflux in the remnant stomach.

Total laparoscopic distal gastrectomy with Roux-en Y reconstruction.

Purpose: The aim of this study was to introduce our technique and evaluate the technical efficacy of Roux-en Y (RY) reconstruction after total laparoscopic distal gastrectomy (TLDG). Methods: We performed TLDG using our own method of RY-type anastomosis in a total of 38 consecutive patients with gastric adenocarcinomas and evaluated the techniques and postoperative outcomes. Results: The mean operative time was 144.5±22.4 minutes, including reconstruction time, which was 26.2±3.5 minutes. Most patients were of pathologic stage IA (76.3%) or IB (10.5%), 3 patients were of stage II, and 2 were of stage IIIA. The length of postoperative hospital stay was 8.3±3.3 days (range, 5 to 20 d). Two cases required reoperation because of internal herniation. According to our endoscopic observation, bile reflux into the gastric remnant stump was not found. Conclusions: TLDG with RY reconstruction is technically feasible in gastric cancer patients.

Gastric Malignant Peripheral Nerve Sheath Tumor A Case Report

Gastric malignant peripheral nerve sheath tumors (MPNSTs) are sarcomas arising within a peripheral nerve. Gastric MPNSTs are extremely rare with only a few cases. We herein describe the case of a 48-year-old man with a gastric MPNST for the first time in Korea, which was diagnosed histopathologically after surgery. The patient underwent curative subtotal gastrectomy with D1+ lymph node dissection and Billroth-II reconstruction. The postoperative recovery was uneventful, and he has had no recurrence until now. The ideal adjuvant treatment protocol is yet to be decided due to the relatively limited number of cases of these tumors previously reported.