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1.  Prognosis of early mucinous gastric carcinoma 
Purpose
Little is known about the clinicopathological features of early mucinous gastric carcinoma (MGC). The purpose of this study was to compare the clinicopathological features and prognosis between patients with early MGC and those with early nonmucinous gastric carcinoma (NMGC).
Methods
We reviewed the records of 2,732 patients diagnosed with gastric carcinoma who were treated surgically. There were 14 patients (0.5%) with early MGC and 958 with early NMGC.
Results
Early MGC patients had a higher prevalence of elevated type (71.4%) compared with early NMGC patients (29.5%). More early MGC patients had submucosal carcinoma, compared with early NMGC patients (78.6% vs. 64.1%). The overall 5-year survival of the patients with early MGC was 97.2% as compared with 92.7% for the patients with early NMGC (P < 0.01). The statistically significant prognostic parameters influencing the 5-year survival rate according to Cox's proportional hazard regression model were: age (risk ratio, 2.22; 95% confidence interval [CI], 1.62-3.04; P < 0.01); sex (risk ratio, 1.97; 95% CI, 1.42-2.73; P < 0.01); and lymph node metastases (risk ratio, 1.88; 95% CI, 1.28-2.77; P < 0.01).
Conclusion
Patients with early MGC had a better prognosis than those with early NMGC. Mucinous histology itself appears not to be an independent prognostic factor. Therefore, early detection is important for improving the prognosis for patients with gastric carcinoma regardless of tumor histology.
doi:10.4174/astr.2014.87.1.5
PMCID: PMC4091442  PMID: 25025020
Gastric neoplasm; Mucinous; Prognosis; Tumor histology
2.  Is Laparoscopy-assisted Radical Gastrectomy Safe in Patients with Child-Pugh Class A Cirrhosis? 
Journal of Gastric Cancer  2013;13(4):207-213.
Purpose
We investigated early postoperative morbidity and mortality in patients with liver cirrhosis who had undergone radical gastrectomy for gastric cancer.
Materials and Methods
We retrospectively reviewed the medical records of 41 patients who underwent radical gastrectomy at the Chonnam National University Hwasun Hospital (Hwasun-gun, Korea) between August 2004 and June 2009. There were few patients with Child-Pugh class B or C; therefore, we restricted patient selection to those with Child-Pugh class A.
Results
Postoperative complications were observed in 22 (53.7%) patients. The most common complications were ascites (46.3%), postoperative hemorrhage (22.0%) and wound infection (12.2%). Intra-abdominal abscess developed in one (2.4%) patient who had undergone open gastrectomy. Massive ascites occurred in 4 (9.8%) patients. Of the patients who underwent open gastrectomy, nine (21.9%) patients required blood transfusions as a result of postoperative hemorrhage. However, most of these patients had advanced gastric cancer. In contrast, most patients who underwent laparoscopic gastrectomy had early stage gastric cancer, and when the confounding effect from the different stages between the two groups was corrected statistically, no statistically significant difference was found. There was also no significant difference between open and laparoscopic gastrectomy in the occurrence rate of other postoperative complications such as ascites, wound infection, and intra-abdominal abscess. No postoperative mortality occurred.
Conclusions
Laparoscopic gastrectomy is a feasible surgical procedure for patients with moderate hepatic dysfunction.
doi:10.5230/jgc.2013.13.4.207
PMCID: PMC3915182  PMID: 24511416
Stomach neoplasms; Liver cirrhosis; Gastrectomy
3.  Preoperative predictors of malignant gastric submucosal tumor 
Purpose
The preoperative prediction of malignant potential in patients with gastric submucosal tumors (SMTs) plays an important role in decisions regarding their surgical management.
Methods
We evaluated the predictors of malignant gastric SMTs in 314 patients with gastric SMTs who underwent surgery in Chonnam National University Hospital.
Results
The malignant SMTs were significantly associated with age (odds ratio [OR], 1.067; 95% confidence interval [CI], 1.042 to 1.091; P < 0.0001), presence of central ulceration (OR, 2.690; 95% CI, 1.224 to 5.909; P = 0.014), and tumor size (OR, 1.791; 95% CI, 1.483 to 2.164; P < 0.0001). Receiver operating characteristic curve analysis showed that tumor size was a good predictor of malignant potential. The most relevant predictor of malignant gastric SMT was tumor size with cut-offs of 4.05 and 6.40 cm.
Conclusion
Our findings indicated that age, central ulceration, and tumor size were significant preoperative predictors of malignant SMTs. We suggest that 4 cm be selected as a threshold value for malignant gastric SMTs. In patients with a gastric SMT larger than 4 cm with ulceration, wide resection of the full thickness of the gastric wall or gastrectomy with adequate margins should be performed because of its malignant potential.
doi:10.4174/jkss.2012.83.2.83
PMCID: PMC3412188  PMID: 22880181
Stomach neoplasms; Submucosal tumor; Malignant factor; Preoperative predictor
4.  Clinicopathological Features of Female Gastric Carcinoma Patients with Curative Resection: Comparison with Male Patients 
Chonnam Medical Journal  2012;48(2):86-90.
Little is known about the clinicopathological features of female gastric carcinoma (FGC) patients. We compared the clinicopathologic features and outcomes of FGC patients with curative resection with those of male gastric carcinoma (MGC) patients. We reviewed the hospital records of 940 FGC patients between 1986 and 2005 at Chonnam National University Hospital. Multivariate analysis showed that presence of serosal invasion, lymph node metastasis, and operative type were significant prognostic factors for survival of FGC patients with curative resection. Furthermore, the overall 5-year survival rate of FGC patients with curative resection (53.4%) was higher than that of MGC patients (47.6%, p<0.05). In advanced cases, no significant difference was observed in the overall 5-year survival rate between the FGC and MGC patients (41.6% vs 37.4%, p>0.05). Therefore, serosal invasion, lymph node metastasis, and type of operation were statistically significant parameters associated with survival. Early detection is more important for improving the prognosis of female patients with gastric cancer than for male patients.
doi:10.4068/cmj.2012.48.2.86
PMCID: PMC3434796  PMID: 22977748
Female gastric carcinoma; Prognosis; Early detection of cancer
5.  The Influence of Nutritional Assessment on the Outcome of Ostomy Takedown 
Purpose
Ostomy takedown is often considered a simple procedure without intention; however, it is associated with significant morbidity. This study is designed to evaluate factors predicting postoperative complications in the ostomy takedown in view of metabolism and nutrition.
Methods
A retrospective, institutional review-board-approved study was performed to identify all patients undergoing takedown of an ostomy from 2004 to 2010.
Results
Of all patients (150), 48 patients (32%; male, 31; female, 17) had complications. Takedown of an end-type ostomy showed a high complication rate; complications occurred in 55.9% of end-type ostomies and 15.7% of loop ostomies (P < 0.001). Severe adhesion was also related to a high rate of overall complication (41.3%) (P = 0.024). In preoperative work-up, ostomy type was not significantly associated with malnutrition status. However, postoperatively severe malnutrition level (albumin <2.8 mg/dL) was statistically significant in increasing the risk of complications (72.7%, P = 0.015). In particular, a significant postoperative decrease in albumin (>1.3 mg/dL) was associated with postoperative complications, particularly surgical site infection (SSI). Marked weight loss such as body mass index downgrading may be associated with the development of complications.
Conclusion
A temporary ostomy may not essentially result in severe malnutrition. However, a postoperative significant decrease in the albumin concentration is an independent risk factor for the development of SSI and complications.
doi:10.3393/jksc.2012.28.3.145
PMCID: PMC3398110  PMID: 22816058
Ostomy takedown; Malnutrition; Albumins; Surgical site infection; Complication
6.  Multivisceral resection for locally advanced rectal cancer: adequate length of distal resection margin 
Purpose
Locally advanced rectal cancer may require an intraoperative decision regarding curative multivisceral resection (MVR) of adjacent organs. In bulky tumor cases, ensuring sufficient distal resection margin (DRM) for achievement of oncologic safety is very difficult. This study is designed to evaluate the adequate length of DRM in multiviscerally resected rectal cancer.
Methods
A total of 324 patients who underwent curative low anterior resection for primary pT3-4 rectal cancer between 1995 and 2004 were identified from a prospectively collected colorectal database.
Results
Short lengths of DRM (≤1 cm) did not compromise essentially poor oncologic outcomes in locally advanced rectal cancer (P = 0.736). However, especially in rectal cancers invading adjacent organs, DRM of less than 2 cm showed poor survival outcome. In 5-year and 10-year survival analysis of MVR, a shorter DRM (<2 cm) showed 41.9% and 30.5%, although a longer DRM (≥2 cm) showed 72.4% and 60.2% (P = 0.03, 0.044). In multivariate analysis of MVR, poorly differentiated histology, ulceroinfiltrative growth of tumor, and short DRM (<2 cm) were significant factors for prediction of poor survival outcome, although short DRM was not significantly related to local and systemic recurrence.
Conclusion
In locally advanced rectal cancer of pT3-4, a short length of DRM (≤1 cm) did not compromise essentially poor oncologic outcome. In rectal cancers invading adjacent organs and requiring MVR, a shorter DRM (<2 cm) was found to be related to poor survival outcome.
doi:10.4174/jkss.2012.82.2.87
PMCID: PMC3278640  PMID: 22347710
Multivisceral resection; Distal resection margin; Locally advanced rectal cancer
7.  Recurring gastrointestinal stromal tumor with splenic metastasis 
Journal of the Korean Surgical Society  2011;81(Suppl 1):S25-S29.
Malignant gastrointestinal stromal tumors (GISTs) are rare non-epithelial, mesenchymal neoplasms of the gastrointestinal tract that metastasize or recur in 30% of patients who undergo surgical resection with curative intent. A 59-year-old man visited our hospital for an examination of a palpable mass in the left abdomen. Fourteen months prior to his visit, the patient underwent gastric wedge resection to remove a GIST of the gastric cardia. At the time of surgery, no evidence of metastatic disease was observed and the pathological interpretation was a high-risk GIST. A follow-up computed tomography scan of the abdomen revealed a partially necrotic solid mass (9.8 × 7.6 cm) and enhancing mass in the spleen (2.3 cm). On exploration, multiple masses were found in the liver, greater omentum, and mesentery. Here, we report a case of recurring GIST of the stomach that metastasized to the spleen. To the best of our knowledge, few reports of metastasis to the spleen exist.
doi:10.4174/jkss.2011.81.Suppl1.S25
PMCID: PMC3267060  PMID: 22319733
Gastrointestinal stromal tumors; Neoplasm metastasis; Spleen
8.  Clinicopathologic characteristics of serosa-positive gastric carcinoma in elderly patients 
Purpose
The relationship between the prognosis and the age of patients with gastric carcinoma is controversial. This study examined the clinicopathologic features of elderly gastric carcinoma patients with serosal invasion.
Methods
We reviewed the hospital records of 136 elderly gastric carcinoma patients with serosal invasion retrospectively to compare the clinicopathologic findings in the elderly (aged > 70 years) and young (aged < 36 years).
Results
The 5-year survival rates of elderly and young patients with curative resection did not differ statistically (33.9% vs. 43.3%; P = 0.318). Multivariate analysis showed that two factors were independent, statistically significant parameters associated with survival: histologic type (risk ratio, 1.805; 95% confidence interval [CI], 1.041 to 3.132; P < 0.05) and operative curability (risk ratio, 2.506; 95% CI, 1.371 to 4.581; P < 0.01).
Conclusion
This study demonstrated that elderly gastric carcinoma patients with serosal invasion do not have a worse prognosis than young patients. The important prognostic factor was whether the patients underwent curative resection.
doi:10.4174/jkss.2011.81.1.19
PMCID: PMC3204556  PMID: 22066096
Gastric carcinoma; Serosal invasion; Elderly; Prognosis; Age

Results 1-8 (8)