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1.  Prospective randomized controlled trial (phase III) to comparing laparoscopic distal gastrectomy with open distal gastrectomy for gastric adenocarcinoma (KLASS 01) 
A randomized controlled trial to evaluate the long-term outcomes of laparoscopic distal gastrectomy for gastric cancer is currently ongoing in Korea. Patients with cT1N0M0-cT2aN0M0 (American Joint Committee on Cancer, 6th edition) distal gastric cancer were randomized to receive either laparoscopic or open distal gastrectomy. For surgical quality control, the surgeons participating in this trial had to have performed at least 50 cases each of laparoscopy-assisted distal gastrectomy and open distal gastrectomy and their institutions should have performed more than 80 cases each of both procedures each year. Fifteen surgeons from 12 institutions recruited 1,415 patients. The primary endpoint is overall survival. The secondary endpoints are disease-free survival, morbidity, mortality, quality of life, inflammatory and immune responses, and cost-effectiveness ( ID: NCT00452751).
PMCID: PMC3566471  PMID: 23396494
Gastric cancer; Laparoscopy distal gastrectomy; Open distal gastrectomy; Randomized controlled trial
2.  Robot-assisted distal gastrectomy for gastric cancer in a situs inversus totalis patient 
A 47-year-old man was referred to Seoul National University Bundang Hospital with an ulcerative lesion in the midbody of the stomach. Computed tomography revealed that he was a situs inversus totalis (SIT) patient. Robot-assisted distal gastrectomy with D1+╬▓ lymph node dissection and Billroth II anastomosis were performed. With the aid of robotic surgery, the surgeon didn't need to change his position and could perform the surgery without any confusion resulting from the patient's reversed anatomy. The operation took 300 minutes, with no intraoperative complications. The postoperative course was uneventful, and the patient was discharged on postoperative day 8. The final pathologic report was pT3N3a by American Joint Committee on Cancer 7th tumor-node-metastasis staging. We successfully performed robot-assisted distal gastrectomy for gastric cancer in a SIT patient. We believe that this is the first case of robotic surgery reported in a SIT patient with gastric cancer.
PMCID: PMC3341483  PMID: 22563541
Situs inversus totalis; Robot surgery; Gastric cancer
3.  Local tissue reaction after injection of contrast media on gastric wall of mouse: experimental study for application of contrast media to computed tomography lymphography 
Computed tomography (CT) lymphography is a simple technique of sentinel node navigation but tissue reaction after injection of contrast media has not been reported yet.
Ninety mice used in this study were divided into three groups: lipiodol, iopamidol, and normal saline. The test compounds were given by submucosal injection to the gastric wall of anesthetized mice. The specimens were subjected to histopathological examination.
The mean grades of acute inflammatory response after iopamidol and lipiodol injection were significantly higher than control group. However, there was no significant difference between iopamidol and lipiodol injection. The mean grade of chronic inflammatory response and fibrosis showed no differences between groups. The presence or absence of fibrinoid necrosis and mesothelial hyperplasia showed no statistical differences at each time point between groups. The foam cell, which is similar to human signet ring cell carcinoma, were not identified in normal saline and iopamidol group, but were detected by postoperative day 7 in lipiodol group.
We conclude that iopamidol and lipiodol when used as a contrast media of CT lymphography is an available material for preoperative sentinel node navigation surgery for gastric cancer with an acceptable incidence of pathological alterations in a mouse model. Our results are potentially useful to clinical (human) application.
PMCID: PMC3278638  PMID: 22347708
Lymphography; Sentinel node; Tissue reaction; Contrast media
4.  Status and prospect of workforce requirement for surgery in republic of Korea 
In order to prepare long-term alternatives to surgical residency training and workforce policies in Korea, objective data are needed; in addition, determination of the status of surgical procedures being performed is also needed.
Cases of surgeries performed by board-certified Korean surgeons for 1 year, from July 2009 to June 2010 were reviewed and analyzed. Variation of the last five years was also investigated against the number of surgery cases of the same item and for data on status of population, medical institutions, and surgeons.
Difficulty in distribution of a given surgery varied according to the classification of medical institution types, and performance of highly difficult surgeries occurred more in tertiary hospitals. The number of surgeries has increased over the last 5 years (28.1%). The number of surgeries among elderly patients (41.5%), high difficulty (41.8%), and tertiary hospitals (34.9%) has especially increased. There has been no increase in the number of diagnosis related group claim cases for the last 5 years (-0.8%). 43.3% of surgeons working at private clinics in Korea did not present surgery as an indicating item of their clinics.
While the demand for surgeons in high risk and highly difficult surgeries is continuously increasing, stagnation is expected in the traditional area. Considering the proportion and current status of surgeons working at private clinics, the need for a realistic reduction in the quota of surgical residents and reconsideration of personnel policies is raised.
PMCID: PMC3243852  PMID: 22200036
Quota; Resident; Surgeon
5.  Is the critical pathway effective for the treatment of gastric cancer? 
The present study was conducted to investigate the low compliance rate of the critical pathway (CP) and whether CP is effective for treatment of gastric cancer in radical gastrectomy.
The medical records of 631 patients who had undergone radical gastrectomy with D2 lymph node dissection were reviewed. This study compared data from patients in early gastric cancer (EGC) and advanced gastric cancer (AGC) groups, which were further subdivided into general care (non-CP) and CP groups.
The mean length of preoperative hospital stays were significantly different between the EGC and AGC patients (P < 0.05). However, there was no difference in the mean length of postoperative hospital stays between non-CP and CP groups among either EGC patients or AGC patients (P > 0.05). The postoperative and total cost of hospitalization was not statistically different between either of the groups (P > 0.05); however, the mean preoperative costs were significantly different (P < 0.05).
We conclude that use of the CP following gastrectomy is unnecessary. To decrease the length of hospital stay and associated costs, preoperative examination and consultation should be performed before admission.
PMCID: PMC3204573  PMID: 22066107
Critical pathways; Fast-track; Stomach neoplasms; Gastrectomy

Results 1-5 (5)