The pattern of postoperative quality of life following minimally invasive gastrectomy for gastric cancer: a prospective cohort from Korean multicenter robotic gastrectomy trial

Purpose@#Quality of life (QOL) has become important in the trend of emphasizing patient satisfaction. This study aimed to evaluate the QOL in patients who underwent laparoscopic or robotic gastrectomy for gastric cancer. @*Methods@#A prospective trial was performed involving patients who underwent laparoscopic or robotic gastrectomy for primary gastric cancer at 11 hospitals in Korea. Within this comparative trial, QOL, postoperative pain, and long-term complications were exanimated. The quality-of-life questionnaire (QLQ)-C30 and QLQ-STO22 developed by the European Organization for Research and Treatment of Cancer were used for the QOL survey. We compared the data after dividing it into several types of characteristics as follows; device (robotic or laparoscopic), operation type, pathological stage, and sex.Biased components were extracted by logistic regression analysis. Propensity score matching was applied to the data set with the biased components. @*Results@#In total, 434 patients (211 for laparoscopic surgery and 223 for robotic surgery) were enrolled, out of which 321 patients who responded to both preoperative and postoperative surveys were selected for analysis. Robotic gastrectomy was not different from laparoscopic gastrectomy with respect to postoperative QOL. Distal gastrectomy showed better scores than total gastrectomy in terms of role functioning, social functioning, fatigue, nausea/vomiting, pain, dyspnea, constipation, financial difficulties, dysphagia, eating restrictions, anxiety, taste, and body image. Male patients showed better scores on the 19 scales compared to female patients. @*Conclusion@#Robotic and laparoscopic approaches for gastric cancer surgery did not differ from each other with respect to QOL. Distal gastrectomy resulted in better QOL than total gastrectomy.

The effect of long Roux-en-Y gastrojejunostomy in gastric cancer patients with type 2 diabetes and body mass index < 35 kg/m2: preliminary results

PURPOSE: We applied a long Roux-en-Y (RY) gastrojejunostomy (bypassed jejunum over 100 cm) as a reconstruction method for diabetes control to gastric cancer patients with type 2 diabetes and body mass index (BMI) < 35 kg/m2. The effect of this procedure on diabetes control was assessed. METHODS: We prospectively performed modified RY gastrojejunostmy after curative radical distal gastrectomy. Thirty patients had completed a 1-year follow-up. Patients were followed concerning their diabetic status. The factors included in the investigation were length of bypassed jejunum, BMI and its reduction ratio, glycated hemoglobin (HbA1c), fasting blood glucose, and duration of diabetes. Diabetic status after surgery was assessed in three categories: remission, improvement, and stationary. In evaluation of surgical effects on diabetes control, remission and improvement groups were regarded as effective groups, while stationary was regarded as an ineffective group. RESULTS: At postoperative one year, statistical significance was observed in the mean BMI and HbA1c. Diabetes control was achieved in 50% of the patients (remission, 30%; improvement, 20%). BMI reduction ratio, preoperative HbA1c, and duration of diabetes were correlated to the status of type 2 diabetes mellitus. The preoperative HbA1c was the most influential predictor in diabetic control. CONCLUSION: The effect of long RY gastrojejunostomy after gastrectomy for diabetes control could be contentious but an applicable reconstruction method for diabetes control in gastric cancer patients with type 2 diabetes and BMI < 35 kg/m2. Diabetes remission is expected to be higher in patients with greater BMI reduction, short duration of diabetes, and lower preoperative HbA1c.

Imaging Findings of Angiomyxolipoma of the Spermatic Cord Mimicking Inguinal Hernia

We report the case in a 72-year-old man who presented with a right inguinal mass and with a one month history that was initially interpreted as an inguinal hernia. Ultrasonography (US) and computed tomography (CT) demonstrated a right inguinal mass, including myxoid and fat component, extending from the right spermatic cord to the right inguinal subcutaneous layer. Mass excision was performed, and the diagnosis turned out to be angiomyxolipoma. Angiomyxolipoma is a rare tumor and the preoperative diagnosis of this disease is very difficult. However, angiomyxolipoma of the spermatic cord should be considered in the differential diagnosis in patients with an irreducible inguinal mass. Imaging diagnosis, such as US and CT may help to make a preoperative diagnosis.

Laparoscopy Assisted versus Open Distal Gastrectomy with D2 Lymph Node Dissection for Advanced Gastric Cancer: Design and Rationale of a Phase II Randomized Controlled Multicenter Trial (COACT 1001)

PURPOSE: Laparoscopy-assisted distal gastrectomy for early gastric cancer has gained acceptance and popularity worldwide. However, laparoscopy-assisted distal gastrectomy for advanced gastric cancer is still controversial. Therefore, we propose this prospective randomized controlled multi-center trial in order to evaluate the safety and feasibility of laparoscopy assisted D2-gastrectomy for advanced stage gastric cancer. MATERIALS AND METHODS: Patients undergoing distal gastrectomy for advanced gastric cancer staged cT2/3/4 cN0/1/2/3a cM0 by endoscopy and computed tomography are eligible for enrollment after giving their informed consent. Patients will be randomized either to laparoscopy-assisted distal gastrectomy or open distal gastrectomy. Sample size calculation revealed that 102 patients are to be included per treatment arm. The primary endpoint is the non-compliance rate of D2 dissection; relevant secondary endpoints are three-year disease free survival, surgical and postoperative complications, hospital stay and unanimity rate of D2 dissection evaluated by reviewing the intraoperative video documentation. DISCUSSION: Oncologic safety is the major concern regarding laparoscopy-assisted distal gastrectomy for advanced gastric cancer. Therefore, the non-compliance rate of clearing the N2 area was chosen as the most important parameter for the technical feasibility of the laparoscopic procedure. Furthermore, surgical quality will be carefully reviewed, that is, three independent experts will review the video records and score with a check list. For a long-term result, disease free survival is considered a secondary endpoint for this trial. This study will offer promising evidence of the feasibility and safety of Laparoscopy-assisted distal gastrectomy for advanced gastric cancer.Trial Registration: NCT01088204 (international), NCCCTS-09-448 (Korea).

Laparoscopic total extraperitoneal repair of lumbar hernia / 대한외과학회지

Lumbar hernia is a rare surgical entity without a standard method of repair. With advancements in laparoscopic techniques, successful lumbar herniorrhaphy can be achieved by the creation of a completely extraperitoneal working space and secure fixation of a wide posterior mesh. We present a total extraperitoneal laparoendoscopic repair of lumbar hernia, which allowed for minimal invasiveness while providing excellent anatomical identification, easy mobilization of contents and wide secure mesh fixation. A total extraperitoneal method of lumbar hernia repair by laparoscopic approach is feasible and may be an ideal option.

The Significance of Metastatic Lymph Node Ratio in the Survival Rate of pT2 Gastric Cancer

PURPOSE: The number of resected lymph nodes can influence the current N staging. This study examined the significance of the metastatic lymph node ratio on the survival of patients with pT2 gastric cancer. METHODS: The records of 176 patients who had undergone curative gastrectomy and diagnosed with pT2 gastric cancer by pathology, between February 1990 and October 2002 were retrospectively reviewed. Those patients with other organ metastases or those who had undergone a dissection of less than 15 lymph nodes were excluded. The clinicopathologic prognostic variables were evaluated using the SPSS statistical program. RESULTS: There were 115 men and 61 women with a mean age of 59 years. The median survival period was 93 months (2~184 months). Metastatic lymph nodes were found in 100 cases (56.8%), a mean of 34.6 lymph nodes were dissected, a mean of 3.2 lymph nodes metastasized, and a mean metastatic lymph node ratio of 0.09 was found. According to the UICC TNM classification, the number of stage IB (N0) cases was 76 (43.2%), stage II (N1) was 74 (42.0%), stage IIIA (N2) was 18 (10.2%), and stage IV (N3) was 8 (4.5%). The overall 5-year survival rate was 75.2%. According to the UICC TNM classification, the 5-year survival rate was stage IB, II, IIIA, and IV was 88.6%, 74.3%, 39.5%, and 33.3%, respectively. The metastatic lymph node ratio (nR) was divided into 4 categories; nR0 (76) = 0, 0

Expression of the Peroxisome-proliferator-activated Receptor-gamma in Human Gastric Cancer

PURPOSE: Recently, interest in peroxisome-proliferator-activated receptors (PPAR) has increased, although clinical studies of the effect of PPAR-gamma expression on gastric cancer have not been reported yet. In this study, we investigated the role of PPAR-gamma expression in gastric cancer patients. MATERIALS AND METHODS: One hundred twenty-eight (128) samples of both gastric cancer and normal tissues were obtained from 128 patients who had undergone at a curative gastrectomy at Seoul Medical Center from Jan. 2001 to Dec. 2005. PPAR-gamma expression was determined by using immunohistochemical staining, and the results were analyzed. The statistical analysis was based on clinicopathological findings and the differences in survival rates. RESULTS: The mean age of the patients was 61, and the male:female ratio was 1.9:1. PPAR-gamma expression was significantly higher in cancer tissues than in normal tissue (81.3% vs. 57.0%, P<0.001). There was insignificant difference between well and moderately differentiated types and poorly differentiated types in terms of the expression of PPAR-gamma (87.0% vs. 74.6%, P=0.074). In the univariate analysis the survival rate was significantly increased when PPAR-gamma was expressed in normal tissue (P=0.003). In the multivariate analysis, only the UICC TNM staging had significance related to the survival rate. CONCLUSION: The rate of PPAR-gamma expression was higher in cancer tissue than it was in normal tissue from gastric cancer patients. In the univariate analysis, PPAR-gamma expression in normal tissue had significance with respect to survival, but the multivariate analysis showed no such significance. Thus, we should further evaluate more cases to determine whether or not such a significance exists.

Comparison of Nodal Staging, of UICC TNM and Japanese Classification, and Prognostic Nodal Grouping of UICC N3M0 in Advanced Gastric Cancer

PURPOSE: We analyzed cases of advanced gastric cancer (AGC) by using two nodal stagings, UICC and Japanese systems. We also analyzed cases of UICC N3M0 by different ways to see which nodal system or group had better prognostic power. MATERIALS AND METHODS: From Feb.1990 to May 2000, 197 UICC M0 patients of AGC who had undergone curative resection were analyzed by using the nodal stagings of the UICC and the Japanese systems. Also, 58 patients with UICC N3M0 gastric cancer were analyzed by using the Japanese n-staging, metastatic ratio and the metastatic number. RESULTS: The 5-year survival rates were 62.9%, 33.0% and 21.2% for UICC N1, N2 and N3, and 61.2% and 25.3% for Japanese n1 and n2, respectively in patients of N3M0 AGC, the 5-year survival rates were 62.5% for Japanese n1, and 33.0% and 22.9% for metastatic ratios of less than 0.5 and metastatic numbers below 26, respectively significantly better than the 5-year survival rates for higher ratios and numbers (P=0.018, 0.021). CONCLUSION: UICC N staging of gastric cancer has better prognostic power with differentiation between stages than Japanese n staging. In patients with UICC N3M0 gastric cancer, the metastatic ratio and the metastatic number, as well as the Japanese n staging, were valuable prognostic factors.

Clinicopathologic Features and Clinical Significance of Small and Diminutive Colorectal Polyps

PURPOSE: Small (6 to 10 mm) and diminutive colon polyps (below 5 mm) are routinely removed at the time of colonoscopy for the prevention of colon cancer. Our aims in this study were to determine clinicopathologic features and frequency of significant synchronous neoplastic lesions of small colon polyps and diminutive colon polyps and to investigate development of colorectal carcinoma via surveillance colonoscopy. METHODS: We evaluated medical reports of all patients undergoing total colonoscopic examination over a 12-month period. Three hundred thirty nine small colorectal polyps, removed during colonoscopy, have been analyzed. We investigated the result of surveillance colonoscopy, also. Using this database, all adenomas were categorized into two groups: Group I, < or =5 mm diameter (diminutive polyp), Group 2, 6 to 10 mm diameter (small polyp). Significant synchronous adenomas were defined as adenoma over 6 mm diameter, dysplasia or cancer. RESULTS: The most common age group was the sixth decade. The male-to-female ratio was 2.1 : 1. Of the small colorectal polyps, 180 (53.1%) were adenomatous, 32 (10.0%) were hyperplastic, 119 (34.9%) were chronic nonspecific inflammation, 3 (0.9 %) were lymphoid hyperplasia, and 4 (1.1%) were cancerous. The most frequent sites of these lesions were rectum and sigmoid (60.2%). Recognizable endoscopic features of polyps were redness (35.8%) and nodule (26.3%). The prevalence of advanced proximal synchronous polyps was 20.7% among patients with distal small lesions. And we detected 2 cases (25%) had new small polyps in follow up colonoscopic examination. CONCLUSIONS: All polyps should be removed when encountered during colonoscopy due to the higher prevalence of adenoma among these lesions. Effort to find new polyps via surveillance colonoscopy is needed.

A Case of Retroperitoneal Schwannoma of the Vagus Nerve / 대한소화기학회지

Schwannomas are benign nerve sheath tumors that originate from any anatomical site. Most schwannomas occur in the head, neck or limbs, but rarely occur in the retroperitoneal space. Furthermore, the schwannoma originating from the vagus nerve of retroperitoneal space is much rare. We experienced a case of retroperitoneal schwannoma of the vagus nerve. A 34-year-old male was refered to our hospital for the evaluation of abdominal mass on ultrasonography. Endoscopic examination revealed submucosal tumor-like lesion on high body of the stomach. Computed tomography (CT) revealed that the stomach was compressed by a solid tumor in the retroperitoneum. On exploratory laparotomy, this mass turned out to be a baseball sized mass in the retroperitoneal space. The mass was excised in an encapsulated state. Histological examination with immunohistochemical stains revealed a schwannoma of the vagus nerve.

Abdominal Distension

No abstract available.

A clinical review on the cancer of the colon and rectum

No abstract available.

Serious Decompression Sickness among Korean Diving Fisherman: An Analysis of 37 Cases / 대한산업의학회지

Hospital records were reviewed for 486 divers who have been diagnosed as decompression sickness(DCS) at Kangnam General Hospital between December 1986 and November 1988. Among 39 cases classified as serious DCS(type II), the patients had been fishery diving in 97.4% of the cases. The ages of the afflicted divers ranged from 22 to 47 years, with a mean of 31.5% years. The divers were experienced being less than one year in 21.6% and 70% of them learned diving skill by self-taught. In 86.5% of the cases the divers had made multiple divies ranged in depth from 31 to 50 meters. Thirty-one(83.7%) of the patients noted their first symptoms within 30 minutes of surfacing. The spinal cord was most often affected, and the most common symptoms were 'numbness' or 'tingling' in one or more extremities and discomfort or pain on the chest. Recompression treatment was delayed for 18 hours in average after the onset of dysbaric symptoms and this treatment is more likely to be effective the sooner that it commences after the onset of dysbaric symptoms.

A Case of Anomalous Termination of the Common Bile Duct into the Duodenal Bulb / 대한소화기내시경학회지

Anatomy of the pancreaticobiliary ductal system is so variable that one should think of its normal anatomy as nonexistent. But exact location of the termination of the common bile duct in important to the biliary surgeon when performing transduodenal exploration of the common bile duct, to the physician and radiologist when diagnosing pancreaticobilijary disease by ERCP. We report a case of Lnomalous termination of the common bile duct into thii. duadenal bulb diagnosed by ERCP and operative cholangiogram.

Anisakis / 대한소화기내시경학회지

Acute gastric anisakiasis is occurred when men intake a raw or inadequate cooked anisakis infected fish. The clinical symptoms are severe cramping abdominal pain, nausea, vomiting, and epigastric fulling sensation. It is well known that the whale is final host and man is opportunistic host. Recently, we experienced three cases of acute gastric anisakiasis. We think that acute gastric anisakiasis is probably rather undetected than rare disease. So through immediate gastrofiberscopy of patients with severe cramping epigstric pain occuring after ingestion of raw fish,we can find more cases of the anisakis larvae. In is adequate to abstract of larvae by biopsy forceps through gastrofiberscopy.

Hyperbaric Oxygen Therapy In Orthopaedic Surgery / 대한정형외과학회잡지

Hyperbaric oxygen therapy (HBO), which in Korea is used chiefly for CO poisoning, can be used in many disorders in orthopaedic field through the action of increasing oxygen tension of peripheral tissue, Since June 1986, when the multiplace hyperbaric chamber was built in our hospital, we have experienced 197 cases of HBO in orthopaedic field and we are to analyze the result of treatment and suggest reasonable indications. The outline of results are as follows ;1. Crushing injuries and wounds caused or accompanied by circulatory disturbance were most frequent among the 197 cases we've experienced, and received 17.5 times of HBO on average. 2. Discernible effectiveness was found in split thickness skin graft, diabetic ulcer and Buerger's disease as compared to the control group. 3. Otalgia was the most common side effect, but not severe. 4. From the above results, it is thought that HBO has fair range of indications in orthopaedic field and is worth using as an adjuvant means to surgery.

The Changes of short-term memory and Autonomic neurocardiac function after 4-10Hz sound and light stimulation: A pilot study / 수면정신생리

OBJECTIVES: Sound and light (SL) stimulation has been used as a method to induce some useful mental states in the fields of psychology and psychiatry. It is believed that sound and light entrainment device (SLED) has some specific effects through synchronization of EEG in patients who use it. Theta frequency is believed to stimulate deep relaxation and short term memory processing. This study was conducted to evaluate if 4-10Hz SL stimulation can induce relaxation and improve short term memory function. METHODS: Ten medical students with no medical or psychiatric problems participated in this study. Subjects were randomly divided into two groups. One group was applied with real SLED was applied to one group (R group) and pseudo SLED to the other group (P group). The two groups were exposed to SL stimulation with SLED 15 minutes a day for 5 days, and after two days rest the two groups were switched over. The Korea Wechsler Adult Intelligence Scale (K-WAIS), Academic Motivation Tests (AMT), Test Anxiety Scale (TAS), Korea Auditory Verbal Learning Test (K-AVLT), and digit span were used to evaluate short term memory. Spielberger's State-Trait anxiety inventory and heart rate variability (HRV) test were used to evaluate degree of relaxation. RESULTS: Compared with S group, R group showed a significant improvement in K-AVLT and digit span after a single application of SL stimulation. But 5-day long application did not reveal any differences between the two groups. A significant change in HRV was observed in 5-day long application of SL stimulation after being switched over to other SLED. CONCLUSION: This pilot study suggests that 4-10Hz SL stimulation has some positive influences on short term memory and relaxation.

Analysis of Surgical Treatments for Hepatolithiasis According to the Site of Biliary stenosis / 한국간담췌외과학회지

BACKGROUND: Hepatolithiasis is found predominantly in Southeast Asia and although it is a pathophysiologically benign disease, it frequently causes serious problems such as recurrent cholangitis, liver abscess, obstructive jaundice and sepsis. As a result it is said to be a clinically malignant disease. In order to select the best surgical treatment according to location of biliary stenosis, we analyzed the clinical manifestation of hepatolithiasis and follow-up results. METHODS: We retrospectively reviewed 42 cases of hepatolithiasis treated by various surgical treatments from Jan. 1987 to Jun. 1998 at the Department of Surgery of Kangnam General Hospital. RESULTS: In cases where the site of biliary stenosis was limited to the left intrahepatic duct, the relative incidence of good results was higher in the hepatectomy group(88.2%) than in the drainage group(0%). And in cases of biliary stenosis in both intrahepatic ducts, the relative incidence of good results was higher in the hepatectomy group(33.3%) than in the drainage group(0%). And in cases of no biliary stenosis, the relative incidence of good results was high(66.7%) even in the drainage group. CONCLUSION: Hepatic resection is a satisfactory treatment option for patients with hepatolithiasis, especially in the cases of biliary stenosis.

Clinical Studies on the 34 Cases of pm - Gastric Cancer / 대한소화기내시경학회지

The records of 34 patients with histologically proven pm-gastric cancer were reviewed from Chonnam University Hospital during the recent 6 year period, 1981, to 1986. The male outnumbered female in a ratio of 2.4:1.0. The peak incidence was 6th decade and mean age were 53.8 years in male, 48.7 years in female respectively. pm-gastric cancer was most often seen on the lesser curvature side, eapecially in the lower 1/3 of the stomach. Macroscopically, it can be divided into early-cancer-like type and Borrmann type. Early-cancer-like type was more frequent than Borrmann type. Early-cancer-like type IIc+III was most often seen with a rate of 20.6%, followed in the order of frequency by Borrman type II, early-cancer-like type IIc, IIa+IIc, and Ile+ IIa. The incidence of lymph node involvement was 26.4% and were related to the macroscopic types and/or histologic differentiation degrees. 5 cases out of 34 pm-gastric cancer expired during the follow up period, and their mean survival time was 32.8 months. The type of operation and the extent of resection were closely related to survival. Five year survival rate was 54.0%. These results shows the significance of the pm-gastrie cancer as a early simulating advanced cancer.

Surgical Treatment of Recurrent Colorectal Cancer

PURPOSE: Recurrent colorectal cancers have important and difficult diagnostic and treatment problems. The purpose of this study is to evaluate the rationale and the efficacy of surgical re-treatment for patients with recurrence following curative surgery for colorectal cancer. METHODS: From January 1991 to December 2002, we experienced 60 (20.9%) patients with recurred colorectal cancer among 287 patients who had curative operations in our hospital. These 60 patients were divided into three groups. Patients in group 1 had curative-intent resections, patients in group 2 had palliative resections, and patients in group 3 had conservertive treatment. The groups consisted of 17 (28.3%), 10 (16.7%) and 33 (55.0%) patients, respectively. We analyzed retrospectively those groups for any recurrence pattern and for survival. RESULTS: Of the 60 patients with recurrent colorectal cancer, in 20 (33.3%) patients the cancer recurred in the colon, and in 40 (66.7%) it recurred in the rectum. Local recurrence was seen in 9 (15.0%) patients, liver metastasis in 25 (41.7%), and pulmonary metastasis in 13 (21.7%). The 1- and 3-, and 5-year survival rates were 86.5%, 31.7%, and 15.9%, respectively, for group 1, 33.3%, 0%, and 0% for group 2, and 28.9%, 4.4%, and 4.4% for group 3. The median survival period was 31 months for group 1, 8 months for group 2, and 7 months for group 3. CONCLUSIONS: Although evaluation was difficult owing to the small number of patients with recurrent colorectal cancer, a significant difference in survival rates was observed between the treatment groups. On the basis of these results, we think that curative-intent aggressive surgery for recurrent colorectal cancer in appropriately selected cases can clearly prolong survival when compared with palliative resections and conservative treatment.