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  • 1
    ISSN: 1436-3305
    Keywords: Key words: gastric cancer, prognostic factor, ratio of involved to resected lymph nodes
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Background. Although the results of gastric cancer treatment have markedly improved, this disease remains the most common cause of cancer death in Korea. Methods. Clinicopathologic characteristics were analyzed for 10 783 consecutive patients who underwent operation for gastric cancer at the Department of Surgery, Seoul National University Hospital, from 1970 to 1996. We also evaluated survival and prognostic factors for 9262 consecutive patients operated from 1981 to 1996. The clinicopathologic variables for evaluating prognostic values were classified as patient-, tumor-, and treatment-related factors. The prognostic significance of treatment modality [surgery alone, surgery + chemotherapy, surgery + immunotherapy + chemotherapy (immunochemosurgery)] was evaluated in patients with stage III gastric cancer (according to the International Union Against Cancer TNM classification of 1987). For the assessment of lymph node metastasis, both the number of involved lymph nodes and the ratio of involved to resected lymph nodes were analyzed, as a quantitative system. Results. The mean age of the 10 783 patients was 53.5 years and the male-to-female ratio was 2.07 : 1. Resection was performed in 9058 patients (84.0% resection rate). The 5-year survival rates were 55.9% for all patients and 64.8% for patients who received curative resection. Age, sex, preoperative hemoglobin and albumin levels, type of operation, curability of operation, tumor location, Borrmann type, tumor size, histologic differentiation, Lauren's classification, perineural invasion, lymphatic invasion, vascular invasion, depth of invasion, number of involved lymph nodes, ratio of involved to resected lymph nodes, and distant metastasis had prognostic significance on univariate analysis. Radical lymph node dissection, with more than 25 resected lymph nodes improved survival in patients with stage II and IIIa disease. As postoperative adjuvant therapy, immunochemotherapy was most effective in patients with stage III disease. Patients with identical numbers of lymph nodes -either the number of involved lymph nodes or the number of resected lymph nodes- were divided according to their ratios of involved-to-resected lymph nodes. In each numeric group, there were significant survival differences according to the ratio of involved-to-resected lymph nodes. However, patients who had the same involved-to-resected lymph node ratio did not show significant differences in survival rate according to either the number of involved or the number of resected lymph nodes. On multivariate analysis, curability of operation, depth of invasion, and ratio of involved to resected lymph nodes were independent significant prognostic factors. Conclusions. Curative resection, depth of invasion, and lymph node metastasis were the most significant prognostic factors in gastric cancer. With regard to the status of lymph node metastasis, the ratio of involved to resected lymph nodes had a more precise and comprehensive prognostic value than only the number of involved or resected lymph nodes. Early detection and curative resection with radical lymph node dissection, followed by immunochemotherapy, particularly in patients with stage III gastric cancer should be the standard treatment in principle, for patients with gastric cancer.
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  • 2
    ISSN: 1530-0358
    Keywords: Gastric cancer ; Familial adenomatous polyposis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Gastric cancer has been recognized as an extracolonic manifestation in patients with familial adenomatous polyposis (FAP). In Korea, gastric cancer is the most common malignant neoplasm. In a recent survey, we collected data from 72 Korean patients with FAP. Among them, three (4.2 percent) were found to have associated gastric cancer. This incidence of gastric cancer in our series is much higher than the previous reports from Japan and other countries. The expected cumulative incidence of gastric cancer among these 72 patients was 0.44, which gives the standardized incidence ratio of 6.9 (95 percent CI, 1.4–20.1). This difference in incidence of gastric cancer was statistically significant (P 〈 0.05), which implies that patients with FAP are at significantly higher risk of developing gastric cancer compared with the general population in Korea. These findings confirm an increased risk of gastric cancer in FAP patients, even in a region where gastric cancer is highly prevalent.
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  • 3
    ISSN: 1534-4681
    Keywords: Early gastric cancer ; Prognostic factor
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Background: Gastric cancer is the most frquent cancer and the leading cause of death from cancer in Korea. Early gastric cancer has been defined as a gastric carcinoma confined to mucosa or submucosa, regardless of lymph node status, and has an excellent prognosis with a 〉90% 5-year survival rate. From 1974 to 1992, we encountered 7,606 cases of gastric cancer and performed 6,928 gastric resections. Among them, 1,136 cases were early gastric cancer (14.9% of all gastric cancer cases and 16.4% of resected gastric cancer cases). Methods: A retrospective analysis of 1,136 cases of early gastric cancer was performed to evaluate the prognostic significance of clinicopathologic features (sex, age, tumor location, gross type, histologic type, depth of invasion, status of lymph node metastasis, resection type). Lymph node metastasis was classified into three groups: N(n=0) for no lymph node metastasis; N(n=1−3) for one to three lymph node metastases; and N(n〉3) for more than three lymph node metastases. All patients received radical total or subtotal gastrectomy with lymph node dissection. Results: In univariate and multivariate analysis of these nine factors, the only statistically significant prognostic factor was regional lymph node metastasis (p〈0.001). The others had no statistically significant association with prognosis. Lymph node metastasis was present in 178 cases (15.7%). The factors associated with the lymph node metastasis were depth of invasion and gross type [protruding type (e.g., types I, IIa)]. One hundred twenty-five of these patients had one to three lymph node metastases, and 53 cases had more than three lymph node metastases. The difference in 5-year survival rates among these groups was statistically significant: 94.5% for N(n=0), 88.3% for N(n=1−3), and 77.3% for N(n〉3). Conclusion: We propose that for early gastric cancer, lymph node dissection is necessary in addition to gastric resection, at least in patients with a high risk of lymph node metastasis.
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  • 4
    ISSN: 1436-2813
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract In study I, 48 ACI and Fisher inbred rats were given MNNG 100 μg/ml, with or without 1 per cent or 3 per cent red pepper diet; in study II, 164 Sprague-Dawley rats given MNNG 100 μg/ml, with or without 5 per cent or 10 per cent NaCl; in study III, 181 Wistar rats given MNNG 83 μg/ml with or without maejoo 10 gm per cent/diet; in study IV, 78 Wistar rats given MNNG 83 μg/ml with or without ginseng extract 150 μg/ml; in study V, 120 Wistar rats given MNNG 83 μg/ml with or without retinyl palmitate 150,000 IU/kg. Except for study II (28 weeks), all rats were fed the diets for 37 weeks and were examined at 38 weeks or 40 weeks. In study I, tumor incidence in rats fed a red pepper diet and MNNG solution were 57 per cent (ACI rats, 1 per cent red pepper) and 63 per cent (Fisher rats, 1 per cent or 3 per cent red pepper) which were higher than control group (44 per cent, 43 per cent); in study II, gastric cancer, 61.9 per cent (10 per cent NaCl-MNNG), 27.3 per cent (control); in study III, gastric cancer, 14.8 per cent (maejoo-MNNG), 24 per cent (control); in study IV, malignant tumor of gastroduodenum, 3.4 per cent (ginseng-MNNG), 32.1 per cent (control); in study V, forestomach papilloma, 10.7 per cent (retinoid-MNNG), 29.4 per cent (control), and cancer in duodenum and small intestine, 50.0 per cent (retinoid-MNNG), 17.6 per cent (control). Thus, gastric carcinogenesis was enhanced by red pepper and a high salt diet, was inhibited by a maejoo and ginseng diet and was not effected by vitamin A.
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  • 5
    Electronic Resource
    Electronic Resource
    Springer
    World journal of surgery 13 (1989), S. 123-123 
    ISSN: 1432-2323
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
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  • 6
    Electronic Resource
    Electronic Resource
    Springer
    World journal of surgery 15 (1991), S. 647-648 
    ISSN: 1432-2323
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
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  • 7
    Electronic Resource
    Electronic Resource
    Springer
    World journal of surgery 15 (1991), S. 782-782 
    ISSN: 1432-2323
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
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  • 8
    ISSN: 1432-2323
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Resumé Par une analyse unit- et multifactorielle de 3926 cas de cancers gastriques recueillis entre 1981 et 1991, on a confirmé la valeur pronostique de plusieurs facteurs clinicopathologiques et on a évalué l'efficacité d'une immunothérapie postopératoire comportant de l'OK-432, du 5-FU et de la mitomycine dans le cancer gastrique du stade III. On a calculé les taux de survie à cinq ans pour chaque catégorie de facteur pronostique et par analyse unifactorielle, on a démontré une différence significative pour la plupart de ces facteurs tels que l'âge, la profondeur d'invasion, les métastases ganglionnaires, le site primitif de la tumeur, la différentiation histologique et l'aspect macroscopique. Il n'y avait pas, par contre, de différence significative en ce qui concerne le sexe. Par analyse multifactorielle, on a mis en évidence une différence significative concernant la profondeur d'invasion et les métastases ganglionnaires (p〈0.001), ainsi que l'aspect macroscopique, le site et la différentiation de la tumeur (p〈0.05). En ce qui concerne le traitement postopératoire, l'immunochimiochirurgic était plus effective chez les patients stade III (p〈0.05). En conclusion, le pronostic du cancer gastrique peut être évalué selon plusieurs facteurs indépendants et l'immunochimiochirugie peut être un traitement efficace en cas de cancer gastrique avancé.
    Abstract: Resumen Se realizó análisis uni y multivariable de 3926 pacientes seleccionados con cáncer gástrico tratados en el lapso de 1981 a 1991, con el fín de confírmar el valor de diversos factores clínicopatológicos de pronóstico y de evaluar la eficacia de la immunoquimitoterapia postoperatoria con OK-432, 5-FU y Mitomicina-C en el cáncer gástrico en estado III. Se determinaron las tasas de sobrevida a cinco años para cada categoría de las variables de pronóstico, y en el análisis univariable la mayoría de las mismas, incluyendo edad, profundidad de la invasión tumoral, metástasis ganglionares linfáticas, ubicación del tumor primario, diferenciación histológica y tipo macroscópico, excepto por el sexo, demostraron alguna significación estadística. El análisis multivariable verificó los factores pronósticos de significación. La profundidad de la invasión y las metástasis ganglionares aparecieron como los factores más poderosos (p〈0.01) y el tipo macroscópico, la ubicación y la differenciación histológica aparecieron como factores adicionales de significación (p〈0.05). En cuanto al tratamiento postoperatorio, la inmunoquimiocirugía fue más efectiva en los pacientes en estado III (p〈0.05). En conclusión, planteamos que es posible predecir el pronóstico en el cáncer gástrico con mayor precisión basándose en tales factores independientes de pronóstico y que la inmunoquimiocirugía puede ser un valioso método de tratamiento en el cáncer gástrico avanzado.
    Notes: Abstract Univariate and multivariate analyses of 3926 selected gastric cancer patients collected between 1981 and 1991 were made to confirm several clinicopathologic prognostic factors and to evaluate the effectiveness of postoperative immunochemotherapy with OK-432, 5-FU, and mitomycin C in stage III gastric cancer. Five-year survival rates for each category of prognostic variables were obtained; and in the univariate analysis, most of the factors (including age, depth of invasion, lymph node metastasis, location of primary tumor, histologic differentiation, and gross type except for sex) showed some significance. Multivariate analysis was conducted and verified significant prognostic factors. Depth of invasion and lymph node metastasis were found to be the most powerful factors (p〈0.001); gross type, location, and histologic differentiation were additional significant factors (p〈0.05). For postoperative treatment, immunochemosurgery was most effective in stage III patients (p〈0.05). In conclusion, we may predict a prognosis for gastric cancer more precisely on the basis of these independent prognostic factors, and immunochemosurgery may be a valuable means to treat advanced gastric cancer.
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  • 9
    ISSN: 1432-2323
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Résumé Pour déterminer une attitude thérapeutique vis-à-vis du diverticule duodénal symptomatique, nous avons revu 26 dossiers médicaux. On a estimé que des symptômes comprenant douleur abdominale, fièvre, frissons, méléna et vomissements, observés chez 18 patients, étaient en rapport avec un diverticule duodénal compliqué. Dix patients ont été traités de façon conservatrice, alors que huit patients ont eu une diverticulectomie associée ou non à un autre procédé. Parmi ces huit patients, un patient qui avait eu une fistule duodénale est décédé au deuxième jour. Les symptômes ont récidivé chez deux patients. Un de ces patients, ayant une sténose de la voie biliaire principale, a eu ensuite une anastomose cholédocojéjunale. Le dernier patient a développé une lithiase de la voie biliaire principale trois ans après, qui a nécessité une cholédocotomie suivie d'une anastomose cholédocojéjunale. Huit patients avaient aussi une lithiase vésiculaire associée à leur diverticule. Cinq des huit patients avaient déjà eu une opération pour leur lithiase, quatre ont été améliorés par un traitement conservateur et un autre a eu une anastomose cholédocojéjunale. Chez deux patients ayant un diverticule asymptomatique, seule une cholécystectomie et une cholédocotomie ont été pratiquées. Un patient a eu une diverticulectomie et une sphinctérotomie pour lithiase cholédocienne et diverticule paravatérien. En conclusion, le traitement du diverticule duodénal doit être réservé pour les cas compliqués et le chirurgien devrait savoir que le diverticule paravatérien peut éventuellement être une cause de lithiase cholédocieme.
    Abstract: Resumen Con el objeto de definir una guía de manejo para el divertículo duodenal sintomático, revisamos las historias clínicas de 26 pacientes. El divertículo duodenal complicado fue la única causa de síntomas-dolor abdominal, fiebre y escalofrios, melena, vómito—en 18 pacientes. Diez pacientes tuvieron mejoría con manejo conservador y 8 fueron sometidos a diverticulectomía con o sin olros procedimientos concomitantes. Entre estos ocho, uno, que tenía fistula duodenal, murio por complicación respiratoria en el segundo día postoperatorio. Síntomas recurrieron en dos pacientes. Uno de ellos presentaba estenosis de la via biliar distal, por lo cual se construyó una coledoyeyunostomía. En el otro, apareció coledocolitiasis 3 años más tarde, por lo cual se practicó coledocolitotomía y coledocoyeyunostomía. Ocho pacientes presentaban coleitiasis asociada: 5 de los 8 tenian historia de operación por colelitiasis y 4 mejoraron con manejo conservador y en 1 se practicó coledocoyeyunostomía. Dos pacientes parecían tener divertículos inocentes y fueron sometidos a colecistectomía y coledocolitotomía solamente. En uno se practicó diverticulectomía y esfinteroplastia por coledocolitiasis y un divertículo pervateriano. En conclusión, la operación para el divertículo duodenal debe ser reservada para los divertículos con complicaciones graves y el cirujano debe tener conciencia de que el diveriículo pervateriano puede ser causa de coledocolitiasis.
    Notes: Abstract To determine management guidelines for symptomatic duodenal diverticulum, we reviewed medical records of 26 patients. Complicated duodenal diverticulum was the only possible cause of symptoms-abdominal pain, fever and chills, melena, vomiting-in 18 patients. Ten patients improved with conservative management, and eight patients underwent diverticulectomy with or without various other procedures. Among the eight patients, one patient who had duodenal fistula died of respiratory complications on the second postoperative day. Symptoms recurred in two patients: One had a distal common bile duct (CBD) stricture and underwent choledochojejunostomy. In the other patient a CBD stone developed 3 years later, and choledocholithotomy and choledochojejunostomy were performed. Eight patients had associated gallstone disease as well as the diverticulum. Five of the eight had a history of operation for gallstone disease; four improved with conservative treatment, and one underwent choledochojejunostomy. Two patients were thought to have an innocent diverticulum and underwent cholecystectomy and choledocholithotomy only. One patient underwent diverticulectomy and sphincteroplasty for a CBD stone and pervaterian diverticulum. In conclusion, operations for duodenal diverticulum should be reserved for seriously complicated diverticula, and the surgeon should be aware that pervaterian diverticulum can be a cause of choledocholithiasis.
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  • 10
    Electronic Resource
    Electronic Resource
    Springer
    World journal of surgery 19 (1995), S. 118-118 
    ISSN: 1432-2323
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
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