• Journal of Digestive Cancer Research
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• v.11 no.3
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• pp.165-170
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• 2023

Gastric cancer is histologically classified into two types. One is the intestinal and diffuse type according to Lauren's classification, and the other is the differentiated and undifferentiated type based on Nakamura's classification. In 2007, Japanese groups proposed a new type of well-differentiated gastric adenocarcinoma in the gastric fundic glands with distinct endoscopic and clinicopathologic features. This is gastric adenocarcinoma of the fundic-gland type (GA-FG), a rare variant of gastric cancer. In a 2012 Korean study, of 6,000 cases of gastric cancer tissues, only three cases of GA-FG were identified. GA-FG is usually located in the upper third of the stomach and not known to be associated with the Helicobacter pylori infection. We herein report a case of GA-FG diagnosed in a 63-year-old man. A gastric polyp was incidentally detected during an upper endoscopy screening while conducting a health check-up, and he was diagnosed with GA-FG after an endoscopic mucosal resection (EMR) was conducted for diagnostic and therapeutic purposes. Our case suggests that for both diagnostic and therapeutic purposes, EMR may be beneficial in case of gastric polyps with suspected GA-FG.

• Journal of Gastric Cancer
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• v.9 no.4
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• pp.177-185
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• 2009

Purpose: Preoperative clinical staging of gastric cancer is very important for determining the treatment plans and predicting the prognosis. The previous reports regarding the accuracy of computed tomography or endoscopic ultrasound for the preoperative staging of gastric cancer have shown various outcomes. We analyzed the diagnostic performance of CT and EUS, which are important staging tools for the staging of TN gastric cancer. Materials and Methods: We retrospectively analyzed 1,174 patients who underwent gastrectomy for gastric cancer at Seoul National University Bundang Hostpital from May, 2003 to December, 2007. We derived the Kappa value to examine the agreement of the preoperative staging obtained from CT and EUS with the pathological staging. Results: The mean age of the 1,174 patients was $59.31{\pm}11.98$ years. Six hundred thirty seven patients had early gastric cancer and 536 had advanced gastric cancer. The diagnostic performance between CT and EUS for the T staging showed no significant difference between CT and EUS for the kappa values. The kappa values showed moderate agreement at 0.4039 (P=0.021) and 0.4201 (P=0.026), respectively. This suggests that there is no difference between the two examinations for the overall T staging. Analysis of the discrimination of mucosal and submucosal lesions with EUS showed an accuracy of 58.92% and a Kappa value of 0.206 (P<0.001), suggesting fair agreement and a lower diagnostic performance than expected. To differentiate lesions with stages higher than or equal to T2 or T3 from the lesion with stages lower than T2 or T3, respectively, adoption of the higher stage from the CT staging or the EUS staging showed a larger AUC of 0.84 than that from either stage alone. The CT-derived node stage had the higher diagnostic performance (68.55%) than that of the EUS-derived node stage (60.82%) for the node staging. Conclusion: The CT-derived stage and EUS-derived stage showed comparable results for determining the T stage of gastric cancer. Yet the higher stage of the two stages from CT and EUS most accurately discriminated between those lesions with stages higher than T2 and those lesions with stages lower than T2.

• Journal of Gastric Cancer
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• v.9 no.4
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• pp.215-222
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• 2009

Purpose: Billroth II gastroenterostomy is a typical reconstruction method after distal gastrectomy for gastric carcinoma, but it has problems, especially frequent reflux esophagitis. Various methods have been tried to address this problem. Among them are Braun enteroenterostomy and Roux-en-Y gastroenterostomy, which are performed separately according to the size of the gastric remnant. The aim of our study was to determine whether these applications are compatible. Materials and Methods: Between September 2003 and April 2007, we performed Roux-en-Y gastroenterostomy operations (14 patients) when the size of the gastric remnant was <10%, Braun enteroenterostomy (17 patients) when the size was between 10 and 20%, and Billroth II gastroenterostomy (14 patients) when the size was between 20 and 40% after subtotal gastrectomy for gastric cancer by a single surgeon at our hospital. We analyzed the results of each treatment. We evaluated the symptoms and endoscopic findings using questionnaires and hospital records. To evaluate nutritional states, we reviewed albumin and hemoglobin levels and body weight changes. Results: All operations were performed safely mortality was 0% and postoperative complications were 8.9%. On endoscopy, reflux gastritis was observed to occur in 7.63%, 18.65% and 40.0%, respectively, of patients who had undergone Roux-en-Y, Braun and Billroth II operations (P=0.13). Reflux esophagitis was observed in 1 patient in the Roux-en-Y group and 1 patient in the Braun group. Endoscopic gastrostasis was observed in 2 patients in the Roux-en-Y group, one of which was thought to cause reflux esophagitis. Patients in the Roux-en-Y group and Braun groups ingested a lower volume of food than did those in the Billroth II group (respectively, 7.1%, 0.0% and 28.7%) and complained less of postprandial discomforts (respectively, 14.3%, 23.5% and 57.1%) and reflux symptoms (respectively 0.0%, 11.8% and 42.9%). Conclusion: The application of Braun enteroenterostomy and Roux-en-Y gastroenterostomy to the small gastric remnant may be effective for reducing reflux symptoms and abdominal discomfort after distal gastric resection. We recommend Roux-en-Y gastroenterostomy when the size of the gastric remnant is <10%, and Braun anastomosis in the others. It will need to be determined which reconstructive procedure is better for many different conditions.

• Journal of Gastric Cancer
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• v.6 no.3
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• pp.161-166
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• 2006

Purpose: Recently, the incidence of early gastric cancer (EGC) patients is rapidly increased in Korea. However, they're often not perceptible by surgical palpation or inspection. The aim of this study is 1) to develope a software that can locate the tumor and measure the mucosal distance from an anatomic landmark to the tumor using CT gastrography and 2) to compare the distance measured by the developed software with the distance measured by the pathologic findings. Materials and Methods: Between January 2004 and September 2005, sixty patients (male=45, female=15, mean 57.8 years old) estimated for EGC with preoperative CT scans and undergone gastrectomies in Kyungpook National University Hospital were enrolled in this study. Preoperative CT scans were performed after insufflations of room air via 5 Fr NG tube. The scans included the following parameters: (slice thickness/reconstruction interval: 0.625 mm, kVp: 120, mAs: 200). 3D volume rendering and measurement of the surface distance from the pylorus to the EGC were performed using the developed software. Results: The average difference between the lesion to pylorus distances measured from pathologic specimens and CT gastrography was $5.3{\pm}2.9\;mm(range,\;0{\sim}23\;mm)$. The lesion to pylorus distance measured from CT gastrography was well correlated with that measured from the pathologic specimens (r=0.9843, P<0.001). Conclusion: These results suggest that the surface distance from an anatomic landmark to the EGC can be measured accurately by CT gastrography. This technique could be used for preoperative localization of early gastric carcinomas to determine the optimal extent of surgical resection.

• International journal of thyroidology
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• v.11 no.2
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• pp.109-116
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• 2018

It is very important to identify recurrent laryngeal nerve (RLN) and prevent RLN injury during thyroid surgery. The intraoperative neuromonitoring (IONM) for the prevention of RLN injury is a useful method because it can identify the location and status of RLN and predict postoperative vocal cord function easily. The IONM consists of a stimulating side that applies electrical stimulation to the nerve and a recording side that measures the surface electromyography (EMG) of the vocal cord muscle through electrode endotracheal tube. The nerve stimulator and surgical dissector are separate instruments. So, during IONM for the prevention of the RLN injury in conventional, endoscopic, or robotic thyroid surgery, repeated exchanging between surgical instruments and the nerve stimulator is inconvenient and time consuming. On the recording side, the accuracy of the electrode endotracheal tube which measures the EMG of the vocalis muscle can be affected by contact with between electrode and vocal fold and position change of patient. We would like to introduce recent several researches to overcome the current limitations of IONM.

• Journal of agricultural medicine and community health
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• v.39 no.3
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• pp.137-145
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• 2014

Objectives: Colonoscopy is a popular tool for screening for colon cancer throughout the world. The incidence of polypectomy and follow-up colonoscopy are persistently increasing but the studies about follow-up test after polypectomy are still lack of its domestic sources. This study is designed to look into the recurrence rate of colon polyps and risk factors after polypectomy. Methods: This is a retrospective study by reviewing medical charts of 147 patients who underwent polypectomy and follow-up colonoscopy from Jan. 2000 to Mar. 2008. The Kudo classification was used to describe the polyps found in the colonoscopy. The follow-up period was defined as the term between polypectomy and the first colonoscopy follow up. Results: Seventy six point two percent of the enrolled patient were male and the mean age was $56.5{\pm}8.1$. Mean follow-up period was $24.9{\pm}13.7$ (6 - 65) months. The cumulative recurrence rate of 1 year was 11.6%. The rate of 2 years was 36.7% and that of 3 years was 55.8%. The number of polyps was the factor which statistically showed significant relation of its recurrence rate. The histological morphology characteristic of polyps could be one independent factor which may be associated to the recurrence of polyps. Conclusions: The importance of colonoscopy follow up after polypectomy was clearly emphasized through the cumulative recurrence rate of 55.8%. Therefore, there is a need for more domestic studies with a large number of patients about the recurrence of polyps after polypectomy.

• Journal of Chest Surgery
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• v.32 no.4
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• pp.388-393
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• 1999

Background: Correct preoperative staging of esophageal cancer is a prerequisite for adequate treatment. We prospectively compared the accuracy of positron emission tomography (PET) with [fluorine-18]FDG in the staging of esophageal cancer to that of computed tomography (CT). Material and Method: The findings of FDG PET and of chest CT including lower neck and the upper abdomen of 20 biopsy-proven squamous cell carcinoma patients (male, 19; female, 1; mean age, 61) were compared with the pathologic findings obtained from a curative esophagectomy with lymph node dissection. Result: The sensitivities of FDG PET and CT for diagnosis of primary tumor were the same, 90.0% (18/20). Both FDG PET and CT failed to show the primary tumor in 2 of 20 patients; one had a 1cm sized carcinoma in situ and the other had T1 stage cancer. By using the results of the pathologic examinations of 193 removed lymph node groups, we calculated the diagnostic sensitivities, specificities and accuracies of PET and CT (*$\chi$2 p < 0.005). Sensitivity** Specificity Accuracy* PET 55.6%(30/54) 97.1%(135/139) 85.5%(165/193) CT 13.0%(7/54) 98.6%(137/139) 74.6%(144/193) One of four patients with a false-positive for PEThad had active pulmonary tuberculosis. Among the 24 tumor involved lymph node groups, PET failed to show tumor metastasis in 5 lymph node groups abutting the tumor and in 14 lymph node groups located where the decay correction was not performed. Conclusion: Based on the above findings, it is suggested that [F-18]FDG-PET is superior to CT in the detection of nodal metastases and in the staging of patients with esophageal cancer.

• The Korean Journal of Nuclear Medicine
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• v.39 no.6
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• pp.456-463
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• 2005

Purpose: we often find variable degrees of FDG uptake and patterns in stomach, which can make difficult to distinguish physiologic uptake from pathologic uptake on FDG PET. The purpose of this study was to find out the significant findings of stomach on FDG PET. Materials and Methods: Thirty-eight patients who underwent both FDG PET and endoscopy within one week from Jun. 2003, to Aug. 2004 were included in this study. We reviewed 38 patients (18 for medical check up, 15 for work up of other malignancies, and 5 for the evaluation of stomach lesion). Their mean age was 56 years old (range:$32{\sim}79$), men and women were 28 and 10, respectively. Two nuclear physicians evaluated five parameters on FDG PET findings of stomach with a consensus: 1) visual grades 2) maximum SUV (max.SUV) 3) focal 4) diffuse and S) asymmetric patterns. We correlated the lesions of FDG PET findings of stomach with those of endoscopy. We considered more than equivocal findings on FDG PET as positive. Results: The six of 38 patients were proven as malignant lesions by endoscopic biopsy and others were inflammatory lesions (ulcer in 3, chronic atrophic gastritis in 12, uncommon forms of gastritis in 5), non-inflammatory lesions (n=3), and normal stomach (n=9). By the visual analysis, malignant lesions had higher FDG uptake than the others. The max.SUV of malignant lesions was $7.95{\pm}4.83$ which was significantly higher than the other benign lesions ($2.9{\pm}0.69$ in ulcer, $3.08{\pm}1.2$ in chronic atrophic gastritis, $3.2{\pm}1.49$ in uncommon forms of gastritis (p=0.044)). In the appearance of stomach on FDG PET, malignant lesions were shown focal (5 of 6) and benign inflammatory lesions were shown diffuse (9 of 20) and asymmetric (14 of 20). Benign lesions and normal stomach were shown variable degrees of uptake and patterns. Some cases of benign inflammatory lesions such as ulcer and gastritis were shown focal and mimicked cancerous lesion (4 of 15). Conclusion: Gastric malignant lesions had higher FDG uptake and focal pattern. However, benign inflammatory lesions had moderate degrees of uptake and diffuse and asymmetric patterns rather than focal. It is difficult to differentiate between benign lesions including normal.

• Journal of Chest Surgery
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• v.29 no.10
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• pp.1123-1128
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• 1996

A clinical study was performed on 152 cases of surgical esophageal disease treated by the Department of Thoracic & Cardiovascular Surgery of Korea University Hospital from Jan. 1989 through July 1994. The most common esophageal disease was cancer which was seen in 73 cases (48%) among 152 cases. All were treated surgically' 52 patients (71%) were managed by curative or palliative resection with reconstruction and feeding gastrostomy or jejunostomy, otherwise Celestine tube insertion was performed on the remaining 21 patients for palliatio'n. Esophageal leiomyoma occurred in 6 cases(3.9%), among them 1 case was performed with trio recoscopic enucleation . Achalasia were in 7 cases (4.6%) and was treated with modified Heller's m otomy and with Belsey Mark IV operation. Diverticulum were in 11 cases (7.2%). Esophageal stricture occurred in 20 cases (14.1 %) and 17 of 20 cases were managed with bypass surgery. Esophageal perforation was seen in 20 cases, its cause was instrumental trauma in 7 cases, stab wound in 4 cases, foreign body in 4 cases, spontaneous perforation in 3 cases, and others 1 case Other disease including congenital lesion was seen In 1 Scases.

• Journal of Gastric Cancer
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• v.8 no.2
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• pp.91-96
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• 2008

Purpose: The early detection of gastric cancer and accuracy of preoperative staging has currently been on the increase due to the development of endoscopy and imaging techniques, but there are still many cases of advanced gastric cancer detected at the first diagnosis and there are also many cases of stage IV gastric cancer diagnosed after a postoperative pathological examination. Although the prognosis of stage IV gastric cancer is very poor, this study was performed to determine the value of the use of aggressive treatment determined after a clinical analysis. Materials and Methods: We retrospectively analyzed 150 patients that were diagnosed with stage IV gastric cancer among 1376 patients who underwent a laparotomy for gastric cancer from January 1994 to December 2006. Results: Of the 150 patients with stage IV gastric cancer who underwent a laparotomy, there were 104 men and 46 women. The mean patient age was 57.8 years (age range, 28~93 years). A subtotal gastrectomy or total gastrectomy was performed in 119 patients and 31 patients underwent an explorative laparotomy. The mean survival time of patients that underwent a gastrectomy and patients that did not undergo a gastrectomy was 722 days (range, 14~4,559 days) and 173 days (range, 16~374 days), respectively this result was statistically significant. When patients that underwent a gastrectomy were classified according to the TNM stage, the mean survival time of 33 patients with stage T4 disease was 534 days (range, 17~3,378 days) and the mean survival time of 63 patients with stage N3 disease was 521 days (range, 14~4,190 days), but there was no statistical significance. Chemotherapy was administered to 98 patients and 52 patients did not receive chemotherapy. The mean survival time of patients that received chemotherapy was 792 days (range, 36~4,559 days) and the mean survival time of patients that did not receive chemotherapy was 243 days (range, 14~2,413 days), with statistical significance. Conclusion: If there is no evidence of distant metastasis in stage IV gastric cancer, one can expect improvement of the survival rate by the use of aggressive treatment, including curative gastric resection with radical lymph node dissection and chemotherapy.