• Journal of Gastric Cancer
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• v.10 no.3
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• pp.106-110
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• 2010

Purpose: The purpose of this study was to analyze the clinical courses of patients with gastric cancer and positive resection margins after a gastrectomy for gastric cancer who did not undergo subsequent surgery. Materials and Methods: Among 4,452 patients who underwent surgery for gastric cancer from January 2001 to December 2007, 20 patients with positive resection margins after gastrectomy for gastric cancer who did not undergo subsequent surgery were included. The recurrence patterns were confirmed by postoperative computed tomography and gastroscopy, which were performed on a planned schedule. All recurrence patterns after gastrectomy were classified as loco-regional, peritoneal, or distant metastases. Results: The patients with confirmed recurrence all had advanced stage cancer (III-IV), and the recurrence sites were variable. However, peritoneal and distant recurrences were more common than loco-regional recurrences. The patients with loco-regional recurrence also had peritoneal and/or distant recurrence. Conclusions: Patients with gastric cancer and a positive resection margin showed more frequent peritoneal and distant metastases than loco-regional recurrence. In addition, patients with loco-regional recurrence also had peritoneal and distant recurrence. A positive resection margin of gastric cancer was related with poor histological differentiation, diffuse type, and advanced stage (III-IV).

• Journal of Gastric Cancer
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• v.14 no.1
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• pp.23-31
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• 2014

Purpose: The role of peritoneal washing cytology in determining further treatment strategies after surgery for gastric cancer remains unclear. One reason for this is the fact that optimal procedures to increase the accuracy of predicting peritoneal metastasis have not been established. The aim of this study was to evaluate the efficacy of cytology using samples harvested from two different abdominal cavity sites during gastric cancer surgery. Materials and Methods: We prospectively recruited 108 patients who were clinically diagnosed with locally advanced gastric cancer (higher than cT1 stage disease). Peritoneal washing fluids were collected from the pouch of Douglas and the subphrenic area. Patients were prospectively followed up for 2 years to determine the recurrence and survival rates. Results: Thirty-three patients dropped out of the study for various reasons, so 75 patients were included in the final analysis. Seven patients (9.3%) showed positive cytology findings, of whom, three showed peritoneal recurrence. Tumor size was the only factor associated with positive cytology findings (P=0.037). The accuracy and specificity of cytology for predicting peritoneal recurrence were 90.1% and 94.2%, respectively, whereas the sensitivity was 50.0%. The survival rate did not differ between patients with positive cytology findings and those with negative cytology findings (P=0.081). Conclusions: Peritoneal washing cytology using samples harvested from two different sites in the abdominal cavity was not able to predict peritoneal recurrence or survival in gastric cancer patients. Further studies will be required to determine whether peritoneal washing cytology during gastric cancer surgery is a meaningful procedure.

• Journal of Gastric Cancer
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• v.24 no.2
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• pp.231-242
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• 2024

Purpose: This study aimed to investigate the recurrence patterns in patients who underwent curative surgery for gastric cancer (GC) and analyze their prognostic value for post-recurrence survival (PRS). Materials and Methods: We retrospectively reviewed the medical records of 204 patients who experienced GC recurrence following curative gastrectomy for GC at a single institution between January 2012 and December 2017. Specific recurrence patterns (lymph node, peritoneal, and hematogenous) and their multiplicity were analyzed as prognostic factors of PRS. Results: The median PRS of the 204 patients was 8.3 months (interquartile range [IQR]: 3.2-17.4). For patients with a single recurrence pattern (n=164), the difference in each recurrence pattern did not show a significant prognostic value for PRS (lymph node vs. peritoneal, P=0.343; peritoneal vs. hematogenous, P=0.660; lymph node vs. hematogenous, P=0.822). However, the patients with a single recurrence pattern had significantly longer PRS than those with multiple recurrence patterns (median PRS: 10.2 months [IQR: 3.7-18.7] vs. 3.9 months [IQR: 1.8-10.4]; P=0.037). In the multivariate analysis, multiple recurrence patterns emerged as independent prognostic factors for poor PRS (hazard ratio, 1.553; 95% confidence interval, 1.092-2.208; P=0.014) along with serosal invasion, recurrence within 1 year after gastrectomy, and the absence of post-recurrence chemotherapy. Conclusions: Regardless of the specific recurrence pattern, multiple recurrence patterns emerged as independent prognostic factors for poor PRS compared with a single recurrence pattern.

• Journal of Gastric Cancer
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• v.7 no.1
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• pp.23-30
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• 2007

Purpose: Evaluating the clinicopathologic characteristics of recurred gastric cancer is essential for early detection of the recurrence and for better clinical outcome. The aim of this study was to establish the patterns of the recurrence, the timing of the recurrence, and the clinical result after recurrence according to the clinicopathologic characteristics of gastric cancer. Materials and Methods: From June 1992 to December 2005, of the 1338 gastric cancer patients who underwent a curative gastric resection, 241 patients who recurred during the follow-up period were selected and their cases were analyzed. The clinicopathologic characteristics of the patients, the time to recurrence after operation and survival were determined retrospectively according to the type of recurrence. Results: For the recurrent group, the numbers of total gastrectomies, advanced stages, lymphatic and/or venous infiltrations, whole stomach cancer cases, large tumors, undifferentiated tumors, and Borrmann type 4 tumors were higher than they were for the non-recurrent group, and the differences were statistically significant. When the recurrence types were classified as peritoneal seeding, hematogenous recurrence, and locoregional recurrence, independent risk factors were female gender, stage III, upper third, and whlole stomach cancer, and undifferentiated- type, diffuse-type, and Borrmann type 4 tumors for peritoneal seeding; early gastric cancer, stage I for hematogenous recurrence; and Borrmann type 1, 2, and 3 tumors for locoregional recurrence. Survival duration after detection of the recurrence was shorter for peritoneal seeding than for hematogenous or locoregional recurrence (7.0 months vs. 9.5 months and 12.5 months). Conclusion: For early detection of the recurrence after curative surgery for gastric cancer, it is important to recognize that the high risk factors for recurrence vary with the clinicopathologic data for the patients.

• Journal of the Korean Society of Radiology
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• v.83 no.4
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• pp.904-909
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• 2022

Uterine cervical cancer is one of the most common malignancies of the female genital tract. Most recurrent cases of uterine cervical cancer are diagnosed within two years after primary treatment, and late recurrence after a disease-free interval of more than five years is rare. In addition, peritoneal metastases usually present as multifocal discrete nodules in the peritoneal cavity with nodular or diffuse peritoneal thickening. Herein, we report an extremely rare case of late recurrent cervical cancer peritoneal metastasis with an unusual manifestation of a large, solitary necrotic mass in the right subphrenic space on contrast-enhanced CT.

• Journal of Gastric Cancer
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• v.9 no.2
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• pp.51-56
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• 2009

Purpose: Peritoneal recurrence has been reported to be the most common form of recurrence of gastric cancer. Peritoneal recurrence can generally be suggested by several types of image studies and also if there is evidence of ascites or Bloomer's rectal shelf. It can be confirmed by explorative laparotomy, but diagnostic laparoscopy is a good alternative method and laparoscopic surgery has also been widely used. We reviewed and analyzed the ability of diagnostic laparoscopy to detect peritoneal recurrence or carcinomatosis, and especially for gastric cancer. Materials and Methods: We performed a retrospective review the 45 gastric cancer patients who were operated via diagnostic laparoscopy between 2004. 2. and 2009. 3. We analyzed the perioperative clinical characteristics and the accuracy of the diagnostic methods. Results: The study groups included 14 patients who had confirmed gastric cancer, but they suspected to have carcinomatosis, and 31 patients who had previously underwent gastric resection, but they suspected to have recurrence. The mean operation time was $44.1\pm26.9$ minutes and the mean postoperative hospital stay was $2.7\pm2.8$ days. There was one case of operation-related complication and no postoperative mortality occurred. The sensitivities for detecting peritoneal recurrence or carcinomatosis were 92.1% for diagnostic laparoscopy, 29.7% for detecting ascites and rectal shelf on the physical examination, 86.5% for abdominal computed tomography, 69.2% for PET CT and 18.8% for CEA. Conclusion: Diagnostic laparoscopy does not require a long operation time or a long hospital stay, and it showed a low complication rate in our study. It has high sensitivity for detecting peritoneal recurrence of gastric cancer. It can be an alternative diagnostic confirmative method and it is useful for deciding on further treatment.

• Journal of Gastric Cancer
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• v.1 no.3
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• pp.174-179
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• 2001

Purpose: For curative resection of recurrent gastric cancer, it is imperative that there be no unrecognized foci of tumoral disease outside the operation field. PET (positron emission tomography) with FDG (18 fluoro-2 deoxy-D-glucose) is a whole-body imaging technique that exploits the increased rate of glycolysis in tumor cells to detect disease. The authors evaluated the usefulness of FDG-PET in assessing resectability of recurrent gastric cancer. Materials and Methods: Seven patients with recurrent gastric cancer were studied with FDG-PET from December 1998 to October 2000. All FDG-PET images were interpreted in conjunction with conventional diagnostic methods. All imaging results were correlated with the pathological diagnosis and clinical outcome. Results: A final diagnosis of recurrence was obtained at 14 sites in all 7 patients by histology or clinical follow up. Locoregional recurrence, including distant metastasis, developed in 6 of 7 patients and distant recurrence in only one. FDG-PET detected all recurrent sites (5 locoregional and 5 distant) in 5 patients without peritoneal recurrence, but did not detect peritoneal seeding in 2 patients with peritoneal recurrence. The accuracy of FDG-PET in estimating resectability was $71.4\%$ (5/7), and that of CT and PET together was $85.7\%$ (6/7). A curative resection could be performed in three of the recurrent patients (2 locoregional and 1 distant recurrence). Conclusion: Our results suggest that FDG-PET may be useful for detecting locoregional and distant recurrence of gastric cancer and for selecting appropriate treatment. However, considering that FDG-PET was limited in detecting peritoneal seeding and determining the exact anatomical extension of tumor, it should be used in conjunction with other anatomical images.

• Journal of Gastric Cancer
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• v.2 no.4
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• pp.195-199
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• 2002

Purpose: Angiogenesis is essential for tumor growth and metastasis and depends on the production of angiogenic factors that are secreted by tumor cells. Vascular endothelial growth factor (VEGF) is the most significant angiogenic factor and a selective mitogen for endothelial cells. VEGF, also known as the vascular permeability factor, acts on endothelial cells to increase microvascular permeability and directly stimulate the growth of new blood vessels. Several studies have reported that the expression of VEGF is correlated with hematogenous recurrence via angiogenesis in gastric carcinomas. This research evaluated the relationship between the expression of VEGF and hepatic and peritoneal recurrence in gastric carcinomas. Materials and Methods: Thirty specimens resected from patients with primary gastric carcinomas who had undergone curative resections were divided into three group: Group I, early gastric carcinomas without recurrence; Group II, advanced gastric carcinomas with hepatic recurrence; and Group III, advanced gastric carcinomas with peritoneal recurrence. The expression of VEGF and the density of the microvessel count were examined using immunohistochemistry. Results: 1) The expression of VEGF in Group II and Group III ($63.2\pm\24.3\%$) was stronger than that in Group I ($7\pm\4.2\%$). The expression of VEGF in Group II ($76.5\pm\13.2\%$) was stronger than that of the Group III ($50\pm\14.2\%$) (P<0.05). 2) The microvessel count in Group II ($49.9\pm14.5$) was more than that in Group I ($8.6\pm2.6$) and Group III ($29.1\pm18.1$) (P<0.05). 3) The microvessel count was increased significantly with increasing the expression of VEGF. Conclusions: The expression of VEGF is associated with advanced stomach cancer and hepatic recurrence has a higher expression of VEGF than peritoneal recurrence with neovascularization. Thus the expression of VEGF can be considered to be a useful indicator of recurrence in gastric carcinoma and especially in hepatic recurrence.

• Electrolytes & blood pressure
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• v.16 no.2
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• pp.27-29
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• 2018

Peritoneal dialysis (PD)-related peritonitis is a major cause of injury and technique failure in patients undergoing PD. Aeromonas hydrophila is ubiquitous in the environment, and is a Gram-negative rod associated with infections in fish and amphibians in most cases; however, it can also cause opportunistic infections in immunocompromised patients. We report a case of A. hydrophila peritonitis in a 56-year-old male on automated PD. Peritonitis may have been caused by contamination of the Set Plus, a component of the automated peritoneal dialysis device. Although Set Plus is disposable, the patient reused the product by cleansing with tap water. He was successfully treated with intraperitoneally-administered ceftazidime and has been well without recurrence for more than 2 years.

• Korean Journal of Radiology
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• v.25 no.1
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• pp.86-102
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• 2024

Early diagnosis, accurate assessment, and localization of peritoneal metastasis (PM) are essential for the selection of appropriate treatments and surgical guidance. However, available imaging modalities (computed tomography [CT], conventional magnetic resonance imaging [MRI], and 18fluorodeoxyglucose positron emission tomography [PET]/CT) have limitations. The advent of new imaging techniques and novel molecular imaging agents have revealed molecular processes in the tumor microenvironment as an application for the early diagnosis and assessment of PM as well as real-time guided surgical resection, which has changed clinical management. In contrast to clinical imaging, which is purely qualitative and subjective for interpreting macroscopic structures, radiomics and artificial intelligence (AI) capitalize on high-dimensional numerical data from images that may reflect tumor pathophysiology. A predictive model can be used to predict the occurrence, recurrence, and prognosis of PM, thereby avoiding unnecessary exploratory surgeries. This review summarizes the role and status of different imaging techniques, especially new imaging strategies such as spectral photon-counting CT, fibroblast activation protein inhibitor (FAPI) PET/CT, near-infrared fluorescence imaging, and PET/MRI, for early diagnosis, assessment of surgical indications, and recurrence monitoring in patients with PM. The clinical applications, limitations, and solutions for fluorescence imaging, radiomics, and AI are also discussed.