• Journal of Gastric Cancer
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• 제9권1호
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• pp.31-35
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• 2009

위장관 칸디다증은 대개는 면역성이 저하된 경우에 기회 감염으로 발현되는 것이 일반적이다. 위장관 칸디다증 중식도 칸디다증이 가장 많은 빈도를 차지하고 있고 주로 면역기능이 억제된 환자에서 잘 발생하지만 드물게 건강한 성인에서도 보고된다. 현재까지는 양성 위궤양에 병발된 위장관 칸디다증이 흔히 보고되었지만 위선암에서 발견된 칸디다증은 비교적 드물다. 저자들은 속쓰림과 소화불량을 주소로 내원한 72세 여자환자에서 수술전 위선암과 칸디다증으로 진단되어 fluconazole을 경구투여를 통하여 칸디다증을 치료한 후 위전절제술을 시행한 증례를 경험하였다. 본 증례의 경험과 문헌 검색을 통하여, 저자들은 위암 수술 전 위암과 함께 위 칸디다증을 진단받은 환자에 대하여 칸디다에 대한 약물 치료 후 수술을 권유하는 바이다.

• Journal of Gastric Cancer
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• 제22권3호
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• pp.210-219
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• 2022

Purpose: Completion total gastrectomy (CTG) for remnant gastric cancer (RGC) is a technically demanding procedure and associated with increased morbidity. The present study aimed to evaluate postoperative complications and their risk factors following surgery for RGC after initial partial gastrectomy due to gastric cancer excluding peptic ulcer. Materials and Methods: We retrospectively reviewed the data of 107 patients who had previously undergone an initial gastric cancer surgery and subsequently underwent CTG for RGC between March 2002 and December 2020. The postoperative complications were graded using the Clavien-Dindo classification. Logistic regression analyses were used to determine the risk factors for complications. Results: Postoperative complications occurred in 34.6% (37/107) of the patients. Intra-abdominal abscess was the most common complication. The significant risk factors for overall complications were multi-visceral resections, longer operation time, and high estimated blood loss in the univariate analysis. The independent risk factors were multi-visceral resection (odds ratio [OR], 2.832; 95% confidence interval [CI], 1.094-7.333; P=0.032) and longer operation time (OR, 1.005; 95% CI, 1.001-1.011; P=0.036) in the multivariate analysis. Previous reconstruction type, minimally invasive approach, and current stage were not associated with the overall complications. Conclusions: Multi-visceral resection and long operation time were significant risk factors for the occurrence of complications following CTG rather than the RGC stage or surgical approach. When multi-visceral resection is required, a more meticulous surgical procedure is warranted to improve the postoperative complications during CTG for RGC after an initial gastric cancer surgery.

• Journal of Gastric Cancer
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• 제16권3호
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• pp.200-206
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• 2016

In Korea, proximal gastrectomy has recently attracted attention as a better choice of function-preserving surgery for proximal early gastric cancer than total gastrectomy. Of the various strategies to overcome reflux symptoms from remnant stomach, double tract reconstruction not only reduces the incidence of anastomosis-related complications, but is also sufficiently reproducible as a laparoscopic procedure. Catching up with the recent rise of single-port laparoscopic surgeries, we performed a pure single-port laparoscopic proximal gastrectomy with DTR. This procedure was designed by merging the function-preserving concept of proximal gastrectomy with single-port laparoscopic total gastrectomy.

• Journal of Gastric Cancer
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• 제17권1호
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• pp.11-20
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• 2017

Purpose: Acupuncture has recently been accepted as a treatment option for managing postoperative ileus (POI) and various functional gastrointestinal disorders. Therefore, we conducted a prospective randomized study to evaluate the effect of acupuncture on POI and other surgical outcomes in patients who underwent gastric surgery. Materials and Methods: Thirty-six patients who underwent distal gastrectomy for gastric cancer from March to December 2015 were randomly assigned to acupuncture or non-acupuncture (NA) groups at 1:1 ratio. The acupuncture treatment was administered treatment once daily for 5 consecutive days starting at postoperative day 1. The primary outcome measure was the number of remnant sitz markers in the small intestine on abdominal radiograph. The secondary outcome measure was the surgical outcome, including the times to first flatus, first defecation, start of water intake, and start of soft diet, as well as length of hospital stay and laboratory findings. Results: The acupuncture group had significantly fewer remnant sitz markers in the small intestine on postoperative days 3 and 5 compared to those in the NA group. A significant difference was observed in the numbers of remnant sitz markers in the small intestine with respect to group differences by time (P<0.0001). The acupuncture group showed relatively better surgical outcomes than those in the NA group, but the differences were not statistically significant. Conclusions: In this clinical trial, acupuncture promoted the passage of sitz markers, which may reflect the possibility of reducing POI after distal gastrectomy.

• Journal of Gastric Cancer
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• 제22권2호
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• pp.145-155
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• 2022

Purpose: Weight loss and deterioration in body composition are observed in patients with gastric cancer (GC) following gastrectomy. This study aimed to investigate the impact of residual stomach volume (RSV) on the nutritional status and body composition of patients with GC treated with distal gastrectomy. Materials and Methods: In total, 227 patients who underwent minimally invasive distal gastrectomy with Billroth 1 anastomosis for stage I GC between February 2015 and May 2018 were enrolled. Clinicodemographic and laboratory data were collected from the GC registry. The RSV, abdominal muscle area, and subcutaneous/visceral fat areas were measured using computed tomography data. Results: A larger RSV was associated with a lower decrease in the nutritional risk index (P=0.004) and hemoglobin level (P=0.003) during the first 3 months after surgery, and better recovery at 12 months. A larger RSV demonstrated an advantage in the preservation of abdominal muscle area (P=0.02) and visceral fat (P=0.04) after surgery, as well as less reduction in weight (P=0.02) and body mass index (P=0.03). Conclusions: Larger RSV was associated with improved nutritional status and better preservation of muscle and fat after distal gastrectomy.

• Journal of Gastric Cancer
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• 제18권2호
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• pp.189-199
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• 2018

Purpose: This study sought to examine whether near total gastrectomy (nTG) confers a longterm nutritional benefit when compared with total gastrectomy (TG) for the treatment of gastric cancer. Materials and Methods: Patients who underwent nTG or TG for gastric cancer were included (n=570). Using the 1:2 matched propensity score, 25 patients from the nTG group and 50 patients from the TG group were compared retrospectively for oncologic outcomes, including long-term survival and nutritional status. Results: The length of the proximal resection margin, number of retrieved lymph nodes and tumor nodes, metastasis stage, short-term postoperative outcomes, and long-term survival were not significantly different between the groups. The body mass index values, and serum total protein and hemoglobin levels of the patients decreased significantly until postoperative 6 months, and then recovered slightly over time (P<0.05); however, there was no difference in the levels between the groups. The prognostic nutritional index values and serum albumin levels decreased significantly until postoperative 6 months and then recovered (P<0.05); the levels decreased more in the nTG group than in the TG group (P<0.05). The mean corpuscular volumes and serum transferrin levels increased significantly until postoperative 1 year and then recovered slightly over time (P<0.05); however, there was no difference between the groups. Serum vitamin $B_{12}$, iron, and ferritin levels of the patients did not change significantly over time, and no difference existed between the groups. Conclusions: A small remnant stomach after nTG conferred no significant nutritional benefits over TG.

• Journal of Gastric Cancer
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• 제23권2호
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• pp.275-288
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• 2023

Purpose: This study aimed to examine the effects of 4 main types of gastrectomy for proximal gastric cancer on postoperative symptoms, living status, and quality of life (QOL) using the Postgastrectomy Syndrome Assessment Scale-45 (PGSAS-45). Materials and Methods: We surveyed 1,685 patients with upper one-third gastric cancer who underwent total gastrectomy (TG; n=1,020), proximal gastrectomy (PG; n=518), TG with jejunal pouch reconstruction (TGJP; n=93), or small remnant distal gastrectomy (SRDG; n=54). The 19 main outcome measures (MOMs) of the PGSAS-45 were compared using the analysis of means (ANOM), and the general QOL score was calculated for each gastrectomy type. Results: Patients who underwent TG experienced the lowest postoperative QOL. ANOM showed that 10 MOMs were worse in patients with TG. Four MOMs improved in patients with PG, while 1 worsened. One MOM was improved in patients with TGJP versus 8 MOMs in patients with SRDG. The general QOL scores were as follows: SRDG (+39 points), TGJP (+6 points), PG (+3 points), and TG (-1 point). Conclusions: The TG group experienced the greatest decline in postoperative QOL. SRDG and PG, which preserve part of the stomach without compromising curability, and TGJP, which is used when TG is required, enhance the postoperative QOL of patients with proximal gastric cancer. When selecting the optimal gastrectomy method, it is essential to understand the characteristics of each and actively incorporate guidance to improve postoperative QOL.

• Journal of Gastric Cancer
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• 제16권4호
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• pp.215-220
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• 2016

Purpose: This study aimed to evaluate the rate, patterns, and risk factors associated with tumor recurrence in patients with T1N0 gastric cancer. Materials and Methods: The medical records of 8,753 patients with pathological T1N0M0 gastric cancer who underwent gastrectomy between 1994 and 2014 at Sungkyunkwan University School of Medicine were examined. Results: Among the 8,753 patients, 95 patients (1.1%) experienced tumor recurrence; this included 31 remnant, 27 hematogenous, 9 lymph nodal, 5 peritoneal, and 23 multiple-site recurrences. When patients were divided into two groups according to the presence of tumor recurrence, the following characteristics were higher in the recurrence group than in the non-recurrence group: older age (${\geq}65years$), male gender, undifferentiated histology, submucosal invasion, and venous invasion. In multivariate analysis, older age, male gender, tumor depth (sm2 and sm3 invasion), and venous invasion were independent risk factors for tumor recurrence. The recurrence rates were 0.7% in patients with less than two risk factors, 1.7% in those with two risk factors, 3.0% in those with three risk factors, and 6.3% in those with four risk factors (P<0.001). Conclusions: Although tumor recurrence is rare in pT1N0M0 gastric cancer, some patients with certain risk factors demonstrate an increased rate of tumor recurrence. Careful follow-up is required for patients with three or four risk factors.

• Journal of Gastric Cancer
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• 제15권1호
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• pp.46-52
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• 2015

Purpose: The aim of this study was to compare the short-term surgical and long-term functional outcomes of Billroth I, Billroth II, and Roux-en-Y reconstruction after laparoscopic distal gastrectomy. Materials and Methods: We retrospectively collected data from 697 patients who underwent laparoscopic distal gastrectomy for operable gastric cancer between January 2009 and December 2012. The patients were classified into three groups according to the reconstruction methods: Billroth I, Billroth II, and Roux-en-Y. The parameters evaluated included patient and tumor characteristics, operative details, and postoperative complications classified according to the Clavien-Dindo classification. Endoscopic findings of the remnant stomach were evaluated according to the residue, gastritis, bile (RGB) classification and the Los Angeles classification 1 year postoperatively. Results: Billroth I, Billroth II, and Roux-en-Y were performed in 165 (23.7%), 371 (53.2%), and 161 patients (23.1%), respectively. Operation time was significantly shorter ($173.4{\pm}44.7$ minute, P<0.001) as was time to first flatus ($2.8{\pm}0.8$ days, P=0.009), time to first soft diet was significantly faster ($4.3{\pm}1.0$ days, P<0.001), and postoperative hospital stay was significantly shorter ($7.7{\pm}4.0$ days, P=0.004) in Billroth I in comparison to the other methods. Postoperative complications higher than Clavien-Dindo grade III occurred in 61 patients (8.8%) with no statistically significant differences between groups (P=0.797). Endoscopic findings confirmed that gastric residue, gastritis, bile reflux, and reflux esophagitis were significantly lower in Roux-en-Y (P<0.001) patients. Conclusions: Roux-en-Y reconstruction after laparoscopic distal gastrectomy for middle-third gastric cancer is beneficial in terms of long-term functional outcome, whereas Billroth I reconstruction for distal-third gastric cancer has a superior short-term surgical outcome and postoperative weight change.

• Journal of Gastric Cancer
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• 제6권1호
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• pp.1-5
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• 2006

목적: 근위부 위절제술 후 식도-위 문합술을 시행받은 환자에서 문합부 협착, 역류성 식도염 등이 드물지 않게 발생한다. 저자들 역시 이러한 합병증을 경험하였고 이를 극복하기 위한 방법으로 공장간치술을 시행하였으며 식도-위 문합술과 공장간치술 간의 경과 관찰을 통해 보다 나은 재건 술식을 찾고자 하였다. 대상 및 방법: 1998년 6월부터 2002년 12월까지 울산의대 서울아산병원 외과에서 상부위암 혹은 위상부의 위장관기질종양으로 진단받고 근위부 위절제술을 시행한 환자를 대상으로 재건 술식에 따른 수술시간, 수술 후 증상, 체중변화, 추적관찰 시 시행한 내시경 소견 등을 비교하였다. 결과: 대상 환자 총 33명의 평균연령은 59세였고, 남녀 비는 3 : 1이었다. 식도-위 문합술을 시행한 환자는 25명, 공장간치술을 시행한 환자는 8명이었다. 통과장애, 속쓰림, 신트림, 구토 등의 증상을 관찰하였으며 식도-위 문합술 환자에서 통과장애 12예, 구토 3예, 속쓰림 4예, 신트림 4예가 관찰되었으며, 공장간치술 환자에서는 통과장애 12예, 구토 3예가 있었고, 속쓰림과 신트림은 관찰되지 않았다. 수술 후 체중변화는 1개월 후 수술 전 체중의 90%까지 감소한 경우가 식도-위 문합술 환자에서 7예, 공장간치술 환자에서 없었다. 수술 후 추적 내시경 검사 결과 역류성 식도염이 관찰된 경우는 식도-위 문합술 환자에서 9예, 공장간치술 환자에서 0예였다. 문합부위 협착으로 인해 풍선 확장술이 필요하였던 경우가 식도-위 문합술 환자에서 4예, 공장간치술 환자에서 1예가 있었다. 결론: 상부 위절제 시 재건방법으로 역류성 식도염 및 여러 소화기 증상을 예방하기 위해 공장간치술이 식도-위문합술의 대안이 될 수 있다고 생각한다. 하지만 통계적 유의성을 가지기 위해 더 많은 대상군이 포함되어야 할 것이다.