• Journal of Gastric Cancer
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• 제13권4호
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• pp.214-225
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• 2013

Purpose: Peritoneal lavage cytology is part of the routine staging workup for patients with advanced gastric cancer. However, no quality assurance study has been conducted to show variations or biases in peritoneal lavage cytology results. The aim of this study was to demonstrate a test execution variation in peritoneal lavage cytology between investigating surgeons. Materials and Methods: A prospective cohort study was designed for determination of the positive rate of peritoneal lavage cytology using a liquid-based preparation method in patients with potentially curable advanced gastric cancer (cT2~4/N0~2/M0). One hundred thirty patients were enrolled and underwent laparotomy, peritoneal lavage cytology, and standard gastrectomy, which were performed by 3 investigating surgeons. Data were analyzed using the chi-square test and a logistic regression model. Results: The overall positive peritoneal cytology rate was 10.0%. Subgroup positive rates were 5.3% in pT1 cancer, 2.0% in pT2/3 cancer, 11.1% in pT4a cancer, and 71.4% in pT4b cancer. In univariate analysis, positive peritoneal cytology showed significant correlation with pT stage, lymphatic invasion, vascular invasion, ascites, and the investigating surgeon. We found the positive rate to be 2.1% for surgeon A, 10.2% for surgeon B, and 20.6% for surgeon C (P=0.024). Multivariate analysis identified pT stage, ascites, and the investigating surgeon to be significant risk factors for positive peritoneal cytology. Conclusions: The peritoneal lavage cytology results were significantly affected by the investigating surgeon, providing strong evidence of test execution variation that could be related to poor diagnostic accuracy and stage migration in patients with advanced gastric cancer.

• Journal of Gastric Cancer
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• 제18권1호
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• pp.90-98
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• 2018

Purpose: We evaluated the learning curve and short-term surgical outcomes of robot-assisted distal gastrectomy (RADG) performed by a single surgeon experienced in open, but not laparoscopic, gastrectomy. We aimed to verify the feasibility of performing RADG without extensive laparoscopic experience. Materials and Methods: Between July 2012 and December 2016, 60 RADG procedures were performed by a single surgeon using the da $Vinci^{(R)}$ Surgical System (Intuitive Surgical). Patient characteristics, the length of the learning curve, surgical parameters, and short-term postoperative outcomes were analyzed and compared before and after the learning curve had been overcome. Results: The duration of surgery rapidly decreased from the first to the fourth case; after 25 procedures, the duration of surgery was stabilized, suggesting that the learning curve had been overcome. Cases were divided into 2 groups: 25 cases before the learning curve had been overcome (early cases) and 35 later cases. The mean duration of surgery was 420.8 minutes for the initial cases and 281.7 minutes for the later cases (P<0.001). The console time was significantly shorter during the later cases (168.6 minutes) than during the early cases (247.1 minutes) (P<0.001). Although the volume of blood loss during surgery declined over time, there was no significant difference between the early and later cases. No other postoperative outcomes differed between the 2 groups. Pathology reports revealed the presence of mucosal invasion in 58 patients and submucosal invasion in 2 patients. Conclusions: RADG can be performed safely with acceptable surgical outcomes by experts in open gastrectomy.

• Journal of Gastric Cancer
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• 제15권4호
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• pp.238-245
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• 2015

Purpose: This study aimed to identify time-dependent prognostic factors and demonstrate the time-dependent effects of important prognostic factors in patients with advanced gastric cancer (AGC). Materials and Methods: We retrospectively evaluated 3,653 patients with AGC who underwent curative standard gastrectomy between 1991 and 2005 at the Korea Cancer Center Hospital. Multivariate survival analysis with Cox proportional hazards regression was used in the analysis. A non-proportionality test based on the Schoenfeld residuals (also known as partial residuals) was performed, and scaled Schoenfeld residuals were plotted over time for each covariate. Results: The multivariate analysis revealed that sex, depth of invasion, metastatic lymph node (LN) ratio, tumor size, and chemotherapy were time-dependent covariates violating the proportional hazards assumption. The prognostic effects (i.e., log of hazard ratio [LHR]) of the time-dependent covariates changed over time during follow-up, and the effects generally diminished with low slope (e.g., depth of invasion and tumor size), with gentle slope (e.g., metastatic LN ratio), or with steep slope (e.g., chemotherapy). Meanwhile, the LHR functions of some covariates (e.g., sex) crossed the zero reference line from positive (i.e., bad prognosis) to negative (i.e., good prognosis). Conclusions: The time-dependent effects of the prognostic factors of AGC are clearly demonstrated in this study. We can suggest that time-dependent effects are not an uncommon phenomenon among prognostic factors of AGC.

• Journal of Gastric Cancer
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• 제21권2호
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• pp.169-178
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• 2021

Purpose: The aim of this study was to investigate the oncologic safety and identify potential candidates for proximal gastrectomy (PG) in upper third advanced gastric cancer (AGC) and esophagogastric junction (EGJ) cancers. Materials and Methods: Among 5,665 patients who underwent gastrectomy for gastric adenocarcinoma between January 2011 and December 2017, 327 patients who underwent total gastrectomy with standard lymph node (LN) dissection for upper third AGC and Siewert type II EGJ cancers were enrolled. We analyzed the correlation between the metastatic rates of distal LNs (No. 4d, 5, 6, and 12a) around the lower part of the stomach and the clinicopathological characteristics. We identified subgroups with no metastasis to the distal LNs. Results: The metastatic rate of distal LNs in proximal AGC and Siewert type II EGJ cancers was 7.0% (23 of 327 patients). On multivariate analysis, pathological T stage (P=0.001), tumor size (P=0.043), and middle third invasion (P=0.003) were significantly associated with distal LN metastases. Pathological 'T2 stage' (n=88), or 'T3 stage with ≤5 cm tumor size' (n=87) showed no metastasis in distal LNs, regardless of middle third invasion. Pathological T3 stage with tumor size > 5 cm (n=61) and T4 stage (n=91) had metastasis in the distal LNs. Conclusions: In the upper third AGC and Siewert type II EGJ cancer, pathological T2 and small-sized T3 stage groups are possible candidates for PG in cases without distal LN metastasis. Further validation studies are required for clinical application.

• Journal of Gastric Cancer
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• 제23권2호
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• pp.355-364
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• 2023

Background: There are no clear guidelines to determine whether to perform D1 or D1+ lymph node dissection in early gastric cancer (EGC). This study aimed to develop a nomogram for estimating the risk of extraperigastric lymph node metastasis (LNM). Materials and Methods: Between 2009 and 2019, a total of 4,482 patients with pathologically confirmed T1 disease at 6 affiliated hospitals were included in this study. The basic clinicopathological characteristics of the positive and negative extraperigastric LNM groups were compared. The possible risk factors were evaluated using univariate and multivariate analyses. Based on these results, a risk prediction model was developed. A nomogram predicting extraperigastric LNM was used for internal validation. Results: Multivariate analyses showed that tumor size (cut-off value 3.0 cm, odds ratio [OR]=1.886, P=0.030), tumor depth (OR=1.853 for tumors with sm2 and sm3 invasion, P=0.010), cross-sectional location (OR=0.490 for tumors located on the greater curvature, P=0.0303), differentiation (OR=0.584 for differentiated tumors, P=0.0070), and lymphovascular invasion (OR=11.125, P<0.001) are possible risk factors for extraperigastric LNM. An equation for estimating the risk of extraperigastric LNM was derived from these risk factors. The equation was internally validated by comparing the actual metastatic rate with the predicted rate, which showed good agreement. Conclusions: A nomogram for estimating the risk of extraperigastric LNM in EGC was successfully developed. Although there are some limitations to applying this model because it was developed based on pathological data, it can be optimally adapted for patients who require curative gastrectomy after endoscopic submucosal dissection.

• 대한한방내과학회지
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• 제23권2호
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• pp.165-173
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• 2002

Purpose : Among numerous biological symptoms of cancer, matrix metalloproteinases (MMPs) are essential for tumor invasion and metastasis. HAD is used as an inhibitor of MMP gene. This study was designed to evaluate the effects of HAD on anti metastasis and preventing recurrence in cancer patients. Materials and Methods : We retrospectively analyzed the medical records of 69 cancer patients who had been administered with HAD for over 12 months continuously in East-West Cancer Center of Oriental Hospital of Daejeon University, from January 1993 to May 2002. Results : We analyzed gender, portion, stage and anti-metastasis & recurrence rates of cancer patients. Analysis of sex cases showed that the percentage of male is 62.3%, female is 37.7%. Analysis of cancer portion showed that the percentage of stomach is 31.9%, colorectum is 26.1%, lung is 21.7%, liver is 8.7%, breast is 8.7% Analysis of stage showed that the rate of III is 78.3%, IV is 13.0% and II is 8.7%. Analysis of anti-metastasis and recurrence rates showed that colorectal cancer is 77.8%, stomach cancer is 63.6%, lung cancer is 33.4% and breast cancer is 33.3% (mean : 53.6%). Conclusions : HAD has significant effects on anti-metastasis and preventing recurrence of tumor on cancer patients. So it helps to prolong the survival rates of cancer patients.

• 사상체질의학회지
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• 제13권2호
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• pp.49-61
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• 2001

The purpose of this article was to compare 'The Discourse on the Constitutional Symptoms and Disease' of ${\ulcorner}$Dongyi Soose Bowon${\lrcorner}$ written in 1894(Old Edition(舊本)) with that of ${\ulcorner}$Dongyi Soose Bowon${\lrcorner}$ published in 1901(In Edition(印本)), and to find the idea of pathologic mechanism and classification of 'the Exterior and Interior disease'. the conclusions were as follows. 1. The classification of constitutional symptoms and disease of Soeumin and Soyangin in 'Old Edition(舊本)' was almost equal to that in 'In Edition(印本)' 2. In pathological mechanism of constitutional symptoms and disease of Soeumin and Soyangin, 'The Exterior Disease' could be explained as the disease resulted from fight between 'Yang-chi(陽氣)(Hot-chi(熱氣))'of 'Thoracic vertebrae' and 'Yin-chi(陰氣)(Cold-chi(寒氣))' of 'Bladder' and 'The Interior Disease' between 'Hot-chi(熱氣)(Stomach-chi(胄氣))' of 'Stomach' and 'Cold-chi(寒氣)' of 'Large intestine'. 3. 'The Exterior Symptoms and Disease of the Exterior and the Interior Disease(表裏之表病)' could be explained as the disease occurring at the Branch portion(large portion)(標) by overcoming of Pathogenic factors but Vital energy still sufficient, and 'The Interior Symptoms and Disease of the Exterior and the Interior Disease(表裏之裏病)' occurring at Root portion(small portion)(裏) by invasion of Pathogenic factors and Vital energy almost exhausted. 4. In the classification of constitutional symptoms and disease of Taeumin, 'The Exterior Symptoms and Disease of the Exterior and the Interior Disease(表裏之表病)' in 'Old Edition(舊本)' were rearranged to 'The Exterior Disease' in 'In Edition(印本)', 'The Interior Symptoms and Disease of the Exterior and the Interior Disease(表裏之裏病)' to 'The Interior Disease'. 5. It was assumed that 'The Exterior and the Interior Disease' of Taeumin could be explained in relation between the exterior and e interior, based on the Healthy energy(保命之主) and e concept of the Branch and the Root portion

• 한국어병학회지
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• 제26권3호
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• pp.255-263
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• 2013

선천성 면역반응은 감염성 질병에 대한 저항력이 부족한 초기 발달단계의 자치어에게 중요하다. 특히 lectin은 선천성 면역반응에 많은 기여를 하고 있으며 종류 또한 다양하다. Lectin의 종류 중 하나인 galectin은 어류 점액 내에 존재하며 선천적으로 외부 병원체로부터 숙주를 보호하는 기능을 지니고 있다. 하지만 어류 galectin과 초기발생단계 시기와 관련된 연구들은 부족한 실정이다. 본 연구는 넙치에서 발현되는 galecin-1을 통하여 자치어의 초기발생단계별 그리고 성어의 조직별 발현을 조사하였다. 초기발생단계별 galectin 발현을 조사한 결과, 부화 전 수정란의 낭배기부터 galectin-1 유전자의 발현이 시작되었으며, 부화 후 25일까지 서서히 증가하였다. 부화 후 30~35일에 galectin-1 유전자의 발현량이 급격하게 증가하였고, 그 이후의 galecin-1 유전자의 발현량은 서서히 감소하였다. 성어 (5개월령, 29개월령)의 조직별 galectin 발현을 조사한 결과, 근육, 장, 지느러미, 위, 눈 조직 순서로 높게 발현하였고, 이외의 조직에서는 발현이 나타나지 않았다. 초기발생단계에서 galectin-1의 발현이 증가되는 것은 낭배기부터 넙치의 근육, 지느러미 그리고 눈 조직이 형성되고 galectin의 분비가 시작되어 기능을 나타내기 때문인 것으로 추측된다. 부화 후 30일부터 galectin의 발현량이 많이 증가하는 것은 장과 위 조직이 활성화됨에 따라 점액의 분비량이 증가하여 galectin의 발현량 또한 증가하는 것으로 판단된다. 이로써 넙치 초기발생단계 시기의 galectin-1 유전자의 발현패턴과 galectin이 점액 내에 다량 포함되어 있는 것을 확인하였으며, galectin의 발현은 선천적 면역반응으로 넙치의 초기발생단계 시기와 성어기에 중요할 것으로 판단된다.

• 사상체질의학회지
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• 제18권2호
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• pp.15-24
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• 2006

1. Objectives This paper was written in order to understand the formative process of Soeumin pharmacology. 2. Methods Souemin pharmacology was analysed with pathology and new prescription in Gabobon(甲午本) and Sinchukbon(辛丑本) of ${\ulcorner}$Dongyi Suse Bowon${\Ircorner}$. 3. Results and Conclusions Soeumin is charactrized to much output of kidney and a little input of speen in sight of ingestive food(水穀). So deficiency of YangQi is a peculiarity of pathology and ascending-Qi is a basic pharmacology. The pharmacology in the exterior disease of Soeumin is built up to base on the old prescription of previous text in Gabobon. Ascending-Yang is the basic pharmacology of Sinchukbon and prescription is summarized to base on the Kyuji-tang. So new prescriptin of Chungoongkyuji-tang and Hwangkikyuji-tang is made by combine Kyuji-tang with Koongkihyangso-san and Bojoongikki-tang. The pharmacology in the interior disease of Soeumin is built up to devide to the weakness of Stomach-Qi, dyspepsia and invasion of cold-Qi. Descending Yin is the basic pharmacology of Sinchukbon and prescription is summarized to base on the Yijoong-tang. Sokunjoong-tang's pharmacology of abdominal pain is newly added and applided to Baekhaoyijoong-tang and Kwankyuboojayijoong-tang. The discourse of the symptoms and diseases at the Sasang Constitutional Medine is built up to base on the previous text in Gabobon and base on clinical experience in Sinchukbon. So clinical experience is the power of summarizing the pharmacology and escaping the previous pharmacology.

• Journal of Gastric Cancer
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• 제20권3호
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• pp.328-336
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• 2020

Purpose: The standard treatment for stage IB gastric cancer is curative surgery alone, but some patients show poor survival with disease recurrence after curative surgery. The aim of this study was to identify prognostic factors of recurrence and long-term survival in patients with stage IB gastric cancer after surgery. Materials and Methods: We retrospectively reviewed data from 253 patients with stage IB gastric cancer who underwent gastrectomy between 2011 and 2016 at Kyungpook National University Chilgok Hospital and analyzed the clinicopathological characteristics associated with recurrence and survival. Results: Fourteen patients experienced recurrence with a mean follow-up of 54.1 months. Two of these patients had locoregional recurrence and 12 patients had systemic recurrence. The median interval between the operation day and the day of recurrence was 11 months (range 4-56 months). Multivariate analysis revealed that lymphatic vessel invasion (LVI) (hazard ratio [HR], 3.851; 95% confidence interval [CI], 1.264-11.732) and the elderly (age≥65) (HR, 3.850; 95% CI, 1.157-12.809) were independent risk factors for recurrence after surgery. The LVI (HR, 3.630; 95% CI, 1.105-11.923) was the independent prognostic factors for disease-specific survival (DSS). The 5-year DSS rates were 96.8% in patients who did not have LVI, and 89.3% in patients who had LVI. Conclusions: This study shows that LVI was associated with recurrence and poor survival in patients with stage IB gastric cancer after curative gastrectomy. Patients diagnosed with LVI require careful attention for systemic recurrence during the follow-up period.