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Endoscopic screening has been adopted in South Korea for the national screening of gastric cancer (GC). This study aimed to assess the effect on overall survival of GC patients and determine the optimal endoscopic screening interval. The baseline characteristics and overall survival of GC patients treated at the National Cancer Center, Korea, between 2010 and 2016 were compared between those without a history of endoscopic evaluation (group N) and those in whom the interval between the last endoscopic evaluations and diagnosis of GC was ≤ 1, 1–2, 2–3, 3–4, or > 4 years (groups 1–5, respectively). A total of 2362 patients met the criteria for the study (1060 in group N and 1302 in groups 1–5). More patients in groups 1–5 were diagnosed with stage I GC (83.7, 83.7, 71.8, 78.2, and 71.6%, respectively) than in group N (62.4%, P

Benign strictures at esophagojejunostomy sites may develop after total gastrectomy, and through-the-scope balloon dilation (TTS-BD) can relieve them. The aim of this study was to evaluate effective and safe balloon diameter for benign stricture after total gastrectomy.From June 2001 to December 2006, 930 gastric cancer patients underwent total gastrectomy with Roux-en-Y esophagojejunostomy in a cancer center hospital. We performed TTS-BD when benign strictures developed. Initial success rate, complication rate, and restenosis rate were evaluated. We classified the patients into three groups according to final dilation diameter and number of sessions.A total of 58 patients (6.2%) developed a benign stricture at the esophagojejunostomy site. We classified them into three groups based on the final luminal diameter of the balloon used and the number of sessions, as follows: group A (n = 20), 13.5-15 mm in one or two sessions; group B (n = 13), 16.5-20 mm in one session; group C (n = 25), 16.5-20 mm in two sessions. The initial success rates were 100% for groups A and B and 96% for group C. A perforation occurred in one patient (7.7%) in group B. Restenosis occurred in two patients (10%) in group A, one patient (7.7%) in group B, and in no patients in group C (p = 0.29). Restenosis was resolved by one or two further TTS-BDs.TTS-BD to 15 mm was a safe and effective treatment for benign esophagojejunostomy strictures following total gastrectomy. Restenosis was not common and could be resolved by one or two further TTS-BD sessions.

Perforations are major complications of endoscopic gastric resection, including endoscopic submucosal dissection (ESD), and are generally detected on chest radiography following ESD. We hypothesized that a small amount of free air, defined as “intraperitoneal air,” would not be noted on chest radiography. In this study we aimed to determine how often intraperitoneal air is seen on a computed tomography (CT) scan after ESD and to evaluate the association between clinical factors and intraperitoneal air. A total of 147 patients who underwent ESD for gastric neoplasms were analyzed between September 2009 and September 2010. Patients underwent both chest radiography and noncontrast CT scans. Intraperitoneal air on the CT scan was stratified by the amount of gas as follows: grade I, free air localized along the outside of the gastric wall; grade II, free air in the lesser sac; and grade III, free air in front of the liver. Intraperitoneal air was detected in 56 patients (38.1 %) by an abdominal CT scan, whereas free air was noted in 2 patients (1.4 %) by chest radiography. Most patients with intraperitoneal air (96.4 %, 54/56) were grade I or II and 3.6 % (2/56) were grade III. Abdominal pain was more frequent in the intraperitoneal air group (32.1 %, 18/56) than in the no intraperitoneal air group (17.6 %, 16/91; P = 0.042). Tumor location at the lesser curvature was more frequent in the intraperitoneal air group (66.1 %, 37/56) than in the no intraperitoneal air group (38.5 %, 35/91; P

Self-expandable metallic stents are used widely to relieve malignant gastric outlet obstruction (GOO). However, restenosis or migration of first stents is a frequent complication. The purpose of this retrospective cohort study was to evaluate the effectiveness of second stents as an approach to manage failure of first stents in patients with malignant GOO. A total of 222 patients with gastric cancer received first stents due to inoperable GOO at National Cancer Center in Korea between January 2008 and June 2011. Monthly follow-up interviews were performed, and second stents (stent-in-stent or stent-after-migration) were inserted in 59 patients by June 2012. Technical and clinical successes and long-term complications were evaluated. The technical and immediate clinical success rates were 98.3 % (58/59) and 91.5 % (54/59), respectively. Patients who received a second stent due to late complications involving the first stent (migration, restenosis, and fracture) showed a higher clinical success rate (95.8 % [46/48]) than patients who received a second stent due to immediate clinical failure of the first stent (72.7 % [8/11], p = 0.04). The immediate clinical success rate of stent-after-migration (100 % [11/11]) was not different from that of stent-in-stent (89.6 % [43/48], p = 1.0). The stent dysfunction rate of stent-after-migration (27.3 % [3/11]) also was similar to that of stent-in-stent (29.2 % [14/48], p = 1.0). The median patencies of stent-in-stent and stent-after-migration were 27.4 and 58.4 weeks, respectively (p = 0.177). There were no significant prognostic factors for patency of second stents. Insertion of a second stent is effective for treating the first-stent failure in gastric cancer patients with GOO, especially if the immediate outcome of the first stent was successful.

The purpose of this study was to identify risk factors associated with lymph node (LN) metastasis in early gastric cancer patients who underwent endoscopic resection (ER) and to evaluate the feasibility of minimal LN dissection in these patients. From January 2001 to March 2011, patients who underwent gastrectomy with lymphadenectomy due to the potential risk of LN metastasis after ER were enrolled at National Cancer Center, Korea. The incidence, risk factors, and distribution of LN metastasis were evaluated. Of the 147 enrolled patients, the LN metastasis was identified in 12 patients (8.2 %). The incidence of LN metastasis was not significantly increased in patients with submucosal invasion, lymphovascular invasion, and mixed undifferentiated histology [odds ratio (OR), 5.55, 1.349, and 0.387; 95 % confidence interval (CI), 0.688–43.943, 0.405–4.494, and 0.081–1.84, respectively]. Tumor size more than 2 cm was significantly associated with LN metastasis (OR, 14.056; 95 % CI, 1.76–112.267). The incidence of LN metastasis gradually increased from 3.2 to 20 %, as number of risk factors increased (P = 0.019). LN metastasis was present primarily along the perigastric area in all except two patients (1.4 %) with skip metastasis to extragastric area. Standard surgery with at least D1 + LN dissection must be recommended for patients who proved to have risk factors for LN metastasis after ER, because the potential of skip metastasis is not negligible. Nevertheless, the minimal LN dissection, such as sentinel basin dissection, might be applied cautiously in patients with small-sized tumors after ER.

The best therapeutic modality has not been established for gastric low-grade adenomas or dysplasia (LGD), which can progress to invasive carcinoma despite a low risk. This study aims to investigate the clinical efficacy, safety, and local recurrence after argon plasma coagulation (APC) treatment of gastric LGD compared with endoscopic submucosal dissection (ESD). A total of 320 patients with gastric LGD ≤2.0 cm treated with APC or ESD between 2004 and 2011 were retrospectively analyzed. We compared local recurrence rate, complication rate, procedure time, and admission to hospital between APC and ESD groups. Of the 320 patients, 116 patients were treated with APC and 204 with ESD. During follow-up, local recurrence was more common in the APC group (3.8 %, 4/106) than the ESD group (0.5 %, 1/188; log-rank test P = 0.036). However, all patients with local recurrence (n = 5) were treated by additional APC, and followed up without further recurrences. ESD was complicated by two perforations (1.0 %, 2/204) compared with no perforations in the APC group (0 %, 0/116). Bleeding complications were not different between the APC (1.7 %, 2/116) and ESD (2.0 %, 4/204) groups. Procedure time was shorter in the APC (7.8 ± 5.1 min) than the ESD (53.1 ± 38.1 min) group (P

Laparoscopically assisted total gastrectomy (LATG) is technically difficult. Robot surgery has theoretical advantages such as increased degrees of freedom of instruments and a three-dimensional view. The current study aimed to determine whether a robot-assisted total gastrectomy (RATG) has a real benefit over LATG in terms of surgical and oncologic outcomes. A single-center case–control study was conducted. The study included 36 patients who underwent RATG and 65 patients who underwent LATG at the National Cancer Center in Korea between February 2009 and May 2011. No patients were excluded from the analysis within the study period. Clinicopathologic data, operative data, postoperative morbidity, and pathologic data were analyzed by Student’s t-tests and Chi-square tests, as indicated. The mean age of the patients was 53.9 ± 11.7 years in the RATG group and 56.9 ± 12.3 years in the LATG group (P = 0.236). The mean BMI was 23.2 ± 2.5 kg/m2 in the RATG group and 23.6 ± 3.4 kg/m2 in the LATG group (P = 0.494). The mean postoperative hospital stay was 8.8 ± 3.3 days in the RATG group and 10.3 ± 10.8 days in the LATG group (P = 0.416). The mean operative time was 305.8 ± 115.8 min in the RATG group and 210.2 ± 57.7 min in the LATG group (P

Self-expandable metallic stents (SEMSs) provide effective palliation for inoperable malignant gastric outlet obstruction (GOO). The objective of this study was to evaluate the effectiveness of SEMSs in patients with recurrent gastric cancer after radical gastrectomy. We retrospectively analyzed data from patients with gastric cancer who underwent endoscopic SEMS placement. The patients had obstructive symptoms due to recurrent gastric cancer after curative-intent subtotal or total gastrectomies. Technical and clinical success rates of stent placement were evaluated and clinical outcomes were compared according to operation types. A total of 15 patients underwent total gastrectomies with esophagojejunostomies and Roux-en-Y reconstructions, 8 underwent subtotal gastrectomies with Billroth I reconstructions, and 12 underwent subtotal gastrectomies with Billroth II reconstructions. Four patients in the Billroth II group received stents in afferent and efferent loops, so a total of 39 stents were placed. Technical success was achieved with 92% (36/39) of stents, and clinical success occurred with 90% (35/39) of stents, with no significant differences among surgery groups or between stent types (covered vs. uncovered). The GOO score (preprocedure: 0.45 ± 0.62) increased by 1 week (2.06 ± 0.51, p

Endoscopic submucosal dissection (ESD) of tumor in the upper part of the stomach is technically difficult and has a high complication rate. We compared the feasibility and safety of ESD for metachronous tumor found in the remnant stomach after distal gastrectomy with ESD for tumor in the upper third of the intact stomach. We retrospectively compared clinical outcome and safety of 13 lesions (11 early gastric cancers (EGCs) and 2 dysplasias) in the remnant stomach and 30 lesions (28 EGCs and 2 dysplasias) in the upper third of the intact stomach. All patients were treated with ESD at a cancer center hospital. En bloc resection rates were 100% (13/13) for remnant gastric tumor and 87% (26/30) for upper-third tumor (p = 0.30). En bloc resection rates with tumor-free margins (R0 resection) were 92% (12/13) for remnant gastric tumor and 73% (22/30) for upper-third tumor (p = 0.24). Curative resection rates were 85% (11/13) for remnant gastric tumor and 67% (20/30) for upper-third tumor (p = 0.29). Median procedure duration for ESD was 68 min (range 32–233 min) in the remnant stomach and 78 min (range 45–261 min) in the intact stomach (p = 0.49). One case of perforation and one of delayed bleeding occurred in the upper-third tumor group, whereas none occurred in the remnant tumor group. Local recurrence was found in no patients in the remnant gastric tumor group but in one patient in the upper-third tumor group. ESD for metachronous remnant gastric tumor was feasible and safe in comparison with ESD for tumor in the upper third of the intact stomach.