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BACKGROUND/AIM Lymph node metastasis is an important prognostic factor in gastric cancer patients. In node-negative (N0) gastric cancer patients, additional prognostic factors are needed to reinforce TNM staging. PATIENTS AND METHODS We semi-quantitatively recorded the presence of lymphatic, venous, and perineural invasion and evaluated the possibility that they could be used as upstaging factors in N0 gastric cancer by comparing N0 gastric cancer cases with N1 cases. RESULTS Venous (p

Background & aims Progranulin (PGRN) is known to promote tumorigenesis and proliferation of several types of cancer cells. However, little is known about the clinicopathological features of patients with gastrointestinal stromal tumors (GISTs) with regard to PGRN expression. Methods A retrospective analysis was performed on patients with GISTs who underwent curative surgical resection between 2007 and 2017. PGRN expression was evaluated by immunohistochemical (IHC) analysis and semi-quantitatively categorized (no expression, 0; weak, 1+; moderate, 2+; strong, 3+). Tumors with a staining intensity of 2+ or 3+ were considered high PGRN expression. Results Fifty-four patients were analyzed; 31 patients (57%) were male. The median age at surgery was 60 years (range, 33–79), and the most common primary site was the stomach (67%). Thirty-five patients (65%) had spindle histology; 42 patients (78%) were separated as a high-risk group according to the modified National Institutes of Health (NIH) classification. High PGRN-expressing tumors were observed in 27 patients (50%), had more epithelioid/mixed histology (68% vs. 32%; p = 0.046), and KIT exon 11 mutations (76% vs. 24%; p = 0.037). Patients with high PGRN-expressing tumors had a worse recurrence-free survival (RFS) (36% of 5-year RFS) compared to those with low PGRN-expressing tumors (96%; p60 years) were independent prognostic factors for poor RFS. Conclusions High PGRN-expressing GISTs showed more epithelioid/mixed histology and KIT exon 11 mutations. PGRN overexpression was significantly associated with poor RFS in patients with GISTs who underwent curative resection.

Prediction of remnant tumor is important in determining subsequent treatment options for gastric cancer patients with positive resection margin (RM) after endoscopic submucosal dissection (ESD).Based on the assumption that pathologic factors, including the length and type of involved RM, could potentially predict residual tumor, we evaluated 451 ESD specimens in patients with early gastric cancer.Of 408 cases, 37 (9.1 %) showed positive RMs. RM involvement in gastric cancer ESD specimens was associated with extended or beyond ESD criteria, greater tumor size, poor differentiation, submucosal invasion, lymphovascular invasion, and upper third location. Among the 37 positive RM cases, residual tumor was present in seven (18.9 %). The presence of residual tumor was not significantly associated with any clinicopathologic parameters except for tumor size and RM status. The total length of the involved RM was the most significant factor associated with the presence of residual tumor (P0.008). A total length cut-off value of 6 mm yielded a sensitivity of 85.7 % and negative predictive value of 94.7 % for predicting remnant tumor at gastrectomy following ESD.In conclusion, when the ESD specimen exhibits positive RM, a quantitative assessment of the involved RM should be included in the pathology report, as this can help the clinician predict remnant tumor and determine appropriate future treatment.

OBJECTIVE Management of esophagojejunostomy leakage (EJL) has a high mortality rate and increases length of hospital stay. The aim of this study was to evaluate the feasibility of early postoperative gastroduodenoscopy and stent insertion to control EJL after total gastrectomy for gastric adenocarcinoma. PATIENTS AND METHODS Among 421 patients, 13 exhibited EJL. Of the 13 patients, 8 were treated with a covered self-expandable metal stent (SEMS) inserted by endoscopy and 5 patients were treated with surgery or conservative treatment. RESULTS The mortality rate was 0% in the SEMS-treated group. The median duration from primary surgery to discovery of leakage was 3.00 days overall [interquartile range (IQR), 2.00 to 5.50 d]. The time to enteral feeding after operation was 24.00 days (IQR, 18.00 to 31.00 d). Median postoperative hospital days was 35.0 days (IQR, 21.00 to 65.00 d). Median duration from leakage to gastroduodenoscopy was 7.00 days (IQR, 1.25 to 14.50 d). On endoscopic findings, most sizes of leakage site were 25% or smaller (8/9, 88.9%) within whole anastomosis size. Eight patients were treated by SEMS. No endoscopic procedure-related or leakage-related deaths occurred. CONCLUSIONS The promising results for endoscopic treatment in this study showed that early endoscopic treatment using a covered SEMS for EJL might be a feasible, safe, and effective method in selected patients.

Background and Aim: In patients with gastric adenocarcinoma (GA), the most common double primary cancer is colorectal cancer. The aim of the present study was to evaluate the necessity of preoperative colonoscopy in patients with GA who have no symptoms of colorectal disease or any past/family history of colorectal cancer. Materials: Colonoscopy was carried out in 205 patients before gastric surgery for treatment of GA. The prevalence of colorectal neoplasms (CRN, adenoma and adenocarcinoma) was evaluated according to age, sex, body mass index (BMI) and stage, location and differentiation of GA. Results: The median age and BMI were 59 years (range 32–81) and 22.9 (range 17.0–42.3), respectively. There were 135 male patients (65.9%). Synchronous adenoma and adenocarcinoma were detected in 68 (33.2%) and four (2.0%) patients, respectively. Univariate analysis showed that patients 50 years and older, male or with multiple GA had a significantly higher incidence of CRN (P = 0.005, 0.019, and 0.023, respectively). All of the GA patients with synchronous colorectal adenocarcinoma were older than 50 years. The stage, location and differentiation of GA and BMI did not show a significant difference in the incidence of CRN. Multivariate analysis showed that age (50 years and older) was the only risk factor of CRN in GA patients (odds ratio 2.470; 95% confidence interval 1.058–5.767). Conclusion: Preoperative colonoscopy for screening of CRN should be considered in GA patients ≥ 50 years because of a relatively high prevalence of CRN and the possibility of synchronous CRC.

The objective of this study was to evaluate the results of radiofrequency ablation (RFA) for the treatment of metachronous hepatic metastases from gastric adenocarcinoma. Between January 2000 and February 2008, we retrospectively reviewed 7 cases for which RFA was performed for treating metachronous hepatic metastases after resection of the primary gastric adenocarcinoma. The median period between curative gastrectomy and metachronous hepatic metastasis was 14 months (range: 6 to 48 mo). The median survival of the patients was 11.0 months (range: 5.5 to 39.2) after the first detection of hepatic metastases and 10.0 months (range: 5 to 38.2) after the first RFA. Hepatic metastases recurred 3 to 21 months after RFA in all patients. A second RFA was performed for a single recurrent hepatic metastasis in 1 patient and this patient survived more than 3 years without recurrence until the time of this study. In conclusion, the efficacy of RFA alone for metachronous hepatic metastases from gastric adenocarcinoma was disappointing due to multiple intrahepatic recurrences. Combination therapy such as systemic chemotherapy or hepatic arterial infusion chemotherapy adjuvant to RFA would more reasonable for treating hepatic metastases from gastric cancer.

Laparoscopy-assisted distal gastrectomy (LADG) is gaining wider acceptance for treating early gastric cancer (EGC). However, many gastric surgeons are still reluctant to perform LADG, mainly because this procedure entails a considerable learning curve. We aimed to evaluate the technical feasibility and short-term outcomes of performing LADG by a single experienced gastric surgeon who initially had no experience with laparoscopic surgery as compared with open distal gastrectomy (ODG). Between January 2006 and December 2007, 177 patients with preoperatively diagnosed EGC located at the middle or lower third of the stomach were enrolled; 102 patients underwent LADG, 4 patients had open conversion, and 71 patients underwent conventional ODG. The operative and early postoperative outcomes from a prospective database were compared between the two groups. The clinicopathological characteristics were similar between the two groups. No operation-related deaths occurred. Although operation time was significantly longer for LADG than for ODG, time to first flatus was shorter and, consequently, postoperative hospital stay was significantly shorter in the LADG group. There was no significant difference in the overall complication rates between the two groups. On comparing the early (n = 50) and late groups (n = 52) of LADG patients, operation time and postoperative hospital stay were shorter and number of retrieved lymph nodes was greater in the late group (p

The HER-2/neu protein is intimately involved with normal cell proliferation and tissue growth and is extensively homologous and related to the epidermal growth factor receptor. HER-2/neu protein expression has been most intensively studied in the context of breast carcinoma, in which its amplification and overexpression correlate with the overall course of disease, and with a poor prognosis, and constitute a predictive factor of poor response to chemotherapy and endocrine therapy. In this study, we investigated the relationship between the expression of HER-2/neu and the clinicopathological characteristics of tumors, including survival. This study was performed with a view toward the future introduction of Herceptin therapy for gastric cancer patients. HER-2/neu overexpression and gene amplification was examined with semiquantitative standardized immunohistochemical staining, chromogenic in situ hybridization (CISH), and fluorescence in situ hybridization (FISH) in 182 gastric cancer patients who underwent curative surgery at the Kangbuk Samsung Hospital. Twenty-nine (15.9%) of 182 patients expressed the HER-2/neu protein by immunohistochemistry. HER-2/neu gene amplification was detected in seven patients by CISH and FISH. Intestinal-type cancers exhibited higher rates of HER-2/neu amplification than did diffuse-type cancers (P < 0.05). Tumors with HER-2/neu amplification were associated with poor mean survival rates (922 vs 3243 days) and 5-year survival rates (21.4% vs 63.0%; P < 0.05). Age, TNM stage, and amplification of HER-2/neu were found to be independently related to survival by multivariate analysis. HER-2/neu amplification may constitute an independent prognostic factor in gastric cancer patients, and patients exhibiting HER-2/neu amplification might constitute potential candidates for new adjuvant therapies which involve the use of humanized monoclonal antibodies.

It is very important to determine the prognostic factors for pancreatic adenocarcinoma when choosing surgical and conservative management strategies. In this study, we identified prognostic factors for survival and recurrence in patients with histologically proven pancreatic adenocarcinoma.Between January 2003 and December 2009, 82 patients with histologically proven pancreatic adenocarcinoma were considered for this study. Follow-up consisted of personal contact with patients or review of electronic medical records at this center and was terminated on December 31, 2011 or upon the patient's death.Overall survival rates of all patients at 1, 3, and 5 years were 51.9, 21.6 and 16.0%. Preoperative jaundice was the only independent prognostic factor for total pancreatic cancer patients, while N stage and perineural invasion in pathological findings was identified as an independent prognostic factor for survival of patients with surgical resection. Chemotherapy was the only independent prognostic factor for survival of patients who underwent palliative surgical bypass.Preoperative jaundice in any patients, lymph node metastasis, perineural invasion in patients with surgical resection, and chemotherapy in patients undergoing palliative surgical bypass are important prognostic factors for survival of pancreatic cancer.

Peritoneal carcinomatosis is the most common recurrence type in gastric cancer. Disseminated tumor cells derived from serosal invasion may be indicators of early peritoneal seeding and subsequent peritoneal dissemination. Reverse-transcriptase polymerase chain reaction (RT-PCR) techniques have been introduced to aid in detection of disseminated tumor cells in peritoneal washes, however, use of a single molecular marker lacks adequate sensitivity. We sought to improve both sensitivity and specificity in detecting disseminated tumor cells in peritoneal washes by using two markers; carcinoembryonic antigen (CEA) and cytokeratin 20 mRNA (CK20 mRNA).Between July 2007 and June 2010, peritoneal washing samples were collected from 131 patients who underwent surgery for histologically proven gastric cancer. CEA and CK20 mRNA levels were quantified using a Light Cycler.Analysis using of the two markers had higher sensitivity (93.9%) and specificity (87.7%) than single marker detection (p0.01, p0.001 respectively). These analyses also correlated with various clinicopathological factors, and aided in predicting survival and peritoneal recurrence.Two-marker analysis has a significant correlation of survival or peritoneal recurrence in gastric cancer, and this analysis may be more useful as a prognostic predictor of peritoneal recurrence compared with RT-PCR mediated detection of CEA or CK20 alone.

In gastric cancer, the classification of lymph node status is still a controversial prognostic factor. Recent studies have proposed a new prognostic factor (metastatic lymph node ratio: MLR) for gastric cancer patients who undergo curative resection. The present study tested the hypothesis that MLR was better than the current pN staging system by analyzing the correlation between MLR and the International Union Against Cancer/American Joint Committee on Cancer (UICC/AJCC) staging system, by analyzing the correlation between MLR and 5-year overall survival (OS), by comparing area under the curve (AUC), and by performing univariate and multivariate analyses for OS.Of 409 patients who were diagnosed with gastric adenocarcinoma between January 2003 and December 2006, 370 patients underwent curative resection and were included in this study. The prognostic significance of the number of metastatic lymph nodes and the metastatic lymph node ratio were compared in AUC and univariate and multivariate Cox regression analyses.MLR was significantly correlated with the depth of invasion and the number of lymph node metastases (p0.001). Increasing MLR also was statistically correlated with a lower 5-year OS rate (p0.001). The AUC of MLR and the number of lymph node metastases were not significantly different (p = 0.825). MLR was an independent prognostic factor on multivariate analysis, but the number of metastatic lymph nodes was not.MLR can be a prognostic factor in patients who undergo radical resection for gastric cancer and can overcome the limitations of existing prognostic factors.

Background/aims Stomach cancer can be easily diagnosed via endoscopy, but also possible to be missed. The aim of this study was to investigate the clinical and endoscopic characteristics of advanced gastric cancers that were not diagnosed based on endoscopic examination. Methods We evaluated patients who had newly diagnosed advanced gastric cancer that was undetected via endoscopy within the last six months. Results Sixteen patients were included in this study. The locations of the cancers were the cardia in six cases, the greater curvature side of the body in eight cases and the antrum in two cases. The histological findings were tubular type adenocarcinoma in 11 cases, with ten cases of moderately to poorly differentiated adenocarcinoma and five cases of signet ring cell type adenocarcinoma. Conclusions Even advanced gastric cancer lesions may not be detected during endoscopy. If a patient continues to complain of upper gastrointestinal symptoms, even though endoscopy does not find abnormal findings, repeated endoscopy and/or additional diagnostic studies should be considered.

Although hepatic resection is widely accepted as a proper modality for treating hepatocellular carcinoma (HCC), a majority of patients are unable to undergo surgical resection due to various tumor and patient factors. Radiofrequency ablation (RFA) has mostly been used as a therapeutic alternative to resection for treating HCC. The objective of this study was to evaluate the results of intraoperative RFA for HCCs in locations difficult for a percutaneous approach.Eight patients (male, seven; age, 49-67 years) with 8 HCCs in difficult locations were treated by intraoperative RFA. Six of the patients had local tumor progression after initial transarterial chemoembolization or ultrasound (US) guided percutaneous RFA. The locations of the tumors were hepatic dome in six patients, posterior subcapsule in one, and caudate lobe in one. The tumor size was 2.0 to 6.4 cm (mean, 3.9 cm). Intraoperative RFA was performed at the tumor itself and an anticipated resection line under US guidance with 3 cm monopolar single or clustered internally cooled electrodes. Tumor resection was performed in six patients. One month later, treatment response was assessed by contrast material-enhanced computed tomography (CT). CT studies were performed every 2 or 3 months after RFA.RFA was technically successful in all tumors, and the contrast-enhanced CT images acquired one month later showed complete disappearance of tumor enhancement. One pneumothorax occurred. After a median follow-up of 18 months (range, 6-30 months), no tumors showed local progression. During the follow-up period, four new recurrent tumors were observed in three patients. Four patients were alive at the time of this report and the other four died of hepatorenal syndrome, liver failure, and progression of new recurrent tumors.Intraoperative RFA with tumor resection can be an alterative treatment option for HCC in locations difficult for a percutaneous approach.

AIM: To determine if surgical biliary bypass would provide improved quality of residual life and safe palliation in elderly patients with unresectable pancreatic head cancer. METHODS: Nineteen patients, 65 years of age or older, were managed with surgical biliary bypass (Group A). These patients were compared with 19 patients under 65 years of age who were managed with surgical biliary bypass (Group B). In addition, the results for group A were compared with those obtained from 17 patients, 65 years of age or older (Group C), who received percutaneous transhepatic biliary drainage to evaluate the quality of residual life. RESULTS: Five patients (26.0%) in Group A had complications, including one intraabdominal abscess, one pulmonary atelectasis, and three wound infections. One death (5.3%) occurred on postoperative day 3. With respect to morbidity, mortality, and postoperative hospitalization, no statistically significant difference was noted between Groups A and B. The number of readmissions and the rate of recurrent jaundice were lower in Group A than in Group C, to a statistically significant degree (P = 0.019, P = 0.029, respectively). The median hospital-free survival period and the median overall survival were also significantly longer in Group A (P = 0.001 and P < 0.001, respectively). CONCLUSION: Surgical palliation does not increase the morbidity or mortality rates, but it does increase the survival rate and improve the quality of life in elderly patients with unresectable pancreatic head cancer.

Laparoscopic cholecystectomy (LC) for complicated acute cholecystitis is associated with high rates of complications and conversion to open cholecystectomy. Percutaneous transhepatic gallbladder drainage (PTGBD) is a safe and effective treatment for acute inflammation of the gallbladder. This study was a retrospective analysis of patients who underwent an LC with or without PTGBD for complicated acute cholecystitis at our hospital between January 2002 and January 2007. Patients were classified into 3 groups: group 1, patients who underwent an LC without preoperative PTGBD (n=60); group 2, patients who underwent an early scheduled LC within 7 days of PTGBD (n=35); and group 3, patients in whom the LC was delayed for a mean of 19.9 days (range, 14 to 39 d) after PTGBD (n=38). The conversion rate to open cholecystectomy and the postoperative complication rate were lower in group 3 than in group 1 (P0.05). Elective delayed LC after PTGBD may lower the conversion and complication rates of patients with complicated acute cholecystitis.

Laparoscopic-assisted gastric surgery has become an option for the treatment of early gastric cancer. However, there are few reports of laparoscopic surgery in the management of advanced gastric cancer. In this study we describe our experience with laparoscopic-assisted distal gastrectomy (LADG) for advanced gastric cancer (AGC).Between November 2004 and June 2007, 47 patients with AGC underwent LADG at our hospital, and 45 of those patients were enrolled in this study. These patients were compared with 83 patients who had AGC and underwent conventional open distal gastrectomy (ODG) during the same period.Operation time was significantly longer in the LADG group than in the ODG group. Estimated blood loss in the LADG group was significantly less than in the ODG group. Time to ambulation and first flatus and duration of analgesic medication were significantly shorter in the LADG group. The morbidity and mortality rate were also lower than in the ODG group, with no statistically significant difference. The distance of the proximal resection margin showed no significant difference compared with ODG (6.3 +/- 0.9 versus 6.5 +/- 0.9 cm; p = 0.228). The mean number of nodes resected with LADG was 35.6 +/- 14.2, and that with ODG was 38.3 +/- 11.4 (p = 0.269). The mean follow-up for the LADG group was 23.6 months (range 9-40 months). In the LADG group, recurrence was observed in six patients (13.3%). Three patients had recurrence and died after 10 (IIIB), 11 (IIIA), and 13 (IIIB) months.LADG with extended lymphadenectomy for AGC is a feasible and safe procedure and has several advantages. Moreover, this method can achieve a radical oncologic equivalent resection. Indications for LADG with extended lymphadenectomy could be expanded in the treatment of locally advanced gastric cancer.

Objective: To assess the need for routine nasogastric decompression after extensive resections in patients with gastric cancer. Design: Prospective randomised study. Setting: University hospital, Korea. Subjects: Over a 1-year period (July 1999-July 2000), 136 patients with gastric cancer who underwent radical gastrectomy with D2 or more lymph node dissection. Interventions: Randomised to have nasogastric decompression ( n = 69) or not ( n = 67). Main outcome measures: Postoperative course, morbidity, and mortality. Results: Time to passage of first flatus, time to taking liquid diet, length of operation, and postoperative hospital stay were all significantly shorter in the no decompression group. Two patients in each group required subsequent nasogastric decompression. There were no significant differences between the two groups concerning the presence of postoperative fever, nausea, vomiting, anastomotic leaks, or pulmonary or wound complications. No patients died. Conclusions: Routine nasogastric decom...

Objective: The long-term survival of patients who undergo surgery for stage IV gastric cancer is poor, due to metastatic spread of the tumor. Intraperitoneal chemotherapy (IPT) as a possible treatment for peritoneal dissemination has been investigated in a number of different tumors. The aim of this study was to investigate the toxicity and impact of early postoperative IPT on the survival of patients with advanced gastric cancer. Methods: Between 1993 and 1997, a total of 91 patients with stage IV gastric cancer who underwent potentially curative or palliative resection received intraperitoneal mitomycin C before closure of the abdominal wound. 5-Fluorouracil and cisplatin were administered intraperitoneally on postoperative days 1–4, and this was repeated at 4-week intervals. Results: All patients received a median of 3 IPT perfusions. There were 24 (26.4%) postoperative complications and 1 (1.1%) mortality. The most frequent hematologic toxicity (grade 3–4) was leukopenia. The major nonhematologic toxicities (grade 3–4) were emesis and nephrotoxicity. After a median follow-up period of 26 months, 14 patients remain alive without evidence of recurrence, whereas 75 patients died due to recurrence or progression of disease. The median survival period for all 91 patients was 15.4 months. When survival according to the residual tumor was analyzed, median survival was 36.0 months in the R0 (curative resection) group, 20.6 months in the R1 group (margins of resected specimens showing microscopic residual tumor or diameter of each residual tumor less than 3 mm) and 9.0 months in the R2 group (macroscopic residual tumor larger than 3 mm) (p < 0.001). Conclusions: IPT was found to be safe, and it appears to improve the prognosis in patients with minimal residual tumors. However, complete cytoreductive surgery is mandatory for achieving the beneficial effect of IPT.

Background The diagnosis and treatment of recurrent gastric cancer remains difficult. The aim of this study was to determine the risk factors for recurrence of gastric cancer and the prognosis for these patients. Methods Of 2328 patients who underwent curative resection for gastric cancer from 1987 to 1995, 508 whose recurrence was confirmed by clinical examination or reoperation were studied retrospectively. The risk factors that determined the recurrence patterns and timing were investigated by univariate and multivariate analysis. Results The mean time to recurrence was 21·8 months and peritoneal recurrence was the most frequent (45·9 per cent). Logistic regression analysis showed that serosal invasion and lymph node metastasis were risk factors for all recurrence patterns and early recurrence (at 24 months or less). In addition, independent risk factors involved in each recurrence pattern included younger age, infiltrative or diffuse type, undifferentiated tumour and total gastrectomy for peritoneal recurrence; older age and larger tumour size for disseminated, haematogenous recurrence; and older age, larger tumour size, infiltrative or diffuse type, proximally located tumour and subtotal gastrectomy for locoregional recurrence. Other risk factors for early recurrence were infiltrative or diffuse type and total gastrec-tomy. Reoperation for cure was possible in only 19 patients and the mean survival time after conservative treatment or palliative operation was less than 12 months. Conclusion The risk factors for each recurrence pattern and timing of gastric cancer can be predicted by the clinicopathological features of the primary tumour. Since the results of treatment remain dismal, studies of perioperative adjuvant therapy in an attempt to reduce recurrence are warranted.

Background/aims Radiofrequency ablation (RFA) has been mostly used as a therapeutic alternative to hepatic resection for treating liver metastasis of colorectal cancer. The purpose of the present study was to determine whether there were differences in outcome between RFA and surgical resection in the treatment of colorectal cancer with liver metastases. Methods We performed a retrospective analysis of 53 patients who underwent only hepatic resection or only RFA for colorectal liver metastases. Twenty-five patients who underwent hepatic resection were compared with 28 patients who underwent RFA for synchronous or metachronous liver metastases. Results The median CEA level at the time of diagnosis of liver metastases was significantly higher in the resection group (14.2 ng/mL vs. 2.8 ng/mL, p=0.002). The median size of main liver metastases was significantly larger in the resection group (4.0 cm vs. 2.05 cm, p=0.002). There was no difference in the percentage of patients experiencing major complication (one patient in each group). The marginal recurrence rate was significantly higher in the RFA group (p=0.004). Disease-free and overall survival were longer in the resection group (p=0.008 and 0.017, respectively). In multivariate analysis, only the type of treatment was a factor associated with disease-free and overall survival (p=0.004 and 0.007, respectively). Conclusions Because of the high marginal recurrence rate, RFA shows an inferior outcome in comparison with surgical resection. Therefore, RFA should be considered for only selected patients with unresectable (by any means) disease or with high operative risk.

There has been considerable controversy over the prognosis of mucinous gastric adenocarcinoma (MGC). In this study we analyzed the clinicopathologic differences between MGC and non-mucinous gastric carcinoma (NMGC). In addition, the relationship between mucin content and other clinicopathologic variables, including prognosis in MGC, was also investigated. We reviewed 2118 patients with pathologically-confirmed gastric cancer who underwent gastrectomy at the Department of Surgery, Yonsei University College of Medicine, during the period between Jan. 1987 and Dec. 1993. Among them, 130 patients had gastric carcinoma with extracellular mucin (MGC) and 1988 patients had gastric carcinoma without extracellular mucin (NMGC). We placed the MGC patients into two groups according to mucin content: mucin content involving over 50% of the tumor (dominant type, n = 94) and mucin content involving less than 50% of the tumor area (partial type, n = 36). The results were as follows: MGC was more common in males than NMGC. The size of the tumor in MGC (mean 5.3 cm) was larger than that of NMGC (mean 4.4 cm). The patients with MGC had a higher incidence of Borrmann type IV (MGC: 16.1%, NMGC: 9.9%), more frequent serosal invasion (MGC: 75.4%, NMGC: 48.6%), lymph-node metastasis (MGC: 75.4%, NMGC: 50.7%), and peritoneal metastasis (MGC: 10.0%, NMGC: 3.5%) than patients with NMGC. The patients with MGC were more advanced in stage at the time of diagnosis and had a worse overall 10-year survival rate (44.9%) than patients with NMGC (54.7%). However, the 10-year survival rate according to the stage of MGC was similar to that of NMGC. There were no significant differences between the mucin content and other pathologic variables, including prognosis, i.e. similar biologic behavior between dominant type MGC and partial type MGC. In conclusion, we suggest that MGC was more frequently diagnosed in advanced stage than NMGC with a poorer prognosis and that it is reasonable to consider the carcinoma with mucin content involving more than 30% of the tumor area as MGC.