72 results on '"Han Hong Lee"'
Search Results
2. The utility of high-mobility group A2 overexpression for predicting the prognosis of gastric cancer patients and its contribution to poor prognosis via chemoresistance and the propensity for the occurrence of carcinomatosis peritonei
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Junhyun Lee, Han Hong Lee, Hayemin Lee, and Chae Youn Lim
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Male ,Oncology ,medicine.medical_specialty ,medicine.medical_treatment ,Perineural invasion ,030230 surgery ,03 medical and health sciences ,0302 clinical medicine ,Stomach Neoplasms ,Internal medicine ,Republic of Korea ,Biomarkers, Tumor ,Humans ,Medicine ,Epidermal growth factor receptor ,Peritoneal Neoplasms ,Survival analysis ,Aged ,Retrospective Studies ,biology ,business.industry ,HMGA2 Protein ,Cancer ,Middle Aged ,medicine.disease ,High-mobility group ,Lymphatic system ,Drug Resistance, Neoplasm ,030220 oncology & carcinogenesis ,biology.protein ,Immunohistochemistry ,Female ,Surgery ,Gastrectomy ,Neoplasm Recurrence, Local ,business - Abstract
Background The aim of this study was to elucidate the correlation of high-mobility group protein A2 overexpression with gastric cancer prognosis and compare its prognostic power with that of pre-existing markers. Methods Malignant tissues from 396 patients with gastric cancer who underwent gastrectomy from 2008 to 2012 were examined. High-mobility group protein A2 expression was assessed by immunohistochemistry and the sensitivity and specificity for predicting disease progression and overall survival of high-mobility group protein A2 and the prognostic biomarkers p53, Ki-67, human epidermal growth factor receptor 2, cyclooxygenase-2, and epidermal growth factor receptor were compared. Results A total of 95 samples (24.1%) showed high-mobility group protein A2 overexpression, which was related to advanced stage, undifferentiated histology, and lymphatic and perineural invasion. Additionally, high-mobility group protein A2 overexpression was an independent prognostic factor in multivariate analysis for disease progression and overall survival. Based on Kaplan-Meier survival analysis disease progression and overall survival, the high-mobility group protein A2-overexpressing patients showed worse survival. The recurrence pattern of peritoneal dissemination was more frequently observed in high-mobility group protein A2-positive group. Moreover, chemoresistance was more frequently observed in the high-mobility group protein A2-positive group. High-mobility group protein A2 exhibited a better ability for predicting disease progression and overall survival than other markers, and the prognostic power was enhanced when high-mobility group protein A2 was used with these markers. Conclusion High-mobility group protein A2 overexpression is associated with chemoresistance and a propensity for carcinomatosis peritonei after surgery in patients with gastric cancer. The power to predict the prognosis of patients with gastric cancer can be enhanced with the use of preexisting biomarkers and high-mobility group protein A2.
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- 2021
3. Modified controlling nutritional status score: A refined prognostic indicator depending on the stage of gastric cancer
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Cho Hyun Park, Han Hong Lee, Chul Hyo Jeon, Ho Seok Seo, Kyo Young Song, Yoon Ju Jung, and Ki Bum Park
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Male ,medicine.medical_specialty ,Scoring system ,Nutritional Status ,Stage ii ,Gastroenterology ,03 medical and health sciences ,chemistry.chemical_compound ,0302 clinical medicine ,High-density lipoprotein ,Gastrectomy ,Stomach Neoplasms ,Internal medicine ,medicine ,Humans ,Stage (cooking) ,Survival analysis ,Retrospective Studies ,business.industry ,Cancer ,Nutritional status ,Middle Aged ,Prognosis ,medicine.disease ,Predictive value ,Survival Rate ,Oncology ,chemistry ,030220 oncology & carcinogenesis ,Female ,030211 gastroenterology & hepatology ,Surgery ,business ,Follow-Up Studies - Abstract
The role of controlling nutritional status (CONUT) score in predicting cancer survival remains uncertain. This study aimed to investigate the predictive value of the CONUT score and to develop a more appropriate scoring system beyond CONUT for gastric cancer.We retrospectively reviewed 1307 patients who underwent curative gastrectomy between 2009 and 2015. The CONUT and three modified scores with modified lipid components (L-CONUT: albumin/total lymphocyte count [TLC]/low density lipoprotein, H-CONUT: albumin/TLC/high density lipoprotein, and T-CONUT: albumin/TLC/triglyceride) were calculated. The predictive value of each scoring system on long-term survival was assessed.The values of the four nutritional scores were categorized into four groups (normal, light, moderate, and severe). The CONUT (P 0.001), L-CONUT (P 0.001), H-CONUT (P 0.001), and T-CONUT (P 0.001) scores showed significant differences in overall survival in between groups. Survival analysis according to the pathological stage showed that advanced age, Eastern Cooperative Oncology Group performance status, male sex, and moderate H-CONUT score (HR, 3.970; 95% CI, 1.826-8.633; P = 0.001) were independent worse prognostic factors for overall survival in the stage I group. In the stage II group, light CONUT score (HR, 2.230; 95% CI, 1.067-4.664; P = 0.033) and moderate CONUT score (HR, 5.077; 95% CI, 1.647-15.650; P = 0.005) were significantly associated with poor prognosis. In the stage III group, no scoring system showed significant results.In advanced gastric cancer (beyond stage II), the prognostic impact of the nutritional scoring system was uncertain. However, the H-CONUT score is a promising indicator of prognosis in stage I, and the CONUT score is useful for predicting long-term survival in stage II gastric cancer.
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- 2020
4. Surveillance Endoscopy Guidelines for Postgastrectomy Patients Based on Risk of Developing Remnant Gastric Cancer
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Han Hong Lee, Eui Soo Han, Ji Hyun Kim, and Ho Seok Seo
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medicine.medical_specialty ,medicine.medical_treatment ,Aftercare ,Anastomosis ,Gastroenterology ,03 medical and health sciences ,0302 clinical medicine ,Gastrectomy ,Stomach Neoplasms ,Surgical oncology ,Internal medicine ,medicine ,Humans ,In patient ,Retrospective Studies ,Postoperative Care ,Billroth II ,business.industry ,Incidence (epidemiology) ,Cancer ,Endoscopy ,medicine.disease ,Surveillance endoscopy ,Oncology ,030220 oncology & carcinogenesis ,030211 gastroenterology & hepatology ,Surgery ,Neoplasm Recurrence, Local ,business - Abstract
Remnant gastric cancer (RGC) has a major impact on the long-term survival of postgastrectomy patients. In this study, we established surveillance endoscopy guidelines for postgastrectomy patients based on the risk of RGC. A total of 6365 patients who underwent gastrectomy at Seoul St. Mary’s Hospital from September 2005 to June 2018 were retrospectively reviewed; 85 patients were identified as having RGC. We divided the RGC patients into subgroups according to the interval between primary and secondary gastrectomy. The curative resection rate was significantly lower in patients with an interval of ≤ 5 years versus > 5 years (p = 0.017). RGC developed more frequently after Billroth II reconstruction, and at the anastomotic site, in patients with a > 10- versus ≤ 10-year interval (p = 0.006 and p = 0.014, respectively). Similar results were observed based on the 15-year interval cutoff (p = 0.001 and 0.018, respectively). The 5-year overall survival rate of patients with a ≤ 5-year interval was significantly lower than that of patients with a > 5-year interval (60.0% versus 85.7%, p = 0.015), while overall survival did not differ between the ≤ 10- and > 10-year, or ≤ 15- and 15-year interval groups. RGC incidence showed a decrease after around 20 years postoperatively. Thorough endoscopic examination should be conducted for up to 5 years postgastrectomy. Routine annual endoscopic follow-up should be performed for up to 20 years after the primary operation for gastric cancer, to allow for early detection of RGC.
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- 2020
5. Negative Impact of Endoscopic Submucosal Dissection on Short-Term Surgical Outcomes of Subsequent Laparoscopic Distal Gastrectomy for Gastric Cancer
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Junhyun Lee, Hayemin Lee, Han Hong Lee, Kyo Young Song, and Cho Hyun Park
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Male ,medicine.medical_specialty ,Endoscopic Mucosal Resection ,medicine.medical_treatment ,Operative Time ,Blood Loss, Surgical ,03 medical and health sciences ,0302 clinical medicine ,Gastrectomy ,Stomach Neoplasms ,Surgical oncology ,medicine ,Humans ,Propensity Score ,Laparoscopy ,Survival rate ,Aged ,medicine.diagnostic_test ,business.industry ,Cancer ,Endoscopic submucosal dissection ,Length of Stay ,Middle Aged ,medicine.disease ,Surgery ,Survival Rate ,Treatment Outcome ,Oncology ,030220 oncology & carcinogenesis ,Propensity score matching ,Female ,030211 gastroenterology & hepatology ,business ,Laparoscopic distal gastrectomy - Abstract
Endoscopic submucosal dissection (ESD) for gastric cancer produces an artificial ulcer, and negative effects on the surgical outcomes of additional gastrectomy after ESD are anticipated. The aim of this study is to analyze the effect of ESD on subsequent laparoscopic radical gastrectomy procedures and to compare the surgical results of post-ESD patients with the control group using propensity score (PS) methods. From 2013 to 2018, 1446 patients underwent totally laparoscopic distal gastrectomy in our center. Among these patients, the clinicopathological factors and short-term surgical outcomes of 107 patients who underwent ESD before surgery (the ESD group) were evaluated. A 1:4 PS matching and inverse probability weighting method was utilized to compare the short-term surgical outcomes of the ESD group with those of a matched control group. A longer operation time was required for the patients who underwent gastrectomy earlier than 24 days after ESD than for the patients who did not. Patients whose ulcer size, due to previous ESD, exceeded 4.6 cm required longer operation times and exhibited more intraoperative blood loss than patients whose ulcer size was small. In the PS matching analysis, patients who underwent distal gastrectomy within 24 days after ESD showed more frequent postoperative morbidity than non-ESD patients. ESD after laparoscopic distal gastrectomy is largely safe in terms of short-term surgical outcomes, but a short interval between the two procedures and a large ESD scar can make subsequent operation difficult.
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- 2019
6. Prospective multicentre randomised clinical trial comparing survival rates, quality of life and nutritional status between advanced gastric cancer patients with different follow-up intensities: study protocol for the STOFOLUP trial
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Bang Wool Eom, Dong-Hoe Koo, Ji Yeong An, Han Hong Lee, Hyoung-Il Kim, Hoon Hur, Moon-Won Yoo, Min-Hee Ryu, Hyuk-Joon Lee, Su Mi Kim, Ji-Ho Park, Jae Seok Min, Kyung Won Seo, Sang-Ho Jeong, Oh Jeong, Oh Kyoung Kwon, Seung Wan Ryu, Chang Hak Yoo, Jae Moon Bae, and Keun Won Ryu
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protocols & guidelines ,Nutritional Status ,General Medicine ,Survival Rate ,gastrointestinal tumours ,Stomach Neoplasms ,Quality of Life ,Humans ,Multicenter Studies as Topic ,Surgery ,Prospective Studies ,Follow-Up Studies ,Randomized Controlled Trials as Topic - Abstract
IntroductionPatients who underwent curative gastrectomy for gastric cancer are regularly followed-up for the early detection of recurrence and postoperative symptom management. However, there is a lack of evidence with regard to proper surveillance intervals and diagnostic tools. This study aims to evaluate whether frequent surveillance tests have a survival benefit or improve the quality of life in patients who underwent curative resection for advanced gastric cancer.Methods and analysisThe STOFOLUP trial is an investigator-initiated, parallel-assigned, multicentre randomised controlled trial involving 16 hospitals in the Republic of Korea. Patients (n=886) diagnosed with pathological stage II or III gastric adenocarcinoma will be randomised to either the 3-month or the 6-month group at a 1:1 ratio, stratified by trial site and tumour stage. Patients allocated to the 3-month group will undergo an abdominal CT scan every 3 months postoperatively and those allocated to the 6-month group will undergo CT every 6 months. The primary endpoint is 3-year overall survival and the secondary endpoints are quality of life, as assessed using KOrean QUality of life in Stomach cancer patients Study group-40, the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 and the stomach cancer-specific module (STO22), and nutritional outcomes. Other survival data including data concerning 3-year disease-free survival, recurrence-free survival, gastric cancer-specific survival and postrecurrence survival will also be estimated. The first patient was enrolled on July 2021 and active patient enrolment is currently underway.Ethics and disseminationThis study has been approved by the Institutional Review Board of eight of the participating hospitals (NCC 2021-0085, KBSMC2021-01-059, SMC 2021-01-140, KC21OEDE0082, 4-2021-0281, AJIRB-MED-INT-20-608, 2021-0515 and H-2102-093-1198). This study will be disseminated through peer-reviewed publications, national or international conferences.Trial registration numberNCT04740346.
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- 2021
7. Development of a staging system and survival prediction model for advanced gastric cancer patients without adjuvant treatment after curative gastrectomy: A retrospective multicenter cohort study
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Ki Bum Park, Kyong-Hwa Jun, Kyo Young Song, Hyungmin Chin, and Han Hong Lee
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Cohort Studies ,Survival Rate ,Gastrectomy ,Stomach Neoplasms ,Humans ,Surgery ,General Medicine ,Adenocarcinoma ,Prognosis ,Neoplasm Staging ,Retrospective Studies - Abstract
Adjuvant chemotherapy (AC) after curative gastrectomy is the standard treatment for patients with locally advanced gastric adenocarcinoma in East Asia; however, for various reasons, some patients do not receive this treatment. The aim of this study was to develop a system that reflects the survival rate of patients who do not receive AC.A modified tumor-node-metastasis (TNM) staging system was developed based on the overall survival (OS) of gastric cancer patients after curative gastrectomy without AC at Seoul St. Mary's hospital. A survival prediction model was developed based on the modified staging system and risk factors for OS, which were examined using the Cox proportional hazards regression model. The model was internally validated for the power of prediction and discrimination, compared with the American Joint Committee on Cancer (AJCC) Cancer Staging Manual 8th edition; it was externally validated using data from two other tertiary teaching hospitals.Of the 185 patients in the development set, the 5-year OS rates for modified stages IIA, IIB, IIC, IIIA, and IIIB were 80.2%, 74.0%, 56.7%, 50.0%, and 25.0%, respectively; the median OS intervals for modified stages IIIC and IIID were 21.0 and 11.0 months, respectively. Age, American Society of Anesthesiologists physical status, and postoperative complications were significantly associated with OS. The concordance index (0.768 vs. 0.686), Akaike Information Criterion (745.88 vs. 794.84), and estimated area under the curve (0.7567 vs. 0.6655) were all superior for the prediction model, compared with the AJCC TNM stage. For the validation set of 157 patients, the model performed better for the prediction and discrimination of OS.The newly developed survival prediction model improves the accuracy of OS prediction for stage II and III gastric cancer patients without AC after curative gastrectomy.
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- 2021
8. A multi-center prospective randomized controlled trial (phase III) comparing the quality of life between laparoscopy-assisted distal gastrectomy and totally laparoscopic distal gastrectomy for gastric Cancer (study protocol)
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Jae Seok Min, Hyun-Dong Chae, Chang In Choi, Hua Huang, Han Hong Lee, Sungsoo Park, Oh Jeong, Sung Il Choi, Ye Seob Jee, Ji-Ho Park, and Chang Min Lee
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0301 basic medicine ,Laparoscopic surgery ,Cancer Research ,medicine.medical_specialty ,Totally laparoscopic distal gastrectomy ,medicine.medical_treatment ,Cost-Benefit Analysis ,Anastomosis ,lcsh:RC254-282 ,law.invention ,03 medical and health sciences ,Study Protocol ,0302 clinical medicine ,Randomized controlled trial ,Clinical Protocols ,law ,Surgical oncology ,Gastrectomy ,Stomach Neoplasms ,Republic of Korea ,Genetics ,Clinical endpoint ,Medicine ,Humans ,Stage (cooking) ,Mortality ,Laparoscopy ,medicine.diagnostic_test ,Laparoscopy-assisted distal gastrectomy ,business.industry ,Cancer ,medicine.disease ,lcsh:Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,Surgery ,030104 developmental biology ,Treatment Outcome ,Oncology ,030220 oncology & carcinogenesis ,Quality of Life ,Morbidity ,business ,Gastric cancer - Abstract
KLASS (the Korean Laparoendoscopic Gastrointestinal Surgery Study) is a time-honored study group that has established laparoscopic surgery for gastrointestinal disease in Korea and has performed some important studies for the rationale of laparoscopic gastrointestinal surgery. A multi-center RCT (randomized controlled trial) to compare the quality of life (QOL) of patients undergoing totally laparoscopic distal gastrectomy (TLDG) and laparoscopy-assisted distal gastrectomy (LADG) for gastric cancer, named as KLASS 07, has been currently prepared in Korea. Patients diagnosed as gastric cancer, with clinical stage IA (T1N0M0) or IB (T1N1M0 / T2N0M0) according to the 7th edition of the Americal Joint Committee on Cancer System, were randomized to receive either TLDG or LADG. For surgical quality control, the surgeons participating in this trial had to have performed at least 50 gastrectomies and at least 30 gastrectomies annually (regardless of open or laparoscopic surgery for gastric cancer). The patients who are allocated to TLDG group undergo intracorporeal anastomosis and those who are assigned to LADG undergo extracorporeal anastomosis for gastrointestinal reconstruction. Thirty-one surgeons from 26 institutions were engaged in this trial. The primary endpoint is 30-day morbidity, and secondary endpoint is QOL assessed by the questionnaire score. The KLASS 07 trial is the first multi-center RCT to investigate whether there are significant and quantifiable differences between the QOL of TLDG and LADG. The findings from this trial are expected to be the critical clues for designing the detailed procedures during laparoscopic surgery for gastric cancer. The protocol of KLASS 07 (CKLASS 01) was registered in http://register.clinicaltrials.gov as NCT03393182 (Date of registration: January 2nd, 2018.).
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- 2019
9. Long-Term Oncological Outcomes of Reduced Three-Port Laparoscopic Gastrectomy for Early-Stage Gastric Carcinoma: a Retrospective Large-Scale Multi-Institutional Study
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Seong Yeob Ryu, Jae Moon Bae, Han Hong Lee, Tae Sung Sohn, Jun Ho Lee, Min Gew Choi, Ho Seok Seo, Oh Jeong, and Sung Kim
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Laparoscopic surgery ,Stomach neoplasm ,Cancer Research ,medicine.medical_specialty ,Survival ,medicine.medical_treatment ,03 medical and health sciences ,0302 clinical medicine ,Port (medical) ,Gastrectomy ,Medicine ,Stage (cooking) ,Laparoscopy ,medicine.diagnostic_test ,business.industry ,Medical record ,Gastroenterology ,Laparoscopic gastrectomy ,Reduced port surgery ,Surgery ,Oncology ,030220 oncology & carcinogenesis ,030211 gastroenterology & hepatology ,Original Article ,business - Abstract
Purpose With advances in surgical techniques, reduced-port laparoscopic surgery is increasingly being performed for the treatment of gastric carcinoma. Many studies have reported satisfactory short-term outcomes after reduced 3-port laparoscopic gastrectomy (LG). The aim of this study was to investigate the long-term oncological outcomes of 3-port LG in patients with gastric carcinoma. Materials and methods We reviewed the medical records of 1,117 patients who underwent LG for gastric carcinoma in three major institutions between 2012 and 2015. The data showed that 460 patients underwent 3-port LG without assistance, and 657 underwent conventional 5-port LG. We compared the overall and disease-free survival rates between the 2 groups. Results There were 642 male and 475 female patients with a mean age of 56.1 years. Among them, 1,028 (92.0%) underwent distal gastrectomy and 89 (8.0%) underwent total gastrectomy. In the final pathologic examination, 1,027 patients (91.9%) were stage I, 73 (6.5%) were stage II, and 17 (1.5%) were stage III, and there were no significant difference in the pathologic stage between groups. The 3- and 5-port LG groups showed no significant differences in the 5-year overall survival (94.3% vs. 96.7%, P=0.138) or disease-free survival (94.3% vs. 95.9%, P=0.231). Stratified analyses according to pT and pN stages also showed no significant differences in overall or disease-free survival between the two groups. Conclusions Long-term survival after 3- and 5-port LG was comparable in patients with early-stage gastric carcinoma. The 3-port technique requiring limited surgical assistance may be an appropriate surgical option for this patient population.
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- 2020
10. Clinicopathological features and management strategy for superficial nonampullary duodenal tumors: a multi-center retrospective study
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Eun Young Kim, Dong Jin Kim, Han Hong Lee, Jun Hyun Lee, Jeong Goo Kim, Kyo Young Song, Jin Jo Kim, Hyung Min Chin, and Wook Kim
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Surgery - Abstract
We investigated the clinicopathological features and management for superficial nonampullary duodenal tumors (SNADTs). The safety and feasibility of laparoscopic management, especially laparoscopic endoscopic cooperative surgery (LECS), were evaluated.A total of 59 patients with SNADTs who underwent operations from January 2009 to December 2018 at all 8 institutions of the Catholic Medical Center were identified in our comprehensive multi-institutional database. Clinicopathological and surgical data on the 4 anatomical regions of the duodenum were collected and compared. Characteristics of conventional laparoscopic procedure (laparoscopy-only) and LECS procedures were also compared.There were significantly more asymptomatic patients with tumors in the first and secondMost of the SNADTs located in proximal duodenum were detected incidentally. GISTs were the most common diagnoses of SNADTs in all locations. In treating these tumors, laparoscopic resection is safe and feasible. Especially, LECS may be ideal for treating small endophytic tumors, minimizing over-resection and postoperative complications.
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- 2022
11. Short-Term Outcomes of Laparoscopic Proximal Gastrectomy With DoubleTract Reconstruction Versus Laparoscopic Total Gastrectomy for Upper Early Gastric Cancer: A KLASS 05 Randomized Clinical Trial.
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Sun-Hwi Hwang, Do Joong Park, Hyung-Ho Kim, Woo Jin Hyung, Hoon Hur, Han-Kwang Yang, Hyuk-Joon Lee, Hyoung-Il Kim, Seong-Ho Kong, Young Woo Kim, Han Hong Lee, Beom Su Kim, Young-Kyu Park, Young-Joon Lee, Sang-Hoon Ahn, In-Seob Lee, Yun-Suhk Suh, Ji-Ho Park, Soyeon Ahn, and Sang-Uk Han
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STOMACH cancer ,GASTRECTOMY ,LAPAROSCOPIC surgery ,CLINICAL trials ,FUNDOPLICATION - Abstract
Purpose: Laparoscopic proximal gastrectomy with double-tract reconstruction (LPG-DTR) is a function-preserving procedure performed for treating upper early gastric cancer (EGC). However, few studies have compared the outcomes of LPG-DTR with those of laparoscopic total gastrectomy (LTG). This study aimed at comparing the short-term outcomes of LPGDTR between LTG and upper EGC. Materials and Methods: For upper-third EGC, a multicenter, prospective, randomized trial was performed to compare those who underwent LPG-DTR with those who underwent LTG. Short-term outcomes, including clinicopathologic results, morbidity, mortality, and postoperative courses, were evaluated using a full analysis set based on the intention-to-treat principle and the per-protocol set. Results: Of the patients, 138 who fulfilled the criteria were randomized to each group. One patient in the LPG-DTR group withdrew consent. Sixty-eight patients underwent LPGDTR and 69 underwent LTG. The operative time (LPG-DTR=219.4 minutes; LTG=201.8 minutes; P=0.085), estimated blood loss (LPG-DTR=76.0 mL; LTG=66.1 mL; P=0.413), and the morbidity rate (LPG-DTR=23.5%; LTG=17.4%; P=0.373) between the groups were not significantly different. No mortality occurred in either of the study groups. Two weeks post operation, the Visick scores for postprandial symptoms, including reflux symptoms, were not significantly different between the groups (P=0.749). Laboratory findings on postoperative day 5 were not significantly different between the groups. Conclusions: The short-term outcomes of LPG-DTR for upper EGC were comparable to those of LTG. Trial Registration: ClinicalTrials.gov Identifier: NCT02892643 [ABSTRACT FROM AUTHOR]
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- 2022
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12. Appropriate Number of Adjuvant Chemotherapy Cycles for Patients with Stage 2 or 3 Gastric Cancer After Curative Gastrectomy: A Multicenter Cohort Study
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Joong-Min Park, Sung Il Choi, Sung Soo Kim, Moon Soo Lee, Kyung Won Seo, Hyoung Il Kim, Myoung Won Son, Sang Eok Lee, Jae-Seok Min, Ye Seob Jee, Han Hong Lee, Moon-Won Yoo, Sun-Hwi Hwang, In Ho Jeong, Hoon Hur, Hyundong Chae, Sung Jin Oh, Chang-Hyun Kim, Sungsoo Park, Sungho Jin, Chang Min Lee, Chan Young Kim, Sang-Il Lee, Sang-Ho Jeong, Kyung Ho Pak, Yong-Joon Lee, Jong-Han Kim, and Young-Gil Son
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medicine.medical_specialty ,medicine.medical_treatment ,Gastroenterology ,Disease-Free Survival ,Cohort Studies ,03 medical and health sciences ,0302 clinical medicine ,Surgical oncology ,Gastrectomy ,Stomach Neoplasms ,Internal medicine ,Antineoplastic Combined Chemotherapy Protocols ,Republic of Korea ,medicine ,Humans ,Stage (cooking) ,Neoplasm Staging ,Retrospective Studies ,business.industry ,Proportional hazards model ,Hazard ratio ,Cancer ,medicine.disease ,Confidence interval ,Oncology ,Chemotherapy, Adjuvant ,030220 oncology & carcinogenesis ,030211 gastroenterology & hepatology ,Surgery ,business ,Adjuvant ,Cohort study - Abstract
Few studies have presented evidence pertaining to the adequate minimum number of adjuvant chemotherapy (AC) cycles required to achieve an oncologic benefit for gastric cancer. From January 2012 to December 2013, data from patients who underwent curative radical gastrectomy and consequently received AC for pathologic stage 2 or 3 gastric cancer at 27 institutions in South Korea were analyzed. The study enrolled 925 patients, 661 patients (71.5%) who completed 8 cycles of AC and 264 patients (28.5%) who did not. Compared with the mean disease-free survival (DFS) of the patients who completed 8 AC cycles (69.3 months), the mean DFS of patients who completed 6 AC cycles (72.4 months; p = 0.531) and those who completed 7 AC cycles (63.7 months; p = 0.184) did not differ significantly. However, the mean DFS of the patients who completed 5 AC cycles (48.2 months; p = 0.016) and those who completed 1–4 AC cycles (62.9 months; p = 0.036) was significantly lower than the DFS of those who completed 8 AC cycles. In the multivariate Cox proportional hazards analysis, the mean DFS was significantly affected by advanced stage, large tumor size, positive vascular invasion, and number of completed AC cycles (1–5 cycles: hazard ratio 1.45; 95% confidence interval 1.01–2.08; p = 0.041). The current multicenter observational cohort study showed that the mean DFS for 6 or 7 AC cycles was similar to that for 8 AC cycles as an adjuvant treatment for gastric cancer.
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- 2020
13. Efficacy and Safety of Ursodeoxycholic Acid for the Prevention of Gallstone Formation After Gastrectomy in Patients With Gastric Cancer: The PEGASUS-D Randomized Clinical Trial
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Soyeon Ahn, Seong-Yeob Ryu, Bang Wool Eom, Taeil Son, Min-Gew Choi, Hye Seong Ahn, Kyung Ho Lee, Sun-Hwi Hwang, Oh Kyoung Kwon, Kyo Young Song, Han Hong Lee, Hoon Hur, Young Suk Park, Do Joong Park, Hong Man Yoon, Sang-Il Lee, Ji Yeong An, Moon-Won Yoo, Dong Kee Jang, and Sang Hyub Lee
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Male ,medicine.medical_specialty ,Randomization ,medicine.medical_treatment ,Gallstones ,030230 surgery ,Placebo ,Gastroenterology ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,Postoperative Complications ,Randomized controlled trial ,Double-Blind Method ,law ,Gastrectomy ,Stomach Neoplasms ,Internal medicine ,Clinical endpoint ,Medicine ,Humans ,Aged ,Original Investigation ,business.industry ,Ursodeoxycholic Acid ,Middle Aged ,medicine.disease ,Ursodeoxycholic acid ,Clinical trial ,Treatment Outcome ,030220 oncology & carcinogenesis ,Surgery ,Female ,business ,medicine.drug - Abstract
IMPORTANCE: The incidence of gallstones has been reported to increase after gastrectomy. However, few studies have been conducted on the prevention of gallstone formation in patients who have undergone gastrectomy. OBJECTIVE: To evaluate the efficacy and safety of ursodeoxycholic acid (UDCA) in preventing gallstone formation after gastrectomy in patients with gastric cancer. DESIGN, SETTING, AND PARTICIPANTS: The PEGASUS-D study (Efficacy and Safety of DWJ1319 in the Prevention of Gallstone Formation after Gastrectomy in Patient with Gastric Cancer: A Multicenter, Randomized, Double-blind, Placebo-controlled Study) was a randomized, double-blind, placebo-controlled clinical trial conducted at 12 institutions in the Republic of Korea. Adults (aged ≥19 years) with a diagnosis of gastric cancer who underwent total, distal, or proximal gastrectomy were enrolled between May 26, 2015, and January 9, 2017; follow-up ended January 8, 2018. Efficacy was evaluated by both the full analysis set, based on the intention-to-treat principle, and the per-protocol set; full analysis set findings were interpreted as the main results. INTERVENTIONS: Eligible participants were randomly assigned to receive 300 mg of UDCA, 600 mg of UDCA, or placebo at a ratio of 1:1:1. Ursodeoxycholic acid and placebo were administered daily for 52 weeks. MAIN OUTCOMES AND MEASURES: Gallstone formation was assessed with abdominal ultrasonography every 3 months for 12 months. Randomization and allocation to trial groups were carried out by an interactive web-response system. The primary end point was the proportion of patients developing gallstones within 12 months after gastrectomy. RESULTS: A total of 521 patients (175 received 300 mg of UDCA, 178 received 600 mg of UDCA, and 168 received placebo) were randomized. The full analysis set included 465 patients (311 men; median age, 56.0 years [interquartile range, 48.0-64.0 years]), with 151 patients in the 300-mg group, 164 patients in the 600-mg group, and 150 patients in the placebo group. The proportion of patients developing gallstones within 12 months after gastrectomy was 8 of 151 (5.3%) in the 300-mg group, 7 of 164 (4.3%) in the 600-mg group, and 25 of 150 (16.7%) in the placebo group. Compared with the placebo group, odds ratios for gallstone formation were 0.27 (95% CI, 0.12-0.62; P = .002) in the 300-mg group and 0.20 (95% CI, 0.08-0.50; P
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- 2020
14. Operative safety of curative gastrectomy after endoscopic submucosal dissection (ESD) for early gastric cancer - 1:2 propensity score matching analysis: A retrospective single-center study (cohort study)
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Chul Hyo Jeon, Han Hong Lee, Ho Seok Seo, Ki Bum Park, Cho Hyun Park, Yoon Ju Jung, and Kyo Young Song
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Adult ,Male ,medicine.medical_specialty ,Endoscopic Mucosal Resection ,medicine.medical_treatment ,Operative Time ,Single Center ,03 medical and health sciences ,0302 clinical medicine ,Gastrectomy ,Stomach Neoplasms ,medicine ,Humans ,Propensity Score ,Early Detection of Cancer ,Aged ,Retrospective Studies ,business.industry ,Incidence (epidemiology) ,General Medicine ,Endoscopic submucosal dissection ,Middle Aged ,Combined Modality Therapy ,Surgery ,Early Gastric Cancer ,Survival Rate ,Treatment Outcome ,030220 oncology & carcinogenesis ,Propensity score matching ,030211 gastroenterology & hepatology ,Female ,Neoplasm Recurrence, Local ,Complication ,business ,Cohort study - Abstract
Background This study aimed to evaluate the operative safety and long-term outcomes of additional curative gastrectomy (ACG) after non-curative endoscopic submucosal dissection (ESD), as compared with standard gastrectomy (SG) without ESD in patients with early gastric cancer. Materials and methods Data from 101 patients receiving ACG after non-curative ESD (Post-ESD group) and 1080 patients after SG without ESD (Surgery-only group), between 2009 and 2016, were reviewed retrospectively. Clinicopathologic characteristics, overall survival (OS), disease-specific survival (DSS), and relapse-free survival (RFS) were compared between groups, using propensity score matching analysis. Results After propensity score matching, a total of 101 patients in the post-ESD group and 202 patients in the surgery-only group were analyzed. The post-ESD group had shorter operation times than did the surgery-only group (p = 0.005). Estimated blood loss and the incidence of postoperative morbidity did not differ between the two groups, and no differences were observed in pathologic outcomes, including N stage (p = 0.268). In addition, 5-year OS, DSS, and RFS rates were not significantly different between groups (OS; 95.1% vs. 98.2%, p = 0.535, DSS; 98.2% vs. 98.7%, p = 0.956, and RFS; 98.6% vs. 98.9%, p = 0.757, respectively). Conclusion ACG can be performed safely after non-curative endoscopic submucosal dissection, with good operative outcomes.
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- 2020
15. Three-Port Right-Side Approach-Duet Totally Laparoscopic Distal Gastrectomy for Uncut Roux-en-Y Reconstruction
- Author
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Yoon Ju Jung, Ji Hyun Kim, Cho Hyun Park, Han Hong Lee, and Ho Seok Seo
- Subjects
Adult ,Male ,medicine.medical_specialty ,medicine.medical_treatment ,Adenocarcinoma ,03 medical and health sciences ,0302 clinical medicine ,Port (medical) ,Gastrectomy ,Stomach Neoplasms ,Humans ,Medicine ,Aged ,Retrospective Studies ,business.industry ,Anastomosis, Roux-en-Y ,Middle Aged ,Roux-en-Y anastomosis ,Surgery ,Treatment Outcome ,030220 oncology & carcinogenesis ,Feasibility Studies ,Female ,Laparoscopy ,030211 gastroenterology & hepatology ,business ,Laparoscopic distal gastrectomy ,Follow-Up Studies - Abstract
This study presents the initial feasibility of three-port right-side approach-duet totally laparoscopic distal gastrectomy (R-duet TLDG) with uncut Roux-en-Y (R-Y) reconstruction for the treatment of lower- or middle-third gastric cancer.A total of 30 patients who underwent R-duet TLDG with uncut R-Y reconstruction for gastric cancer were enrolled. All patients were treated at the Catholic Medical Center. Reconstructions were performed intracorporeally without special instruments. The clinicopathological characteristics, operative details, postoperative short-term outcomes, and postoperative follow-up endoscopy results were analyzed retrospectively.All operations were performed by three-port R-duet TLDG. There were no conversions to an open approach, and no additional ports were placed. The mean operating time was 170 minutes, and the mean number of retrieved lymph nodes was 44. Three patients experienced mild postoperative complications, including small bowel ileus and pneumonia. Follow-up endoscopy was carried out at 3 months. No patients had experienced moderate-or-severe food stasis, alkaline gastritis, or bile reflux during the follow-up period. Recanalization of the biliopancreatic limb was not observed.R-duet TLDG with uncut R-Y reconstruction could be safely performed as a reduced port surgery without special instruments.
- Published
- 2018
16. Recent Status of Laparoscopic Distal Gastrectomy in Korea: A Multicenter Retrospective Cohort Study (Pre-study Survey of KLASS-07 Trial)
- Author
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Chang Min Lee, Sungsoo Park, Ji-Ho Park, Han Hong Lee, Oh Jeong, Chang In Choi, and Ye Seob Jee
- Subjects
0301 basic medicine ,Laparoscopic surgery ,Cancer Research ,medicine.medical_specialty ,baseline survey ,medicine.medical_treatment ,Anastomosis ,lcsh:RC254-282 ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,Randomized controlled trial ,law ,medicine ,Original Research ,business.industry ,gastric cancer ,Retrospective cohort study ,Perioperative ,lcsh:Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,laparoscopic surgery ,gastrectomy ,Surgery ,030104 developmental biology ,multicenter study ,Oncology ,030220 oncology & carcinogenesis ,Cohort ,Gastrectomy ,business ,Body mass index - Abstract
Purpose: To analyze the surgical trend and brief postoperative results of laparoscopic distal gastrectomy (LDG) in Korea on the basis of a multicenter cohort.Materials and Methods: Data of 812 patients who underwent LDG between January and December 2016 were collected from 14 surgeons at 7 institutions. Patients were divided into laparoscopy-assisted distal gastrectomy (LADG) group and totally laparoscopic distal gastrectomy (TLDG) group. Perioperative and clinicopathologic outcomes were compared retrospectively.Results: Among the patients [n = 222 (27.3%) LADG; n = 590 (72.7%) TLDG], there are no significant differences in patient's demographics (sex, age, body mass index, and American Society of Anesthesiologists score). Billroth-I anastomosis (84.7%) was most performed in the LADG group, but Billroth-II anastomosis (59.0%) in the TLDG group (p < 0.001). The mean operative time was longer in the TLDG group (197.3 ± 44.4 min vs. 222.0 ± 60.2 min, p < 0.001), and there was no statistical difference in the hospital stay between the two groups (9.6 ± 4.8 days vs. 8.9 ± 7.1 days, p = 0.149). There were no significant differences in morbidity and mortality between the two groups. The length of proximal margin was longer in the TLDG group (4.3 ± 3.1 cm vs. 6.0 ± 3.4 cm, p < 0.001), but the distal margin was longer in the LADG group (6.5 ± 3.7 cm vs. 5.5 ± 3.1 cm, p < 0.001). The distribution of operations among each institution was shown very heterogeneously.Conclusion: There was no significant difference related to surgical outcome between LADG and TLDG in pre-study survey prior to KLASS-07 trial. Therefore, to obtain more reliable data, well designed prospective randomized controlled study is needed.
- Published
- 2019
17. Borrmann Type 1 Cancer is Associated with a High Recurrence Rate in Locally Advanced Gastric Cancer
- Author
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Han Hong Lee, Ho Seok Seo, Ji Hyun Kim, Cho Hyun Park, and Yoon Ju Jung
- Subjects
Male ,medicine.medical_specialty ,Gastroenterology ,03 medical and health sciences ,0302 clinical medicine ,Gastrectomy ,Risk Factors ,Stomach Neoplasms ,Surgical oncology ,Internal medicine ,Republic of Korea ,medicine ,Humans ,Clinical significance ,Risk factor ,Lymph node ,Survival rate ,Neoplasm Staging ,Retrospective Studies ,business.industry ,Incidence ,Stomach ,Cancer ,Retrospective cohort study ,Middle Aged ,medicine.disease ,Survival Rate ,medicine.anatomical_structure ,Oncology ,030220 oncology & carcinogenesis ,Female ,030211 gastroenterology & hepatology ,Surgery ,Neoplasm Recurrence, Local ,business ,Follow-Up Studies - Abstract
This study aimed to investigate the clinicopathologic characteristics and outcomes of Borrmann type 1 gastric cancer and evaluate its clinical significance in advanced gastric cancer compared with Borrmann types 2 and 3 cancer. Between January 1989 and December 2013, 1949 patients with advanced gastric cancer who underwent curative gastrectomy at our institution were enrolled in the study. Of the 1949 patients, 59 (3%) exhibited Borrmann type 1 cancer, characterized by a large size, rare serosal invasion, lower lymph node involvement, location in the upper third of the stomach, intestinal type, and differentiated histology. The recurrence rate was higher for Borrmann type 1 than for Borrmann types 2 and 3 cancer. In addition, more than half of the Borrmann type 1 recurrences showed a hematogenous pattern. However, overall survival did not differ significantly among the three cancer types. In the multivariate analysis, Borrmann type 1 cancer, with tumor depth, node metastasis, and vascular invasion, was an independent risk factor associated with recurrence. Particularly, Borrmann type 1 cancer showed a worse prognosis in both overall survival and recurrence-free survival than the other Borrmann types in the upper third of the stomach. Borrmann type 1 gastric cancer is associated with a higher recurrence rate than Borrmann types 2 and 3, but not with a difference in the overall survival rate.
- Published
- 2018
18. Efficacy of Adjuvant S-1 Versus XELOX Chemotherapy for Patients with Gastric Cancer After D2 Lymph Node Dissection: A Retrospective, Multi-Center Observational Study
- Author
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Hyoung Il Kim, Min Chan Kim, Chang Min Lee, Han Hong Lee, Jae Seok Min, In-Hwan Kim, In Kyu Kwon, Sungsoo Park, Sang-Il Lee, and Hyun-Dong Chae
- Subjects
Male ,medicine.medical_specialty ,Oxaloacetates ,medicine.medical_treatment ,Deoxycytidine ,Gastroenterology ,Disease-Free Survival ,Capecitabine ,03 medical and health sciences ,0302 clinical medicine ,Stomach Neoplasms ,Internal medicine ,Antineoplastic Combined Chemotherapy Protocols ,medicine ,Humans ,030212 general & internal medicine ,Survival rate ,Lymph node ,Aged ,Neoplasm Staging ,Retrospective Studies ,Tegafur ,Chemotherapy ,business.industry ,Hazard ratio ,Cancer ,Retrospective cohort study ,Middle Aged ,medicine.disease ,humanities ,Oxaliplatin ,Drug Combinations ,Oxonic Acid ,medicine.anatomical_structure ,Oncology ,Chemotherapy, Adjuvant ,030220 oncology & carcinogenesis ,Lymph Node Excision ,Female ,Surgery ,Fluorouracil ,business ,medicine.drug - Abstract
After curative resection of gastric cancer with D2 lymph node dissection, postoperative adjuvant chemotherapy with S-1 or capecitabine plus oxaliplatin (XELOX) is considered to be standard therapy in Eastern countries. This study aimed to compare the efficacies of adjuvant S-1 and XELOX chemotherapy for gastric cancer patients after D2 dissection based on disease-free survival (DFS). This retrospective observational study was conducted at 29 tertiary hospitals in Korea. Of 1898 patients who underwent curative resection and received adjuvant chemotherapy for gastric cancer between February 2012 and December 2013, 1088 patients who met the eligibility criteria were enrolled in the study. After propensity score-matching, the 3-year disease-free survival rate (DFS) was used to compare efficacies directly between adjuvant XELOX and S-1 chemotherapies for patients with stage 2 or 3 gastric cancer after D2 gastrectomy. The 3-year DFS rates for the S-1 and XELOX groups did not differ significantly among disease stages 2A, 2B, and 3A (all p > 0.05). However, the survival rates for the S-1 group were significantly lower than for the XELOX group for stage 3B (65.8% vs. 68.6%; p = 0.019) and stage 3C (48.4% vs. 66.7%; p = 0.002) gastric cancer. The hazard ratios (HRs) of S-1 chemotherapy for recurrence compared with XELOX for stages 3B and 3C were respectively 2.030 [95% confidence interval (CI), 1.110–3.715; p = 0.022] and 2.732 (95% CI 1.427–5.234; p = 0.002). Adjuvant XELOX chemotherapy was more effective than S-1 for patients with stage 3B or 3C gastric cancer after D2 lymph node dissection.
- Published
- 2018
19. Cross-Sectional Location of Gastric Cancer Affects the Long-Term Survival of Patients as Tumor Invasion Deepens
- Author
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Han Hong Lee, Cho Hyun Park, Yoon Ju Jung, Ji Hyun Kim, and Ho Seok Seo
- Subjects
Male ,Oncology ,medicine.medical_specialty ,medicine.medical_treatment ,Adenocarcinoma ,03 medical and health sciences ,0302 clinical medicine ,Gastrectomy ,Stomach Neoplasms ,Surgical oncology ,Internal medicine ,medicine ,Humans ,Neoplasm Invasiveness ,Stage (cooking) ,Survival rate ,Retrospective Studies ,business.industry ,Hazard ratio ,Cancer ,Retrospective cohort study ,Prognosis ,medicine.disease ,Confidence interval ,Survival Rate ,Cross-Sectional Studies ,Lymphatic Metastasis ,030220 oncology & carcinogenesis ,Lymph Node Excision ,Female ,030211 gastroenterology & hepatology ,Surgery ,business ,Follow-Up Studies - Abstract
The prognosis of gastric cancer is generally determined by tumor depth and lymph node metastasis, while the effect of cross-sectional tumor location on prognosis remains unclear. This study recruited patients who had been diagnosed with gastric cancer and who underwent gastrectomy from 1989 to 2012. The cross-sectional locations of the gastric cancers were classified into four regions: the lesser (LC) and greater curvatures (GC), and anterior (AW) and posterior walls (PW). Overall, 4820 patients were enrolled in this study. The most common site of gastric cancer among the four cross-sectional locations was the LC (46.4%), while the proportions of PW (19.9%), AW (18.4%), and GC (15.4%) were similar. Overall survival differed statistically (p = 0.013) according to the cross-sectional location, and the 5-year overall survival of those with tumors with a GC location was significantly worse (p = 0.003) than for the other three locations. In subgroup multivariate analysis, GC location was an independent prognostic indicator for a worse clinical outcome at T stage 3–4b (hazard ratio 1.365, 95% confidence interval 1.150–1.620, p
- Published
- 2017
20. Meta-analysis and systematic review on laparoscopic-assisted distal gastrectomy (LADG) and totally laparoscopic distal gastrectomy (TLDG) for gastric cancer: Preliminary study for a multicenter prospective KLASS07 trial
- Author
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Ji-Ho Park, Jae Seok Min, Chang Min Lee, Jong Han Kim, Hyun-Dong Chae, Jeong Oh, Min Seo Kim, Hyui Eun Jin, Ye Seob Jee, Hua Huang, Han Hong Lee, Sungsoo Park, Chang In Choi, Sung Il Choi, and Yoontaek Lee
- Subjects
medicine.medical_specialty ,MEDLINE ,030230 surgery ,Anastomosis ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,Postoperative Complications ,Randomized controlled trial ,Quality of life ,law ,Gastrectomy ,Stomach Neoplasms ,medicine ,Humans ,Prospective cohort study ,Pain Measurement ,Pain, Postoperative ,business.industry ,Cosmesis ,General Medicine ,Odds ratio ,Surgery ,Oncology ,030220 oncology & carcinogenesis ,Meta-analysis ,Laparoscopy ,business - Abstract
Background The curative surgical treatment of gastric cancer in the current laparoscopic surgical era relies on the surgeon's preference, technical difficulties, and concerns regarding outcome have led to the availability of totally laparoscopic distal gastrectomy (TLDG) and laparoscopic-assisted distal gastrectomy (LADG). A consensus on which of the two procedures is preferable is necessary. Therefore, the aim of this study was to evaluate the differences between LADG and TLDG in terms of surgical outcomes, postoperative recovery, pain, and complications. Methods PubMed, Google Scholar, Medline, Embase, and Cochrane databases were explored up to 2017 to evaluate TLDG and LADG. Parameters including surgical outcomes, postoperative recovery, and postoperative complications were subjected to meta-analysis to calculate the odds ratio and weighted mean difference with 95% confidence intervals (c.i.). Results Twenty-five studies (24 non-RCT and 1 RCT) with a total of 4562 gastric cancer patients were included in the meta-analysis. Under reconstruction-matched analysis, overall complications and anastomotic complications were similar for TLDG and LADG. Nevertheless, short-term outcomes such as blood loss, time to first soft diet, hospital stay, analgesic use, and CRP level were favourable for TLDG, while all other surgical outcomes showed no difference. Conclusions TLDG and LADG did not show significant differences in surgical outcomes and postoperative complications, including anastomotic-related morbidity. Therefore, decisive factors in selecting surgical procedures, which previously consisted of surgical outcomes, have been superseded by extra-surgical values such as cosmesis, economics, and patient's quality of life. These factors will be explored in a future multicentre prospective study (KLASS07 trial).
- Published
- 2019
21. Stage-specific difference in timing and pattern of initial recurrence after curative surgery for gastric cancer
- Author
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Cho Hyun Park, Han Hong Lee, Ho Seok Seo, Ji Hyun Kim, and Yoon Ju Jung
- Subjects
Adult ,Male ,medicine.medical_specialty ,Time Factors ,medicine.medical_treatment ,Adenocarcinoma ,Metastasis ,03 medical and health sciences ,Young Adult ,0302 clinical medicine ,Interquartile range ,Gastrectomy ,Stomach Neoplasms ,Republic of Korea ,medicine ,Humans ,Neoplasm Invasiveness ,Radical surgery ,Stage (cooking) ,Aged ,Neoplasm Staging ,Retrospective Studies ,Aged, 80 and over ,business.industry ,Incidence (epidemiology) ,Incidence ,Cancer ,Middle Aged ,medicine.disease ,Surgery ,Survival Rate ,Oncology ,030220 oncology & carcinogenesis ,Lymphatic Metastasis ,Curative surgery ,030211 gastroenterology & hepatology ,Female ,Neoplasm Recurrence, Local ,business ,Follow-Up Studies - Abstract
Background Gastric cancer (GC) follow-up schedule after curative surgery is universally recommended based on the pathologic stage, but their details, including intervals and modalities of surveillance have not yet been standardised. The aim of this study was to investigate the characteristics of GC recurrence by stage to establish optimal postoperative surveillance strategies. Methods Medical information on 5095 patients with GC who underwent curative intent gastrectomy in our institution between January 1989 and December 2013 was reviewed retrospectively. Moreover, 656 patients who had recurrences after radical surgery were identified. Clinicopathologic characteristics, timing and pattern of recurrence, and survival data of these patients were analysed. Results Among the 656 patients, 50 (7.6%), 123 (18.8%), and 483 (73.6%) had stages I, II, and III GC, respectively. The median times to initial recurrence in patients with stages I, II, and III GC were 23.5 months (interquartile range [IQR], 13.0–33.0 months), 13.0 months (IQR, 9.0–25.0 months), and 12.0 months (IQR, 7.0–21.0 months), respectively. In patients with stage I GC, more than half (58%) of them had distant organ metastasis; otherwise, peritoneal dissemination (39%) was the most common pattern in patients with stage III GC. Conclusions Despite the low incidence, the time of initial recurrence in stage I GC was longer than those in stage II and III GC. Moreover, the pattern of initial recurrence was also different according to the pathologic stage. Therefore, clinicians should consider stage-specific differences of recurrence in setting up surveillance strategies after curative surgery for GC patients.
- Published
- 2019
22. ASO Author Reflections: Borrmann Type as a Characteristic Phenotype of Advanced Gastric Cancer
- Author
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Han Hong Lee
- Subjects
Oncology ,medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,MEDLINE ,Advanced gastric cancer ,Phenotype ,03 medical and health sciences ,0302 clinical medicine ,Surgical oncology ,Gastrectomy ,Stomach Neoplasms ,030220 oncology & carcinogenesis ,Internal medicine ,medicine ,Humans ,030211 gastroenterology & hepatology ,Surgery ,business - Published
- 2018
23. Hybrid Robotic and Laparoscopic Gastrectomy for Gastric Cancer: Comparison with Conventional Laparoscopic Gastrectomy
- Author
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So Jung Kim, Yoon Ju Jung, Ho Seok Seo, Kyo Young Song, Chul Hyo Jeon, and Han Hong Lee
- Subjects
Laparoscopic surgery ,Cancer Research ,medicine.medical_specialty ,Neutrophils ,Inflammatory response ,medicine.medical_treatment ,Postoperative complications ,Gastrectomy ,Medicine ,Lymphocytes ,Laparoscopy ,Lymph node ,medicine.diagnostic_test ,business.industry ,Gastroenterology ,Laparoscopic gastrectomy ,Cancer ,Robotics ,medicine.disease ,Surgery ,Dissection ,medicine.anatomical_structure ,Oncology ,Original Article ,business - Abstract
Purpose The benefits of robotic gastrectomy remain controversial. We designed this study to elucidate the advantages of a hybrid robot and laparoscopic gastrectomy over conventional laparoscopic surgery. Materials and methods A total of 176 patients who underwent gastrectomy for gastric cancer were included in this study. We compared 88 patients treated with hybrid robotic and laparoscopic gastrectomy (HRLG) and 88 patients who underwent conventional laparoscopic gastrectomy (CLG). In HRLG, suprapancreatic lymph node (LN) dissection was performed in a robotic setting. Clinicopathological characteristics, operative details, and short-term outcomes were analyzed for the patients. Results The number of LNs retrieved from the suprapancreatic area was significantly greater in the HRLG group (11.27±5.46 vs. 9.17±5.19, P=0.010). C-reactive protein levels were greater in the CLG group on both postoperative day (POD) 1 (5.11±2.64 vs. 4.29±2.38, P=0.030) and POD 5 (9.86±6.51 vs. 7.75±5.17, P=0.019). In addition, the neutrophil-to-lymphocyte ratio was significantly greater in the CLG group on both POD 1 (7.44±4.72 vs. 6.16±2.91, P=0.031) and POD 5 (4.87±3.75 vs. 3.81±1.87, P=0.020). Pulmonary complications occurred only in the CLG group (4/88 [4.5%] vs. 0/88 [0%], P=0.043). Conclusions HRLG is superior to CLG in terms of suprapancreatic LN dissection and postoperative inflammatory response.
- Published
- 2021
24. Impact of a Delayed Laparoscopic Appendectomy on the Risk of Complications in Acute Appendicitis: A Retrospective Study of 4,065 Patients
- Author
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Han Hong Lee, Yong-Seok Kim, Hyun Kyu Kim, and Soo Ho Lee
- Subjects
Adult ,Male ,medicine.medical_specialty ,Abdominal Abscess ,Time Factors ,Adolescent ,Perforation (oil well) ,030230 surgery ,Group B ,Time-to-Treatment ,Young Adult ,03 medical and health sciences ,Postoperative Complications ,0302 clinical medicine ,Risk Factors ,Appendectomy ,Humans ,Medicine ,Young adult ,Abscess ,Retrospective Studies ,business.industry ,Incidence ,General surgery ,Incidence (epidemiology) ,Gastroenterology ,Retrospective cohort study ,Middle Aged ,Appendicitis ,medicine.disease ,Surgery ,Intestinal Perforation ,030220 oncology & carcinogenesis ,Female ,business - Abstract
Background: Urgent surgery performed for appendicitis is hypothesized to avoid complications such as perforation or abscess. This study aimed to evaluate the effect of the timing of surgery on the complications of laparoscopic appendectomy. Methods: A retrospective review of 4,065 patients who underwent a laparoscopic appendectomy was conducted. The demographic data, time of presentation, physical findings, diagnostic data and complications were recorded. The patients were divided into 4 groups (Group A, 0-6 h; Group B, 6-12 h; Group C, 12-18 h; Group D, over 18 h) based on the time elapsed from the evaluation at the emergency room to the appendectomy. Results: Group A consisted of 2,084 (51.3%) patients, Group B consisted of 1,553 (38.2%) patients, Group C consisted of 388 (9.5%) patients and Group D consisted of 40 (1.8%) patients. A perforated appendicitis was observed in 560 (13.8%) patients. Postoperative complications developed in 293 (7.2%) patients. No significant differences in perforation and postoperative complications were observed between the 4 groups. Conclusion: The timing of surgery did not affect the incidence of complications or perforated appendicitis.
- Published
- 2016
25. Efficacy and Safety of Ursodeoxycholic acid in the Prevention of Gallstone Formation after Gastrectomy in Patients with Gastric Cancer: A Randomized, Double-blind, Placebo-controlled Study (PEGASUS-D)
- Author
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Hoon Hur, Hye Seong Ahn, Ryu Seong-Yeob, Sang-Il Lee, Bang Wool Eom, Moon-Won Yoo, Ji Yeong An, Dong Kee Jang, Sun-Hwi Hwang, Han Hong Lee, Kyo Young Song, Do Joong Park, Hong Man Yoon, Min-Gew Choi, Kyung Ho Lee, Young Suk Park, Taeil Son, Sang Hyub Lee, and Oh Kyoung Kwon
- Subjects
medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Placebo-controlled study ,Cancer ,General Medicine ,medicine.disease ,Gastroenterology ,Ursodeoxycholic acid ,Double blind ,Oncology ,Internal medicine ,medicine ,Surgery ,Gastrectomy ,In patient ,business ,medicine.drug - Published
- 2020
26. The Relevance of Serosal Exposure Without Nodal Metastasis in Resectional Gastric Cancer
- Author
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Cho Hyun Park, Han Hong Lee, Ji Hyun Kim, Yoon Ju Jung, and Ho Seok Seo
- Subjects
Male ,medicine.medical_specialty ,Gastroenterology ,03 medical and health sciences ,0302 clinical medicine ,Serous Membrane ,Surgical oncology ,Gastrectomy ,Stomach Neoplasms ,Internal medicine ,Adjuvant therapy ,Medicine ,Humans ,Neoplasm Invasiveness ,Survival rate ,Peritoneal Neoplasms ,Neoplasm Staging ,Retrospective Studies ,business.industry ,Incidence (epidemiology) ,Nodal metastasis ,Cancer ,Retrospective cohort study ,Middle Aged ,medicine.disease ,Prognosis ,Early Gastric Cancer ,Survival Rate ,Oncology ,030220 oncology & carcinogenesis ,030211 gastroenterology & hepatology ,Surgery ,Female ,Neoplasm Recurrence, Local ,business ,Follow-Up Studies - Abstract
According to 8th AJCC/UICC TNM criteria, stage IIB includes pT1N3M0, pT2N2M0, pT3N1M0, and pT4aN0M0, which includes not only early gastric cancer but also locally advanced cancer. There are currently no data about whether there is any additional impact of serosal exposed cancer without nodal metastasis (pT4aN0) on patients’ survival outcomes compared with other subgroups in IIB. Patients who underwent radical gastrectomy for gastric cancer patients were enrolled, including 427 patients in stage IIB; 20 (4.68%), 104 (24.35%), 172 (40.28%), and 131 (30.67%) patients were classified as pT1N3a, pT2N2, pT3N1, and pT4aN0, respectively. Clinicopathological characteristics, recurrence pattern, and survival and recurrence rates were analyzed according to the TNM subgroups. Cancer-specific and relapse-free survival were significantly worse in serosal exposed cancer than in nonserosal exposed cancer in stage IIB (P = 0.019 and P = 0.015). Recurrence rate was highest in the pT4aN0 subgroup (29.0%) in stage IIB, and peritoneal metastasis was the most common pattern. Survival outcomes of the pT4aN0 subgroup were not significantly different from those of the stage IIIA or pT4aN1 subgroups. Patients with serosal exposed cancer without nodal metastasis shows worse cancer specific and disease-free survival with higher incidence of peritoneal metastasis than other subgroups in stage IIB. Further surveillance studies, including staging laparoscopy and active adjuvant therapy, are required in this subgroup of patients.
- Published
- 2018
27. Safety of Laparoscopic Radical Gastrectomy in Gastric Cancer Patients with End-Stage Renal Disease
- Author
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Jeong Goo Kim, Kyong Hwa Jun, Kyo Young Song, Junhyun Lee, Hyung Min Chin, Jin Jo Kim, Hayemin Lee, Dong Jin Kim, Cho Hyun Park, Sung Geun Kim, Seung Man Park, Han Hong Lee, and Wook Kim
- Subjects
Cancer Research ,medicine.medical_specialty ,medicine.medical_treatment ,Stomach neoplasms ,Kidney failure ,End stage renal disease ,03 medical and health sciences ,0302 clinical medicine ,Blood loss ,Gastrectomy ,medicine ,Laparoscopy ,Radical gastrectomy ,medicine.diagnostic_test ,business.industry ,Significant difference ,Gastroenterology ,Laparoscopic gastrectomy ,Cancer ,medicine.disease ,Surgery ,Oncology ,030220 oncology & carcinogenesis ,030211 gastroenterology & hepatology ,Original Article ,business - Abstract
Purpose The surgical outcomes of end-stage renal disease (ESRD) patients undergoing radical gastrectomy for gastric cancer were inferior compared with those of non-ESRD patients. This study aimed to evaluate the short- and long-term surgical outcomes of ESRD patients undergoing laparoscopic gastrectomy (LG) and open gastrectomy (OG) for gastric cancer. Materials and methods Between 2004 and 2014, 38 patients (OG: 21 patients, LG: 17 patients) with ESRD underwent gastrectomy for gastric cancer. Comparisons were made based on the clinicopathological characteristics, surgical outcomes, and long-term survival rates. Results No significant differences were noted in the clinicopathological characteristics of either group. LG patients had lower estimated blood loss volumes than OG patients (LG vs. OG: 94 vs. 275 mL, P=0.005). The operation time and postoperative hospital stay were similar in both the groups. The postoperative morbidity for LG and OG patients was 41.1% and 33.3%, respectively (P=0.873). No significant difference was observed in the long-term overall survival rates between the 2 groups (5-year overall survival, LG vs. OG: 82.4% vs. 64.7%, P=0.947). Conclusions In ESRD patients, LG yielded non-inferior short- and long-term surgical outcomes compared to OG. Laparoscopic procedures might be safely adopted for ESRD patients who can benefit from the advantages of minimally invasive surgery.
- Published
- 2018
28. A465 Usefulness of V-shaped liver retraction in sleeve gastrectomy for patients with morbid obesity
- Author
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Han Hong Lee
- Subjects
Morbid obesity ,medicine.medical_specialty ,Sleeve gastrectomy ,business.industry ,medicine.medical_treatment ,medicine ,Surgery ,business - Published
- 2019
29. Radical Gastrectomy After Chemotherapy May Prolong Survival in Stage IV Gastric Cancer: A Korean Multi-institutional Analysis
- Author
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Han Mo Yoo, Eun Young Kim, Ho Seok Seo, Han Hong Lee, Jun Hyun Lee, Wook Kim, Sung Keun Kim, Kyo Young Song, Jin-Jo Kim, Kyung Hwa Chun, Chang-Hyun Kim, Hyung Min Chin, Seung Man Park, Yoon Ju Jung, Hae Myung Jeon, Jeong Goo Kim, Dong Jin Kim, and Cho Hyun Park
- Subjects
Male ,medicine.medical_specialty ,Palliative care ,medicine.medical_treatment ,Gastroenterology ,03 medical and health sciences ,0302 clinical medicine ,Gastrectomy ,Stomach Neoplasms ,Internal medicine ,medicine ,Humans ,Survival rate ,Aged ,Neoplasm Staging ,Chemotherapy ,business.industry ,Palliative Care ,Cancer ,Vascular surgery ,Middle Aged ,medicine.disease ,Prognosis ,Combined Modality Therapy ,Survival Rate ,Cardiothoracic surgery ,030220 oncology & carcinogenesis ,030211 gastroenterology & hepatology ,Surgery ,Female ,business ,Abdominal surgery - Abstract
BACKGROUND: Despite the development of newer treatments, the prognosis for patients with stage IV gastric cancer remains grave. This study evaluated the efficacy of gastrectomy following response to chemotherapy in patients with stage IV gastric cancer.A total of 419 patients who were diagnosed with stage IV gastric cancer were identified from the multi-institutional Catholic Gastric Cancer Study Group database. The patients were divided into four groups: 212 were in the chemotherapy only (CTx) group, 124 were in the chemotherapy after palliative gastrectomy (G-CTx) group, 23 were in the radical gastrectomy after chemotherapy (CTx-G) group, and 60 were in the best supportive care group. To compensate for the effects of chemotherapy, cases of chemotherapy responsive were analyzed separately. To identify factors affecting survival rates, cure rates for surgery in the surgery group were analyzed.The 3-year survival rate of the CTx-G group was significantly higher than that of the CTx group (42.8 vs. 12.0%, p = 0.001). Moreover, the CTx-G group's 3-year survival rate was greater than that of the G-CTx group (42.8 vs. 37.1%, p = 0.207). Chemotherapy-responsive patients in the CTx-G group had a better 3-year survival rate than those in the G-CTx group (46.1 vs. 18.4%, respectively, p = 0.011). In the surgery group, R0 resection led to a significantly better 3-year survival rate than palliative gastrectomy (61.1 vs. 16.2%, p = 0.003).Adjuvant surgery might improve the survival rate of patients with stage IV gastric cancer, particularly in R0 resection cases.
- Published
- 2018
30. Splenic Infarction as a Delayed Febrile Complication Following Radical Gastrectomy for Gastric Cancer Patients: Computed Tomography-Based Analysis
- Author
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Moon Hyung Choi, Han Hong Lee, Kyo Young Song, Ho Seok Seo, Ji Hyun Kim, Cho Hyun Park, and Yoon Ju Jung
- Subjects
Adult ,Male ,medicine.medical_specialty ,Fever ,medicine.medical_treatment ,Infarction ,030230 surgery ,Splenic artery ,03 medical and health sciences ,0302 clinical medicine ,Postoperative Complications ,Gastrectomy ,Stomach Neoplasms ,medicine.artery ,medicine ,Humans ,Splenic Infarction ,Aged ,Retrospective Studies ,business.industry ,Middle Aged ,medicine.disease ,Dissection ,Cardiothoracic surgery ,030220 oncology & carcinogenesis ,Splenic infarction ,Surgery ,Female ,Radiology ,Complication ,business ,Tomography, X-Ray Computed ,Abdominal surgery - Abstract
The aim of this study was to evaluate the incidence and clinical characteristics of splenic infarction (SI) in gastric cancer patients who have undergone gastrectomy. For this study, the medical records of 1084 patients were reviewed and 877 patients were ultimately enrolled. The times of symptom onset, diagnosis of SI, and complete resolution on CT were calculated from the day of the operation. Based on the wedge shape of the SI in all cases, the total volume of the SI was measured based on that of a corn kernel. Thirty-six patients (4.10%) were diagnosed with SI after gastrectomy; four of these patients (0.45%) developed complications associated with the SI. Total gastrectomy and extended lymph node dissection were risk factors for development of SI. Patients with complications exhibited inflammatory signs between 7 and 10 days after surgery. The mean volume of the SI was 4025.69 mm3. The mean time to complete resolution on the CT scan was 327 days postoperatively. In 30 cases, small branched arteries from the splenic artery that could have caused the SI were retrospectively detected on the preoperative CT scans. Although the incidence of the SI was low, large volume of the SI is associated with complication development. Measuring the infarction volume via a CT scan may be useful to decide on the treatment strategy. Preoperative 3-D reconstruction of the splenic artery tributaries may help reduce the risk of inadvertent SI.
- Published
- 2017
31. Usefulness of Two-Dimensional Values Measured Using Preoperative Multidetector Computed Tomography in Predicting Lymph Node Metastasis of Gastric Cancer
- Author
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Hae Myung Jeon, Young Mi Ku, Han Hong Lee, and Su Lim Lee
- Subjects
Male ,medicine.medical_specialty ,Pathological staging ,Adenocarcinoma ,Metastasis ,Stomach Neoplasms ,Multidetector Computed Tomography ,Preoperative Care ,Image Processing, Computer-Assisted ,medicine ,Humans ,Cutoff ,Lymph node ,Neoplasm Staging ,integumentary system ,business.industry ,Hazard ratio ,Area under the curve ,Cancer ,Middle Aged ,Prognosis ,medicine.disease ,Confidence interval ,medicine.anatomical_structure ,ROC Curve ,Oncology ,Lymphatic Metastasis ,Lymph Node Excision ,Female ,Surgery ,Lymph Nodes ,Radiology ,business ,Follow-Up Studies - Abstract
Multidetector computed tomography (MDCT) is essential for the prediction of lymph node (LN) metastasis in gastric cancer. However, the measurement method and size criteria for metastatic LNs using MDCT are unclear.MDCTs of gastric cancer patients who underwent surgery and had pathological staging were reviewed by radiologists. The two-dimensional cutoff values for LNs with suspected metastasis were calculated, and clinicopathological data were analyzed using those cutoff values.The total number of enrolled patients was 327. The cutoff values of the maximal area with metastatic LNs were obtained significantly at stations 3, 4, and 6, and those values were 112.09, 33.79, and 85.88 mm(2), respectively. The common cutoff value was 112.09 mm(2), and the area under the curve was 0.617 (P = 0.002). The overall survival rate of the patients with LNs less than 112.09 mm(2) was significantly better than those with LNs greater than 112.09 mm(2) (P0.001). In multivariate analysis, the maximal LN area was an independent prognostic factor (adjusted hazard ratio, 1.697 [95% confidence interval 1.116-2.582]).Using two-dimensional values for LNs measured by MDCT is a practical method of predicting metastatic LNs in gastric cancer. The maximal LN area value would be useful in both the preoperative staging and prognosis prediction of gastric cancer.
- Published
- 2015
32. Right-Side Approach-Duet Totally Laparoscopic Distal Gastrectomy (R-Duet TLDG) Using a Three-Port to Treat Gastric Cancer
- Author
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Han Hong Lee, Kyo Young Song, Yoon Ju Jung, Ji Hyun Kim, Cho Hyun Park, and Ho Seok Seo
- Subjects
Stomach neoplasm ,Laparoscopic surgery ,Male ,medicine.medical_specialty ,medicine.medical_treatment ,03 medical and health sciences ,0302 clinical medicine ,Port (medical) ,Blood loss ,Gastrectomy ,Stomach Neoplasms ,medicine ,Humans ,Aged ,Retrospective Studies ,business.industry ,General surgery ,Gastroenterology ,Soft diet ,Cancer ,Middle Aged ,medicine.disease ,Surgery ,Treatment Outcome ,030220 oncology & carcinogenesis ,Feasibility Studies ,Lymph Node Excision ,030211 gastroenterology & hepatology ,Female ,Laparoscopy ,Lymph Nodes ,business ,Gastroenterostomy ,Laparoscopic distal gastrectomy - Abstract
Gastric cancer is commonly treated via minimally invasive surgery. The present study explored the feasibility of right-side approach-duet (R-duet) totally laparoscopic distal gastrectomy using a three-port compared with a four- or five-port. A total of 251 patients who underwent curative totally laparoscopic distal gastrectomy for gastric cancer (72 R-duet, 74 four-port, and 105 five-port) at the Catholic Medical Center were enrolled. All operations were performed using conventional laparoscopic instruments. The clinicopathological characteristics, operative details, and postoperative short-term outcomes were analyzed retrospectively. The clinicopathological characteristics did not differ significantly among the groups, except that the N stage was higher in the five-port group. The operating time was significantly longer in the four-port than the R-duet group (R-duet, four-port, and five-port 148.2 ± 30.7, 162.4 ± 30.6, and 159.9 ± 31.5 min, respectively; p = 0.024). The estimated blood loss did not differ significantly. Postoperatively, the times to flatus and to soft diet consumption and the hospital stay were significantly longer in the five-port group. The extent of postoperative complications did not differ among the groups. R-duet totally laparoscopic distal gastrectomy is a reliable form of reduced-port surgery when used to treat gastric cancer; no special instruments are required.
- Published
- 2017
33. Nationwide survey of partial fundoplication in Korea: comparison with total fundoplication
- Author
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Han Hong Lee, Jin-Jo Kim, Jong-Han Kim, Kyung Won Seo, Joong-Min Park, Sang-Uk Han, Sungsoo Park, Chang Min Lee, Kyong Hwa Jun, and Sung Soo Kim
- Subjects
Antireflux surgery ,medicine.medical_specialty ,business.industry ,Reflux ,Fundoplication ,Nationwide survey ,Secondary procedure ,Dysphagia ,Surgery ,03 medical and health sciences ,0302 clinical medicine ,Gastroesophageal reflux ,030220 oncology & carcinogenesis ,Total fundoplication ,medicine ,030211 gastroenterology & hepatology ,Original Article ,medicine.symptom ,business ,Flatulence ,Partial fundoplication - Abstract
Purpose Laparoscopic total fundoplication is the standard surgery for gastroesophageal reflux disease. However, partial fundoplication may be a viable alternative. Here, we conducted a nationwide survey of partial fundoplication in Korea. Methods The Korean Anti-Reflux Surgery study group recorded 32 cases of partial fundoplication at eight hospitals between September 2009 and January 2016. The surgical outcomes and postoperative adverse symptoms in these cases were evaluated and compared with 86 cases of total fundoplication. Results Anterior partial fundoplication was performed in 20 cases (62.5%) and posterior in 12 (37.5%). In most cases, partial fundoplication was a secondary procedure after operations for other conditions. Half of patients who underwent partial fundoplication had typical symptoms at the time of initial diagnosis, and most of them showed excellent (68.8%), good (25.0%), or fair (6.3%) symptom resolution at discharge. Compared to total fundoplication, partial fundoplication showed no difference in the resolution rate of typical and atypical symptoms. However, adverse symptoms such as dysphagia, difficult belching, gas bloating and flatulence were less common after partial fundoplication. Conclusion Although antireflux surgery is not popular in Korea and total fundoplication is the primary surgical choice for gastroesophageal reflux disease, partial fundoplication may be useful in certain conditions because it has less postoperative adverse symptoms but similar efficacy to total fundoplication.
- Published
- 2017
34. Necessity of D2 lymph node dissection in older patients ≥80years with gastric cancer
- Author
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Cho Hyun Park, Ho Seok Seo, Yoon Ju Jung, Han Hong Lee, and Ji Hyun Kim
- Subjects
Male ,medicine.medical_specialty ,Dissection (medical) ,Kaplan-Meier Estimate ,03 medical and health sciences ,0302 clinical medicine ,Postoperative Complications ,Risk Factors ,Stomach Neoplasms ,Outcome Assessment, Health Care ,Medicine ,Humans ,030212 general & internal medicine ,Risk factor ,Lymph node ,Survival analysis ,Neoplasm Staging ,Proportional Hazards Models ,Retrospective Studies ,Aged, 80 and over ,business.industry ,Proportional hazards model ,Hazard ratio ,Cancer ,Odds ratio ,medicine.disease ,Survival Analysis ,Surgery ,medicine.anatomical_structure ,Oncology ,030220 oncology & carcinogenesis ,Lymph Node Excision ,Female ,Geriatrics and Gerontology ,business - Abstract
Objectives This study analyzed the effect of D2 lymph node (LN) dissection on complications and survival in older patients with gastric cancer. Materials and Methods A total of 103 octogenarian patients who underwent curative gastrectomy for gastric cancer were divided into two groups (D2 and D1) according to the extent of LN dissection and analyzed retrospectively for complications and survival. Results No differences were observed in short-term postoperative outcomes, including complication rates, between the two groups. In a survival analysis, D2 LN dissection did not improve overall survival (OS) in any patient, including advanced cases. A Cox regression analysis revealed that the independent risk factors for OS were history of coronary artery disease (hazard ratio [HR], 11.095), postoperative short-term complications (HR, 9.939), and TNM stage (HR, 6.299). The extent of LN dissection was not an independent risk factor for OS, and D2 or more LN dissection (odds ratio, 10.89) increased the risk independently. Conclusions D2 or more LN dissection did not improve survival, but rather increased the risk of complications. Thus, LN dissection should be performed sparingly in octogenarian patients with gastric cancer.
- Published
- 2017
35. IASGO Society News
- Author
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Keisuke Sato, Yuta Abe, Osamu Itano, Fuyo Yoshimi, Tobias Goeser, Kan Handa, Ippei Yamana, Ulrich Töx, Keishi Yamashita, Christian Benzing, Shinsuke Takeno, Hideki Hayashi, John Hogan, Han Hong Lee, Toshimichi Tanaka, Yuichi Yamashita, Kei Hosoda, Somaiah Aroori, Sergio Gentilli, Carlo Vivaldi, Hans-Michael Hau, Calogero Iacono, Atsushi Nagashima, D. A. Stell, Jessica M. Leers, Rishabh Sehgal, Masahiko Watanabe, Alberto Oldani, Hiroshi Kawahira, Alessandro Franchello, Daisuke Horibe, Martin Maus, Monika Carpelan-Holmström, Ilona Keränen, Anna Lepistö, Arnulf H. Hoelscher, Hisashi Gunji, Riikka Lindén, Yong-Seok Kim, C. Briggs, Tomohisa Egawa, Takeo Sato, Babett Muhl, Hiroshi Kawasaki, Kouichi Hayano, Werner Druck Medien Ag, Minoru Kitago, Hideo Nagai, Soo Ho Lee, Matthew J. Bowles, Hyun Kyu Kim, Kazuhito Sasaki, Till Herbold, Teppei Yamada, Hisashiro Matsubara, Yuko Kitagawa, Yasuhiro Ito, Georg Wiltberger, Masaya Uesato, Ritja Savolainen, Motohiro Sato, Felix Krenzien, Masayuki Kano, S Brinkmann, Shintaro Shibutani, Dezső Kelemen, Gisele Aaltonen, J. Calvin Coffey, Hartmut Schaefer, Ken Koyama, Peter L. Labib, Michael Bartels, Takatoshi Nakamura, Tatsuya Hashimoto, Peter O'Leary, Luca Portigliotti, Dermot Murphy, Naoyuki Hanari, Maurizio Ferrari, and Marc Bludau
- Subjects
medicine.medical_specialty ,business.industry ,Internal medicine ,Family medicine ,Gastroenterology ,Medicine ,Surgery ,business - Published
- 2016
36. Efficacy of an antiadhesive agent for the prevention of intra-abdominal adhesions after radical gastrectomy
- Author
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Hae Myung Jeon, Wook Ro Kim, Han Mo Yoo, Hyung Min Jin, Dong Jin Kim, Han Hong Lee, Kyo Young Song, Cho Hyun Park, Eun Young Kim, Sung Geun Kim, Jeong Gu Kim, Jun Hyun Lee, and Kyung Hwa Jeon
- Subjects
medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,General Medicine ,Anastomosis ,medicine.disease ,law.invention ,Surgery ,Bowel obstruction ,03 medical and health sciences ,0302 clinical medicine ,medicine.anatomical_structure ,Randomized controlled trial ,law ,030220 oncology & carcinogenesis ,Multicenter trial ,Clinical endpoint ,Medicine ,Abdomen ,Cumulative incidence ,Gastrectomy ,030212 general & internal medicine ,business - Abstract
Background Guardix-SG is a poloxamer-based antiadhesive agent. The aim of this study was to investigate its efficacy in preventing abdominal adhesions in gastric cancer patients undergoing gastrectomy. Few clinical studies have reported that antiadhesive agent reduces the incidence of adhesion after gastrectomy. Methods We conducted a multicenter trial from June 2013 and August 2015 in patients with gastric adenocarcinoma undergoing radical gastrectomy. Patients were randomly assigned to the Guardix treatment or control group. Postoperative adhesions were diagnosed based on postoperative symptoms, plain x-ray films, and computed tomography. The primary endpoint of the study was the incidence of small bowel obstruction in the first postoperative year. The secondary end-point was the safety of Guardix-SG. Results The study included 109 patients in the Guardix group and 105 patients in the control group. The groups were similarly matched with pathological stage, operation type, anastomosis method, midline incision length, and the extent of lymph node dissection. Eight in the Guardix group and 21 in the control group experienced intestinal obstruction during the 1-year follow-up period. The cumulative incidence of small bowel obstruction was significantly lower in the Guardix group compared to that seen in the control group (4.7% vs 8.6% at 6 months and 7.3% vs 20% at 1 year; P = .007, log-rank test). There were no differences in postoperative complications and adverse events. Conclusion Guardix-SG significantly decreased the incidence of intestinal obstruction without affecting the incidence of postoperative complications.
- Published
- 2019
37. Multicenter prospective randomized controlled trial of comparing laparoscopic proximal gastrectomy and laparoscopic total gastrectomy for upper third early gastric cancer (KLASS-05)
- Author
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Yun-Suhk Suh, Han Hong Lee, Beom Su Kim, Sang Hoon Ahn, Ji Ho Park, In-Seob Lee, Young-Woo Kim, Do Joong Park, Sun-Hwi Hwang, Seong-Ho Kong, Han-Kwang Yang, Hyung Ho Kim, Hoon Hur, Hyoung Il Kim, Woo Jin Hyung, Young-Kyu Park, Hyuk-Joon Lee, Young-Joon Lee, and Sang-Uk Han
- Subjects
Cancer Research ,medicine.medical_specialty ,Proximal gastrectomy ,business.industry ,Gastroenterology ,law.invention ,Surgery ,Early Gastric Cancer ,03 medical and health sciences ,0302 clinical medicine ,Oncology ,Randomized controlled trial ,law ,030220 oncology & carcinogenesis ,Internal medicine ,medicine ,Laparoscopic total gastrectomy ,Upper third ,Reflux esophagitis ,business ,Laparoscopic proximal gastrectomy ,030215 immunology - Abstract
TPS184 Background: Proximal gastrectomy (PG) is rarely performed for upper third early gastric cancer (EGC) because of postoperative reflux esophagitis. Recently, PG with double tract reconstruction was introduced and reported to have a reflux of approximately the same frequency as total gastrectomy (TG) with esophagojejunostomy. PG has several theoretical advantages over TG but has not yet been proven in randomized controlled trial. This study aimed to provide scientific evidence of laparoscopic PG with double tract reconstruction as a standard procedure for proximal EGC. Methods: The present trial is multicenter, prospective, randomized, controlled trial with superiority design. A total of 138 patients with upper third cT1N0M0 gastric adenocarcinoma are randomized to laparoscopic PG with double tract reconstruction and laparoscopic TG with esophagojejunostomy. Patients are enrolled for two years and followed up for two years. Primary co-endpoints are hemoglobin change and vitamin B12 cumulative supplement quantity after 2 years of operation. We used the alpha-split method to set the hemoglobin to 4% and vitamin B12 to 1% for alpha. The sample size needed was 62 patients for each arm. Accounting for 10% follow-up loss, the enrollment of 69 patients in each group was required. Secondary endpoints are prevalence rate of postoperative reflux esophagitis, morbidity and mortality, quality of life 2-year after operations, relapse-free survival, and overall survival. Nineteen investigators from 10 institutes participated in this trial. The first patient was enrolled on October 27, 2016 and we completed the patient enrollment on September 17, 2018. Clinical trial information: NCT02892643.
- Published
- 2019
38. Impact of the Cross-Sectional Location of Multidetector Computed Tomography Scans on Prediction of Serosal Exposure in Patients with Advanced Gastric Cancer
- Author
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Han Hong Lee, Young Mi Ku, Su Lim Lee, and Hae Myung Jeon
- Subjects
Adult ,Male ,medicine.medical_specialty ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,0302 clinical medicine ,Predictive Value of Tests ,Stomach Neoplasms ,Multidetector computed tomography ,Multidetector Computed Tomography ,Medicine ,Humans ,In patient ,Neoplasm Invasiveness ,cardiovascular diseases ,Pathological ,Aged ,Neoplasm Staging ,Aged, 80 and over ,business.industry ,Stomach ,Cancer ,Perigastric ,Advanced gastric cancer ,Middle Aged ,medicine.disease ,medicine.anatomical_structure ,Oncology ,030220 oncology & carcinogenesis ,Predictive value of tests ,cardiovascular system ,Surgery ,Female ,Radiology ,Peritoneum ,business - Abstract
The extent of serosal exposure varies depending on the cross-section of the stomach that is viewed, affected by the visceral peritoneum of the omentum. Although multidetector computed tomography (MDCT) is the most useful method to predict serosal exposure, the MDCT criteria for such exposure by cross-sectional location remain to be established. The MDCT of gastric cancer patients who underwent surgery, and for whom pathological reports were available, were reviewed by radiologists. The MDCT criteria for invasion depth were divided into five grades: (1) smooth margin; (2) undulating margin; (3) streaky margin within vessels; (4) nodular margin within perigastric vessels; and (5) streaky or nodular margin over the perigastric vessels. The five grades were compared in terms of pathological tumor depth by curvature and wall group. A total of 125 patients of stage ≥ T2 were enrolled. The five MDCT grades correlated with tumor depth (P
- Published
- 2016
39. Safety of laparoscopic radical gastrectomy in gastric cancer patients with liver cirrhosis
- Author
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Jun Hyun Lee, Han Hong Lee, Dong Jin Kim, Cho Hyun Park, Wook Kim, Hyung Min Jin, and Jin Jo Kim
- Subjects
Adult ,Liver Cirrhosis ,Male ,medicine.medical_specialty ,Cirrhosis ,medicine.medical_treatment ,Operative Time ,Gastroenterology ,03 medical and health sciences ,0302 clinical medicine ,Postoperative Complications ,Gastrectomy ,Stomach Neoplasms ,Internal medicine ,Medicine ,Humans ,Survival rate ,Aged ,business.industry ,Stomach ,Cancer ,Hepatology ,Length of Stay ,Middle Aged ,medicine.disease ,Survival Rate ,medicine.anatomical_structure ,030220 oncology & carcinogenesis ,Feasibility Studies ,030211 gastroenterology & hepatology ,Surgery ,Female ,Laparoscopy ,business ,Complication ,Abdominal surgery - Abstract
Laparoscopic gastrectomy (LG) in gastric cancer patients with liver cirrhosis (LC) has rarely been reported. In this study, we aimed to elucidate the feasibility of LG compared with that of open gastrectomy (OG) for LC patients. Of the 75 LC patients who underwent radical gastrectomy for gastric cancer between April 2005 and March 2014, 36 patients who underwent LG were compared with 39 patients who underwent OG. Comparisons were based on clinicopathologic characteristics, surgical outcomes, and long-term survival rates. Comparison of LG and OG revealed no significant differences in the clinicopathologic characteristics. Five patients in the LG group and eight in the OG group showed a Child–Turcotte–Pugh score (CTPs) over A. In surgical outcomes, we observed shorter operation times (191.4 ± 63.9 vs. 225.9 ± 77.1 min, p = 0.039), reduced estimated blood loss (175.5 ± 214.1 vs. 396.9 ± 514.8 ml, p = 0.021), and shorter hospital stays (10.4 ± 4.6 vs. 13.7 ± 5.8 days, p = 0.008) in LG than OG. Regarding postoperative morbidity, 7 (19.4%) and 10 (25.6%) complications were observed in the LG and OG groups, respectively. There was no difference in complications between the two groups regardless of the CTPs. One patient with a CTPs of C succumbed to hepatic failure following LG. Long-term survival and overall and recurrence-free survival rates did not differ between the two groups. Even in cases with CTPs B, LG with lymph node dissection for gastric cancer patient was safer and acceptable than OG was. Therefore, LG can be considered an alternative surgical approach in gastric cancer with LC.
- Published
- 2016
40. Surgeon's Experience Overrides the Effect of Hospital Volume for Postoperative Outcomes of Laparoscopic Surgery in Gastric Cancer: Multi-institutional Study
- Author
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Han Hong Lee, Hoon Hur, Ju Hee Lee, Min Gyu Kim, Do Joong Park, and Sang-Yong Son
- Subjects
Laparoscopic surgery ,Adult ,Male ,medicine.medical_specialty ,Hospitals, Low-Volume ,medicine.medical_treatment ,Operative Time ,Blood Loss, Surgical ,Extent of resection ,03 medical and health sciences ,0302 clinical medicine ,Hospital volume ,Postoperative Complications ,Older patients ,Surgical oncology ,Gastrectomy ,Stomach Neoplasms ,Medicine ,Humans ,Aged ,Aged, 80 and over ,business.industry ,Significant difference ,Cancer ,Perioperative ,Length of Stay ,Middle Aged ,medicine.disease ,Surgery ,Oncology ,030220 oncology & carcinogenesis ,Lymph Node Excision ,030211 gastroenterology & hepatology ,Female ,Laparoscopy ,Clinical Competence ,business ,Hospitals, High-Volume - Abstract
Hospital volume is known to be a crucial factor in reducing postoperative morbidity and mortality in laparoscopic gastrectomy for gastric cancer. However, it is unclear whether surgeon’s individual experience can overcome the effect of hospital volume. Clinicopathologic data of initial 50 laparoscopic gastrectomy cases were collected from six gastric cancer surgeons. Half of the six surgeons worked in high-volume centers, and the other half worked in low-volume hospitals. Perioperative outcomes were compared between the high-volume centers and the low-volume hospitals. Three low-volume hospitals in this study contained significantly more male and older patients with a higher American Society of Anesthesiologists score than high-volume centers. Although high- and low-volume hospitals mainly used laparoscopy-assisted and totally laparoscopic approach, respectively, there were no differences between the two groups in the extent of resection, operating time, estimated blood loss, and number of collected lymph nodes. Postoperative recovery such as duration to soft diet and hospital stay did not differ between the high- and the low-volume hospitals. No significant difference was found in postoperative morbidities by Clavien–Dindo classification. There was no mortality reported in both groups of the enrolled hospitals. Hospital volume is not a decisive factor in affecting postoperative morbidity and mortality for well-trained beginners in laparoscopic surgery for gastric cancer.
- Published
- 2016
41. Short-Term Outcomes of Three-Port Totally Laparoscopic Distal Gastrectomy in the Treatment of Gastric Cancer: Comparison with a Four-Port Approach Using a Propensity Score Matching Analysis
- Author
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Han Hong Lee and Ho Seok Seo
- Subjects
Laparoscopic surgery ,Male ,medicine.medical_specialty ,Matching (statistics) ,medicine.medical_treatment ,Operative Time ,Body Mass Index ,03 medical and health sciences ,0302 clinical medicine ,Postoperative Complications ,Gastrectomy ,Stomach Neoplasms ,medicine ,Humans ,Laparoscopy ,Propensity Score ,Aged ,medicine.diagnostic_test ,business.industry ,Length of Stay ,Middle Aged ,medicine.disease ,Comorbidity ,Patient Discharge ,Surgery ,Early Gastric Cancer ,Treatment Outcome ,030220 oncology & carcinogenesis ,Case-Control Studies ,Propensity score matching ,030211 gastroenterology & hepatology ,Female ,business ,Body mass index - Abstract
We evaluated the feasibility of a three-port totally laparoscopic distal gastrectomy (TLDG) as a reduced port laparoscopic surgery for the treatment of early gastric cancer (EGC).In total, 110 patients who underwent three-port TLDG (n = 25) and four-port TLDG (n = 85) were enrolled. A propensity score matching analysis was used to compensate for the differences between the groups in age, gender, body mass index, Eastern Cooperative Oncology Group classification, and comorbidity. After the matching, operative details, pathological features, and short-term postoperative outcomes were compared between groups.By propensity score matching, 25 matched pairs were created, and no characteristic difference was observed between the groups. Operating time was significantly shorter in the three-port TLDG group than in the four-port TLDG group (139.4 ± 39.4 minutes versus 184.8 ± 42.1 minutes, respectively; P .001). Duration until discharge was significantly shorter in the three-port TLDG group than in the four-port TLDG group (8.2 ± 5.6 days versus 10.2 ± 6.6 days, respectively; P .046). Regarding pathological features, including TNM stage, no significant difference was observed between the groups.The three-port TLDG is a practical method as a reduced port surgery and has better short-term outcomes than the four-port TLDG for the treatment of EGC.
- Published
- 2016
42. Training of Surgical Endoscopists in Korea: Assessment of the Learning Curve Using a Cumulative Sum Model
- Author
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Cho Hyun Park, Han Hong Lee, Kyo Young Song, and Hae Myung Jeon
- Subjects
Male ,Models, Educational ,medicine.medical_specialty ,education ,Education ,medicine ,Humans ,Medical physics ,Endoscopy, Digestive System ,Gastrointestinal endoscopy ,Korea ,medicine.diagnostic_test ,business.industry ,Esophagogastroduodenoscopy ,Upper endoscopy ,Mean value ,Gastroenterology ,Internship and Residency ,Problem-Based Learning ,Surgical training ,Surgery ,Endoscopy ,Education, Medical, Graduate ,Learning curve ,Female ,Clinical Competence ,Curriculum ,business ,Training program ,Learning Curve ,Program Evaluation - Abstract
Objective Surgeons' interest and participation in endoscopy have increased recently. The aims of the present study were to assess the learning curve for surgical training in upper endoscopy and to suggest an appropriate training program for surgeons in Korea. Design Under the supervision of skilled endoscopists, 4 trainees who participated in this study performed more than 150 esophagogastroduodenoscopy procedures, according to the recommendations of the American Society for Gastrointestinal Endoscopy. The success of the procedures was defined as the fulfillment of designated time and checkpoints. A cumulative sum model was used to assess the learning curve. Results During the same period, the 4 trainees completed 158, 160, 166, and 180 procedures, respectively. Plateau points occurred on the learning curve at the 81st, 90th, 98th, and 111th case in the cumulative sum model and the mean value of the plateau was the 95th case. Conclusions An intensive education tool and training module that meets the conditions of surgical residents is mandatory for the training of proficient surgical endoscopists.
- Published
- 2012
43. CD133 expression is correlated with chemoresistance and early recurrence of gastric cancer
- Author
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Jeong Soo Kim, Chang Hyeok An, Kyung Jin Seo, Hae Myung Jeon, and Han Hong Lee
- Subjects
Oncology ,medicine.medical_specialty ,Predictive marker ,business.industry ,Cancer ,General Medicine ,Drug resistance ,medicine.disease ,carbohydrates (lipids) ,Cancer stem cell ,Internal medicine ,embryonic structures ,medicine ,Neoplasm ,Immunohistochemistry ,Surgery ,business ,Survival rate ,Survival analysis - Abstract
Background CD133 has been suggested to be a cancer stem cell (CSC) marker in various types of cancers. The present study assessed the relationship between CD133 expression and clinicopathological features of gastric cancer. In addition, the prognostic value of CD133 for gastric cancer was evaluated. Methods In total, 100 advanced gastric cancer patients who received curative gastrectomy and adjuvant chemotherapy were included. CD133 expression was determined by immunohistochemistry and clinicopathological results, including survival, were analyzed. Results CD133 was expressed in 23% of advanced gastric cancer patients (23/100). CD133 expression was significantly associated with serosal exposure (P = 0.036), venous invasion (P = 0.047), well and moderate differentiation (P = 0.002), and intestinal-type Lauren classification (P = 0.001). CD133-positive patients had a significantly worse 5-year disease-free (28.1% vs. 65.8%, P = 0.002) and overall (47.5% vs. 74.0%, P = 0.037) survival rate than those who were CD133-negative. A multivariate analysis suggested that CD133 expression significantly affected the 5-year disease-free and overall survival. Conclusions CD133 may play an important role in chemoresistance and recurrence, thus representing a promising predictive marker for the prognosis of gastric cancer. J. Surg. Oncol. 2012; 106: 999–1004. © 2012 Wiley Periodicals, Inc.
- Published
- 2012
44. Is the 5-ports approach necessary in laparoscopic gastrectomy? Feasibility of reduced-port totally laparoscopic gastrectomy for the treatment of gastric cancer: A Prospective Cohort Study
- Author
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Han Hong Lee and Ho Seok Seo
- Subjects
Stomach neoplasm ,Laparoscopic surgery ,Male ,medicine.medical_specialty ,medicine.medical_treatment ,Operative Time ,Comorbidity ,03 medical and health sciences ,0302 clinical medicine ,Gastrectomy ,Stomach Neoplasms ,medicine ,Humans ,Postoperative Period ,Prospective Studies ,Laparoscopy ,Prospective cohort study ,Aged ,Retrospective Studies ,medicine.diagnostic_test ,business.industry ,Cancer ,Retrospective cohort study ,General Medicine ,Length of Stay ,Middle Aged ,medicine.disease ,Surgery ,Treatment Outcome ,030220 oncology & carcinogenesis ,Quality of Life ,Feasibility Studies ,030211 gastroenterology & hepatology ,Female ,business - Abstract
Interest of gastric cancer patients in the quality of life postoperatively with respect to reduced scarring is increasing. This study aimed to evaluate the feasibility of reduced-port totally laparoscopic gastrectomy (RepTLG) for the treatment of gastric cancer.In total, 170 patients who underwent RepTLG (n = 97) or conventional totally laparoscopic gastrectomy (cTLG) (n = 73) were enrolled. Clinicopathological features, operative details, and short-term postoperative outcomes were analyzed retrospectively and compared between groups.There were no significant differences for preoperative comorbidity between the RepTLG and c TLG groups, although patients in the RepTLG group were older than those in the cTLG group (63.5 ± 11.1 vs. 59.3 ± 10.6; p = 0.014). Operating time was shorter in the RepTLG group compared to the cTLG group (187.5 ± 67.7 min vs. 219.6 ± 43.3 min; p 0.001) and duration of flatus of the RepTLG group was shorter than that of the cTLG group (2.7 ± 0.6 days vs. 2.9 ± 0.8 days; p = 0.016).RepTLG is a reliable scar reducing method with good operative and short-term outcomes for the treatment of gastric cancer compared with cTLG.
- Published
- 2015
45. Clinical Implication of Serosal Change in Pathologic Subserosa-Limited Gastric Cancer
- Author
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Cho Hyun Park, Jun Suh Lee, Joo Mee Kim, Han Hong Lee, Hun Jung, Kyo Yung Song, and Myung Hae Jeon
- Subjects
Adult ,Male ,medicine.medical_specialty ,Adenocarcinoma ,Gastroenterology ,Neoplasm Seeding ,Serous Membrane ,Gastrectomy ,Stomach Neoplasms ,Internal medicine ,medicine ,Humans ,skin and connective tissue diseases ,Survival rate ,Aged ,Neoplasm Staging ,Retrospective Studies ,Aged, 80 and over ,business.industry ,Cancer ,Middle Aged ,Prognosis ,medicine.disease ,Survival Analysis ,Surgery ,Cardiac surgery ,Survival Rate ,Cardiothoracic surgery ,Lymphatic Metastasis ,Relative risk ,Subserosa ,Female ,sense organs ,Lymph ,Neoplasm Recurrence, Local ,business ,Follow-Up Studies ,Abdominal surgery - Abstract
The aim of this study was to evaluate the clinical implication of serosal change in pathologic subserosa-limited gastric cancer based on a retrospective analysis. A total of 285 patients who were diagnosed with pathologically subserosa-limited gastric cancer were included. The patients were divided into two groups: the accordance group, with subserosa-limited cancer without macroscopic serosa change (n = 124); the discordance group, with subserosa-limited cancer showing macroscopic serosal change (n = 161). Tumor size, number of metastatic lymph nodes, and pathologic N stage were significantly associated with macroscopic serosal change. Serosal change patients presented a higher recurrence rate compared with patients without serosal change (38.0 vs. 20.2% for the 5-year recurrence rate, P = 0.002), and peritoneal seeding presented frequently in serosal-change patients with significance (41.1%). Likewise, the overall survival of serosal-change patients was significantly worse than that for those without serosal change (66.9 vs. 81.4% for the 5-year survival rate, P = 0.002). Serosal change was an independent prognostic factor for overall survival (relative risk 1.784, P = 0.039). Serosal change in pathologic subserosa-limited gastric cancer is related to poor survival. Therefore, adjuvant chemotherapy should be considered for these patients, and adequate follow-up programs instituted for early detection of peritoneal seeding.
- Published
- 2011
46. Negative impact of leakage on survival of patients undergoing curative resection for advanced gastric cancer
- Author
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Cho Hyun Park, Hae Myung Jeon, Jung Ho Shim, Han Mo Yoo, Kyo Young Song, and Han Hong Lee
- Subjects
medicine.medical_specialty ,business.industry ,Proportional hazards model ,medicine.medical_treatment ,Hazard ratio ,General Medicine ,Odds ratio ,Anastomosis ,Surgery ,Oncology ,Medicine ,Gastrectomy ,business ,Prospective cohort study ,Survival rate ,Leakage (electronics) - Abstract
Background and Objectives Leakage has been shown to adversely affect survival in patients undergoing surgery for gastrointestinal malignancies. However, the effect of leakage following radical gastrectomy in patients with gastric cancer remains unclear. Methods In total, 478 patients with advanced gastric cancer who underwent surgery with curative intent were reviewed. Anastomosis or duodenal stump leakage was diagnosed clinically or radiologically. Risk factors for leakage were evaluated by univariate and multivariate analyses. The impact of leakage on patient survival was analyzed using the Kaplan–Meier method. Results Leakage was diagnosed in 32 of 478 patients (6.7%); 14 patients (2.9%) exhibited esophagojejunal anastomotic leakage, 14 (2.9%) showed duodenal stump leakage, and four (0.8%) showed gastroduodenal anastomotic leakage. Poor performance status [odds ratio (OR): 4.01, 95% confidence interval (CI): 1.80–8.93] and tumor location (OR: 3.74, 95% CI: 1.56–8.89) were risk factors for postoperative leakage. Overall mean survival of patients with leakage was significantly lower than that of patients without leakage (30.5 vs. 96.2 months; P
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- 2011
47. Robot-assisted distal gastrectomy for gastric cancer: initial experience
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Kyo Young Song, Han Hong Lee, Cho Hyun Park, Hun Jung, Hoon Hur, and Hae Myung Jeon
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Adult ,Male ,medicine.medical_specialty ,medicine.medical_treatment ,Endoscopy, Gastrointestinal ,Endosonography ,Diagnosis, Differential ,Gastrectomy ,Stomach Neoplasms ,medicine ,Humans ,Robotic surgery ,Stomach cancer ,Aged ,Retrospective Studies ,medicine.diagnostic_test ,business.industry ,Cancer ,Retrospective cohort study ,Robotics ,General Medicine ,Middle Aged ,medicine.disease ,Surgery ,Early Gastric Cancer ,Endoscopy ,Early Diagnosis ,Treatment Outcome ,Resection margin ,Feasibility Studies ,Female ,Tomography, X-Ray Computed ,business - Abstract
Background This study evaluated the feasibility and safety of robotic surgery in gastrectomy for gastric cancer. Methods Between April and October 2009, 12 patients who were diagnosed with stage I gastric cancer underwent robot-assisted distal gastrectomy (RADG) using the da Vinci System (Intuitive Surgical, Sunnyvale, CA). The clinical and pathological characteristics of the patients and surgical outcome were analyzed. Results All procedures were completed successfully, with no laparoscopic or open conversion. The mean operating time was 253 minutes (range 170–365), and the mean blood loss was 135 mL (range 30–500). The resection margin was negative in all specimens, and a mean of 46 (range 21–115) lymph nodes was retrieved. The mean time to resume a soft diet and hospital stay was 4.6 and 6.6 days, respectively. Acute pancreatitis occurred in 1 patient and resolved with conservative management. Conclusions In our initial experience, RADG was feasible, enabling a fast patient recovery and good operative outcome.
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- 2011
48. Long-term outcomes and survival after laparoscopy-assisted distal gastrectomy for gastric cancer: Three-year survival analysis of a single-center experience in Korea
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Cho Hyun Park, Jung Ho Shim, Han Hong Lee, Kyo Young Song, Han Mo Yoo, Jun Gi Kim, and Hae Myung Jeon
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medicine.medical_specialty ,medicine.diagnostic_test ,business.industry ,Mortality rate ,medicine.medical_treatment ,General Medicine ,Single Center ,Gastroenterology ,Surgery ,Early Gastric Cancer ,Oncology ,Internal medicine ,medicine ,Gastrectomy ,Stage (cooking) ,Laparoscopy ,business ,Survival rate ,Survival analysis - Abstract
Background and Objectives Laparoscopy-assisted distal gastrectomy (LADG) has been established as an alternative treatment for early gastric cancer (EGC) because of excellent short-term results. However, only a few reports have considered the long-term outcomes of LADG. In this study, we investigated the 3-year outcome and survival of patients who underwent LADG. Methods We assessed 182 patients with gastric adenocarcinoma who underwent LADG. The indication for LADG was confined to EGCs (T1N0 or T1N1 cases). The clinicopathological characteristics and long-term survival data of all patients were analyzed. Results The overall morbidity and mortality rates of the patients were 11% and 0%, respectively. An analysis of the final pathological stages of the patients revealed that 160 had stage Ia, 20 had stage Ib, and only 2 had stage II. The median follow-up period was 44 months (range, 2–73 months), and there were two recurrences. Five patients died of other causes, but no patients died of a gastric cancer recurrence. The 3-year overall and disease-specific survival rates were 97.3% and 100%, respectively. Conclusions LADG for EGC is acceptable in terms of both short- and long-term outcomes. Thus, LADG can be considered a primary treatment for EGC. J. Surg. Oncol. 2011; 104:511–515. © 2011 Wiley-Liss, Inc.
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- 2011
49. Intragastric approach for submucosal tumors located near the Z-line: A hybrid laparoscopic and endoscopic technique
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Kyo Young Song, Cho Hyun Park, Han Hong Lee, Han Mo Yoo, Hae Myung Jeon, Jung Ho Shim, and Jun Gi Kim
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medicine.medical_specialty ,Tumor size ,medicine.diagnostic_test ,business.industry ,Laparoscopic wedge resection ,General Medicine ,medicine.disease ,Resection ,Surgery ,Leiomyoma ,Oncology ,medicine ,Laparoscopic resection ,Stromal tumor ,business ,Laparoscopy ,Hospital stay - Abstract
Background The present study was designed to evaluate the feasibility and impact of the “intragastric” approach to laparoscopic wedge resection as a surgical option for the treatment of suspected small sized gastric submucosal tumors (SMTs) located at the level of Z-line. Methods We reviewed six patients who underwent laparoscopic intragastric resection of a suspected gastric SMT. In all cases, tumor mass was located just below the Z-line. The patients' clinicopathologic characteristics and surgical outcomes were prospectively recorded and reviewed. Results All six patients were underwent successfully laparoscopic wedge resection by the intragastric approach using a balloon-type trocar. No case was required open conversion. The mean operation time was 128 min, and the mean hospital stay was 4 days. Five cases were proven to have leiomyoma, and one case was found to have gastrointestinal stromal tumor with low risk. The mean tumor size was 2.7 cm. Conclusion Laparoscopic resection through the “intragastric” approach is a safe and feasible option for gastric SMTs located at the level of Z-line. J. Surg. Oncol. 2011; 104:312–315. © 2011 Wiley-Liss, Inc.
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- 2011
50. Laparoscopic Wedge Resection for Gastric Submucosal Tumors: A Size-Location Matched Case-Control Study
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Han Hong Lee, Kyo Young Song, Hae Myung Jeon, Hoon Hur, Cho Hyun Park, and Hun Jung
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Adult ,Male ,Laparoscopic surgery ,medicine.medical_specialty ,medicine.medical_treatment ,Medical Records ,Resection ,Gastrectomy ,Stomach Neoplasms ,Humans ,Medicine ,Prospective Studies ,Aged ,GiST ,Tumor size ,business.industry ,Standard treatment ,Laparoscopic wedge resection ,Case-control study ,Length of Stay ,Middle Aged ,Curvatures of the stomach ,Surgery ,Treatment Outcome ,Gastric Mucosa ,Case-Control Studies ,Female ,Laparoscopy ,business - Abstract
Laparoscopic local resection for gastric submucosal tumors (SMTs) has become accepted as a standard treatment because it offers less postoperative pain and faster recovery. However, until recently, the laparoscopic approach has been limited by tumor location and size. The aim of this study was to examine the efficacy and safety of laparoscopic wedge resection (LWR) in comparison to open wedge resection (OWR), based on tumor size and location.In this case-control study, 50 patients who received LWR for gastric SMTs were carefully matched by size and location of the tumor; 50 patients underwent OWR during the same period. Patient demographics, clinicopathologic characteristics, and postoperative courses were compared.After matching for tumor size and location, the LWR group showed more favorable results than the OWR group in terms of the starting time of soft meals (mean days, 3.4 vs 4.8, respectively; p0.001) and length of hospital stay (mean days, 5.7 vs 7.8, respectively; p0.001), but not in terms of operative time (mean minutes, 153 vs 127, respectively; p0.05). The rate of postoperative complications did not differ between the groups.This case-control study suggests that laparoscopic surgery can be safely performed for gastric SMTs and results in a better postoperative recovery, regardless of tumor size or location.
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- 2011
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