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Purpose The Trastuzumab for gastric cancer (GC) trial identified human epidermal growth factor receptor 2 (HER2) as a predictor of successful treatment with trastuzumab (HER2 receptor targeting agent) among patients with advanced/metastatic GC. To date, the prevalence of HER2 overexpression in the Korean population is unknown. The present study aimed to assess the incidence of HER2 positivity among GC and gastroesophageal (GE) junction cancer samples and the relationship between HER2 overexpression and clinicopathological characteristics in Korean patients. Materials and methods Tumor samples collected from 1,695 patients with histologically proven GC or GE junction enrolled at 14 different hospitals in Korea were examined. After gathering clinicopathological data of all patients, HER2 status was assessed by immunohistochemistry (IHC) at each hospital, and IHC 2+ cases were subjected to silver-enhanced in situ hybridization at 3 central laboratories. Results A total of 182 specimens tested positive for HER2, whereas 1,505 tested negative. Therefore, the overall HER2-positive rate in this study was 10.8% (95% confidence interval=9.3%-12.3%). The HER2-positive rate was higher among intestinal-type cases (17.6%) than among other types, and was higher among patients older than 70 years and 50 years of age, compared to other age groups. Conclusions Our evaluation of the HER2 positivity rate (10.8%) among Korean patients with GC and GE junction indicated the necessity of epidemiological data when conducting studies related to HER2 expression in GC and GE junction.

Purpose: Most stomach surgeons have been educated sufficiently in conventional open distal gastrectomy (ODG) but insufficiently in laparoscopy-assisted distal gastrectomy (LADG). We compared learning curves and clinical outcomes between ODG and LADG by a single surgeon who had sufficient education of ODG and insufficient education of LADG. Materials and Methods: ODG (90 patients, January through September, 2004) and LADG groups (90 patients, June 2006 to June 2007) were compared. The learning curve was assessed with the mean number of retrieved lymph nodes, operation time, and postoperative morbidity/mortality. Results: Mean operation time was 168.3 minutes for ODG and 183.6 minutes for LADG. The mean number of retrieved lymph nodes was 37.9. Up to about the 20th to 25th cases, the slope decrease in the learning curve for LADG was more apparent than for ODG, although they both reached plateaus after the 50th cases. The mean number of retrieved lymph nodes reached the overall mean after the 30th and 40th cases for ODG and LADG, respectively. For ODG, complications were evenly distributed throughout the subgroups, whereas for LADG, complications occurred in 10 (33.3%) of the first 30 cases. Conclusions: Compared with conventional ODG, LADG is feasible, in particular for a surgeon who has had much experience with conventional ODG, although LADG required more operative time, slightly more time to get adequately retrieved lymph nodes and more complications. However, there were more minor problems in the first 30 LADG than ODG cases. The unfavorable results for LADG can be overcome easily through an adequate training program for LADG.

// Se-Hoon Hong 1, * , Won Jae Lee 1, * , Young Doo Kim 1 , Hyunjoo Kim 1 , Young-Jun Jeon 1 , Bitna Lim 1 , Dong-Hyung Cho 2 , Won Do Heo 3 , Doo-Hyun Yang 4 , Chan-Young Kim 4 , Han-Kwang Yang 5 , Jin Kuk Yang 6 , Yong-Keun Jung 1 1 School of Biological Science, Seoul National University, Gwanak-gu, Seoul 151-747, Korea 2 Graduate School of East-West Medical Science, Kyung Hee University, Gyeoggi-Do 446-701, Korea 3 Department of Biological Sciences, Korea Advanced Institute of Science and Technology, Daejeon 305-701, Korea 4 Department of Surgery, Chonbuk National University Medical School, Jeonju 561-180, Korea 5 Department of Surgery, Seoul National University College of Medicine, Seoul 110-744, Korea 6 Department of Chemistry, College of Natural Sciences, Soongsil University, Seoul 156-743, Korea * These authors have contributed equally to this work Correspondence to: Yong-Keun Jung, e-mail: ykjung@snu.ac.kr Keywords: ERBB3, ERBB2, HRG-β1, gastric cancer, APIP Received: July 17, 2015 Accepted: February 20, 2016 Published: March 01, 2016 ABSTRACT Despite the fact that the epidermal growth factor (EGF) family member ERBB3 (HER3) is deregulated in many cancers, the list of ERBB3-interacting partners remains limited. Here, we report that the Apaf-1-interacting protein (APIP) stimulates heregulin-β1 (HRG-β1)/ERBB3-driven cell proliferation and tumorigenesis. APIP levels are frequently increased in human gastric cancers and gastric cancer-derived cells. Cell proliferation and tumor formation are repressed by APIP downregulation and stimulated by its overexpression. APIP's role in the ERBB3 pathway is not associated with its functions within the methionine salvage pathway. In response to HRG-β1, APIP binds to the ERBB3 receptor, leading to an enhanced binding of ERBB3 and ERBB2 that results in sustained activations of ERK1/2 and AKT protein kinases. Furthermore, HRG-β1/ERBB3-dependent signaling is gained in APIP transgenic mouse embryonic fibroblasts (MEFs), but not lost in Apip −/− MEFs. Our findings offer compelling evidence that APIP plays an essential role in ERBB3 signaling as a positive regulator for tumorigenesis, warranting future development of therapeutic strategies for ERBB3-driven gastric cancer.

PTEN is a tumor suppressor gene that is frequently mutated or deleted in a variety of human cancers including human gastric cancer. PTEN functions primarily as a lipid phosphatase and plays a key role in the regulation of the PI3 kinase/Akt pathway, thereby modulating cell proliferation and cell survival. On the other hand, the IGF system plays an important role in cell proliferation and cell survival via the PI3 kinase/Akt and MAP kinase pathways in many cancer cells. To characterize the impact of PTEN on the IGF-IGFR-IGFBP axis in gastric cancer, we overexpressed PTEN using an adenovirus gene transfer system in human gastric adenocarcinoma cells, SNU-484 and SNU-663, which lack PTEN. Overexpression of PTEN inhibited serum-induced as well as IGF-I-induced cell proliferation as compared to control cells. PTEN overexpression resulted in a significant decrease in the expression of IGF-I, -II, and IGF-IR. Interestingly, amongst the six IGFBPs, only IGFBP-3 was upregulated by PTEN, whereas IGFBP-4 and -6 were reduced. The IGFBP-3 promoter activity assay and Western immunoblotting demonstrate that PTEN regulates IGFBP-3 at the transcriptional level. In addition, the PI3 kinase inhibitor, LY294002, upregulates IGFBP-3 expression but downregulates IGF-I and IGF-II, indicating that PTEN controls IGFBP-3 and IGFs by an Akt-dependent pathway. These findings suggest that PTEN may inhibit antiapoptotic IGF actions not only by blocking the IGF-IGFR-induced Akt activity, but also by regulating expression of components of the IGF system, in particular, upregulation of IGFBP-3, which is known to exert antiproliferative effects through IGF-dependent and IGF-independent mechanisms in cancer cells.

Cyanex-272 isa commercially available extractant along with its series,Cyanex-301 and Cyanex-302. The structural formulas andphysical properties or the Cyanex series are given in Table 1.That is, the organophosphorus compounds containing thephosphoryl group (P=O) have been widely used as analyticalextractants since the 1940s. Especially, Smart and coauthorsmeasured the metal extracting abilities of these threeextractants, and found that Cyanex-301 and Cyanex-302extracted metal ions much better than Cyanex-272 in thescCO

AIM: To evaluate the feasibility and safety of fluoroscopic-guided covered metallic stent placements in providing palliative care for patients with inoperable malignant gastric outlet obstruction. MATERIALS AND METHODS: Under fluoroscopic guidance, placement of self-expandable, covered stents was attempted in 20 patients with inoperable or recurrent gastric cancer (age range 36–79 years). All patients had inoperable gastric outlet obstruction, 13 with native anatomy and seven with post-operative anatomy (gastrointestinal anastomotic sites). All patients had intolerance to oral alimentation and/or vomiting after ingestion. Success was defined both technically and clinically. RESULTS: The placement of the stent was technically successful in 18 patients and failed in two patients (technical success: 90%). The cause of the technical failures was an inability to negotiate the guide wire through the obstruction sites in spite of the use of both fluoroscopic and endoscopic guidance. After stent placement, 15 patients were able to ingest at least liquids and had a markedly decreased incidence of vomiting (clinical success: 75%). During the mean follow-up of 6 weeks, there have been no stent reocclusion and no life-threatening complications except migration of two stents in one patient. CONCLUSION: Fluoroscopically guided covered metallic stent placement appears to be valuable for the palliative treatment of malignant obstruction of gastric outlet and post-operative gastrointestinal anastomoses. Lee, J. M. et al. (2001). Clinical Radiology56, 560–567 .

Purpose: To evaluate the efficacy of the placement of covered metallic stents for palliation of gastrointestinal anastomotic strictures secondary to recurrent gastric cancer. Methods: Under fluoroscopic guidance, placement of one or two self-expandable covered metallic stents was attempted perorally in 11 patents (aged 48-76 years) with anastomotic stenoses due to recurrent gastric malignancies. The strictures involved both the afferent and efferent loops in three patients. All patients had poor peroral food intake with severe nausea and vomiting after ingestion. The technical and clinical success was evaluated. Results: Placement of the covered stent was technically successful in 13 of 15 (87%) attempts in ten patients. After the procedure, 9 of 11 (82%) patients overall were able to ingest at least a liquid diet and had markedly decreased incidence of vomiting. During the follow-up of 2–31 weeks (mean 8.5 weeks) there were no major complications. Conclusion: These preliminary results suggest that flexible, covered stents may provide effective palliation of malignant anastomotic stricture secondary to recurrent gastric cancer.

Insulin-like growth factor (IGF)-I and -II are potent mitogens and postulated to exert autocrine, and paracrine effects on growth regulation in human gastric cancer. Their mitogenic effects are tightly regulated by the IGF binding proteins (IGFBPs). In this study, we evaluated the mRNA expression of IGF-I, IGF-II and the IGFBPs in a panel of human gastric cancer cell lines, and normal and tumour tissue specimens from patients with gastric cancer by reverse transcriptase-polymerase chain reaction (RT-PCR) and competitive PCR. Conditioned media (CM) of the gastric cancer cell lines were studied for the secretion of the IGFBPs by western ligand blot (WLB) and western immunoblot (WIB). IGF-I and IGF-II were expressed in all of the gastric cancer cell lines, and the normal and tumour tissue specimens. Overexpression of the IGFs, in particular, IGF-II, was observed in the tumour tissues. The expression pattern of IGFBPs was heterogeneous among the gastric cancer cell lines. IGFBP-2 was expressed in all of the gastric cancer cell lines, whereas IGFBP-1 was not detected in any cell lines. IGFBP-4 was expressed in the most of cell lines. IGFBP-3, IGFBP-5 and IGFBP-6 were expressed in approximately 50% of cell lines. In addition, exogenous IGF-I and IGF-II stimulated the proliferation of gastric cancer cells, suggesting the existence of a functional IGF system in gastric cancer. Taken together, our data-suggest that the IGF-IGFBP system may play an important role in the initiation, progression and metastasis of gastric cancer. Further studies are needed to understand the exact role of IGFs and IGFBPs in gastric neoplasia.

Insulin-like growth factor (IGF)-binding protein-3 (IGFBP-3), the predominant IGF carrier protein in circulation, is posttranslationally modified in vivo by IGFBP-3 protease(s) into a number of fragments. Based on the ascertained and predicted recognition sites for known IGFBP-3 proteases, FLAG-epitope tagged intact IGFBP-3, NH2terminal (1–97), intermediate fragment (88–148), and COOH-terminal fragments (98–264 and (184–264) were generated in a baculovirus and/or Escherichia coli expression system and examined, by Western ligand blot and affinity cross-linking assays, for their ability to bind IGF and insulin. The NH2- and COOH-terminal fragments bound both IGF and insulin specifically (albeit with significantly reduced affinity) for IGF but higher affinity for insulin, when compared with intact IGFBP-3. The effect of IGFBP-3 and the fragments on IGF-I receptor (IGFIR) signaling pathways was studied by testing IGF-I-induced receptor autophosphorylation in IGFIR-overexpressing NIH-3T3 cells. IGFBP-3 showed...

Purpose The present study is to investigate the clinical utility of tumor marker cutoff ratio (TMR) and develop a TMR combination scoring system based on preoperative tumor marker (TM) levels to prognosis prediction in gastric cancer. Methods We include 1,142 patients for whom two or more TMs were measured and who underwent radical gastrectomy between 1990 and 2003. Results Five-year risk of recurrence (5 YRR) for carcinoembryonic antigen (CEA) TMRs were 18.3%, 29.8%, 61.4% for TMR < 1.0, 1.0 ≤ TMR < 2.0, TMR ≥ 2.0 respectively. 5 YRR for carbohydrate antigen 19-9 (CA 19-9) TMR were 19.7%, 35.6%, 58.4% for TMR < 1.0, 1.0 ≤ TMR < 3.0, TMR ≥ 3.0, respectively. 5 YRR for carbohydrate antigen 72-4 (CA 72-4) TMR were 15.2% and 33.6% for TMR < 1.0 and TMR ≥ 1.0, respectively. We defined high TMR (TMR ≥ 2.0 for CEA, TMR ≥ 3.0 for CA19-9), low TMR (1.0 ≤ TMR < 2 for CEA, 1.0 ≤ TMR < 3.0 for CA 19-9 and 1.0 ≤ TMR for CA72-4) and negative TMR (TMR < 1.0 for all TMs). A TMR combination scoring system was devised with negative scored as zero points, low as 1 and high as 2 for each TMR. TMR scores were divided into four categories (score 0, 1, 2, 3 and above) based on the calculated TMR score and 5 YRR were found to be 12.8%, 23.9%, 45.5%, and 68.3%, respectively (P < 0.05). Multivariate analysis showed that our scoring system was a significant independent prognostic factor. Conclusion Preoperative TMRs such as CEA, CA 19-9, and CA 72-4 show a correlation with prognosis and the TMR combination scoring system could be a useful tool for the prediction of prognosis in gastric cancer.

To overcome the drawbacks of the modified Gianturco stent tube with barbs, a new barbless stent tube was constructed. Twenty-two barbless stent tubes 4.5-14.0 cm long were placed with a new introducing tube in 21 patients: 10 stent tubes in 10 patients with recurrent dysphagia after radiation therapy or chemotherapy, 10 in 10 patients with esophageal cancer in whom surgical management was contraindicated, and two in one patient with postoperative benign stricture. No technical failure or procedural complications occurred. After the procedure, all but two patients could ingest most or all foods. In two patients with an esophagorespiratory fistula and one patient with esophageal rupture, the barbless stent tube successfully occluded the fistula and rupture site. The stent tube migrated in one patient. Fifteen patients are surviving, with the stent tubes patent for 3-35 weeks (mean patency, 13 weeks); the six other patients died 7-24 weeks (mean, 16 weeks) after stent placement. It is concluded that barbless stent tubes show promise in the management of dysphagia caused by esophageal strictures.

This study was done to evaluate the prognostic factors that may affect the survival of patients with recurrent hepatic metastasis after curative resection of gastric cancer.We reviewed the medical records of 73 patients with recurrent hepatic metastasis after surgical treatment of gastric cancer from January 1995 to December 2005. Prognostic factors were classified into three groups: primary tumor factors, recurrent hepatic factors, and treatment factors. The prognostic values of these factors were assessed using univariate and multivariate analyses by the log-rank test in the Kaplan-Meier method and Cox's proportional hazard model.The overall median survival rate of the 73 study patients was 20.0 months [95% confidence interval (CI) 15.4-24.6 months]. The median survival rate after diagnosis of recurrent hepatic metastasis was 5 months (95% CI 3.5-6.5 months). Univariate analysis showed that the favorable prognostic factors were stage I and II among the primary tumor factors, no extrahepatic metastasis and unilobar distribution among the recurrent hepatic factors, and radiofrequency ablation (RFA) +/- chemotherapy among the treatment factors when operative treatment had been excluded. The independent favorable prognostic factors revealed by the multivariate analysis were no extrahepatic metastasis and RFA +/- chemotherapy. The median survival rate of patients who had two favorable prognostic factors was 27 months (95% CI 0-66.38 months).Improvement in the survival rate can be expected with RFA +/- chemotherapy for patients with recurrent gastric cancer in the liver without extrahepatic metastasis.

Angiomyolipomas (AMLs), a form of benign mesenchymal hamartoma, arise primarily in the kidneys of patients with or without tuberous sclerosis. Extra-renal AMLs are very rare and are most commonly found in the liver. AMLs of the small intestine are exceedingly rare. Here, a case of a 28-year-old man, who presented with ileal intussusception caused by ileal AML is reported. The clinicopathological and immunohistochemical findings of ileal AMLs are discussed and the literature on small intestinal AMLs is reviewed.

The present study attempted to determine whether N stage could be adjusted for the differences in survival rates based on the ratio between the examined and metastatic lymph nodes (LN ratio). Five hundred and twenty-nine patients with both >15 lymph nodes examined and ≥ N1 after R0 resection were enrolled in the present study. To determine the cutoff LN ratio, the ratios at each N stage were compared at intervals of 10% with the log-rank test of Kaplan–Meier estimates of the survival curves. The 5-year survival rate of patients with N1 was 71.7%. Those of N2 patients with LN ratio of

Twenty-one patients with primary stage IV gastric cancer were treated with a wide-spectrum regimen, designated as FEPMTX therapy to establish an effective salvage chemotherapy.FEPMTX therapy consisted of 5-fluorouracil and the triple biochemical modulators in addition to epirubicin. The schedule comprised 3 days continuous administration of 5-fluorouracil (350 mg/m2/day) and; methotrexate (MTX; 35 mg/m2) on day 1, calcium leucovorin (LV; 30 mg/m2) on day 2 and 3, cisplatin (CDDP; 30 mg/m2) and epirubicin (20 mg/m2) on day 3 every 2 weeks in principle.Eleven partial responses, five no changes and five progressive diseases were obtained, and the response rate was 52%. Ten patients (partial response 7, no change 2, progressive disease 1) received gastrectomy (resectability rate 48%). The survival of responders was significantly longer than that of non-responders (median survival time, 356 days vs. 152 days) while there was no significant prolongation by resection of the primary lesion. Adverse effects such as myelosuppression, anorexia and fatigue sometimes occurred, but were mild and the regimen was well tolerated by all the patients.FEPMTX is thought to be an effective regimen for neoadjuvant chemotherapy with longer survival and little toxicity for patients with high-grade advanced gastric cancer.

Although the incidence rates of anastomotic leaks after radical gastrectomy in a patient with gastric cancer are generally low, when the complication ensues, morbidity and mortality rates rise, varying between 18% and 30%. We used self-expandable, covered metallic stent to occlude the leakage site in a patient with recurrent postoperative anastomotic leaks. The deployment of the covered stent was successful, and immediate leak occlusion was obtained after the procedure. During follow-up, the patient had unrecognized passage of the stent per rectum and showed no anastomotic leak on upper gastrointestinal series. We suggest that implementation of covered metallic stent should be considered as a valuable, alternative therapeutic option for the treatment of intractable postoperative anastomotic leak after radical gastrectomy.

The conventional definition of an insulin-like growth factor binding protein (IGFBP) is a protein whose major function is to act as a carrier for the insulin-like growth factors (IGFs). Based on this simple criterion, six IGFBPs that bind IGFs with high affinity, designated IGFBP-1 to -6 (33) have been identified to date from numerous biological systems. Although distinct structural differences exist among the six IGFBPs, a key conserved feature is the high number of cysteines (16–20 cysteines) found in IGFBPs. The clustering of the invariant cysteines at the amino (N)-terminal and carboxy (C)-terminal thirds (Fig. 1) of the proteins has led to models proposing that the N-terminus and C-terminus are two domains that, together, form the tertiary site necessary for high-affinity IGF binding. This striking structural feature, as well as the capacity of the proteins to bind IGFs with high affinity, have become the signature criteria for determining whether a protein is a member of the IGFBP family. However, this conventional dogma for IGFBPs has been challenged recently; a group of cysteine-rich proteins (8,28,45) has been identified whose N-terminus is homologous to the IGFBP N-terminal domain, but that deviate from the common IGFBP structure in the mid-region and C-terminus (Fig. 1). The relatedness of these proteins to the IGFBPs is substantiated further by the demonstration that they can also bind IGFs, albeit at a lower affinity than observed with IGFBP-1 to -6 (18,30). These findings suggest that the IGFBP family should be expanded to include those proteins that share significant domain conservation as well as demonstrable abilities to bind IGFs. Furthermore, it is proposed that these new IGFBP-related proteins, together with the conventional IGFBPs, constitute an IGFBP superfamily (18). The concept of a superfamily denotes that members are united by some common structural and functional features that are conserved through evolution. We suggest that the proteins of the IGFBP superfamily be subgrouped into those that bind IGF with high affinity (IGFBP-1 to -6), and those that bind IGF with low affinity (new members).

Connective Tissue Growth Factor (CTGF) is a cysteine-rich peptide involved in human atherosclerosis and fibrotic disorders such as scleroderma. CTGF has considerable N-terminal sequence similarity with the insulin-like growth factor binding proteins (IGFBPs), including preservation of cysteines, and has been postulated to be a member of the IGFBP superfamily. Indeed, recent studies have shown that baculovirus generated CTGF, a secreted 38-kDa protein, binds IGFs in a specific manner, leading to the provisional renaming of CTGF as IGFBP-8 (or IGFBP-rP2). With immunoprecipitation and immunoblotting, using polyclonal anti-IGFBP-rP2 antibody generated against recombinant human IGFBP-rP2bac, IGFBP-rP2 can be identified in the serum-free conditioned media of Hs578T human breast cancer cells, as well as in various human biological fluids, such as normal sera, pregnancy sera, and cerebrospinal, amniotic, follicular and peritoneal fluids. Glycosylation studies with endoglycosidase F reveal that endogenous human IGFBP-rP2 is a secreted, glycosylated, approximately 32-38-kDa protein with 2-8-kDa of N-linked sugars and a 30-kDa core. There are 18- and 24-kDa proteins that appear to be IGFBP-rP2 degradation products. In Hs578T human breast cancer cells, transforming growth factor (TGF)-beta 2, a potent growth inhibitor for these cells, upregulates IGFBP-rP2 mRNA and protein levels. Expression of Hs578T IGFBP-rP2 is significantly increased by TGF-beta 2 treatment in a dose-dependent manner, with 2.5- and 6-fold increases in mRNA and protein levels, respectively, at a TGF-beta 2 concentration of 10 ng/ml. Our studies indicate that IGFBP-rP2 appears to be an important endocrine factor, and one of the critical downstream effectors of the critical downstream effectors of TGF-beta, similar to the role of IGFBP-3 in TGF-beta-induced growth inhibition in human breast cancer cells.

Intussusception is a rare cause of postoperative intestinal obstruction in adults. Many retrograde intussusceptions occur during the period following gastrectomy. A 77-year-old woman visited our hospital because of detected gastric adenocarcinoma. She received radical total gastrectomy with Roux-en-Y esophagojejunostomy. On the fifth postoperative day, she complained of abdominal pain, and we found leakage at the esophagojejunostomy site and dilatation of the Roux limb and the afferent limb of the jejunojejunostomy. Emergency surgery was performed. Retrograde jejunojejunal intussusception accompanied with a nasojejunal feeding tube was found at the efferent loop of the jejunojejunostomy. No ischemic change was found; therefore, manual reduction and primary repair of esophagojejunostomy was performed. She was discharged without complications on the 23rd re-postoperativeday. We suggest that the nasojejunal feeding tube acted as a trigger of intussusception because there was no definitive small bowel mass or postoperative adhesion. We present our findings here along with a brief review of the literature.

A new technique, which requires a simple surgical gastrostomy without general anesthesia, is described for placement of covered expandable metallic stents. This technique was performed successfully in a patient with malignant obstruction of the gastric antrum, obviating palliative surgical resection.

Purpose: The incidence of upper gastric cancer and especially the diffuse type have increased in western countries. The aim this study was to investigate the chronologic changes of the clinicopathological features and survival rates of Korean upper gastric cancer patients. Materials and Methods: 1,638 gastric cancer patients who underwent gastrectomy were included in this study and they were divided into two groups; the 1990's (1991~1999, n=987) and the early 2000's (2000~2003, n=651). We evaluated the differences of the clinicopathologic features and the factors that affected the survival rates by univariative and multivariative analysis. Results: The older age (>60) patients increased from 42.7% to 50.7% respectively. Being overweight (body mass index23) also increased from 31.5% to 43.2%. For the pathology, the incidence of stage Ia gastric cancer increased (29.8% to 44.5%) and the incidence of stage IV gastric cancer decreased (23.5% to 11.8%). Yet there was no difference according to the WHO classification, Lauren's classification and the location of tumor between the groups. The 5 year survival rates increased 67.7% to 83.7%, according to the group. Multivariative analysis showed that the odd ratios of the early 2000s was 0.715 (95% CI; 0.555~0.921) as compared to that of the 1990s. Conclusion: There were no changes of the clinicopathologic features, like the pattern in western countries, although the incidence early gastric cancer, old age patients and overweight patients increased. The survival rate of early 2000s was better that that of the 1990s.

Purpose: Postoperative Infectious complications are recognized as major complications that are associated with surgery. Although many studies have focused on the risk factors of postoperative complications, little is known about the risk factors of infectious complications after gastric cancer surgery, and especially after elective gastrectomy. There is now more and more interest in the risk factors of infectious complications in relation to controlling infection and as indicators of qualitatively assessing infectious complications. The aim of this study was to evaluate the risk factors related with infectious complications after performing elective gastrectomy for treating gastric cancer. Materials and Methods: We retrospectively reviewed a total of 788 patients who had undergone elective gastrectomy for gastric cancer between Jan. 2000 and Dec. 2007. The characteristics of the patients were divided according to the patients' factors and the operations' factors. Results: The patients' mean age was 58.9 (range: 24~91) years; 545 were male and 243 were female. The mean duration of the hospital stay was 20.3 days (range: 5~135 days), the mean operation time was 181.3 minutes (range: 65~440 minutes). The total complication rate was 17.1% (n=135) and the complication rate was 38.5% (n=52) among the 135 patients with infectious complications. The infectious complications were surgical site infection (59.7%), Pneumonia (19.3%), intra-abdominal abscess (11.5%), pseudomembranous colitis (5.7%), bacteremia (1.9%) and hepatic abscess (1.9%). On the univariate analysis, the significant risk factors were male gender, blood transfusion, smoking at the time of diagnosis, alcohol drinking, diabetes mellitus and previous cardiovascular disease (P

Purpose: We have evaluated changes of body composition for patients that underwent a radical gastrectomy for stomach cancer by the use of available bioelectrical impedance analysis during the first year following surgery. We plan to utilize these findings in nutritional and physiological studies. Materials and Methods: We evaluated clinical changes in body composition in patients using the bioelectrical impedance method (Inbody 4.0, Biospace, Korea), between November 2003 to November 2004. A total of 98 patients agreed to enroll in this study among all of the patients that underwent a radical gastrectomy. Results: The average weight decreased by 6.7%, and 9.4%, within the first and 6 months after surgery, respectively (P

Purpose: The purpose of this study is to determine whether it is possible to evaluate patients with pN2 or pN3 early gastric cancer (EGC) as being in an advanced stage before and during the operation. Materials and Methods: 4,430 patients underwent a gastrectomy for cancer from 1990 to 2003. Eight of the 552 patients with EGC included pN2 or pN3. The estimated clinical and surgical stage before and during the operation were compared to the pathological results, and a follow-up of progression was done. Results: The patients were evenly distributed among all age groups with seven men and one woman. The pre-operative estimate of T1 by CT was 25% (2/8). In the main, the cT stage was over estimated. The estimate of over N2 was 50% (4/8). One patient was preoperatively staged as la sT1 during operation was 57.1% (4/7), and the estimate of over N2 was 67% (4/6). Two patients were intraoperatively evaluated as Ia. Only one patient survived over 5 years, and the mean survival of these patients was 15 months . Conclusion: It was generally possible to evaluate patients with EGC of over pN2 as being in an advanced stage before and during the operation. Although very rare (2/552, 0.04%), there were EGC patients whose stages were not predictable at all. Therefore, more precise preoperative and intraoperative staging methods are warranted.

Purpose: We analyzed the clinicopathologic features, including treatment and outcome, and the survival rates between young and elderly patients with gastric cancer. Materials and Methods: Clinical information was reviewed for 1086 patients who had undergone a gastrectomy for gastric cancer during a 10-year period from 1990 to 1999, and the patients were assigned to one of two groups: the A group (). Results: Compared to the B group, the A group had more females (47.3% vs 32.9%), a greater frequency of family history of cancer (15.4% vs 3.5%), and greater proportions of histologically poorly differentiated tumors (84.5% vs 40.2%) and Lauren diffuse-type tumors (69.1% vs 35.1%)(P

F-18 FDG-PET/CT could be used to evaluate the surveillance of recurrent stomach cancer, but some cases reported as false-positives. The authors found an activated charcoal granuloma from intraperitoneal chemotherapy by using a curative resection and mitomycin C for stomach cancer. A mass behind the right colon that showed on CT 6 months after an operation in a 46-year-old male patient had no progression in size, but 36 months after the operation, an increase was seen on F-18 FDG-PET/CT, and a metastatic tumor was suspected. The tumor was resected by an explorative laparotomy and was diagnosed as being an activated charcoal granuloma based on the histologic finding. Based on this case, we should be reminded of the possibility of a false-positive on analysis of F-18 FDG-PET/CT caused by an activated charcoal granuloma in a patient who has intraperitoneal chemotherapy.

Purpose: Recurrence occurs in various forms and in different organs after a curative resection of gastric cancer. The most common location for hematogenous recurrence is the liver. The aim of this study was to evaluate the clinicopathological risk factors associated with hepatic recurrence after surgical treatment of gastric cancer. Materials and Methods: We reviewed the medical records of 838 patients who had taken radical surgery for primary gastric cancers at Chonbuk National University Hospital between January 1992 and December 1999. According to the medical records, we retrospectively investigated the association between the clinicopathologic variables and hepatic recurence. Results: Recurrence of gastric cancer was documented in 201 out of the 838 patients (23.98%). Hepatic recurrences were found in 59 out of 201 patients (29.35%). Multiple logistic regression analysis identified the following as independent risk factors of hepatic recurrence: Lauren's Intestinal type (OR, 6.60; 95% Cl, 1.53 to 28.9; p=0.011) and proximal resection of margin below 6 cm (OR, 3.76; 95% Cl, 1.03 to 13.67; P=0.045). Conclusion: Various studies on clinocopathologic risk factors of liver recurrence with molecular biologic research should make possible the prediction of recurrence and help high-risk patients to find appropriate management.

Purpose: The most feared complication of gastrointestinal tract operations is anastomotic leakage, not only because of the presumed individual surgeon's culpability but also because of the assumption that this event is often fatal. We have experienced 32 cases of anastomotic leakage after elective gastric resection during 8 years. The purpose of this study was to evaluate the result of their treatment. Materials and Methods: We evaluated the records of 1335 patients who had undergone elective gastric resection for an adenocarcinoma of stomach from January 1995 to October 2003 and conducted a retrospective, multivariate analysis. Results: Of the 1335 patients, 32 () sustained an anastomotic leakage. Anastomotic leakages usually developed on mean postoperative day (range: days).Overall, (10/32) of patients who sustained an anastomotic leakage died. The anastomotic leakages were identifed by radiological study or by operative finding at the site of the duodenal stump (20 patients), the esophagojejunostomy (7), the gastroduodenostomy (4), and the gastrojejunostomy (1). Fourteen patients () underwent a relaparotomy, a drainage procedure in the main, and 18 patients () were treated conservatively. The mortality rates were (6/14) and (4/18), respectively, but this difference was not statistically significant. A cox's proportional hazard analysis showed that a body-mass Index CI: ) and non-enteral feeding (odds ratio 18.27, CI 2.22.150.69) were independent factors of mortality due to anastomotic leakage. Conclusion: Our observations show that anastomotic leakage after an elective gastric resection has a high risk of being fatal. Moreover, for a patient with a body-mass index lower than and/or non-enteral feeding, an anastomotic leakage after an elective gastric resection has a higher risk of being fatal.

Purpose: This study was performed to evaluate the effectiveness of the serum tumor markers CEA, CA 19-9, and CA 72-4 in monitoring the recurrence of gastric cancer and in its preoperative assessment. Materials and Methods: Two hundred fifty-five patients who underwent potentially curative surgery during period from January 1995 to December 2000 at the Department of Surgery were assessed. Serum samples were obtained preoperatively, 2 weeks after the surgery, and at 6-month intervals. The cut-off levels were established as 5 ng/ml for CEA, 36 U/ml for CA 19-9, and 4 U/ml for CA 72-4. The tumor stage was described according to the 5th edition of the Union Internationale Contra la Cancer (UICC) TNM classification in 1997. Results: The preoperative positivities were for CEA, for CA 19-9, and for CA 72-4. The serum levels of the three tumor markers decreased after curative surgery. The preoperative serum levels of the three tumor markers were significantly related to the depth of invasion, the tumor size, lymph-node metastasis, the pathologic stage, and recurrence, except that CEA was not associated with tumor size. The marker sensitivities in recurrent cases were for CEA, for CA 19-9, and for CA 72-4, and the marker specificities were for CEA, for CA 19-9, and for CA 72-4. Conclusion: The preoperative serum levels of CEA, CA 19-9, and CA 72-4 are not useful for the initial diagnosis of gastric cancer because of their low positivity. However, we should consider their relationship with depth of invasion, lymph-node metastasis, tumor size, pathologic stage, and recurrence. Also, the follow-up levels of the three markers have a statistical relationship with recurrence of gastric cancer even though their sensitivities are low.

Purpose: To assess the usefulness of 0.5 %-methylcellulose as oral contrast agent in spiral CT examinations for the evaluation of anastomotic site and remnant stomach in patients who have undergone subtotal gastrectomy due to stomach cancer. Materials and Methods: Twenty-seven patients who underwent subtotal gastrectomy for stomach cancer and were referred for the evaluation of anastomosis recurrence and lymph node metastasis were prosepectively analyzed by spiral CT. They were divided into two groups: before scanning, group A patients drank0.5 %-methylcellulous 500ml as oral contrast agent, while those in group B drank diluted gastrografin 500ml. Three patients were examined twice. Anatomic delineation of the anastomosis site was graded by two radiologists as excellent (3), good (2), fair (1), or poor (0). To evaluate the degree of distension, maximal transverse and anterior-posterior diameter of remnant stomach and anastomotic sites were measured. Results: In Group A, anatomic delineation of the anastomotic site was very much better than in group B (mean score: 2.93 vs 1.80, p) Conclusion : In patients who had undergone subtotal gastrectomy, the use of 0.5 %-methylcellulose as oral contrast agent for spiral CT showed excellent anatomic delineation of the anastomotic site and distension of remnant stomach.

Recent findings have indicated that insulin-like growth factors (IGF-I and IGF-II) may play a role in neoplasia. Alteration of serum IGFs or IGF Binding Proteins (IGFBPs) have been reported in some tumors. In this study, we measured serum IGF-I, IGF-II and IGFBPs profile in gastric cancer by radioimmunoassay and Western ligand blots. The serum IGF-I level in gastric cancer was significantly lower than in control subjects (65.2 +/- 26.5 vs 148.4 +/- 55.2 ng/ml, p < 0.01) and was further decreased to 45.5 +/- 20.9 ng/ml after surgery. The serum IGF-II level was slightly higher than that in control subjects (826.3 +/- 360.2 vs 735.7 +/- 154.6 ng/ml) but it was significantly decreased after surgery (525.7 +/- 220.1 ng/ml, p < 0.05). The serum IGFBP-3 level was not significantly different from those in control subjects. However, we observed a decreased level of serum IGFBP-3 after surgery, and incubation of postoperative serum with control serum resulted in a significant reduction of IGFBP-3 level. The reduction of IGFBP-3 in postoperative serum was mainly due to surgery associated IGFBP-3 protease activity. This protease activity was totally inhibited by aprotinin, EDTA and PMSF but not by pepstatin and leupeptin. This inhibition pattern is consistant with cation dependent serine protease. We speculate that proteolysis of IGFBP-3 may contribute to increase the bioavailability of IGFs.