Laparoscopic surgery for left-sided colon cancer: Clinical and long-term oncologic outcomes

PURPOSE: Laparoscopic surgery for left-sided colon cancer is one of the most frequent procedures performed in laparoscopic colorectal surgery. In this study, we analyzed clinical and long-term oncological outcomes of left-sided colon cancer patients who underwent conventional laparoscopic surgery (CLS) and hand-assisted laparoscopic surgery (HALS).METHODS: A total of 172 CLS patients and 72 HALS patients for left-sided colon cancer from July 2001 to December 2011 were included in this study. The collected data included the clinical and oncological outcomes. We analyzed overall survival and disease-free survival by tumor, node, metastasis (TNM) stage.RESULTS: The mean age of the patients was 64 years, and male patients were predominant. The mean follow-up period was 58.1 months. The number of patients that belong in each TNM stage 0, I, II, III, and IV was as follows: 17 (7%), 47 (19.2%), 70 (28.7%), 80 (32.8%), and 30 (12.3%), respectively. Overall 5-year survival rate for TNM stage I, II, III, and IV was 87.1%, 82.8%, 82%, and 12%, respectively. Overall 5-year survival rate for CLS group and HALS group was 90.2% and 66.7%, 86.5% and 77%, 88.7% and 67.4%, and 18.9% and 0%, respectively. Disease-free 5-year survival rate for TNM stage I, II, and III was 97.7%, 90.7%, and 72.8%, respectively. Disease-free 5-year survival rate for CLS group and HALS group was 97.3% and 100%, 100% and 78.8%, and 81% and 55.1%, respectively.CONCLUSION: These data show the feasibility and safety of laparoscopic surgery for left-sided colon cancer in terms of long-term oncological outcomes.

Gastrointestinal Stromal Tumor of the Stomach Presenting as Multilobular with Diffuse Calcifications

Gastrointestinal stromal tumors (GISTs) are the most common primary mesenchymal neoplasms of the gastrointestinal tract and usually appear as a well-circumscribed mass. However, it may be difficult to confirm the extent of the disease for some GISTs. A 70-year-old asymptomatic female presented for a regular physical exam. An esophagogastroduodenoscopy showed a 2.0 cm protruding mass on the gastric fundus. Endoscopic ultrasound revealed an ill-defined heterogenous hypoechoic lesion (3.0×1.5 cm). A computed tomography (CT) scan demonstrated a 4.5 cm multifocal calcified mass at the gastric body as well as at the gastric fundus. Laparoscopic gastric wedge resection was performed according to the extent of multifocal calcifications that are shown on the CT. Intraoperative specimen mammography and intraoperative biopsy might be helpful to obtain a tumor-free margin. Final pathologic diagnosis was an intermediate risk GIST in multilobular form. In patients with diffuse multifocal calcifications in the stomach, the possibility of GIST should be considered.

Predictive Factors to Distinguish Between Patients With Noncomplicated Appendicitis and Those With Complicated Appendicitis

PURPOSE: Recently, randomized controlled trials have reported that conservative therapy can be a treatment option in patients with noncomplicated appendicitis. However, preoperative diagnosis of noncomplicated appendicitis is difficult. In this study, we determined predictive factors to distinguish patients with noncomplicated appendicitis from those with complicated appendicitis. METHODS: A total of 351 patients who underwent surgical treatment for acute appendicitis from January 2011 to December 2012 were included in this study. We classified patients into noncomplicated or complicated appendicitis groups based on the findings of abdominal computed tomography and pathology. We performed a retrospective analysis to find factors that could be used to discriminate between noncomplicated and complicated appendicitis. RESULTS: The mean age of the patients in the complicated appendicitis group (54.5 years) was higher than that of the patients in the noncomplicated appendicitis group (40.2 years) (P < 0.001), but the male-to-female ratios were similar. In the univariate analysis, the appendicocecal junction's diameter, appendiceal maximal diameter, appendiceal wall enhancement, periappendiceal fat infiltration, ascites, abscesses, neutrophil proportion, C-reactive protein (CRP), aspartate aminotransferase, and total bilirubin were statistically significant factors. However, in the multivariate analysis, the appendiceal maximal diameter (P = 0.018; odds ratio [OR], 1.129), periappendiceal fat infiltration (P = 0.025; OR, 5.778), ascites (P = 0.038; OR, 2.902), and CRP (P < 0.001; OR, 1.368) were statistically significant. CONCLUSION: Several factors can be used to distinguish between noncomplicated and complicated appendicitis. Using these factors, we could more accurately distinguish patients with noncomplicated appendicitis from those with complicated appendicitis.

The Role of Hand-Assisted Laparoscopic Surgery in a Right Hemicolectomy for Right-Sided Colon Cancer

PURPOSE: The purpose of this study is to evaluate the perioperative and long-term oncologic outcomes of hand-assisted laparoscopic surgery (HALS) and standard laparoscopic surgery (SLS) and assess the role of HALS in the management of right-sided colon cancer. METHODS: The study group included 53 patients who underwent HALS and 45 patients who underwent SLS for right-sided colon cancer between April 2002 and December 2008. RESULTS: The patients in each group were similar in age, American Society of Anesthesiologist (ASA) score, body mass index, and history of previous abdominal surgeries. Eight patients in the HALS group and no patient in the SLS group exhibited signs of tumor invasion into adjacent structures. No differences were noted in the time to return of normal bowel function, time to toleration of diet, lengths of hospital stay and narcotic usage, and rate of postoperative complications. The median incision length was longer in the HALS group (HALS: 7.0 cm vs. SLS: 4.8 cm, P < 0.001). The HALS group had a significantly higher pathologic TNM stage and significantly larger tumor size (HALS: 6.0 cm vs. SLS: 3.3 cm, P < 0.001). The 5-year overall, disease-free, and cancer-specific survival rates of the HALS and the SLS groups were 87.3%, 75.2%, and 93.9% and 86.4%, 78.0%, and 90.7%, respectively (P = 0.826, P = 0.574, and P = 0.826). CONCLUSION: Although patients in the HALS group had more advanced disease and underwent more complex procedures than those in the SLS group, the short-term benefits and the oncologic outcomes between the two groups were comparable. HALS can, therefore, be considered an alternative to SLS for bulky and fixed right-sided colon cancer.

Mycotic Abdominal Aortic Aneurysm Caused by Bacteroides Thetaiotaomicron and Acinetobacter Lwoffii: The First Case in Korea

Mycotic aneurysms are uncommon, but are fatal without appropriate management. Previous reports have shown that anaerobes and gram-negative organisms are less common but more dangerous than other causative agents of mycotic aneurysm. We report the case of a 60-year-old man with poorly controlled diabetes mellitus and atherosclerosis in the aorta, and a 10-day of history of lower abdominal pain and fever. This man was diagnosed with an uncommon abdominal aorta mycotic aneurysm caused by Bacteroides thetaiotaomicron and Acinetobacter lwoffii. The aneurysm was successfully treated with antibiotics therapy and aorto-bi-external iliac artery bypass with debridement of the infected aortic wall. We present this case together with a review of the relevant literature.

Pulmonary Thromboembolism in Patients with Acute Deep Vein Thrombosis / 대한혈관외과학회지

PURPOSE: Pulmonary thromboembolism (PTE) is one of the most critical complications of deep vein thrombosis (DVT). Studies on the incidence and the treatment of PTE are rare in Korea compared to western countries. This study analyzed the occurrence, risk factors and treatment of PTE in the patients diagnosed as acute DVT in a single center in Korea. METHODS: The study population was 84 patients diagnosed as acute DVT in Eulji University Hospital from August 2006 to March 2012. Of these patients, 51 patients who underwent chest computed tomography were finally included in this study. We performed a retrospective study and analyzed clinical characteristics, risk factors, and treatment of PTE. RESULTS: Among the 51 patients diagnosed as acute DVT, 22 patients (43.1%) had findings of PTE on chest computed tomography. PTE was more prevalent in male patients, when acute DVT occurred in the right lower extremity and proximal vein. All PTE patients were successfully treated with low molecular weight heparin. There was no mortality. CONCLUSION: Patients with acute DVT had similar incidence of PTE to western countries. However, PTE was successfully treated with conservative treatment. Therefore, expanding the indications of aggressive and invasive treatments, such as filter insertions, should be cautiously considered in Korean PTE patients.

The Effects of Preoperative 18F-FDG PET/CT in Breast Cancer Patients in Comparison to the Conventional Imaging Study / 한국유방암학회지

PURPOSE: There have been recent studies of the 18F-fluorodeoxyglucose positron emission tomography and computed tomography (18F-FDG PET/CT) in the staging, detection, and follow-up of the breast cancer occurrence and recurrence. There was controversy concerning the use of 18F-FDG PET/CT for staging primary breast cancer. In this study, we investigated the potential effects of 18F-FDG PET/CT in the initial assessment of patients with primary breast cancer. METHODS: From January 2008 to December 2009, 154 consecutive biopsy-proven invasive breast cancer patients were enrolled in this study. Patients underwent conventional imaging studies including mammography, breast ultrasonography (USG), and magnetic resonance imaging for local assessment, and plain chest X-ray, liver USG, and bone scan to rule out distant metastasis. All 154 patients underwent 18F-FDG PET/CT in the initial assessment. RESULTS: 18F-FDG PET/CT did not detect primary breast lesions in 16 patients with a sensitivity of 89.6% and detected only 5 multiple lesions (12.5%) out of 40 cases. Histologically confirmed axillary lymph node (LN) metastases were in 51 patients, and the sensitivity and specificity of 18F-FDG PET/CT to detect metastatic axilla were 37.3% and 95.8%, respectively; whereas the corresponding estimates of USG were 41.2% and 93.7%, respectively. Eleven extra-axillary LN metastases were found in eight patients, and seven lesions were detected by 18F-FDG PET/CT only. The sensitivity and specificity of 18F-FDG PET/CT in detecting distant metastasis were 100% and 96.4%, respectively; whereas the sensitivity and specificity of the conventional imaging were 61.5% and 99.2%, respectively. CONCLUSION: 18F-FDG PET/CT cannot be recommended as a primary diagnostic procedure in breast cancer, but it has the potential to be used as an additional imaging tool for the detection of axillary metastasis, distant metastasis, and extra-axillary LN metastasis. 18F-FDG PET/CT cannot solely replace the conventional diagnostic procedure in primary breast cancer. The best approach may be the combination of different imaging modalities.

Impact of PTGBD on Patients with Acute Complicated Cholecystitis: Consecutive 4,000 Cases of Laparoscopic Cholecystectomy / 대한내시경복강경외과학회지

PURPOSE: The aim of this study was to determine the advantage of adequate PTGBD in acute complicated cholecystitis patients. METHODS: We performed a retrospective review of a collected database from September 2001 to July 2008. Acute cholecystitis with gangrene or perforation was defined as acute complicated cholecystitis. A PTGBD was performed for these patients immediately after the diagnosis using US or CT and then a tubogram was performed after 5~7 days. After evaluating the gallbladder (GB) and common bile duct (CBD) with a tubogram, we removed the drainage tube and the patients underwent a LC after readmission. RESULTS: Three hundred seventy four of the 893 patients who were diagnosed with acute cholecystitis underwent PTGBD. While 19 (3.2%) of the total acute cholecystitis patients were converted to open cholecystectomy due to severe inflammation, 14 (3.7%) of the acute complicated patients were converted to open cholecystectomy. In 79 patients, the pre-operative tubogram showed the presence of CBD stone and so ERCP was performed. There were no post-operative deaths. CONCLUSION: PTBGD in acute complicated cholecystitis patients allows the early relief of acute cholecystitis symptoms. This allows sufficient evaluation and treatment for CBD during the PTGBD state. Furthermore, this decreases the mortality and morbidity in the high-risk patients due to sufficient evaluation and management of the underlying critical disease, which allows elective cholecystectomy when the patients is in better condition for surgery. Therefore, PTGBD can be useful for acute complicated cholecystitis.

A giant retroperitoneal lymphangioma in a patient with neurofibromatosis type 1 / 대한외과학회지

Neurofibromatosis type 1 (NF-1) is a genetically inherited disorder that may cause skin abnormalities and tumors that form on nerve tissues. These tumors can be small or large and can occur anywhere in the body, including the brain, spinal cord, or other peripheral nerves. Retroperitoneal lymphangiomas are very rare benign malformations of the lymphatic system. About 95% lymphangiomas occur in the skin and the subcutaneous tissues of the head, neck and axillary region and the remaining 5% appear in other parts of the body such as lungs, pleura, pericardium, liver, gallbladder, kidney, and the mesentery. Herein, we report the case of a giant retroperitoneal lymphangioma in a patient with NF-1 with a review of the literature.

Experience of non-vascular complications following endovascular aneurysm repair for abdominal aortic aneurysm / 대한외과학회지

Endovascular aneurysm repair (EVAR) for the treatment of abdominal aortic aneurysm (AAA) is a widely used method, and its decreased invasiveness compared to traditional surgical repair has brought about reduced rates of morbidity and mortality. Several vascular complications related to the procedure have been reported, but non-vascular complications have rarely occurred. We report herein the case of a 78-year-old man who underwent EVAR for AAA and presented with active duodenal ulcer bleeding and acute acalculous cholecystitis as complications after the procedure. We must consider that a wide spectrum of complications may occur following EVAR, and therefore it is important to evaluate the risks of complication and to take the necessary measures to minimize them.

Impact of PTGBD on Patients with Acute Complicated Cholecystitis: Consecutive 4,000 Cases of Laparoscopic Cholecystectomy / 대한내시경복강경외과학회지

PURPOSE: The aim of this study was to determine the advantages of adequate PTGBD in patients with acute complicated cholecystitis. METHODS: We performed a retrospective review of a database that was collected from September 2001 to July 2008. Acute cholecystitis with gangrene or perforation was defined as acute complicated cholecystitis. A PTGBD was performed for the patients immediately after the diagnosis using US or CT and then a tubogram was performed after 5~7 days. After evaluating the gallbladder (GB) and common bile duct (CBD) with a tubogram, we removed the drainage and the patients underwent a LC after readmission. RESULTS: Three hundred seventy four of the 893 patients who were diagnosed with acute cholecystitis underwent PTGBD. While 19 (3.2%) of the total acute cholecystitis patients were converted to open cholecystectomy due to severe inflammation, 14 (3.7%) acute complicated patients were converted to open cholecystectomy. In 79 patients, the pre-operative tubogram showed the presence of CBD stone and so ERCP was performed. There was no post-operative death. CONCLUSION: Performing PTBGD in patients with acute complicated cholecystitis allows the early relief of the symptoms of acute cholecystitis. This allows for sufficient evaluation and treatment for CBD during the PTGBD state. Further, PTBGD decreases the mortality and morbidity in the high-risk patients due to sufficient evaluation and management of the underlying critical disease. PTBGD allows for performing elective cholecystectomy when the patient is in a better condition for surgery. Therefore, PTGBD can be useful for treating acute complicated cholecystitis.

Isolated Dissection of Superior Mesenteric Artery: Study on the Treatment Guidelines

PURPOSE: Isolated superior mesenteric artery (SMA) dissection is a rare, but increasing vascular disorder. However, optimal treatment guidelines are not well established. The purpose of this study is to review a single institutional experience in the management of isolated SMA dissections and establish optimal treatment guidelines. METHODS: Between November 2004 and August 2009, 26 patients were diagnosed with isolated SMA dissection at Eulji University Hospital. Diagnosis was confirmed with CT scans in all patients. We retrospectively reviewed the medical records, imaging studies, and the early outcomes of the patients. RESULTS: There were 22 (84.5%) men and 4 women. The mean age was 55.4 (39~74) years. The mean follow-up was 39.1 (4.1~53.3) months. In 15 patients, CT scans were performed for abdominal pain, and in the other 11 patients, the isolated SMA dissections were detected incidentally during workup for other causes. The radiographic findings included an intimal flap with a patent false lumen in 16 and intramural hematoma in 10. The dissection started at a mean of 22.3 (5~46) mm from the origin of the SMA with a mean length was 47.7 (10~150) mm. Treatments included expectant management in 13, anticoagulation in 6, stenting in 6 patients, and surgery in one case of bowel infarction. None required additional intervention. All patients remained asymptomatic during follow-up. CONCLUSION: Most patients with isolated SMA dissection were successfully managed medically. Surgical or percutaneous intervention should be reserved for those with evidence of bowel necrosis or mesenteric ischemia and failed cases to initial medical treatment.

Endovascular Treatment for Chronic Total Occlusions of Peripheral Arteries

PURPOSE: The TransAtlantic Inter-Society Consensus offers the proper guidelines for the treatment of peripheral arterial disease (PAD). Many new devices and surgical techniques have been introduced to the medical field and these have been aggressively used to manage the patients with PAD. We performed this study to evaluate the current status of endovascular therapy based on the literature and we review the efficacy and safety of the new devices used in the field. METHODS: A search of the literature was performed in the PubMed and science websites. The keywords were "chronic total occlusions", "superficial femoral artery revascularization", "peripheral arterial disease" and "endovascular therapy". RESULTS: The variation of the results was large according to the studies. The rough technical success rate was 80~90% and the 1 year clinical success rate, the primary patency rate and the limb salvage rate for chronic total occlusions were approximately 50~70%, 50% and 80~90%. The efficacy and safety of the new devices used in the field were acceptable. CONCLUSION: Further refinement of the guidewires and sheaths and the development of adjunctive devices have allowed traversal of even the long lesions and this has increased the technical success. Although surgery remains the principal treatment for patients with lower limb ischemia, surgeons must now assess the benefits and risks associated with various treatment options, including endovascular therapy.

The Evaluation of the Saphenofemoral Junction after Endovenous Laser Treatment for Varicose Veins and Its Clinical Significance

PURPOSE: The aim of this study is to evaluate the anatomy of the saphenofemoral junction (SFJ) after endovenous laser treatment (EVLT) with using a duplex scan and to assess its clinical significance. METHODS: Thirty two limbs of 26 patients who underwent EVLT between 2004 and 2006 were examined with duplex ultrasound scanning. The mean follow-up time was 25.9 months. We evaluate the presence of reflux, the patency of the proximal great saphenous vein and the number of the remaining patent tributary veins. RESULTS: The occlusion of the SFJ was classified into four categories 1) complete obstruction in 7 (21.9%), 2) complete obstruction with only one patent tributary vein in 6 (18.8%), 3) near complete obstruction (the patent length of the greater saphenous vein 5 cm) in 1 case. A patent SFJ with one or more intact tributaries was present in 25 (78.1%) limbs. However, there was no reflux in all the cases. CONCLUSION: EVLT is an effective and minimally invasive treatment for varicose veins. Although the SFJ tributaries and the patency of the proximal great saphenous vein after endovenous laser treatment were present, there was no reflux or recurrence of varicose veins.

A Comparison of Standard Laparoscopic Surgery and Hand-Assisted Laparoscopic Surgery in Patients with Diverticular Diseases of the Large and the Small Bowel

PURPOSE: In complicated diverticular disease, hand-assisted laparoscopic surgery (HALS) has been considered as a useful alternative treatment to standard laparoscopic surgery (SLS) and open surgery. As compared with standard laparoscopic surgery, HALS offers advantages such as tactile sense, better exposure, and shorter learning curve. Minimally invasive surgery is another advantage of HALS. The aim of this study was to compare SLS to HALS in patients with diverticular diseases of the small bowel and the colon. METHODS: We retrospectively reviewed the records of 32 patients who had undergone SLS and HALS for diverticular disease between February 2002 and March 2009. RESULTS: Of the 32 patients, 20 patients (62.5%) were in the SLS group, and 12 patients (37.5%) were in the HALS group. The mean maximal incision length was longer in the HALS group (SLS group vs. HALS group, 4.5 vs. 7.4 cm, P<0.001). However, the mean operating time, the time to flatus, the time to diet, the mean duration of narcotic analgesia, the length of hospital stay, and the postoperative complications were similar. There was no mortality in either group. CONCLUSION: The longest incision length for the HALS group was longer than that for the SLS group, but HALS could reduce the conversion rate and has the many advantages of minimally invasive surgery. For complicated diverticular disease, HALS may be considered as a useful alternative treatment.

Analysis of Anastomotic Leakage after an Anterior Resection for Rectal Cancer

PURPOSE: The aim of our study was to identify risk factors associated with anastomotic leakage (AL) after an anterior resection (high anterior resection+low anterior resection) for rectal cancer. METHODS: Between January 1998 and December 2007, 356 patients underwent an anterior resection for rectal cancer. Early anastomotic leakage (EAL) was defined as leakage identified during hospitalization. Late anastomotic leakage (LAL) was defined as leakage identified in outpatients. RESULTS: AL (EAL+LAL) occurred in 30 patients (8.4%, mean time: 15.4 days). Among of them, EAL occurred in 20 patients (5.6%, mean time: 5.1 days), and LAL occurred in 10 patients (2.8%, mean time: 36.0 days). In the univariate analysis, the size of the tumor, the tumor level from the anal verge, and the level of anastomosis were significantly associated with AL. In EAL, the size of the tumor, the tumor level from the anal verge, the level of anastomosis, the operation type, and the value of serum albumin on day 3 after the operation were risk factors. In LAL, the tumor level from the anal verge and the level of anastomosis were risk factors. In the multivariate analysis, tumor size >7 cm (AL: P<0.001, EAL: P<0.001) and tumor level from the anal verge < or =8 cm (AL: P=0.014, EAL: P=0.001) were independent risk factors. CONCLUSION: AL and EAL after an anterior resection for rectal cancer were related to the size of the tumor and the level of the tumor from the anal verge.

Celiomesenteric Trunk with Concurrent Common Hepatic Artery Aneurysm: A Case Report

Celiomesenteric trunk is a rare anomaly, and its co-occurrence with an aneurysm is even more unusual. We present a case of celiomesenteric trunk with a concurrent hepatic arterial aneurysm, both of which were found incidentally on screening abdominal ultrasonography.

EVAR with Aortouniiliac Stent Graft and Converter in a Patient with AAA andIliac Artery Occlusion

Endovascular aneurysm repair (EVAR) has become increasingly popular since Parodi reported the first endovascular repair in 1991. Aortobiiliac stent grafting has gained popularity as an endovascular technique for managing abdominal aortic aneurysms (AAA), but the use of aortouniiliac stenting with femorofemoral bypass increases the proportion of patients treatable by endovascular techniques. The Zenith AAA Endovascular Graft Converter is used to convert a bifurcated graft to an aortouniiliac graft. We report successful EVAR using an aortouniiliac stent graft and converter in a 66-year-old man with an AAA and right common iliac artery occlusion. The preoperative CT angiography showed an infrarenal AAA 78 mm in diameter and right common iliac artery occlusion with recanalization by a collateral epigastric artery. The converter was deployed after placement of the main body, and the iliac leg extension was placed in the left external iliac artery. No postoperative complications occurred, and no endoleak was seen on follow-up CT angiography.

Endovascular Aneurysm Repair of the Abdominal Aortic Aneurysm Performed by Vascular Surgeon

PURPOSE: We report our early experience of endovascular abdominal aortic aneurysm repair (EAVR) performed by vascular surgeon. METHODS: A retrospective study was performed based on the medical records of 9 cases operated for EVAR due to abdominal aortic aneurysm at the Eulji University Hospital from Jan. 2007 to Apr. 2008. RESULTS: 9 subjects consisted of 7 males and 2 female and their mean age was 70.0 years. The surgical indications of EVAR were 5 cases of abdominal pain, 3 asymptomatic cases, and 1 of pulsating abdominal mass. The mean diameter of aneurysm, mean diameter of the aortic neck, mean length of the neck and mean aortic neck angle was 56.0 mm, 23.4 mm, 32.0 mm and 46.8o respectively. The mean time for stent-grafting was 241.8 minutes and the mean contrast amount was 301.4 ml. Adjunctive procedures were performed in 3 cases. One case had the type II endoleak from the right internal iliac artery. And all cases showed to be technical and clinical success. Deployment-related complications occurred in 2 cases (access site hematoma and lymphorrhea). Mean length of hospitalization and ICU stay were 10.5, 1.2 days. The mean follow up period was 2.4 months (1~12). There was no newly developed complication such as endoleak and so on. CONCLUSION: In this study, it was shown that vascular surgeon could successfully perform EVAR. In this era of minimal invasive surgery, vascular surgeon should play an important role even in intervention such as EVAR. And it suggests that it requires more effort and the experience of a vascular surgeon.

Gastric Schwannoma Treated by Laparoscopic Surgery

Gastric schwannoma is a very rare gastrointestinal mesenchymal tumor. Schwannoma in the gastrointestinal tract is usually not symptomatic, and preoperative abdominal CT or endoscopic evaluation cannot distinguish it from gastrointestinal stromal tumor. Surgical resection of this tumor is adequate to achieve a good prognosis. We performed laparoscopic gastric wedge resection in two patients who had the preoperative diagnosis of gastric gastrointestinal stromal tumor. In both cases, the postoperative immunohistochemistry staining was positive for S-100 protein and it was negative for CD34, which is consistent with gastric schwannoma. We report here on two cases of gastric schwannoma along with a review of the literatures.