A Case of Eosinophilic Gastritis Mimicking Borrmann Type-4 Advanced Gastric Cancer

Eosinophilic gastroenteritis is a rare clinicopathologic entity of unknown etiology with a variety of digestive symptoms. The pathogenesis is poorly understood. Diagnostic criteria include demonstration of eosinophilic infiltration of the affected bowel wall, lack of evidence of extraintestinal disease, and exclusion of various disorders that could mimic similar conditions. The disease might involve any area of the gastrointestinal tract from the esophagus to the rectum, but the stomach and the proximal small bowel are most commonly affected. The clinical features depend on which layer and site are involved. We report the case of a 59-year-old male patient with a 3-week history of post-prandial vomiting with malnutrition and weight loss. An abdominopelvic CT showed a gastric outlet obstruction with diffuse wall thickening, as with linitis plastica. Three gastrofiberscopic biopsies showed chronic gastritis. We carried out a radical total gastrectomy with D2 lymph node dissection. The pathologic report revealed a mural type eosinophilic gastritis with a marked hypertrophic scar formation at the proper muscle layer. We report this case with a brief review of the literature.

A Case of Locally Recurrent Gastric Cancer at Kim's Tie Site of the Jejunum after a Total Gastrectomy

Despite improvements in the surgical treatment of gastric adenocarcinomas, the recurrence rates remain high in patients with advanced-stage disease. Most of the recurrence occurs within 3 years of the surgical resection, and nearly 90% of the patients with recurrence die within 2 years of the diagnosis of recurrence. A recent study analyzed recurrence patterns for patients who had undergone a potentially curative gastrectomy. For those patients, 33% of the recurrences involved locoregional sites, 44% the peritoneum, and 38% distant sites. A 51-year-old female patient was diagnosed with stomach cancer and underwent a total gastrectomy with D2 lymph node dissection during Oct. 1999. The pathologic report indicated a T3N1M0 tumor. We performed immunochemotherapy for 2 years with regular follow up. A gastrofiberscopic examination done during Sep. 2004, cancer recurrence was found at the *Kim's tie site of the jejunual loop. We did an abdominal exploration and a segmental resection of cancer site with pathologically negative resection margins. After the operation, we started secondary chemotherapy with TS-1.

Gastrointestinal Anisakiasis

We report a case of gastrointestinal anisakiasis which was misinterpreted as a gastrointestinal stromal tumor until an operation and pathological report. A 44-year-old female was diagnosed as having a gastrointestinal stromal tumor on esophagogastroduodenoscopy during a routine medical examination. The esophagogastroduodenoscopy revealed a 1 cm sized submucosal tumor at the gastric mid-body. Endoscopic ultrasonography showed a low echoic tumor, with an irregular margin, in the submucosal layer. The patient underwent a wedge resection of the gastric lesion. A histological examination revealed chronic granulomatous inflammation, with abscess formation and a parasitic organism, morphologically consistent with anisakiasis.

Giant Gastrointestinal Stromal Tumor Accompanying Stomach Cancer

We report a case of giant malignant gastrointestinal stromal tumor (GIST) accompanying an advanced gastric adenocarcinoma. A 73-year-old male patient was admitted to our hospital due to epigastric discomfort. In gastrofiberscopic examination, a localized Borrmann III gastric cancer at the lower body and antrum was noted. In endoscopic ultrasonographic examination, T3 hyperechoic advanced gastric cancer lesion and a relatively well-marginated heterogenous hypoechoic huge mass with a size of 10 cm were noted. In abdomen CT findings, localized wall thickening in the gastric antrum and the anterior wall, and a 11-cm-sized large heterogeneously enhancing mass in gastric body, posterior wall were noted. We did a radical subtotal gastrectomy, including a huge mass, with D2 lymph node dissection. Pathologic findings revealed double primary gastric neoplasms (synchronous occurrence of an adenocarcinoma and a huge GIST). Although closely juxtaposed, these two tumors had not merged and were separated by the thin rim of the muscularis propria.

Anastomosis Site Stricture after Using Stapler Devices in a Total Gastrectomy

PUPOSE: Anastomosis site stricture is a common complication after a total gastrectomy. End-to-end anastomosis (EEA) stapler devices are preferred to a hand-sewn esophagojejunostomy these days. However, stapling devices have been reported not to reduce the incidence of esophagojejunostomy site stricture considerably. MATERIALS AND METHODS: From Sep. 1998 to Dec. 2000, at Korea Gastic Cancer Center, Seoul Paik Hospital, Inje University, we experienced 228 total gastrectomies in which EEA stapling devices had been used. We investigated the correlation of the stricture with the size of the EEA stapling device, the type of esophagojejunal reconstruction, reflux esophagitis, and duration of stricture development. RESULTS: Among the 228 cases, as far as the patient's age was concerned, the 7th decade was the most common 64 cases, followed by the 5th decades. The Male-to-female ratio was 2.3 : 1. A loop esophagojejunostomy was used in 223 cases, and the Roux-en-Y method was used in 5 cases. The 32 patients with anastomosis site stricture were patients with loop esophagojejunal anastomosis. Anastomosis site stricture occurred in 14% (32/228) of the total gastrectomy cases, in15.9% (11/69) of the total gastrectomies involving stapler devices with a 25-mm diameter, and in 13.2% (21/159) of the total gastrectomies involving staper devices with a 28-mm diameter. There was no correlation between the incidence of stricture and EEA- stapling device size (P>0.05). Reflux esophagitis occurred in 56 of the 228 cases, with 7 of those 56 cases (12.5%) and 25 of the remaining 172 cases (14.5%) having strictures. There was no considerable difference in the stricture incidence rate according to the presence of reflux esophagitis (P>0.05). The onset of stricture development, occurred within 6 months in 16 cases, including 4 cases of reflux esophagitis, between 7 and 18 months in 14 cases, including 3 cases of reflux eshophagitis, and after 19 months in 2 cases. CONCLUSION: An esophagojejunostomy site stricture after a total gastrectomy was not correlated with the esophagojejunal reconstruction type, the size of the stapling device, or the presence of reflux esophagitis. General anastomosis technical factors (e.g., adequate blood supply, tension-free manner, adequate hemostasis) may be more important to prevent anastomosis site stricture after an esophagojejunostomy during a total gastrectomy.

A Case of Advanced Gastric Cancer with Virchow's Node and Lung Metastasis Successfully Resected after Combined Chemotherapy of Taxotere, CDDP, and 5-FU

We report a case of advanced gastric cancer with Virchow's node and lung metastasis that responded remarkably to preoperative chemotherapy. A 47-year-old female patient was diagnosed as having incurable advanced gastric cancer with Virchow's node and multiple lung metastasis. Preoperative chemotherapy with Taxotere, CDDP and 5FU was carried out. After four courses of the regimen, the Virchow's node and the lung metastasis had disappeared, and a marked reduction of the gastric lesion was observed on the CT scan. Consequently, the patient underwent a total gastrectomy with D2 lymph node dissection. On histopathological examination, cancer cells were found to have infiltrated up to the muscle layer of the gastric wall, and 42 out of 60 resected lymph nodes were found to be metastatic. The patient received another two courses of chemotherapy after the operation

Detection of Helicobacter pylori Infection Rate in Resected Gastric Cancer Patients

PURPOSE: This study aims to determine the infection rate of Helicobacter pylori (H. pylori) in gastric cancer patients who received gastrectomies, and to compare the rates of H.pylori infection detected by serological test and that of histopathological test, and to evaluate its clinical meaning. MATERIALS AND METHODS: Fifty two patients were selected from those who underwent gastrectomies at the Department of Surgery, Samsung Medical Center, from March 1997 to May 1997. The control group consisted of healthy 103 persons visited the center for health promotion in Samsung Medical Center. In both groups, we quantitatively checked serum level of IgG anti H. pylori antibody titer by ELISA using GAP IgG test kit (BioRad, USA) for the serological test, and we microscopically examined the surgical specimen stained by Warthin-Starry silver staining method for the histopathological test. RESULTS: The seropositive rate of H. pylori in the patients' group was 71.2% (37/52), and the control group was 65.0% (67/103). The difference between two groups was statistically significant. However the histopathological study showed that the overall detection rate of H. pylori was 61.5% (32/52) in the patients' group and 61.2% (63/103) in the control group; and this difference was not statistically significant. CONCLUSION: We could confirm that H.pylori infection rate in the gastric cancer resected patients was statistically higher than in the normal healthy persons even in small population. And the detection method for the H. pylori infection by serological test was presumed to be better than that of histopathological test using surgical specimen. Further study for the larger population by well-organized multicenters will be needed.

The Roles of Helicobacter pylori Infection and Interleukin-1beta Polymorphism in Gastric Cancer

PURPOSE: Recently the theory has been developed that host genetic factor affects interleukin (IL)-1beta might exert an influence on the divergent clinical outcomes. We evaluated the roles of H. pylori infection and polymorphism of IL-1beta in the carcinogenesis of gastric adenocarcinoma. METHODS: Gastric cancer tissues from 68 patients, peripheral blood from 43 controls, and various gastric cancer cell lines (MKN45, MKN74, SNU620, SNU638, SNU216, SNU601, and AGS) were used. Single nucleotide polymorphism (SNP) of IL-1beta-31 and the length of tandem repeat of IL-1RN were analyzed by PCR and automatic DNA sequencer. IL-1beta mRNA expressions from gastric cancer tissues were measured using semiquantitative RT-PCR and compared according to SNP of IL-1beta-31. We also investigated the IL-1beta-31 SNP from various cancer cell lines and measured IL-1beta mRNA and protein expressions using semiquantitative RT- PCR and ELISA. We constructed reporter systems for IL-1beta-31T/T and IL-1beta-31C/C and the responses to antigen PMA and H. pylori were compared. RESULTS: We couldn't find any significant difference in the frequencies of IL-1beta-31 SNP and IL-1RN polymorphism between the gastric cancer and control groups. IL-1beta mRNA and protein expression were significantly more highly responsive to PMA at IL-1beta-31 T/T type as compared with those of C/T or C/C type when studied in gastric cancer cell lines, although we couldn't find any significant difference of IL-1beta mRNA expression according to IL-1beta-31 SNP when studied in gastric cancer tissue. When we compared the activities of reporter systems, the basal luciferase activity, response to PMA, and response to H. pylori of reporter genes was 1.30-fold, 1.32-fold, and 1.62-fold higher respectively in pIL-1beta T/T type as compared with pIL-1beta C/C type. CONCLUSIONS: These findings indicate that SNP of IL-1beta exerts an influence on the expression of IL-1beta and there is a significant difference in response to environmental factors. They also suggest that the host with IL-1beta-31 T/T type has a higher risk of hypochlorhydria, gastric atrophy, and after all gastric cancer in response to H. pylori infection. However the relationship between polymorphism of IL-1beta and gastric adenocarcinoma require further study.

Influence of Nodal Yields on Staging of Gastric Cancer and on Survival

PURPOSE: In the fifth edition of International Union Against Cancer (UICC) TNM, nodal staging for gastric cancer is based on the number of metastatic lymph nodes. Variability in the extent of lymphadenectomy and lymph node retrieval can affect the number of metastatic lymph nodes. In this study, the authors attempted to evaluate the influence of nodal yields on the staging of gastric cancer and survival rates. METHODS: A retrospective study was performed in 4354 consecutive patients with gastric cancer, who had undergone curative resection (R0) with nodal yields of 15 or more from 1986 to 1995. Patients were classified into three groups according to the number of nodes examined: patients with nodal yields of 15 or more but less than 30 for group A, 30-39 for group B, and 40 or more for group C. The number of metastatic lymph nodes and the survival rates for each pTNM stage were analyzed for each group. RESULTS: The number of metastatic lymph nodes significantly increased with nodal yields. Greater nodal yields resulted in a higher survival rates with a statistically significant difference between patients with nodal yields of 30 or more, and those with less than 30 in stage IB (p<0.05) and IIIB (p<0.01). CONCLUSION: Our results suggest two possibilities of stage migration and survival benefit according to the difference of nodal yields. Therefore, for minimizing stage migration and maximizing the benefit of survival, at least 30 or more lymphnodes should be resected and examined in gastric cancer surgery.

Analysis of Surgical Outcome of Gastric Adenomatous Polyp

PURPOSE: Adenomatous polyps in the stomach are rather uncommon, however are related to a malignant transformation. So, in such cases it is important to predict cancer risk and to select an appropriate surgical method. The aim of this study is to examine clinicopathologic factor for predicting malignancy and determine appropriate surgical management of gastric adenomatous polyps. METHODS: A total 41 patients who underwent surgery from 1996 to 1999 for gastric adenomatous polyps at the Department of Surgery, Seoul National University Hospital were included this study. All patients had undergone preoperative endoscopic biopsy and histology was confirmed. Authors analyzed the clinicopathologic factors associated with malignancy and the outcome of surgical treatment. RESULTS: Of the 41 patients, 17 patients had an adenomatous polyp alone, 24 patients had an adenomatous polyp associated with malignancy. The location, number, size and morphology of the polyp were not associated with malignancy. Only cellular atypism in the preoperative biopsy was significantly associated with malignancy. 31 patients underwent subtotal gastrectomy whereas 10 patients wedge resection. All lymph nodes resected in patients with adenocarcinoma were negative. Recurrence of polyp or adenocarcinoma had not occurred in any patients after follow-up of mean 22 months. CONCLUSION: Cellular atypism detected in preoperative histology was associated with malignancy in gastric adenomatous polyp. Lymph node metastasis was negative in patients with malignancy. Our findings support the wedge resection withsafe margin as being appropriate in surgical management of gastric adenomatous polyps.

History of the Korean Gastric Cancer Association

No abstract available.

Immunochemosurgery for Gastric Carcinoma

PURPOSE: The purpose of this study is to analyze the clinicopathologic characteristics of gastric cancer patients and to evaluate the survival and prognostic factors and effect of immunochemosurgery for gastric cancer patients. MATENRIALS AND METHODS: The clinicopathologic characteristics were analyzed for 12,277 consecutive patients who underwent operation for gastric cancer from 1970 to 1999. We also evaluated the survival and prognostic factors for 9,262 consecutive patients from 1981 to 1996. The prognostic significance of treatment modality [surgery alone, surgery +chemotherapy, surgery+immunotherapy+chemotherapy (immunochemosurgery)] were evaluated in stage III gastric cancer. RESULTS: The 5-year survival rate (5-YSR) of overall patients was 55.8%, and that of patients who received curative resection was 64.8%. The 5-YSRs according to TNM stage were 92.9% for Ia, 84.2% for Ib, 69.3% for II, 45.8% for IIIa, 29.6% for IIIb and 9.2% for IV. Regarding adjuvant treatment modality, significant survival difference was observed in stage III patients. The 5-year survival rates were 44.8% for immunochemosurgery group, 36.8% for surgery+chemotherapy group and 27.2% for surgery alone group. Curative resection, depth of invasion and lymph node metastasis were the most significant prognostic factors in gastric cancer. CONCLUSION: Consequently, early detection and curative resection with radical lymph node dissection, followed by immunochemotherapy especially in patients with stage III gastric cancer should be recommended as a standard treatment principle for patients with gastric cancer.

Prediction of Peritoneal Recurrence after a Curative Resection for Gastric Cancers Based on Clinicopathologic Factors

PURPOSE: This study was designed to investigate the clinicopathologic factors related to peritoneal recurrence and to predict peritoneal recurrence based on clinicopathologic factors. METHODS: A retrospective analysis of 383 patients with peritoneal recurrence, out of 4184 patients who had undergone curative gastric resection at SNUH from 1986 through 1996 was done. RESULTS: Of the patients with peritoneal recurrence, 275 (71.8%), 97 (25.3%), and 11 (2.9%) were early (0~24 months), intermediate (24~60), and late (more than 60) recurrence, respectively. In multivariate analysis, serosal invasion, lymph node metastasis, size of tumor, Borrmann type, perineural invasion and sex were independent prognostic factors for peritoneal recurrence. After classifying all patients into 16 groups on the basis of 4 factors, serosal invasion, lymph node metastasis, Borrmann type, and size, the number and proportion of a patients with peritoneal recurrence was obtained. There was 4.2% peritoneal recurrence in the most favorable group (n = 71), which had a Borrmann type 1 or 2 lesion less than 5 cm in maximal diameter with neither serosal invasion nor lymph node metastasis. There was a 25.4% peritoneal recurrence in the most unfavorable group (n = 331), which had a Borrmann type 3 or 4 lesion more than 5 cm with serosal invasion and lymph node metastasis. CONCLUSION: Our results suggest that patients with a Borrmann 3 or 4 lesion more than 5cm in maximal diameter, with serosal invasion and lymph node metastasis have thehighest risk for peritoneal recurrence. These patients could be considered as candidates for a treatment modality such as intraperitoneal chemotherapy or hyperthermic chemotherapy.

A Clinicopathological Analysis of Recurrent Gastric Cancer / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: This study was designed to investigate the correlation between the clinicopathologic characteristics and the recurrence pattern of gastric cancer and to define survival difference according to treatment modality after diagnosis of recurrence. MATERIALS AND METHODS: We retrospectively reviewed the medical records of 4184 patients who had undergone radical surgery for primary gastric cancer from 1986 through 1996. Clinicopathologic factors were analyzed for the relationship of each factor with the pattern of recurrence. And the survival after diagnosis of recurrence was compared among the treatment modalities. RESULTS: Recurrence pattern was confirmed in 1141 patients. Loco-regional recurrence occurred in 291 patients (20.1%), peritoneal recurrence in 383 (26.5%), distant recurrence in 290 (20.1%), and mixed recurrence in 177 (12.3%), respectively. Early recurrence (less than 2 years) occurred in 767 (69.3%), intermediate recurrence (2~5 years) in 286 (25.8%), and late recurrence (more than 5 years) in 54 (4.9%). In multivariate analysis, T stage, N stage, size of tumor and perineural invasion were independent prognostic factors for recurrence. Median survival from diagnosis of recurrence was 24.2 months in the curative operation group, 7.7 months in the chemotherapy group, 7.1 months in the non-curative operation group and 3.3 months in the conservative treatment group, respectively (p=0.000). CONCLUSION: The clinicopathological analysis of recurrent gastric cancer showed recurrent patterns and prognostic factors. Curative resection is suggested to have survival benefit in recurrent gastric cancer patients, although it was possible in patients with limited extent of disease.

Prognostic Significance of Lymph Node Micrometastasis in pT2N0 Gastric Cancer / 대한암학회지

PURPOSE: The prognostic significance of lymph node (LN) micrometastasis in gastric cancer remains contro versial. We therefore investigated the clinicopathologic factors related to LN micrometastasis and evaluated the clinical relevance of micrometastasis with regard to urrence. MATERIALS AND METHODS: A total of 1083 LNs from 39 patients with pT2N0 gastric cancer and who underwent curative resection in 1993 were further immunohistochemically stained using an anti-cytokeratin Ab cocktail (AE1-AE3). RESULTS: Micrometastases were found in 3.9% (42/1083) of the resected LNs and 53.8% (21/39) of the patients with pT2N0 gastric cancer. LN micrometastasis was found to be significantly related with histologic differentiation. The recurrence rate of gastric cancer was higher in patients with LN micrometastasis (31.6%) than in those without (6.3%), with a borderline significance (p=0.074). In uni variate analysis, patients with LN micrometastasis had a shorter 5-year disease-free survival (65%) than those without LN micrometastasis (87%) (p=0.075). In multivariate analysis, multiple LN micrometastasis was associated with a poor prognosis, but with a borderline significance (p=0.069, Risk ratio 4.815) CONCLUSION: We were able to identify LN micrometastases missed on routine H-E staining, using an immuno histochemical technique. Our results suggest that LN micrometastasis is associated with the recurrence of pT2N0 gastric cancer.

The Risk of Gastric Cancer in Koreans according to Smoking, Drinking, Diet, and the Genetic Polymorphisms of Glutathione S-Transferases and L-myc Protooncogene / 대한암학회지

PURPOSE: This study was performed to investigate the interaction of genetic polymorphisms of glutathione S-transferases and L-myc proto-oncogene with smoking, drinking, and dietary factors in the carcinogenesis of gastric cancer. MATERIALS AND METHODS: Two hundred and four gastric cancer patients and 1:1 matched hospital controls were the study subjects. They were interviewed with a questionnaire including alcohol consumption, smoking and dietary habit. We investigated genetic polymorphisms of GSTM1, GSTT1 and L-myc genes using PCR-RFLP techniques. RESULTS: Smoking and soybean paste stew were risk factors and doughnut, fried potato, welsh onion, rice cake, seaweed, slices of raw fish, melon, tomato, garlic and onion were protective factors of gastric cancer. The odds ratios of some food items changed significantly according to the genotypes; green vegetables and pork according to the GSTM1 genotype; pork, soybean curd, steamed or hard-boiled soybean and welsh onion according to the GSTT1 genotype; rice cake and garlic according to the L-myc proto-oncogene genotype. CONCLUSION: These results suggest that the genetic polymorphisms of GSTM1, GSTT1 and L-myc genes might modify the effects of environmental factors on gastric cancer possibly by engaging in the metabolism of food, alcohol and cigarette smoke.

The Incidence of Hereditary Gastric Cancer in Korean / 대한암학회지

PURPOSE: We wanted to determine the incidence of HGC (hereditary gastric cancer) in Korean under the minimal criteria of ICG-HGC (International Collaborative Group on Hereditary Gastric Cancer). MATERIALS AND METHODS: Tumor registry abstracts of 1752 patients who underwent operations for gastric cancer during the time period 1996 to 1998 in the Department of Surgery at Seoul National University College of Medicine were examined. Based on their family histories, candidate HGCs were identified. Their detailed family histories including diagnosis of cancer, age at diagnosis, and dates of birth and death were obtained from interviews by phone. Another study was performed on 195 patients with gastric cancer who admitted for operations in the same department during the time period April, 1999 to June, 1999. Their detailed family histories were also obtained from probands or nearest relatives during admission. Pedigree studies of documented families were conducted. Minimal Criteria of ICG-HGC we used for present study are as followings: At least three relatives with histologically verified gastric cancer; one of them should be a first-degree relative to the other two. At least two successive generations should be affected. In one of the relatives, gastric cancer should be diagnosed under 45 years of age. Suspected HGC fullfills only two of the above three criteria. HNPCC, FAP and Li-Fraumeni syndromes should be excluded. RESULTS: A total of 12 HGCs were identified in this study. In recent 3 years, during the time period 1996 to 1998, the incidence of true and suspected HGC accounted for 6 (0.3%) and 44 probands (2.5%) among 1752 patients (in 1996, 0.4% and 3.2%; in 1997, 0.3% and 1.8%; in 1998, 0.3% and 2.8%) respectively. In contrast, during the time period April, 1999 to June, 1999, the incidence of true and suspected HGC increased up to 3.1% (6 probands) and 11.3% (22 probands), respectively, out of 195 patients (in April, 1999, 0% and 11.7%; in May, 1999, 4% and 14.7%; in June, 1999, 5% and 6.7%). There was no difference in terms of the incidence even if the third criterion of age at diagnosis among Minimal Criteria of ICG-HGC was modified from 'under 45 years of age' to 50. Mean ages of 12 probands (46.3 8.8) were statistically younger than those of control gastric cancer patients (54.2 11.5) retrieved from database of Department of Surgery at Seoul National University College of Medicine. CONCLUSION: In the present study, the incidences of HGC were remarkably altered in accordance with study methods. Retrospective reviews of medical records revealed to be ineffective for this kind of study since their informations were often incomplete and some suspected patients were lost during follow-up. According to the Minimal Criteria of ICG-HGC, the incidence of true and suspected HGC was 3.1% (6 probands) and 11.3% (22 probands), respectively, out of 195 gastric cancer patients. We propose that families who meet the Minimal Criteria of ICG-HGC should be prospectively found in order to determine the exact incidence of HGC in Korean.

Clinicopathologic Characteristics and p53, c-erbB2, nm23 Protein Expression in Gastric Remnant Cancer / 대한암학회지

PURPOSE: The goal of this study was to evaluate the clinicopathologic characteristics and to investigate the expression of p53, c-erbB2, and nm23 protein in gastric remnant cancer. MATERIALS AND METHODS: We evaluated the clinicopathologic characteristics and expression of p53, c-erbB2, and nm23 protein in 37 cases gastric remnant cancer (GRC) that detected at least 5 years after initial surgery, and compare them with adenocarcinoma from intact stomach. Twenty-seven patients among the 37 patients of GRC and 271 patients of primary gastric cancer (PGC) were chosen for immunohistochemical staining against p53, c-erbB2, and nm23. RESULTS: The median age was 59 years, male was predominant and median time interval between operations were 15 years. GRC initially operated for benign disease were detected later after initial gastrectomy and had a tendency toward lymph node metastasis than those initially operated for malignant disease. Resection was performed in 31 patients (81.0%) in whom 28 patient (71.0%) with curative intent. The overall 5-year survival rate was 44.8%. Multivariate analysis had revealed that depth of invasion was the most significant prognostic factor. p53, c-erbB2, and nm23 protein expression rates of GRC were 44.4%, 14.8%, and 66.7%, respectively and those of PGC were 45.4%, 16.2%, and 85.1%, respectively. p53 protein was more frequently expressed in well differentiated, Laurens intestinal carcinoma in both GRC and PGC. p53 protein expression and depth of invasion had an inverse relationship only in GRC. c-erbB2 protein was more frequently expressed in well differentiated, Laurens intestinal carcinoma in PGC. nm23 protein expression was more frequently expressed in the group of positive lymph node metastasis in GRC. CONCLUSION: Early detection by periodic endoscopic follow-up and radical resection is a reasonable treatment policy for GRC. The results of p53, c-erbB2, and nm23 expression suggest that they might have somewhat different roles in the pathogenesis and progression in GRC and PGC, so further study may be of benefit hereafter.

Billroth I Anastomosis after a Radical Subtotal Gastrectomy The Safety of the Double-Stapling Method

PURPOSE: We compared the safety of the double-stapling method with that of the hand-sewn method when performing a Billroth I anastomosis (BI) after a radical subtotal gastrectomy. METHODS: Fifty-three (53) patients who received a BI with stapler from February 1998 to April 1999 were compared with 24 patients who received a BI with the hand-sewn method from January 1996 to December 1998. All the patients were divided into three groups according to the type of reconstruction: Group 1 (n=42), double- stapling method, Group 2 (n=11), anastomosis through posterior gastric wall, and Group 3 (n=24), hand- sewn method. The length of the greater curvature, lesser curvature, and proximal margin and the number of resected lymph nodes were compared for radicality, and the incidence of complications was reviewed. ANOVA and the chi-square test were used for the statistical analysis. RESULTS: The mean ages were 55.2+/-10.8, 59.8+/-9.7, and 54.7+/-11.9 years for groups 1, 2, and 3, respectively. The sex ratios were 2.2:1, 1.2:1, and 1.4:1. The lengths (cm) of the greater curvature were 17.2+/-2.5, 18.4+/-2.5, and 18.6+/-3.3, and the lengths of the lesser curvature were 10.4+/-1.5, 10.9+/-1.6, and 10.7+/-2.1; however, the differences were not statistically significant (p>0.05). The lengths of the proximal resection margin were 5.4+/-2.5, 8.2+/-3.3, and 6.0+/-3.2 (p<0.05), and the numbers of resected lymph nodes were 25.3+/-8.3, 19.1+/-5.8, and 32.+/- 13.7 (p<0.01). We experienced no complication in any group, except one case of leakage in the hand-sewn group. CONCLUSION: The double-stapling technique is a safe operative method in BI after a radical subtotal gastrectomy with its very low complication rate. Especially, the so- called Tornado method is a more useful method since it doesn't need a gastrotomy in the remnant stomach.

Billroth I Anastomosis after a Radical Subtotal Gastrectomy The Safety of the Double-Stapling Method

PURPOSE: We compared the safety of the double-stapling method with that of the hand-sewn method when performing a Billroth I anastomosis (BI) after a radical subtotal gastrectomy. METHODS: Fifty-three (53) patients who received a BI with stapler from February 1998 to April 1999 were compared with 24 patients who received a BI with the hand-sewn method from January 1996 to December 1998. All the patients were divided into three groups according to the type of reconstruction: Group 1 (n=42), double- stapling method, Group 2 (n=11), anastomosis through posterior gastric wall, and Group 3 (n=24), hand- sewn method. The length of the greater curvature, lesser curvature, and proximal margin and the number of resected lymph nodes were compared for radicality, and the incidence of complications was reviewed. ANOVA and the chi-square test were used for the statistical analysis. RESULTS: The mean ages were 55.2+/-10.8, 59.8+/-9.7, and 54.7+/-11.9 years for groups 1, 2, and 3, respectively. The sex ratios were 2.2:1, 1.2:1, and 1.4:1. The lengths (cm) of the greater curvature were 17.2+/-2.5, 18.4+/-2.5, and 18.6+/-3.3, and the lengths of the lesser curvature were 10.4+/-1.5, 10.9+/-1.6, and 10.7+/-2.1; however, the differences were not statistically significant (p>0.05). The lengths of the proximal resection margin were 5.4+/-2.5, 8.2+/-3.3, and 6.0+/-3.2 (p<0.05), and the numbers of resected lymph nodes were 25.3+/-8.3, 19.1+/-5.8, and 32.+/- 13.7 (p<0.01). We experienced no complication in any group, except one case of leakage in the hand-sewn group. CONCLUSION: The double-stapling technique is a safe operative method in BI after a radical subtotal gastrectomy with its very low complication rate. Especially, the so- called Tornado method is a more useful method since it doesn't need a gastrotomy in the remnant stomach.