Laparoscopic Appendectomy is Feasible for Inexperienced Surgeons in the Early Days of Individual Laparoscopic Training Courses

PURPOSE: Recently, laparoscopic appendectomy (LA) has been widely performed in developed countries. In addition, minimally invasive surgery such as LA is a challenge to surgical residents. The aim of this study is to evaluate learning curve of residents in comparison to that of experienced surgeons. METHODS: Fifty cases of LA that were performed by experienced surgeons (group A) and forty-seven cases of LA that were performed by 8 residents (group B) were reviewed retrospectively. RESULTS: Operative time was longer in group B (50.8+/-12 vs. 82.8+/-40 min. P<0.001). Hospital days of group B was shorter (4.8+/-2.4 vs. 3.7+/-2.1 days P=0.021). No other parameters were statistically significant. In group A, wound infection developed in 1 case. In group B, wound infection developed in 4 cases, intraabdominal abscess in 1, subcutaneous emphysema in 1. CONCLUSION: Inexperienced surgeons can perform laparoscopic appendectomy easily in the early days of individual laparoscopic training course.

A Study on the Chemosensitivity of Advanced Gastric Cancer

PURPOSE: Despite the reduced incidence and mortality of gastric cancer, this illness still remains the second leading cause of cancer death in Korea. Various adjuvant chemotherapies have been proposed for patients with advanced gastric cancer. Randomized trials comparing chemotherapies with best supportive care have consistently shown that cytotoxic treatment is of some benefit. Nevertheless, there has been no major improvement in the overall prognosis of advanced gastric cancer. METHODS: We have examined the chemotherapy sensitivity of advanced gastric cancer specimens by using an ex vivo ATP based chemosensitivity assay (ATP-TCA). A variety of chemotherapeutic agents were tested. The one hundred and forty specimens we tested were from resection specimens. RESULTS: The histological tumor classification, lymphatic invasion, neural invasion and venous invasion affected the chemosensitivity of some drugs. 5-FU was a more potent drug than cisplatin, doxorubicin, iriontecan and methotrexate. The chemosensitivity of differentiated cancer was different compared to that of undifferentiated cancer. Doxorubicin and iriontecan were more effective in poorly differentiated, signet ring cell and diffuse type cancers. The manner of tumor invasion affected the chemosensitivity to some drugs. CONCLUSISON: Further study is necessary to assess the effectiveness of some chemotherapy drugs on advanced gastric cancer, including their effect on tumor recurrence and patient survival.

Predictive Factors for Lymph Node Metastasis in Early Gastric Cancer

This report is a clinical review of 298 cases of early gastric cancer that were treated at Kosin Medical Hospital during 8 years from 1984 to 1992. In 1962, the Japanese Gastroenterological Endoscopy Society defined early gastric cancer as a lesion confined to the mucosa or submucosa and not related to the presence of lymph-node metastasis. The prognosis for early gastric cancer (EGC) is generally excellent, but the proportion of EGC cases progressing to advanced gastric cancer is steadily increasing nowadays. The presence or absence of lymph-node metastasis in EGC is an important prognostic factor; in other words, the survival rate or recurrence rate of node-negative EGC is known to be much better than that of node-positive EGC. The incidence of EGC among resected gastric cancers was 14.7%, and has been increasing annually. The mean age of the EGC patient was 52.4 years, and the most common type was IIc. The size of the lesion was variable, but the most common range was 1~3 cm. Lymph-node metastasis accurred more frequently with the larger sized lesions. In this study, several factors such as age, sex, tumer location, tumer size, depth of invasion, macroscopic and histologic type were evaluated to determine frequency of lymph node metastasis. In the analysis of these eight facters, sex, tumer size, depth of invasion and Lauren type were statistically correlated with lymp node metastasis.