Jejunogastric intussusception after totally laparoscopic distal gastrectomy for gastric cancer: a rare case report and review of the literature

Jejunogastric intussusception (JGI) is a rare complication of gastric surgery, with most cases occurring in the form of long-term complications following gastric surgeries. We present a case of JGI in a 74-year-old man who presented with progressive abdominal pain and distention, and was admitted to our hospital. The patient had undergone a totally laparoscopic distal gastrectomy with a Billroth II gastrojejunostomy 9 days previously. Computed tomography and endoscopic findings revealed the presence of a small bowel loop within the gastric lumen, which we failed to reduce in size. We performed an emergency laparoscopic exploration and immediate reduction of the JGI. The efferent and afferent loops were then fixed to the mesentery and the stomach. The postoperative course was uneventful and the patient remained asymptomatic during the 1-year follow-up period.

Comparison of Post-Operative Nutritional Status according to the Extent of Gastrectomy and the Reconstruction Method in Patients with Gastric Cancer

Purpose@#Malnutrition is the main complication after gastrectomy and the degree may vary depending on the extent of resection. This study sought to help determine an appropriate type of resection and provide methods for addressing malnutrition after gastrectomy. @*Materials and Methods@#We retrospectively reviewed medical records of patients with gastric cancer who underwent radical resection at the Soonchunhyang University Cheonan Hospital between December 2012 and December 2013.A total of 100 patients were screened, and all patients were followed for 1 to 3 years. Among this group, 12 underwent total gastrectomy, 5 underwent proximal gastrectomy, 46 underwent distal gastrectomy with Billroth I anastomosis, and 37 with Billroth II anastomosis. The nutritional status assessment included body weight, body mass index, serum albumin, serum hemoglobin, vitamin B12, ferritin, and Nutritional Risk Index (NRI). @*Results@#Patients who underwent total gastrectomy had lower hemoglobin and vitamin B12 levels compared to patients who underwent distal gastrectomy. The NRI was statistically significantly lower in patients who underwent total gastrectomy than patients who underwent distal gastrectomy. Patients who underwent total gastrectomy had lower vitamin B12 than patients who underwent proximal gastrectomy till the second year after gastrectomy. Regarding postdistal gastrectomy reconstruction, there was no statistically significant difference between the Billroth I and Billroth II groups. @*Conclusion@#This study showed that patients who underwent total gastrectomy were more susceptible to malnutrition than those who underwent distal or proximal gastrectomy. Patients who undergo gastrectomy should be monitored carefully for nutritional status and given appropriate nutritional support in the post-operative period.

Development and Validation of a Symptom-Focused Quality of Life Questionnaire (KOQUSS-40) for Gastric Cancer Patients after Gastrectomy / Journal of the Korean Cancer Association, 대한암학회지

Purpose@#Patients who have undergone gastrectomy have unique symptoms that are not appropriately assessed using currently available tools. This study developed and validated a symptom-focused quality of life (QoL) questionnaire for patients who have received gastrectomy for gastric cancer. Materials and Methods Based on a literature review, patient interviews, and expert consultation by the KOrean QUality of life in Stomach cancer patients Study group (KOQUSS), the initial item pool was developed. Two large-scale developmental studies were then sequentially conducted for exploratory factor analyses for content validity and item reduction. The final item pool was validated in a separate cohort of patients and assessed for internal consistency, test-retest reliability, construct validity, and clinical validity. @*Results@#The initial questionnaire consisted of 46-items in 12 domains. Data from 465 patients at 11 institutions, followed by 499 patients at 13 institutions, were used to conduct item reduction and exploratory factor analyses. The final questionnaire (KOQUSS-40) comprised 40 items within 11 domains. Validation of KOQUSS-40 was conducted on 413 patients from 12 hospitals. KOQUSS-40 was found to have good model fit. The mean summary score of the KOQUSS-40 was correlated with the EORTC QLQ-C30 and STO22 (correlation coefficients, 0.821 and 0.778, respectively). The KOQUSS-40 score was also correlated with clinical factors, and had acceptable internal consistency (> 0.7). Test-retest reliability was greater than 0.8. Conclusion The KOQUSS-40 can be used to assess QoL of gastric cancer patients after gastrectomy and allows for a robust comparison of surgical techniques in clinical trials.

Development and Validation of a Symptom-Focused Quality of Life Questionnaire (KOQUSS-40) for Gastric Cancer Patients after Gastrectomy / Journal of the Korean Cancer Association, 대한암학회지

Purpose@#Patients who have undergone gastrectomy have unique symptoms that are not appropriately assessed using currently available tools. This study developed and validated a symptom-focused quality of life (QoL) questionnaire for patients who have received gastrectomy for gastric cancer. Materials and Methods Based on a literature review, patient interviews, and expert consultation by the KOrean QUality of life in Stomach cancer patients Study group (KOQUSS), the initial item pool was developed. Two large-scale developmental studies were then sequentially conducted for exploratory factor analyses for content validity and item reduction. The final item pool was validated in a separate cohort of patients and assessed for internal consistency, test-retest reliability, construct validity, and clinical validity. @*Results@#The initial questionnaire consisted of 46-items in 12 domains. Data from 465 patients at 11 institutions, followed by 499 patients at 13 institutions, were used to conduct item reduction and exploratory factor analyses. The final questionnaire (KOQUSS-40) comprised 40 items within 11 domains. Validation of KOQUSS-40 was conducted on 413 patients from 12 hospitals. KOQUSS-40 was found to have good model fit. The mean summary score of the KOQUSS-40 was correlated with the EORTC QLQ-C30 and STO22 (correlation coefficients, 0.821 and 0.778, respectively). The KOQUSS-40 score was also correlated with clinical factors, and had acceptable internal consistency (> 0.7). Test-retest reliability was greater than 0.8. Conclusion The KOQUSS-40 can be used to assess QoL of gastric cancer patients after gastrectomy and allows for a robust comparison of surgical techniques in clinical trials.

Enlarged lymph nodes diagnosed with Langerhans cell histiocytosis found in a direct inguinal hernia: a case report

It is unusual that an unexpected mass is encountered within a hernia sac. This report describes a patient diagnosed with Langerhans cell histiocytosis (LCH) after surgery for an inguinal hernia. A 64-year-old male patient presented with inguinal mass over a 1-year period. Direct inguinal hernias were found in both sides, and enlarged lymph nodes were found in both hernia sacs. Laparoscopic totally extraperitoneal repair was done, and one enlarged lymph node within inguinal hernia sac was excised for diagnostic purposes.Microscopic findings showed the distinctive cytologic features of Langerhans cells and immunohisto chemical staining are positive for CD1a and S-100. LCH is a rare disorder, and the involvement of the lymph nodes with no other sites of disease is uncommon. To the best of our knowledge, this is the first report of LCH within an inguinal hernia sac. Multidisciplinary approach should be considered to provide better detection and treatment.

A Case Giving Proof of Pathogenesis of Abdominoscrotal Hydrocele: A Case Report

An abdominoscrotal hydrocele (ASH) is an uncommon condition characterized by cystic mass that occupies the scrotum and abdomen. The characteristic aspect is the presence of two hydrocele sacs in the abdominal cavity and the scrotum, and compression of one side causes enlargement of the other side, thereby connecting the two sacs. There are several hypotheses regarding the occurrence of ASH. However, the evidence of the hypotheses is lacking. The patient was a 52-year-old male. During observation of the right inguinoscrotal hydrocele, the patient complained of a palpable mass lesion on the right lower quadrant of the abdomen. Physical examination revealed ASH that occurred with the growth of the inguinoscrotal hydrocele. This was further confirmed by sequential imaging test thereby proposing the verification of cephalad extension of hydrocele. The surgical excision was recommended and inguinal exploration was performed under general anesthesia. No evidence of relapse was observed during the 2-year follow-up period after surgery. The present case proves the cephalad extension of hydrocele among other hypotheses on the etiology of ASH.

Current Status of Bariatric and Metabolic Surgery in Daejeon and Chungcheong Province: Early Experiences after Public Medical Insurance Coverage in 2019

Purpose@#This study aimed to investigate the current status of bariatric and metabolic surgery in Daejeon and Chungcheong province and to describe the early experiences after public medical insurance coverage in 2019. @*Materials and Methods@#Between January 2019 and August 2019, 64 cases of bariatric and metabolic surgery were performed in patients with morbid obesity or uncontrolled type 2 diabetes. We prospectively collected and analyzed data regarding the patients’ demographics and comorbidities, surgical results, and early complications. The patient information before and after the insurance coverage was also compared. @*Results@#The number of surgeries in 9 years has been caught up only in the last 8 months after insurance coverage (58 vs. 64 patients). The mean body mass index was 37.7±5.8 kg/m2 (range, 22.7-52.1 kg/m2). The most frequently performed surgery was sleeve gastrectomy (53 cases, 82.8%), followed by Roux-en-Y gastric bypass (9 cases, 14.1%), and adjustable gastric banding (2 cases, 3.1%). Postoperative complications occurred in 6 patients (9.4%), and there was no mortality. The mean operation time (225.3±85.4 vs. 156.1±61.8 min, P＜0.001) and postoperative stay (5.9±4.5 vs. 4.3±2.0 days, P=0.013) after the insurance coverage were significantly shorter than those before the insurance coverage. @*Conclusion@#We could assess the patients who had bariatric and metabolic surgery in Daejeon and Chungcheong province after public medical insurance coverage in 2019.

Long-term Efficacy of S-1 Monotherapy or Capecitabine Plus Oxaliplatin as Adjuvant Chemotherapy for Patients with Stage II or III Gastric Cancer after Curative Gastrectomy: a Propensity Score-Matched Multicenter Cohort Study

Purpose@#To compare long-term disease-free survival (DFS) between patients receiving tegafur/gimeracil/oteracil (S-1) or capecitabine plus oxaliplatin (CAPOX) adjuvant chemotherapy (AC) for gastric cancer (GC). @*Materials and Methods@#This retrospective multicenter observational study enrolled 983 patients who underwent curative gastrectomy with consecutive AC with S-1 or CAPOX for stage II or III GC at 27 hospitals in Korea between February 2012 and December 2013. We conducted propensity score matching to reduce selection bias. Long-term oncologic outcomes, including DFS rate over 5 years (over-5yr DFS), were analyzed postoperatively. @*Results@#The median and longest follow-up period were 59.0 and 87.6 months, respectively. DFS rate did not differ between patients who received S-1 and CAPOX for pathologic stage II (P=0.677) and stage III (P=0.899) GC. Moreover, hazard ratio (HR) for recurrence did not differ significantly between S-1 and CAPOX (reference) in stage II (HR, 1.846; 95% confidence interval [CI], 0.693–4.919; P=0.220) and stage III (HR, 0.942; 95% CI, 0.664–1.337; P=0.738) GC. After adjustment for significance in multivariate analysis, pT (4 vs. 1) (HR, 11.667; 95% CI, 1.595–85.351; P=0.016), pN stage (0 vs. 3) (HR, 2.788; 95% CI, 1.502–5.174; P=0.001), and completion of planned chemotherapy (HR, 2.213; 95% CI, 1.618–3.028; P<0.001) were determined as independent prognostic factors for DFS. @*Conclusions@#S-1 and CAPOX AC regimens did not show significant difference in over-5yr DFS after curative gastrectomy in patients with stage II or III GC. The pT, pN stage, and completion of planned chemotherapy were prognostic factors for GC recurrence.

A Case of a Patent Omphalomesenteric Duct Presenting with Meconium Discharge from the Umbilicus

The omphalomesenteric duct is a link between the primitive midgut and the yolk sac. Normally, the duct obliterates around 6 weeks of gestation, yet varying degrees of incomplete obliteration can take place in 1%–4% of infants. This study described the case of a newborn with a patent omphalomesenteric duct remnant fistula identified at birth with meconium in the umbilical cord. At birth, the infant presented meconium staining and meconium discharged within the umbilical cord. Physical examination and other examinations showed no other specific findings. The omphalomesenteric duct fistula was confirmed through the imaging study (abdominal ultrasonography, gastrografin enema). A surgery was carried out where the remnant was resected. The patient did well and was discharged soon after without complication.

Clinical relevance of Lgr5 expression in colorectal cancer patients

PURPOSE: Lgr5 is a well-known stem cell marker in colorectal cancer (CRC). This retrospective study evaluated the expressions of Lgr5 in CRC specimens, and examined whether these expressions were associated with survival outcomes.METHODS: We used immunohistochemistry to retrospectively examine expressions of Lgr5 in paraffin-embedded specimens from 337 patients with CRC between January 2009 and December 2013. All clinicopathologic data were collected by retrospective review based on medical records. The correlation between its expression and clinicopathological data as well as clinical outcomes of patients was analyzed.RESULTS: Low expression and high expression of Lgr5 in 337 patients were 175 (51.9%) and 162 (48.1%), respectively. There was no statistically significant difference in the association of Lgr5 expression with clinicopathologic factors (age, tumor location, lymphatic invasion, vascular invasion, perineural invasion, TNM stage, and differentiation). In the survival analysis, the high expression group of Lgr5 showed a better prognosis than the low expression group in disease-free survival (P=0.044). However, overall survival was not significantly different between the two groups (P=0.087). In multivariate analysis, we found that high expression of Lgr5 was independent prognostic factor for tumor relapse (hazard ratio, 0.601; 95% confidence interval, 0.388–0.929; P=0.022).CONCLUSION: In present study, high expression of Lgr5 is an independent predictor of favorable prognosis in patients with CRC. So, further well designed, prospective, large scale studies are needed to examine the value of Lgr5 as a prognostic biomarker for CRC.

CORRIGENDUM: Correction of funding statement in ACKNOWLEDGEMENTS section: Epigenetic inactivation of RUNX3 in colorectal cancer

Correction of funding statement in ACKNOWLEDGEMENTS section.

Who Can Perform Adjuvant Chemotherapy Treatment for Gastric Cancer? A Multicenter Retrospective Overview of the Current Status in Korea

PURPOSE: To investigate the current status of adjuvant chemotherapy (AC) regimens in Korea and the difference in efficacy of AC administered by surgical and medical oncologists in patients with stage II or III gastric cancers. MATERIALS AND METHODS: We performed a retrospective observational study among 1,049 patients who underwent curative resection and received AC for stage II and III gastric cancers between February 2012 and December 2013 at 29 tertiary referral university hospitals in Korea. To minimize the influence of potential confounders on selection bias, propensity score matching (PSM) was used based on binary logistic regression analysis. The 3-year disease-free survival (DFS) rates were compared between patients who received AC administered by medical oncologists or surgical oncologists. RESULTS: Between February 2012 and December 2013 in Korea, the most commonly prescribed AC by medical oncologists was tegafur/gimeracil/oteracil (S-1, 47.72%), followed by capecitabine with oxaliplatin (XELOX, 16.33%). After performing PSM, surgical oncologists (82.74%) completed AC as planned more often than medical oncologists (75.9%), with statistical significance (P=0.036). No difference in the 3-year DFS rates of stage II (P=0.567) or stage III (P=0.545) gastric cancer was found between the medical and surgical oncologist groups. CONCLUSIONS: S-1 monotherapy and XELOX are a main stay of AC, regardless of whether the prescribing physician is a medical or surgical oncologist. The better compliance with AC by surgical oncologists is a valid reason to advocate that surgical oncologists perform the treatment of AC for stage II or III gastric cancers.

Feasibility of Single-Incision Laparoscopic Appendectomy in Pregnant Women

OBJECTIVE: Owing to advances in laparoscopic technique and equipment, a single-port laparoscopic surgery has been applied in various fields of surgery. However, the application of a single-port laparoscopic surgery for pregnant women has been rarely reported. The aim of this study was to emphasize the feasibility of single-port laparoscopic appendectomy in pregnant women. METHODS: In seven pregnant women who underwent abdominal ultrasonography and physical examination, surgery was performed under the diagnosis of acute appendicitis. In all the patients, single-port laparoscopic appendectomy was performed in the same way. The laparoscopic surgical devices used during surgery were same as those in conventional laparoscopic appendectomy. RESULTS: Age ranged from 25 to 33 years (mean, 29.7 years), gestational age ranged from 7 weeks 3 days to 17 weeks 6 days (mean gestational age, 14 weeks 3 days). The mean operation time was 19 minutes (range, 16–22 minutes). No surgical related complications and any issues occurred. CONCLUSION: Single-port laparoscopic appendectomy for pregnant women is considered one of the treatment methods.

Current Status of Metabolic and Bariatric Surgery in Daejeon/Chungcheong Area

PURPOSE: The aim of our study is to investigate the current status of metabolic and bariatric surgery in Daejeon and Chungcheong province and examine the role and necessity of the community research society. MATERIALS AND METHODS: In this retrospective study, 58 patients who underwent bariatric and metabolic surgery from January 2010 to June 2018 were included. Patients' demographics and comorbidities, operation type and early complications were analyzed. RESULTS: Mean age was 36.9±11.4 (range, 18–64) years, and mean preoperative body mass index was 39.2±6.9 (range, 24.6–56.1) kg/m². The most frequently performed operation was sleeve gastrectomy (48 cases, 82.8%), followed by adjustable gastric banding (8 cases, 13.8%) and Roux-en-Y gastric bypass (2 cases, 3.4%). Postoperative complications were reported in two patients; however, no mortality was reported. CONCLUSION: We investigated the patients who underwent metabolic and bariatric surgery in Daejeon Chungcheong province. Our research society will continue to ensure safe operation and proper management of morbidly obese patients in our community.

Prevalence of Malnutrition in Hospitalized Patients: a Multicenter Cross-sectional Study

BACKGROUND: Malnutrition is associated with many adverse clinical outcomes. The present study aimed to identify the prevalence of malnutrition in hospitalized patients in Korea, evaluate the association between malnutrition and clinical outcomes, and ascertain the risk factors of malnutrition. METHODS: A multicenter cross-sectional study was performed with 300 patients recruited from among the patients admitted in 25 hospitals on January 6, 2014. Nutritional status was assessed by using the Subjective Global Assessment (SGA). Demographic characteristics and underlying diseases were compared according to nutritional status. Logistic regression analysis was performed to identify the risk factors of malnutrition. Clinical outcomes such as rate of admission in intensive care units, length of hospital stay, and survival rate were evaluated. RESULTS: The prevalence of malnutrition in the hospitalized patients was 22.0%. Old age (≥ 70 years), admission for medical treatment or diagnostic work-up, and underlying pulmonary or oncological disease were associated with malnutrition. Old age and admission for medical treatment or diagnostic work-up were identified to be risk factors of malnutrition in the multivariate analysis. Patients with malnutrition had longer hospital stay (SGA A = 7.63 ± 6.03 days, B = 9.02 ± 9.96 days, and C = 12.18 ± 7.24 days, P = 0.018) and lower 90-day survival rate (SGA A = 97.9%, B = 90.7%, and C = 58.3%, P < 0.001). CONCLUSION: Malnutrition was common in hospitalized patients, and resulted in longer hospitalization and associated lower survival rate. The rate of malnutrition tended to be higher when the patient was older than 70 years old or hospitalized for medical treatment or diagnostic work-up compared to elective surgery.

Epigenetic inactivation of RUNX3 in colorectal cancer

PURPOSE: Emerging evidence indicates that runt-related transcription factor 3 (RUNX3) is an important tumor suppressor gene in several cancer types, including colorectal cancer (CRC). However, the clinical significance of RUNX3 inactivation in CRC remains unclear. The aim of this study was to examine the correlation between clinicopathologic factors and RUNX3 hypermethylation/expression in CRC. METHODS: Sixty-two CRC patients who were treated at the Soonchunhyang University College of Medicine were recruited in this study. The hypermethylation of CpG islands in the RUNX3 promoter and the expression of RUNX3 mRNA were identified by methylation-specific polymerase chain reaction (PCR) and reverse transcriptase-PCR, respectively. The expression of RUNX3 was determined by immunohistochemical staining. RESULTS: Of the 62 CRC tissue samples, 20 (32.3%) presented hypermethylated RUNX3 promoters. Aberrant RUNX3 hypermethylation was found to be associated with vascular (P = 0.006) and lymphatic (P = 0.002) invasion. Hypermethylation of RUNX3 was associated with poor survival outcomes (P = 0.038). However, expression of RUNX3 was not a prognostic factor (P = 0.363). CONCLUSION: Hypermethylation of RUNX3 may be a predictor of a poor prognosis in CRC.

Clinicopathological Significance of Large Tumor Suppressor (LATS) Expression in Gastric Cancer

PURPOSE: The aims of this study were to evaluate the expression of the large tumor suppressor (LATS) genes LATS1 and LATS2 by immunohistochemical staining of gastric cancer, and to evaluate the clinicopathological significance of LATS expression and its correlation with overall survival (OS). MATERIALS AND METHODS: LATS1 and LATS2 expression in a tissue microarray was detected by immunohistochemistry, using 264 gastric cancer specimens surgically resected between July 2006 and December 2009. RESULTS: Low expression of LATS1 was significantly associated with more advanced American Joint Committee on Cancer (AJCC) stage (P=0.001) and T stage (P=0.032), lymph node (LN) metastasis (P=0.040), perineural invasion (P=0.042), poor histologic grade (P=0.007), and diffuse-type histology by the Lauren classification (P=0.033). Low expression of LATS2 was significantly correlated with older age (≥65, P=0.027), more advanced AJCC stage (P=0.001) and T stage (P=0.001), LN metastasis (P=0.004), perineural invasion (P=0.004), poor histologic grade (P<0.001), and diffuse-type histology by the Lauren classification (P<0.001). Kaplan-Meier survival analysis revealed significantly poor OS rates in the groups with low LATS1 (P=0.037) and LATS2 (P=0.037) expression. CONCLUSIONS: Expression of LATS1 or LATS2 is a significant marker for a good prognosis in patients with gastric cancer.

Programmed death-1 (PD-1) ligand 1 and PD-1 ligand 2 expressions and their clinical relevance in colorectal cancer

PURPOSE: Programmed death-1 and its ligands (PD-L1 and PD-L2) can induce T-cell apoptosis in many solid tumors, although there is limited information regarding their roles in colorectal cancer.METHODS: We used immunohistochemistry to retrospectively examine expressions of PD-L1 and PD-L2 in paraffin-embedded specimens from 104 patients with colorectal cancer.RESULTS: Among the 104 included patients, 31 patients (29.8%) had positive PD-L1 expression and 73 patients (70.2%) had negative PD-L1 expression. Positive PD-L2 expression was observed in 83 patients (79.8%) and negative PD-L2 expression was observed in 21 patients (20.2%). Positive PD-L1 expression group showed higher overall survival rate (OS) and disease-free survival (DFS) than negative PD-L1 expression group. However, the overall survival and DFS were not significantly different between positive and negative PD-L2 expressions group. The multivariate analyses revealed that short OS was independently associated with positive PD-L1 expression (hazard ratio [HR], 2.781; 95% confidence interval [CI], 1.284–6.026; P=0.01), regional lymph node status (HR, 2.611; 95% CI, 1.258–5.418; P=0.01), and distant metastasis (HR, 4.279; 95% CI, 1.449–12.638; P=0.009). In addition, short DFS was independently associated with positive PD-L1 expression (HR, 2.846; 95% CI, 1.393–5.815; P=0.004) and regional lymph node status (HR, 2.310; 95% CI, 1.122–4.758; P=0.023).CONCLUSION: Although prospective multi-center studies are needed to validate our findings, we found that PD-L1 expression predicted OS and DFS among patients with colorectal cancer.

Prognostic and Clinicopathological Significance of Transducer-Like Enhancer of Split 1 Expression in Gastric Cancer

PURPOSE: Transducer-like enhancer of split 1 (TLE1) is a member of the Groucho/TLE family of transcriptional co-repressors that regulate the transcriptional activity of numerous genes. TLE1 is involved in the tumorigenesis of various tumors. We investigated the prognostic significance of TLE1 expression and its association with clinicopathological parameters in gastric cancer (GC) patients. MATERIALS AND METHODS: Immunohistochemical analysis of six tissue microarrays was performed to examine TLE1 expression using 291 surgically resected GC specimens from the Soonchunhyang University Cheonan Hospital between July 2006 and December 2009. RESULTS: In the non-neoplastic gastric mucosa, TLE1 expression was negative. In GC, 121 patients (41.6%) were positive for TLE1. The expression of TLE1 was significantly associated with male gender (P=0.021), less frequent lymphatic (P=0.017) or perineural invasion (P=0.029), intestinal type according to the Lauren classification (P=0.024), good histologic grade (P<0.001), early pathologic T-stage (P=0.012), and early American Joint Committee on Cancer stage (P=0.022). In the Kaplan-Meier analysis, the TLE1 expression was significantly associated with longer disease-free (P=0.022) and overall (P=0.001) survival rates. CONCLUSIONS: We suggested that TLE1 expression is a good prognostic indicator in GCs.

Clinicopathological Significance of Elevated PIK3CA Expression in Gastric Cancer

PURPOSE: PIK3CA is often mutated in a variety of malignancies, including colon, gastric, ovary, breast, and brain tumors. We investigated PIK3CA expression in gastric cancer and explored the relationships between the PIK3CA expression level and clinicopathological features as well as survival of the patients. MATERIALS AND METHODS: We examined PIK3CA expression in a tissue microarray of 178 gastric adenocarcinomas by immunohisto-chemistry and reviewed patients' medical records. RESULTS: In our study, 112 of the 178 gastric cancer patients displayed positive PIK3CA expression. Overexpression of PIK3CA was correlated with low grade differentiation (P=0.001), frequent lymphatic invasion (P=0.032), and high T stage (P=0.040). Patients with positive PIK3CA staining were more likely to display worse overall survival rate than those with negative PIK3CA staining, as determined by Kaplan-Meier survival analysis with log-rank test (P=0.047) and a univariate analysis using the Cox proportional hazard model (hazard ratio=1.832, P=0.051). CONCLUSIONS: Elevated PIK3CA expression was significantly correlated with tumor invasiveness, tumor phenotypes, and poor patient survival.