A Systematic Review and Meta-Analysis on the Effects of Oral Stimulation Interventions on the Transition from Tube to Oral Feeding in Premature Infants / 임상간호연구

PURPOSE: The purpose of this study was to evaluate the effects of oral stimulation interventions on the transition from tube to oral feeding in preterm infants through systematic review. METHODS: The randomized clinical trials published between 1980 and 2015 were searched using domestic and international databases, and five randomized studies were selected for this study. The quality of study was assessed by assessment tool from the SIGN and meta-analysis was performed using the Cochrane Review Manager software Version 5.3 (RevMan). RESULTS: Oral stimulation intervention in preterm infants decreased the transition time from tube to oral feeding (Post Menstrual Age, Day of life). Especially, a significant medium effect size was found in the number of days needed on the transition (ES=-4.95, p=.02). The oral stimulation intervention also had a significant large effect on the length of stay at hospital (ES=-8.33, p < .001). CONCLUSION: Based on the findings, oral stimulation interventions could be useful to facilitate the transition from tube to oral feeding in preterm infants in terms of reducing the length of stay at hospital and the number of days needed on transition.

Risk Factors of Lymph Node Metastasis in Papillary Thyroid Microcarcinoma

PURPOSE: Despite the overall excellent prognosis for patients with papillary thyroid microcarcinoma (PTMC), these tumors are also associated with a 5% relatively high lymph node (LN) recurrence rate and the optimal surgical extent of papillary thyroid microcarcinoma has been controversial. Cervical LN metastases (LNMs) are found in about 40~65% of patients with PTMC. The aim of this study is to identify the factors affecting lymph node metastases (LNMs) in patients with PTMC. METHODS: We performed a retrospective study of 335 patients with PTMC who underwent total thyroidectomy or lobectomy with elective central lymph node dissection (CLND) at Kangnam St. Mary's Hospital between Jan. 2006 and Dec. 2008. We investigated the association of LNMs and clinicopathologic factors such as sex, age, multiplicity, extrathyroidal extension, and tumor size. RESULTS: LNMs were present in 88 patients (26.3%). Univariate analysis showed that less than 45 years of age, male, multiplicity, a tumor size of greater than 5 mm, thyroid capsular invasion and extrathyroidal extension were predictive factors for LNMs (P5 mm), male, age (<45) and extrathyroidal extension were determined as the predictive factors for LNMs, which occurred in about one fourth of the patients with PTMC. Therefore, elective CLND should be considered in patients with PTMC who have these factors through a thorough investigation before surgery.

Follicular Variant of Papillary Thyroid Carcinoma; Clinicopathologic Features / 대한내분비외과학회지

PURPOSE: The follicular variant of papillary thyroid carcinoma (FVPTC) is the most common subtype of papillary thyroid carcinoma (PTC). However, the clinicopathologic features of patients with FVPTC with those of patients with pure PTC is ill-understood. This study evaluated differences in clinicopathologic features of FVPTC compared with pure PTC. METHODS: All patients with FVPTC or pure PTC diagnosed between January 2006 and August 2008 at our institution were retrospectively reviewed. The two groups were compared in terms of clinocopathological features. RESULTS: Of 417 patients, 370 had PTC, and 47 patients had FVPTC. The meanage was 47.1 years. There was no differencein age and sex ratio between the two groups, and both groups were similar in terms of tumor size, presence of multifocality, thyroid capsular invasion, and extrathyroidal extension. However, FVPTC patients had significantly lower lymph node metastases (P=0.015) and significantly higher tumor encapsulation (P=0.031). Galectin-3 expression was decreased in FVPTC (P=.012). CONCLUSION: The clinicopathologic features of FVPTC are more favorable. The possibility of FVPTC could be considered when thyroid nodules with negative galectin-3 expression have suspicious or malignant fine needle aspiration biopsy.

The Use of Short-term Antimicrobial Prophylaxis in Elective Surgery for Gastric Cancer

PURPOSE: Although most surgeons generally administer prophylactic antibiotics for more than three days, the optimal duration of antimicrobial prophylaxis in elective gastric surgery is still open to debate. The aim of this study was to determine if the duration of prophylactic antibiotic use can affect the recovery of patients after elective gastric surgery. MATERIALS AND METHODS: A total of 93 patients with gastric cancer were enrolled in this study, between January 2007 and December 2007. Patients were excluded if they had an infection at the time of surgery or they underwent an emergency operation. The first antibiotics were commonly given from just prior to the operation. The patients were divided into three groups according to the operation periods: those who received antibiotics only on the day of operation (arm A), those who received antibiotics for up to 3 days (arm B), and those who received antibiotics for more than 5 days postoperatively (arm C). The antibiotic that was used was second generation cephalosporin. RESULTS: The rate of surgical site infection was 12.9% (n=4) in arm A, 16.1% (n=5) in arm B and 19.4% (n=6) in arm C, respectively (P=0.788). No relationship was observed between the duration of prophylaxis and the rate of fever or the neutrophil counts during postoperative 7 days (P=0.119, P=0.855). CONCLUSION: The prophylactic effect of antibiotics on recovery, with the antibiotics being received only on the day of the operation, is as effective as receiving antibiotics for a longer duration after gastric cancer surgery.

Clinical Features of Gastric Cancer Patients with a Second Primary Cancer

PURPOSE: The aim of this study was to clarify the risk factors and clinicopathologic features of gastric cancer patients with a second primary cancer (SPC). METHODS: The data on 2455 patients with gastric cancer was analyzed retrospectively with respect to the clinicopathologic features of the pathologically proven SPC. RESULTS: Of the 2,455 patients, there were 90 (3.7%) gastric cancer patients with SPC. Among them, 31 patients had synchronous cancers and 59 had metachronous cancers. Of the 59 metachronous cancers, 21 were found before the gastric surgery and 38 were found after the gastric surgery. The most prevalent SPC was colorectal cancer (28 cases) and followed by cancer in the liver (13 cases) kidney and pancreas (6 cases each, respectively). Among the 61 patients with SPC found after gastric cancer surgery, 31 cases (50%) were diagnosed within 2 years. On comparison of the clinicopathologic features, the patients with SPC tended to be older, more prone to have early gastric carcinoma and to have multiple gastric lesions. The survival rate of the patients with SPC and gastric cancer alone was not different; however, there was a significantly difference for the patients with early gastric cancer (61.7% vs. 91.3%, respectively, P < 0.05). CONCLUSION: For the patients who were older, had multiple primary lesions or they had early gastric cancer, evaluation for SPC, and especially in the colon and liver, should be considered during routine follow up.

Modified FOLFOX-6 Chemotherapy for Recurrent or Inoperable Gastric Cancer Patients

PURPOSE: We wanted to evaluate the efficacy and toxicity of modified FOLFOX-6 chemotherapy for treating recurrent or inoperable gastric cancer patients. MATERIALS AND METHODS: From April 2006 to August 2007, 35 patients with recurrent gastric cancer after curative resection and 43 patients with inoperable gastric cancer underwent chemotherapy, and the results were retrospectively investigated. RESULTS: 78 patients were assessable for response and toxicity, and they underwent an average of 7.1 cycles of chemotherapy. The response was evaluated according to the RECIST criteria. 11 partial responses (14.1%), 35 cases of stable disease (44.9%), and 32 cases of progressive disease (41%) were observed. The median time to progression was 6 months, and the average overall survival was 13 months. CTCAE grade 1 or 2 anemia (52.6%) was the most prevalent toxicity. Other common toxicities included thrombocytopenia (17.9%) and peripheral neuropathy (30.8%). There were 13 changes in the chemotherapy regimen to S1-cisplatin due to disease progression, but only an average of 1.76 cycles of S1-cisplatin were delivered due to severe toxicities and poor compliance. CONCLUSION: Acceptable efficacy and toxicity were seen as 59% of the patients showed non-progression, and no grade 3 or 4 toxicities were observed. In conclusion, the modified FOLFOX-6 chemotherapy is considered to be the proper 1st-line choice as a palliative treatment for recurrent or inoperable gastric cancer patients.

Primary Gastric Choriocarcinoma

The majority of choriocarcinomas occur in the uterus as gestational malignant tumors. Rarely, a choriocarcinoma appears in the gastrointestinal tract, and the tumor is assumed to arise from a different histogenetic origin as compared to tumors of other sites. A primary gastric choriocarcinoma is a rare aggressive, widely metastatic malignant tumor, and has a poor prognosis. Reported here is a case of a 69-year-old woman with a primary gastric choriocarcinoma who presented with melena, epigastric pain, and was diagnosed with a poorly differentiated adenocarcinoma based on a preoperative endoscopic biopsy. Gastrectomy with lymph node dissection, followed by postoperative chemotherapy, is the treatment of choice. Therefore, in the case of a poorly differentiated adenocarcinoma with a bleeding tendency, a meticulous examination with the suspicion of a choriocarcinoma should be undertaken.

Laparoscopic Wedge Resection of GISTs Involving the Second Portion of the Duodenum

The optimal surgical procedure for treatment of gastrointestinal stromal tumors (GISTs) of the duodenum remains undefined. Therefore, various surgical procedures have been introduced as treatment options for duodenal GISTs. Due to the anatomical complexity, the laparoscopic approach has been considered as a contraindication. Especially for GISTs located at the second portion of the duodenum, a laparoscopic wedge resection is technically difficult to perform. We describe the surgical technique of laparoscopic wedge resection with hand-sewn closure for GISTs that involve the second portion of the duodenum.

Correlation between the Serum Leptin Level and the Expression of Leptin in Stomach Cancer Patients

PURPOSE: The adipocyte-derived cytokine leptin plays a major role in the control of stable body weight by suppressing food intake and increasing energy metabolism. Leptin regulates the cell proliferation of various epithelial cells and it may be involved in the promotion of cancer. Leptin and its receptor are highly expressed in gastric adenocarcinoma, but the association between the serum leptin level and the tissue expression of leptin is uncertain. We evaluated the serum leptin level and the expressions of leptin and leptin receptor in gastric cancer, and we explore the possible mechanism and role of leptin in the carcinogenesis of gastric cancer. MATERIALS AND METHODS: 72 carcinomas that were curatively resected at our hospital from October 2005 to March 2007 were included in this study. By immunoassay and immunohistochemical staining, we evaluated the serum leptin level and the expressions of leptin and its receptor, and we analyzed their relationship together with the clinicopathological variables. RESULTS: The serum leptin level was increased as the patient's BMI increased and it was decreased in H. pylori infected patients. The expression of leptin was increased as the TNM stage increased (P=0.014), and the expression of leptin receptor in the intestinal type gastric adenocarcinoma was higher than that in the diffuse type gastric adenocarcinoma (71.4% vs 28.6%, respectively, P=0.033). CONCLUSION: There was no significant correlation between the serum leptin level and expression of leptin in gastric cancer patients. The expression of leptin was associated with the TNM stage, but its role in the pathogenesis of gastric cancer has to be elucidated.

Alterations in Hepatic Function after Laparoscopic Assisted Distal Gastrectomy: A Prospective Study

PURPOSE: There is concern about the potential adverse effects on hepatic function due to increased intraabdominal pressure during pneumoperitoneum. The changes in hepatic function following a laparoscopy assisted distal gastrectomy (LADG) and conventional open distal gastrectomy (ODG) for gastric cancer were compared. METHODS: Between July 2004 and May 2005, 60 patients diagnosed with early gastric cancer at Kangnam St' Mary's hospital; 30 each having undergone LADG and ODG were studied. The levels of alkaline phosphatase (ALP), total bilirubin (TB), aspartate transferase (AST) and alanine transferase (ALT) between the two groups were compared at 24 and 72 hours postoperatively. RESULTS: The age, sex, body mass index and preoperative hepatic function were not different between the two groups. The operative times were significantly longer in the LADG than the ODG group (298 vs. 184 minutes, P 0.05). CONCLUSION: After a LADG, the levels of hepatic transaminases were immediately elevated, but returned to normal levels within 72 hours. A LADG with prolonged pneumoperitoneum is considered safe in patients with normal liver function prior to the operation. In addition, to evaluate the safety of a LADG in the patients with decreased hepatic function, a large scaled randomized prospective trial will be required.

The Difference of Akt Phosphorylation with Different Strengths of Hemodynamic Forces on the Endothelial Cell

PURPOSE: Mechanical forces including shear stress (SS) and cyclic strain (CS) trigger signal transducing events and modulate gene expression in vascular endothelial cells (ECs). However, differences in intracellular events and gene expression depend on the intensity of the forces, which remain unknown. We attempted to clarify the effect of different strengths of SS and CS by determination of the Akt phosphorylation of ECs. METHOD: ECs were exposed to the arterial level of orbital SS with an orbital shaker (210 rpm) or laminar SS (14 dyne/cm2) with a parallel plate or CS (10%) at a frequency of 60 cycles/min. Akt phosphorylation was assessed by immunocytochemical staining and Western blotting with specific antibodies against the phosphorylated Akt. RESULT: Akt demonstrated a time-dependent stimulation of Akt phosphorylation by mechanical forces with a maximal increase up to 2.5-fold after 30 minutes of orbital SS exposure, 3-fold after 2 minutes of laminar SS exposure and 2.3-fold after 30 minutes of CS exposure. Akt phosphorylation in the periphery of the membrane was significantly increased, compared to at the center of the membrane. It was up to 1.4-fold after 30 minutes of orbital SS and up to 2.4-fold after 30 minutes of CS (P<0.05). CONCLUSION: Our results demonstrate that all types of hemodynamic forces phosphorylated Akt in a time-dependent manner and different types of SS may have different effects on the ECs. In addition, the phosphorylation of Akt is dependent on the intensity of the mechanical forces on ECs.

Concurrence of Spatially Separated Medullary Carcinoma and Papillary Carcinoma of the Thyroid Gland: A Report of Three Cases

Although medullary thyroid carcinoma (MTC) may coexist with papillary thyroid carcinoma (PTC) as a collision tumor within the same nodule or as two or more spatially separated tumors, these two carcinomas rarely coexist. We encountered three cases of sporadic MTCs spatially separated from PTCs, which occurred concurrently, either within the same thyroid lobe or in different thyroid lobes. In each of the cases the patients underwent total thyroidectomy and neck dissection. PTC metastases of the lymph node were observed in two of the cases and MTC metastasis of the lymph node was observed in one case. Among the multiple thyroid nodules affected by both MTCs and PTCs, only the dominant nodules had spread to the lymph nodes. Because MTC has a different clinical significance from PTC, in patients with multiple thyroid nodules, appropriate diagnostic approaches, such as fine needle aspiration of all possible nodules and measurement of serum calcitonin level, should be performed.

Use of Complementary and Alternative Medicine by Gastric Cancer Patients

PURPOSE: Complementary and alternative medicine (CAM) has recently been spotlighted, and CAM can be defined as methods for treating diseases or ways to maintain physical health that out lie outside the boundaries of conventional medicine. We have conducted research to determine the status of CAM usage among Korean gastric cancer patients and their attitudes toward it, to determine what better can be done about CAM. METHODS: We surveyed those patients in St. Mary Hospital who were diagnosed to gastric cancer and who volunteered to participate in this study. The survey consists of 38 questions and each question covered personal characteristics information as to whether they have used CAM, whether they were satisfied after taking CAM and their intentions for re-use. RESULTS: A total of 195 patients answered the survey. 80 patients (41%) experienced CAM for the purpose of remedying their gastric cancer. The top leading CAM was dietary supplement for 52% of the patients, ginseng for 26% of the patients and Chinese herbal medicine for 10.8% of the patients. 54 patients (67.5%) were satisfied with the results of the CAM and they said that it had an effect on fatigue (45%). The statistics showed positive correlation between the level of education and the CAM users (P=0.001). CONCLUSION: The percentage of patients using CAM among the gastric cancer patients was high, up to 41%. Most of these patients wanted more information and discussion with their physicians about CAM therapies. The interesting thing was that most of the CAM was oral medicine. Based on our findings, research on the safety and effectiveness of CAM is required.

DNMT3b Promoter Polymorphism and Risk of Gastric Cancer in the Korean Population

PURPOSE: DNA methylation is an important epigenetic factor in tumorigenesis. We hypothesized that polymorphism of the promoter of the DNA methyltransferase 3b (DNMT3b) genes, which are responsible for regulating the methylation status of tumor suppressor genes, are associated with increased risk of gastric cancer. MATERIALS AND METHODS: In this hospital-based case-control study, to determine the role of this polymorphism of the promoter of DNA methyltransferase 3b (DNMT3b) genes in gastric cancer, we genotyped 176 cases and 70 control subjects. To determine the genotype, we used a polymerase chain reaction restriction fragment length polymorphism assay. We compared alleles and genotypes between the two groups and revealed an association of DNMT3b promoter polymorphism with increased risk of gastric cancer in the Korean population. RESULTS: Genotype frequencies were 14.8% (Cytosine-Cytosine), 71.6% (Cytosine-Thymine), and 13.6% (Thymine- Thymine) in the case patients and 40.0% (Cytosine-Cytosine), 42.9% (Cytosine-Thymine), and 17.1% (Thymine-Thymine) in the control subjects, respectively. Compared with CC homozygotes, CT heterozygotes had a 4.523-fold increased risk (OR, 2.13; 95% CI, 2.324~8.803), and the TT homozygotes had a 2.154-fold elevated risk (OR, 1.42; 95% CI, 0.899~5.165). For the T variant genotype (CT+TT), there was a 3.846-fold increased risk (OR, 1.88; 95% CI, 2.040~7.251). However, no significance was observed in the genotype distributions of both polymorphisms according to histopathology, stage of stomach cancer. The Ssame results were observed with Helicobacter infection. CONCLUSION: DNMT3b promoter polymorphism, especially the T variant genotype, is associated significantly with thean increased risk of gastric cancer.

Comparison of the Results in Gastric Carcinoma Patients undergoing Billroth I and Billroth II Gastrectomiesy

PURPOSE: The proper reconstruction technique to use after a distal subtotal gastrectomy for a gastric carcinoma, there has been a subject for debated what is the proper reconstruction technique. The aim of this study was to compare the gastric- emptying time and the quality of life following both B-I and B-II reconstructions after a distal gastrectomy for a gastric adenocarcinoma. MATERIALS AND METHODS: We studied 122 patients who had undergone a distal gastrectomy for a gastric adenocarcinoma between June 1999 and July 2002 at our hospital. 51 patients underwent B-I group, and 71 patients underwent B-II group. To evaluate the gastric-emptying time, we analyzed the T1/2 time by means of radionuclide scintigraphy using a gamma camera after ingestion of an (99m)Tc-tin-colloid steamed egg. The nutritional status was measured by the weight change. Postgastrectomy syndrome was evaluated using an abdominal symptoms survey. Dumping syndrome was measured using the Sigstad dumping score. RESULTS: The gastric-emptying time was somewhat delayed in the B-I group after a 6 month period, but there was no difference after 12 months between the two groups. There was less weight loss in the B-I group than in the B-II group (P=0.023). Fewer abdominal symptoms were occurred in the B-I group than in the B-II group. Dumping syndrome occurred less frequently in the B-I group than in the B-II group (P=0.013). CONCLUSION: In our study, the Billroth I reconstruction led to less weight loss, a better nutritional status, and a better quality of life than the Billroth II reconstruction. We concluded that after a distal subtotal gastrectomy, the Billroth I reconstruction would be considered when the procedure is oncologically suitable.

Clinical Usefulness of a Totally Laparoscopic Gastrectomy

PURPOSE: In Korea, the number of laparoscopy-assisted distal gastrectomies for early gastric cancer patients has been on the increase. Although minimally invasive surgery is more beneficial, no reported case of a total laparoscopic gastrectomy has been reported because of difficulty with intracorporeal anastomosis. This study attempts, through our experience, to determine the safety and feasibility of a total laparoscopic gastrectomy with various types of intracorporeal anastomosis using laparoscopic linears stapler in treating early gastric carcinomas. MATERIALS AND METHODS: We investigated the surgical results and clinicopatholgical characteristics of 81 patients that underwent a totally laparoscopic distal gastrectomy at our department between June 2004 and May 2007. The intracorporeal anastomoses were performed by using laparoscopic linear staplers. RESULTS: The mean operative time was 287 minutes, the mean anastomotic time was 40 minutes, and the mean number of laparoscopic linear staplers used for an operation was 7.5. The mean time to the first flatus, the first food intake, and discharge from hospital was 2.9, 3.6, and 10.3 days respectively. There were 11 cases of postoperative complications, but no case of postoperative mortality or conversion to an open procedure. In 75 patients with an adenocarcinoma, the mean number of lymph nodes harvested was 38.1 and the stage distribution was as follows: stage I, 72 patients; stage II, 2 patients; stage IV, 1 patient. During the mean follow-up period of 14 months, 5 patients died of other causes and there were no cases of cancer recurrence. CONCLUSION: A total laparoscopic gastrectomy with intracorporeal anastomosis by using a laparoscopic linear stapler was found to be safe and feasible. We were able to obtain acceptable surgical outcomes in terms of minimal invasiveness.

Comparison of an Uncut Roux-en-Y Gastrojejunostomy with a Billroth I Gastroduodenostomy after Totally Laproscopic Distal Gastrectomy

PURPOSE: An uncut Roux-en-Y gastrojejunostomy has been known to be effective in preventing bile reflux gastritis in the remnant stomach and the Roux stasis syndrome. MATERIALS AND METHODS: To evaluate the usefulness of a totally laparoscopic uncut Roux-en-Y gastrojejunostomy (TLuRYGJ) after a distal gastrectomy, we reviewed the medical records of 19 consecutive patients that underwent a TLuRYGJ at our institution, and 11 consecutive patients who underwent a totally laparoscopic Billroth I gastrectomy (TLB-I) during the same period. RESULTS: Postoperative gastrointestinal symptoms related to the postgastrectomy syndrome and the Visick classification at six months after surgery were not different in the two groups; however, there was no case of symptomatic bile reflux gastritis and only one case of delayed gastric empting, for which medication was required, in the TLuRYGJ group. The endoscopic findings of the remnant stomach for bile reflux gastritis at six months after surgery were better in the TLuRYGJ group than in the TLB-I group. CONCLUSION: A TLuRYGJ was found to be effective in preventing bile reflux gastritis and the Roux stasis syndrome.

Pledget as a Useful Substitute for a Knot in Intracorporeal Continuous Gastrointestinal Suturing

PURPOSE: Pledget is a PTFE felt that is usually used for suture reinforcement in cardiovascular surgery. In order to minimize the difficulty in intracorporeal continuous gastrointestinal suturing by reducing the number of tied knots, we have used pledget as substitute for a knot (pledget suturing). MATERIALS AND METHODS: Thirty-two consecutive patients who underwent totally laparoscopic uncut Roux-en-Y gastrojejunostomy after distal gastrectomy in our institution were enrolled in this study, and the patients were divided into three groups according to the method of intracorporeal anastomosis. Basically, intracorporeal anastomosis was performed by several firings of linear staplers; however, the entry holes for the stapler at the jejunojejunostomy and the gastrojejunostomy were closed by pledget suturing in group A (8 patients), the entry hole for the stapler at jejunojejunostomy was closed by conventional suturing in group B (8 patients), and all of the entry holes for the stapler were closed by stapling in group C (16 patients). The surgical outcomes of each group were compared to each other. RESULTS: The anastomotic time in group A was not longer than in group B, although there were more sutures used in group A, but it was longer than in group C. The number of stapler cartridges used in group A was the smallest among the three groups. In group B, there were two cases of a break of suture material during anastomosis, there were no such cases in group A. There was no complication related to anastomosis in all of the groups. CONCLUSION: Pledget was found to be useful for minimizing the difficulty in intracoproreal continuous gastrointestinal suturing and reducing the number of stapler cartilages used in intracorporeal anastomosis.

Clinicopathologic Characteristics of and Prognosis for Patients with a Borrmann Type IV Gastric Carcinoma

PURPOSE: The prognosis for patients with a Borrmann type IV gastric cancer is extremely poor despite an aggressive surgical approach. We evaluated the clinicopathological features for Borrmann type IV cancers to find treatment strategy. MATERIALS AND METHODS: The 1098 patients with advanced gastric cancer who underwent surgical resection between 1990 and 2001 were analyzed. These patients were divided into two groups: 81 patients with a Borrmann type IV carcinoma, and 1017 patients with all other types of gastric carcinomas. RESULTS: Patients with a Borrmann type IV carcinoma were younger than those with other types, and female was prevalent (p=0.000). Of the patients with a Borrmann type IV gastric carcinoma, 68 patients (84%) were classified as stage III or IV at the initial diagnosis. The histologic type was commonly undifferentiated and serosal infiltration; nodal involvement and lymphatic invasion were more frequent in patients with a Borrmann type IV than in those with other types of cancer. Multivariate analysis confirmed that the extent of lymph node metastasis was a negative prognostic factor for Borrmann type IV gastric carcinomas. The curability for a Borrmann type IV carcinoma was only 53.1%, and peritoneal dissemination rate was 25.9%. The predominant pattern of recurrence for a Borrmann type IV gastric carcinoma was peritoneal dissemination, and it was significantly different with other types (93.1% vs 55.8%, P<0.05). The 5-year survival rate of patients with a Borrmann type IV gastric carcinoma was significantly lower than those of patients with other types of cancer, even though a curative resection had been accomplished (26% vs 63%, p<0.005). The 5-year survival rates of patients with a Borrmann type IV carcinoma following a curative resection were 44.9%, 24%, and 0% for stages II, III and IV, respectively (p<0.05). CONCLUSION: Because the prognosis for patients of a Borrmann type IV gastric cancer is extremely poor despite a curative resection, preoperative and/or intraperitoneal chemotherapy should be considered. And diagnostic laparoscopy and peritoneal cytology may be used to play an important role in accurate staging workup.

Clinical Analysis According to p21(Waf1/Cip1) and p27(Kip1) Expression in Gastric Cancer

PURPOSE: The p21(Waf1/Cip1) protein inhibits the cell cycle by inhibiting the phosphorylation at the G1-->S check point, and the p27(Kip1) protein similarly performs the suppressor function by controlling the p27-mediated G1 arrest. In this study, we analysed the clinical status and survival rates in correlations with p21 and p27 expression patterns in gastric cancer. MATERIALS AND METHODS: Between 1993 and 1997, 192 patients who underwent surgeries in Catholic Medical Center were analysed retrospectively in this study. Immunohistochemical staining was performed and if the nuclei of the tumor cells were stained, we assumed those as positive results. Statistical analysis was based on clinicopathological findings and differences in survival rates. RESULTS: The expression rate of p27 was 28.1% and 15.6% in p21 each. The ratio of T1-2(80.0%) was significantly high in p21 (+), but the ratio of T3-4 (50.6%) was slightly high in p21 (-). There was no statistical significance regarding other factors. The results in p27 was not much different from expression rate of p21 in T-stage. In addition, p27 expression in diffuse type (91.3%) was higher than in intestinal type (62.7%) by Lauren's classification (P <0.05). Also, there was no statistical significance in other factors. In the correlation of p21 and p27, p27 was positive when p21 was positive (53.5%). Conversely, p27 was negative when p21 was negative (76.5%, p <0.05). In the p21 and p27 combination test, there was higher rate of T1-2 (87.5%) in p21 (+)/p27 (+), and higher rate of T3-4 (58.1%) in p21 (-)/p27 (-) (P <0.05). Results showed higher rate of intestinal type (100%) in p21 (+)/p27 (+), and diffuse type (87.0%) was dominant in p21 (-)/p27 (-) (P <0.05) by Lauren's classification. Moreover, there was no statistical significance in the 5-year survival rate in the expression of p21 and p27, and the 5-year survival rate was highest in the case of p21 (+)/p27 (+) without statistical significance. CONCLUSION: In our study, p21(Waf1/Cip1) and p27(Kip1) expressed similar patterns. The expression of p21(Waf1/Cip1) and p27(Kip1) affected the degree of invasiveness of the tumor, and. Combined examination result revealed the correlation of p21(Waf1/Cip1) and p27(Kip1) with Lauren's classification and depth of invasion of the tumor. However, we assumed that little difference between the survival rates depending on expression of p21(Waf1/Cip1) and p27(Kip1) has limited their value as predictable prognostic indicators.