Analysis of the Potent Prognostic Factors in Luminal-Type Breast Cancer / 한국유방암학회지

PURPOSE: Luminal-type breast cancer has a good prognosis compared to other types, such as human epidermal growth factor receptor 2 and triple negative types. Luminal-type breast cancer is classified into luminal A and B, according to the proliferation index. We investigated the clinicopathological factors that affect the prognosis of the luminal-type subgroups. METHODS: We reviewed the medical records and the pathologic reports of 159 luminal-type breast cancer patients who were treated between February 2005 and November 2007. We divided luminal-type breast cancer into luminal A and B, according to Ki-67 (cutoff value, 14%) and analyzed the clinicopathologic factors, such as age at diagnosis, intensity score of estrogen receptor and progesterone receptor, histologic grade, and Bcl-2. Moreover, we compared the disease-free survival (DFS) of each group. RESULTS: In the univariate analysis, age (p=0.004), tumor size (p=0.010), lymph node metastasis (p=0.001), and Bcl-2 (p=0.002) were statistically significant factors in luminal-type breast cancer. In the multivariate analysis, lymph node (p=0.049) and Bcl-2 (p=0.034) were significant relevant factors in luminal-type breast cancer. In the subgroup analysis, the increased Bcl-2 (cutoff value, 33%) was related with a longer DFS in the luminal B group (p=0.004). CONCLUSION: In our study, luminal A breast cancer showed a longer DFS than luminal B breast cancer, further, Bcl-2 may be a potent prognostic factor in luminal-type breast cancer.

Comparative Study of a Single-Incision Laparoscopic and a Conventional Laparoscopic Appendectomy for the Treatment of Acute Appendicitis

PURPOSE: For the treatment of acute appendicitis, a conventional laparoscopic appendectomy (LA) has been widely performed. Recently, the use of single incision laparoscopic surgery (SILS) is increasing because it is believed to have advantages over conventional laparoscopic surgery. In this study, we compared SILS and a conventional LA. METHODS: We analyzed the 217 patients who received laparoscopy-assisted appendectomies between August 2010 and April 2012 at Inje University Sanggye Paik Hospital. One hundred-twelve patients underwent SILS, and 105 patients underwent LA. For the two groups, we compared the operation times, postoperative laboratory results, postoperative pain, hospital stay, and postoperative complications. RESULTS: The patients' demographics, including body mass index, were not significantly different between the two groups. There were 6 perforated appendicitis cases in the SILS group and 5 cases in the LA group. The mean operative time in the SILS group was 65.88 +/- 22.74 minutes whereas that in the LA group was 61.70 +/- 22.27 minutes (P = 0.276). There were no significant differences in the mean hospital stays, use of nonsteroidal antiinflammatory drugs, and wound infections between the two groups. CONCLUSION: Postoperative pain, complications and hospital stay showed no statistically significant differences between the SILS and the LA groups. However, our SILS method uses a single trocar and two latex tubes, so cost savings and reduced interference during surgery are expected.

Comparision of Needlescopic Appendectomy versus Conventional Laparoscopic Appendectomy in Children / 대한내시경복강경외과학회지

PURPOSE: This clinical study evaluated the feasibility of needlescopic appendectomy (NA) in young patients with acute appendicitis, and we compare the outcome of this new technique with that of conventional laparoscopic appendectomy (LA). METHODS: Two groups of young patients who underwent laparoscopic appendectomy at Sanggye Paik Hospital between January 2009 and December 2009 were studied. In the first group, a 2-mm instrument appendectomy was performed in 13 patients. These patients were compared with the second group, which were 21 patients who underwent conventional laparoscopic appendectomy. Statistical significance was set at p values<0.05. RESULTS: The patient demographics and operative findings were similar in both groups. There was no conversion to open appendectomy in either group. Postoperative ileus was occurred in 3 patients who underwent LA, but there was no statistical difference between the both groups (p=0.154). The needlescopic group had a shorter mean operative time (p=0.65), but there was no statistically significance. The mean hospital stay was significantly shorter (p=0.026) in the needlescopic group than that in the conventional laparoscopic group. CONCLUSION: According to our experience, needlescopic laparoscopic appendectomy is a safe and feasible procedure as compared with that of conventional laparoscopic appendectomy in young patients.

Survival Rate and Prognostic Factors in Perforated Colorectal Cancer Patients: A Case-Control Study

PURPOSE: Perforations are rare but serious complications in colorectal cancer. Controversy exists over whether to perform a radical operation because colorectal cancer perforation is considered as an advanced stage disease, and septic complications of peritonitis have been identified as being responsible for a poor prognosis. The aim of this study was to assess the correlation between the survival rate and the clinicopathological parameters that might be used as predictive factors of the prognosis for perforated colorectal cancer. METHODS: The analysis was based on 24 cases of perforated colorectal cancer (the case group), 48 cases of matching uncomplicated colorectal cancer (the control group), and 72 cases of the case and the control groups combined together (the combined group), all of which were identified during a 10-yr period in a single institution. RESULTS: The five-year survival rates of the perforated colorectal cancer patients and their matching controls were similar (P=0.484). No significant differences in the locations of the cancer, the pre-operative carcinoembryonic antigen (CEA) levels, the tumor sizes, the resection margins, or the numbers of the lymph nodes harvested were found between the two groups. A univariate analysis of the prognostic factors that influenced the case group revealed that adjuvant chemotherapy (P=0.004) was significantly correlated to a better five-year survival rate. A univariate analysis of the prognostic factors that influenced the five-year survival rate of the combined group revealed that the stage (P<0.001), the pre-op CEA level (P=0.018), the angio invasion (P=0.019), the perineural invasion (P=0.019), the number of harvested lymph nodes (P=0.004), and adjuvant chemotherapy (P=0.001) were significantly correlated to the five-year survival rate. The identified independent prognostic factors in the combined group were the stage (hazard ratio, 5.20), angio-invasion (hazard ratio, 2.81), and adjuvant chemotherapy (hazard ratio, 0.17). CONCLUSION: The clinical pathway of perforated colorectal cancer is similar to that of uncomplicated colorectal cancer. Therefore, perforated colorectal cancer patients should be recommended for treatment with the appropriate radical operation and adjuvant chemotherapy based on oncologic principles.

Comparison of Laparoscopic and Open Adrenalectomy / 대한내분비외과학회지

PURPOSE: Advancements in technology and surgical skill have extended the applications of minimally invasive surgery, and various studies have suggested that laparoscopic adrenalectomy (LA) might lead to better clinical outcomes compared to open surgery. We reviewed our experience in order to evaluate the clinical outcomes of laparoscopic and open adrenalectomy (OA). METHODS: We retrospectively analyzed the clinical records of 41 patients who underwent surgery for adrenal lesions between 1998 and 2006. Outcome measurements included gender, age, diagnosis, lesion size, operative time, intraoperative blood loss, procedure-related complications, time to first oral intake, and postoperative hospital stay. RESULTS: There were 19 LAs and 22 OAs. There were no significant differences in gender, age, lesion location (right or left), comorbidity, complications, or postoperative hospital stay. The mean operative time was longer in the LA group than in the OA group (OA 215, LA 273 min, P=0.048). Resumption of oral intake occurred at 3.4 days in the OA group and at 1.9 days in the LA group (P<0.001), and the incidence of bleeding that required transfusion was 58% in the OA group and 21% in the LA group (P=0.018). We divided the LA group into 14 pure LAs (pLA) and 5 conversions from laparoscopic procedures to open adrenalectomy (CA). Significant postoperative complications occurred in the OA, pLA, and CA groups at rates of 18%, 14%, and 80%, respectively (OA vs pLA, P=0.569 pLA vs CA, P=0.017 OA vs CA, P=0.017), and postoperative hospital stays were 11.1, 5.7, and 19.6 days for each group, respectively (OA vs pLA, P=0.005 pLA vs CA, P<0.001 OA vs CA, P=0.025). CONCLUSION: Patients who underwent pLA had similar postoperative complications, but shorter hospital stays and shorter times to first oral intake compared to OA. Patients in the CA group had longer operative times, longer postoperative hospital stays, and significantly higher rates of variable complications compared to the pLA and OA groups. Careful preoperative selection of patients for LA is important to avoid unnecessary CA.

Analysis of Factors Affecting Local Recurrences after Thyroid Surgery in Low Risk Papillary Thyroid Carcinomas / 대한내분비외과학회지

PURPOSE: This study analyzed factors affecting local recurrences in AGES low risk papillary thyroid carcinomas (PTCs). METHODS: The clinical records of 89 patients who underwent thyroidectomy because of PTC were reviewed. Seventy patients had belonged to low risk PTC according to the AGES classification scheme. The clinical data of these patients concerning disease recurrence was analyzed considering age, gender, operative methods, tumor size, lymph node (LN) metastasis, postoperative radioactive iodine scan (RI scan ¹³¹I), and Synthyroid® intake. RESULTS: Of the 70 patients, 56 were female (80%). Thirtyseven patients underwent total thyroidectomy with central neck LN dissection and 33 patients underwent partial thyroidectomy with ipsilateral central neck LN dissection. Mean tumor size was 2 cm (0.4~6 cm) and 31 patients had LN metastasis. Levels were 2 cm (P=0.030) and partial thyroidectomy (P=0.045). There was no significant association between local recurrence and age, gender, extrathyroidal extension, LN metastasis, RI scan ¹³¹I, or Synthyroid® intake. CONCLUSION: Partial thyroidectomy and tumor size >2 cm are significantly associated with local recurrence in AGES low risk papillary thyroid carcinomas.

Traumatic Isolated SMA Dissecting Aneurysm Associated with Burst Fractures of Lumbar Spines

Isolated dissecting aneurysm of the superior mesenteric artery (SMA) is a rare condition. Although aneurysms of the SMA are frequently classified with other splanchnic aneurysms, dissecting SMA aneurysms are quite different in terms of their etiology and natural history. Therefore, independent consideration is warranted during their treatment. In this case report, a dissecting aneurysm was accompanied by burst fractures of the first and third lumbar spines at the same height. We treated the patient, who was suffering from chronic post-prandial intermittent abdominal pain after falling down. The patient stopped displaying repeated episodes of abdominal pain did not recur after the false lumen entry was closed by a short exclusion stent graft, and there were no procedural complications. The stent graft remained patent, and the patient has remained free of symptoms during the 16 months follow-up period. We present here the case of a traumatic isolated SMA dissecting aneurysm that was successfully managed by endovascular treatment.

Traumatic Isolated SMA Dissecting Aneurysm Associated with Burst Fractures of Lumbar Spines

Isolated dissecting aneurysm of the superior mesenteric artery (SMA) is a rare condition. Although aneurysms of the SMA are frequently classified with other splanchnic aneurysms, dissecting SMA aneurysms are quite different in terms of their etiology and natural history. Therefore, independent consideration is warranted during their treatment. In this case report, a dissecting aneurysm was accompanied by burst fractures of the first and third lumbar spines at the same height. We treated the patient, who was suffering from chronic post-prandial intermittent abdominal pain after falling down. The patient stopped displaying repeated episodes of abdominal pain did not recur after the false lumen entry was closed by a short exclusion stent graft, and there were no procedural complications. The stent graft remained patent, and the patient has remained free of symptoms during the 16 months follow-up period. We present here the case of a traumatic isolated SMA dissecting aneurysm that was successfully managed by endovascular treatment.

Proliferative Markers of Breast Cancer / 한국유방암학회지

PURPOSE: The mitotic index (MI) and Ki-67 labeling index have been used as cell proliferative markers in the various tumors. Topoisomerase II alpha (Topo II alpha) is also expressed in proliferating cells. The aim of this study was to evaluate the correlations between the MI, Ki-67, and Topo II alpha expression as proliferative markers of breast cancer. METHODS: The cell proliferative activity of 181 breast cancers was measured using MI, Ki-67 labeling index and Topo II alpha expression. The correlation between the measured markers was also analyzed. RESULTS: The MI, Ki-67, and Topo II alpha were significantly correlated with each other(p < 0.000). The MI and Ki-67 labeling index were associated with high histological grade, and absence of hormone receptor (p < 0.000). Topo II alpha expression was correlated with high histological grade (p < 0.000), absence of hormone receptor and HER-2/neu overexpression (p < 0.043). The MI, Ki-67, and Topo II alpha were not associated with any other clinical variables, such as age, tumor size, and lymph node status. CONCLUSION: The three proliferative indices were significantly associated with aggressive features of breast cancer, and significantly correlated with each other.

Relationship between E2F1 Expression and Clinical Outcome in Node-Positive Breast Cancer / 한국유방암학회지

PURPOSE: This study was performed to investigate whether the E2F1 protein expression can be used as a prognostic factor in clinical breast cancer. METHODS: The expressions of E2F1 and retinoblastoma protein (pRB) were analyzed in 165 lymph node positive breast cancers. All patients underwent adjuvant chemotherapy with fluorouracil, doxorubicin, and cyclophosphamide (FAC) after curative surgery. RESULTS: E2F1 was expressed in 43.6% and pRB was expressed in 46.1%. E2F1 expression was significantly increased in pRB-expressing tumors and was associated with S-phase fraction. By univariate survival analyses, E2F1 expression and ER were the significant prognostic factors for the disease recurrence and patient survival. E2F1 was the only significant prognostic factor for the patient outcome after FAC chemotherapy by multivariate analysis. CONCLUSION: Conclusion The results of the current study indicate that abnormal expression of E2F1 and pRB is prevalent and are intimately associated with each other in clinical breast cancer. A significant association between E2F1 expression and patient survival after FAC chemotherapy mondates a further validation study.

Expression of Cyclooxygenase-2 and Inducible Nitric Oxide Synthase in Colorectal Cancer

PURPOSE: Recently, it has been recognized that both cyclooxygenase-2 (COX-2) and inducible nitric oxide synthase (iNOS) produce important endogeneous factors of human tumor progression. The aims of this study is to investigate the correlation between the expression of COX-2 and iNOS and to assess the clinicopathological significance of COX-2 and iNOS expression in patients with colorectal cancer. METHODS: One hundred and five patients, who underwent curative resection of colorectal cancer from 1994 to 1997 were analyzed retrospectively. The monoclonal antibody to the COX-2 and iNOS were used for the immunohistochemical analysis. RESULTS: In 105 patients the COX-2 and iNOS positive rate were 86.7% and 69.5% respectively. There was significant correlation between COX-2 and iNOS expression (r= 0.378, P<0.01), that is, the lesions which expressed high level of COX-2 also expressed iNOS highly. The proliferation index (Ki-67 labeling index) was correlated with iNOS (P=0.013), and the microscopic differentiation with COX-2 (P=0.004). However, the expression of COX-2 and iNOS proteins did not correlate with any other clinicopathological parameters including patient survival. CONCLUSIONS: Although the pattern of positive expression was similar in both enzymes, the expression of both enzymes was not related to prognosis in patients with colorectal cancer. But COX-2 and iNOS seems to have a role not only in carcinogenesis but also tumor cells proliferation. To evaluate the exact role of these enzymes, further studies of the apoptosis and cancer metastasis and of links between the cancer related factors of COX-2 and iNOS are warranted.

Clinical Value of the Change in the Serum Carcinoembryonic Antigen (CEA) Level after Curative Surgery in Colorectal Cancer

PURPOSE: This retrospective study was designed to evaluate the clinical value of changes in the serum carcinoembryonic antigen (CEA) level after curative surgery in colorectal cancer patients. METHODS: The clinical value of preoperative serum CEA and dCEA (postoperative 7-day CEA/preoperative CEA) in 115 patients with colorectal cancer, who underwent curative surgery at our Department of General Surgery from 1994 to 1997, was investigated. RESULTS: The preoperative CEA level was significantly associated with histologic differentiation (P=0.035) and reccurence (P=0.044), but not gender, tumor size, lymph node metastases, Duke's stage, and vascular invasion. dCEA was significantly associated with lymph-node metastases (P=0.017), histologic differentiation (P=0.024), Duke's stage (P=0.021), recurrence (P=0.008), and survival rate (P=0.0379). Especially, in the abnormal preoperative CEA level (>5 ng/mL) group, if dCEA was more than 0.5, these patients had a very poor prognosis (P=0.0003). CONCLUSIONS: dCEA was associated with more clinicopathologic prognostic factors than preoperative CEA, especially with survival rate. Therefore, we expect dCEA to be a more useful tool for predicting patient outcome.

The Clinical Significance of Cyclooxygenase 2 Expression in Colorectal Cancer

PURPOSE: Epidemiologic studies have indicated that the use of nonsteroidal anti-inflammatory drugs, which inhibit cyclooxygenase activity, reduce the risk of colorectal cancer. In addition, several studies have demonstrated the increased expression of cyclooxygenase-2 (COX-2) in human colorectal cancer tissues. However, the role of COX-2 in colorectal cancer has not been fully established. The aim of this study was to clarify the clinicopathologic significance of COX-2 expression in human colorectal cancer. METHODS: We performed immunohistochemical straining for COX-2 expression in 124 human colorectal cancer specimens. COX-2 expression was then compared with clinicopathologic factors and survival outcomes. RESULTS: COX-2 was expressed in the cytoplasm of the cancer cells. COX-2 expression was noted in 86.3% of the cancer patients and significantly correlated with the histologic type. The depth of invasion, tumor size, lymph node metastasis and stage were not correlated with COX-2 expression. Multivariate analysis for the factors associated with survival showed that serum CEA, size, depth and lymph node involvement correlated with survival, but COX-2 expression had no correlation. CONCLUSION: These data suggest that COX-2 expression in primary lesion of colorectal cancer may not be a useful marker for evaluating prognosis. However, further studies are necessary for identification of the roles in colorectal carcinogenesis.

Chemoembolization in Synchronous Liver Metastases from Nonfunctioning Endocrine Tumor of Pancreas / 한국간담췌외과학회지

Pancreatic endocrine tumors are rare and represent a heterogeneous group of benign or malignant lesions. In nonfunctioning tumors, lacking the features of an endocrine tumor syndrome, they seldom present until there is advanced local disease. Endocrine tumors of the pancreas, even in case of liver involvement, are generally characterized by a slower evolution and a better prognosis, if compared with ductal carcinoma. This fact gives reason to a radical surgical approach and to the research of any effective adjuvant treatment including hormonal suppression, systemic chemotherapy and hepatic transarterial chemoembolization (TACE). We report a case of synchronous liver metastases from nonfunctioning pancreatic endocrine tumor in 66 year old female patient.

The Correlations between the Expression of Cyclin E and Clinical Features of the Primary Breast Cancer

PURPOSE: Cyclin E is a key regulatory protein in the G1-S transition during the cell cycle. The correlations between cyclin E protein and the clinical features of breast cancer were investigated in order to evaluate its clinical utility in invasive breast cancer. METHODS: An immunohistochemical assay for cyclin E was performed in 101 consecutive invasive breast cancers. The correlation between cyclin E expression and the clinicobiological parameters including patient survival was analyzed. RESULTS: Cyclin E expression was observed in 50 patients (49.5%). The scoring of the cyclin E expression level was divided into low (or=25%). In high nuclear grade tumors, cyclin E overexpression was much higher than that in low nuclear grade tumors (P=0.049). In the younger age group (<50 yrs), cyclin E expression was significantly higher than the older age group (P= 0.016). No significant correlation was observed between cyclin E and the tumor size, lymph node status, hormonal receptor status, histological grade, mitotic index and Ki67. In multivariate analysis, only the lymph node status was significantly associated with the patients' outcome (P= 0.002). CONCLUSION: Cyclin E overexpression did not have prognostic impact on the patients' survival rate in invasive breast cancer. In high nuclear grade tumors, the cyclin E expression level was much higher. The definite value of cyclin E as a clinicobiologic marker should be further investigated by prospective studies with other cell regulatory proteins.

Comparison of Tamoxifen and Toremifene as Adjuvant Treatment in Node-negative Postmenopausal Breast Cancer

PURPOSE: To evaluate the differences in therapeutic efficacy and toxicity profiles between adjuvant toremifene and tamoxifene in postmenopausal breast cancer patients. METHODS: Toremifene 40 mg (n=115) and tamoxifen 20 mg (n =116) were administered daily for more than 2 years after curative surgery for lymph node-negative breast cancer. Toxicity profiles were compared between the two groups and the patient survival rate was also analyzed. RESULTS: Sweating and hot flashes were the most common symptoms in the two groups (toremifene vs. tamoxifen= 47.8% vs. 49.1%). Increase of vaginal discharge (39.1% vs. 36.2%) and weight gain (21.7% vs. 24.1%) were the next following adverse effects. There was no significant difference in adverse effect between the two groups. During the median follow-up period of 25 months (range: 9~38 months), five (4.3%) and four (3.3%) patients treated by toremifene and tamoxifen, respectively, had recurrent disease. CONCLUSION: The clinical outcome and adverse effect profiles of toremifene were similar to those of tamoxifen. Toremifene at 40 mg/day seems to be as safe and effective as tamoxifen at 20 mg/day in the treatment of postmenopausal, node-negative, breast cancer. However, a longer follow-up study is needed to verify this.

Interrelation of Cyclin D1, Cyclin E, and p27Kip1 Expression on Tissue Arrays of Breast Cancer / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: To evaluate the clinical impact of the altered expression of cell cycle regulators in stage I and II breast cancers. MATERIALS AND METHODS: The interaction between cyclin D1/E and p27Kip1 expressions were analyzed using tissue microarray (TMA) technology in 133 breast cancers. Data from the immunohistochemical assays of 3 molecules were merged, and analyzed, with a Ki67 labeling index of the same tumors. RESULTS: Cyclin D1 was expressed in 72 breast carcinomas (54.1%) and cyclin E in 60 (45.1%) out of the 133 breast carcinomas. Expressions of cyclin D1 and cyclin E were inversely related to each other, and significantly associated with the estrogen receptor (ER) expression and differentiation of the breast carcinoma. The expression of cyclin E was significantly decreased in tumors expressing cyclin D1 (p=0.022). There was a trend for cyclin D1 expression to increase in tumors expressing p27Kip1 (p=0.053), but the expression of cyclin E did not correlate with p27Kip1 expression. The Ki67 labeling index was markedly increased in tumors expressing cyclin E, whereas it was significantly decreased in the cyclin D1 or p27Kip1 expressing-tumors. From survival analysis, cyclin E expression was the only significant variable for the prediction of poor survival. CONCLUSION: The abnormal expressions of cell cycle regulatory molecules are prevalent, and interrelated with each other in breast cancer. Integration of TMA technology allowed a high-throughput analysis for correlating molecular the in situ findings, with the clinico-pathologic information. Among the three molecules studied, the cyclin E had a prognostic implication for stage I and II breast cancer.

Significance of the Expression of p27(Kip1) Protein in Human Breast Cancer / 한국유방암학회지

PURPOSE: p27(Kip1) is a member of the Cip/Kip family of cyclin-dependent kinase inhibitors. It binds to a variety of cyclin/CDK complexes, inhibits kinase activity and blocks the cell cycle as a negative regulator. Reduced p27(Kip1) expression has been reported to be a significant predictor of poor survival in numerous human breast cancers. We executed p27(Kip1) protein assay in primary breast cancer and compared these result with known prognostic parameters. METHODS: Immunohistochemical assay was performed on tissue microarrays from 183 patients with breast cancer to evaluate the biologic and clinical significance of p27(Kip1) expression. RESULTS: Decreased p27(Kip1) expression was significantly associated with clinical stage (P=0.027), low nuclear grade (P<0.001), high histologic grade (P<0.001), high score mitotic index (P<0.001), increased Ki67 labeled index (P=0.006) and negative estrogen receptor status (P=0.0024). In survival analysis, p27(Kip1) was useful to predict disease- free survival (P=0.0106) and overall survival (P=0.0154) of the patient after surgery followed by chemotherapy or radiation therapy. CONCLUSION: Reduced expression of p27(Kip1) protein was as sociated with biologically aggressive phenotype of breast cancer and was an useful to predict patient outcome.

Expression of p27Kip1 Protein Associated with Poor Clinical Outcome in Human Gastric Cancer

PURPOSE: p27Kip1 protein is an inhibitor of cyclin-dependent kinases and is thought to be a potential prognostic indicator for numerous human cancers. We investigated the expression of p27Kip1 in gastric cancer in order to estimate its clinical utility. METHODS: Immunohistochemical assay for p27Kip1 protein was performed in 64 patients with primary gastric cancer. The correlation between p27Kip1 and clinical-biological parameters including patient survival was analyzed. RESULTS: p27Kip1 expression was suppressed in 40 (62.5%) of 64 gastric cancer patients. Expression of p27Kip1 was significantly reduced in poorly differentiated cancers (82.1%, 23/28; P=0.015) and was also reduced in tumors with a high S-phase fraction as compared with tumors showing a low S-phase fraction (86.7%, 26/30, 41.2%, 14/34; P=0.0002). In univariate analysis, the extent of the disease (P<0.001), and reduced expression of p27Kip1 (P=0.0006) were statistically significant to predict the patient's outcome, however depth of invasion (P=0.008) and pathologic stage (P=0.009) emerged as significant prognostic indicators in the multivariate analysis. CONCLUSION: The expression of p27Kip1 is closely linked with cell proliferation and differentiation of human gastric cancer. p27Kip1 appears to have potential as a prognostic marker in the management of gastric cancer patients.

Safety and Effect of the Perigastric Devascularization with Transection of Esophagus for Treatment of Esophageal Varices

PURPOSE: There are a variety of approaches to the treatment of esophageal varix. This study evaluates the value of perigastric devascularization with transection of the esophagus, a non-shunt operation, for the management of bleeding esophageal varices. METHODS: We retrospectively analyzed the medical records of 16 patients with esophageal varix bleeding who had undergone perigastric devascularization with transection of the esophagus from 1990 through 2000. RESULTS: The mean age of the patients was 40.8 years and the most common underlying pathology was viral hepatitis. All patients had a history of previous variceal bleeding. Elective and prophylactic surgery was done in 8 and 5 patients respectively, and emergency surgery in 3 patients. One patient in Child group C and underwent emergency surgery, died after operation (mortality rate 6.3%). In the remaining 15 patients, two patients died of hepatocellular carcinoma. None of the patients demonstrated rebleeding or recurrence of the varix in the follow-up period. In 8 patients, the liver function, as measured by Child-Pugh classification, was improved following surgery as compared with measurements at the time of admission. CONCLUSION: According to this study, in spite of the small number of patients, we suggest that perigastric devascularization with transection of the esophagus is a very safe and effective treatment modality for esophageal varix bleeding, particularly if it can be done for an elective or prophylactic purpose. Furthermore, we propose that the operation should be carried out in an elective rather than in emergency manner following the improvement of liver function by non- invasive medical treatment.