Totally Laparoscopic Roux-en-Y Gastrojejunostomy after Laparoscopic Distal Gastrectomy: Analysis of Initial 50 Consecutive Cases of Single Surgeon in Comparison with Totally Laparoscopic Billroth I Reconstruction

PURPOSE: Roux-en-Y reconstruction (RY) in laparoscopic distal gastrectomy for gastric cancer is a more complicated procedure than Billroth-I (BI) or Billroth-II. Here, we offer a totally laparoscopic simple RY using linear staplers. MATERIALS AND METHODS: Each 50 consecutive patients with totally laparoscopic distal gastrectomy with RY and BI were enrolled in this study. Technical safety and surgical outcomes of RY were evaluated in comparison with BI. RESULTS: In all patients, RY gastrectomy using linear staplers was safely performed without any events during surgery. The mean operation time and anastomosis time were 177.0±37.6 min and 14.4±5.6 min for RY, respectively, which were significantly longer than those for BI (150.4±34.0 min and 5.9±2.2 min, respectively). There were no differences in amount of blood loss, time to flatus passage, diet start, length of hospital stay, and postoperative inflammatory response between the two groups. Although there was no significant difference in surgical complications between RY and BI (6.0% and 14.0%), the RY group showed no anastomosis site-related complications. CONCLUSION: The double stapling method using linear staplers in totally laparoscopic RY reconstruction is a simple and safe procedure.ope

The Assessment of the Oncological Safety Margin of Insufficient Lymph Node Dissection in pT2 (pm) Gastric Cancer

PURPOSE: To identify the effect of insufficient lymph node dissection (LND) on the survival of patients with pT2 gastric cancer. MATERIALS AND METHODS: A total of 340 patients (120 patients with insufficient LND and others with D2 LND) who underwent gastrectomy for pT2 gastric cancer between January 2008 and December 2010 were included. RESULTS: The incidence of preoperatively diagnosed early gastric cancer was higher and there were fewer metastatic lymph nodes (LNs) in the insufficient LND group than the D2 group, but there was no survival difference between two groups (p=0.365). Among the 89 patients with metastatic LNs after D2 LND, 13 patients (14.6%) had metastatic LNs at selected N2 stations (#10, 11, or 12a), but none of these patients were in the pN1 category. One patient had five metastatic LNs at station #11p with no metastatic LNs at any other stations. The number of metastatic LNs was identified as the only risk factor for LN metastasis at selected N2 stations by logistic regression. CONCLUSION: If a patient has pN0 or pN1 category after insufficient LND for pT2 gastric cancer, the surgery can be regarded as secure. However, for patients with pN2 or pN3 category, more careful examination is required.ope

Circumference of 《L'Education Sentimentale》

In this thesis based on 《L' Education Sentimentale》 by Gustave Flaubert, I attempt to give full recolonization and correct evaluation to readers about 'his work through the process of production and the echos after publication. For my aim, I collected many materials and arranged them by order. Comparing Flaubert's letters with the·contemporary criticisms on him, I investigated those problems which 《L' Education Sentimentale》presents to modern readers. My thesis is divided into three parts. In the first part, I deal with how 《L' Education Sentimentale》was planned. In the second part. I study how the plans are produced, accomplished and published. In the third part, I consider the echos after publication. Also, I study and describe in full all things of circumstance surroundings《L' Education Sentimentale》with tho help of criticisms in newspapers and magazines during his time. Thus, I present problems about super-realism, existentialism and anti-roman. From this Point of view I present Flaubert as an object of studies. From all this studies, I "have established accurate and concrete point of view about Flaubert's 《L' Education Sentimentale》.목차 = 0 영문초록 = 0 Ⅰ. 서론 = 1 Ⅱ. 본론 = 4 1. 《L'Education Sentimentale》의 구상 = 4 2. 《L'Education Sentimentale》의 제작과정 = 14 1) 《L'Education Sentimentale》이 탈고될 때까지의 Flaubert의 주변 = 14 2) 《L'Education Sentimentale》의 완성에서 발표에 이르는 과정 = 21 3. 《L'Education Sentimentale》 發表後의 반향 = 32 Ⅲ. 결론 = 68 주 = 72 참고문헌 = 7

Impact of early positive culture results on the short-term outcomes of liver transplants

의학과/석사이식 초기의 감염은 간이식의 초기 성적을 결정하는 주요한 인자이다. 본 연구에서는 간이식 직후 조기에 발생하는 감염과 그러한 감염으로 인한 조기 사망 환자들의 특성을 비교, 분석함으로써 간이식 후 초기 감염발생과 그로 인한 사망의 위험인자를 분석하고자 하였다. 2005년 9월 1일부터 2010년 8월 31일까지 본원에서 간이식을 시행 받은 환자 219예의 간이식을 대상으로 후향적 연구를 진행하였다. 배양 결과가 음성인 환자 군을 배양음성군, 배양 결과가 양성이나 간이식 후 1개월 이후까지 생존한 환자 군을 배양양성/생존군, 배양 결과 양성이면서 간이식 후 1개월 이내에 사망한 환자 군을 배양양성/사망군으로 분류하였다. 감염양성/사망군에서 MELD 점수가 더 높았고, 뇌사자 전간이식, 이식수술 전 감염, 중환자실 입실의 경우가 더 많았으며 이식 이후 지속적 신 대체요법을 시행한 경우가 유의하게 많았다. 다변량 분석 결과 이식 전 중환자실에 재원하였던 경우(HR=16.3, CI=2.6-102.3, P=0.003)와 이식 후 7일 이내 조기 배양 결과 양성이었던 경우 (HR=38.7, CI=4.1-368.8, P=0.001)가 이식 후 1개월 이내 감염으로 인한 사망의 독립적인 위험인자로 분석되었다. 따라서, 술전 중환자실 입실 경력과 이식 후 1주 이내의 균배양 양성결과는 이식 후 1개월 이내의 사망과 연관된 예후를 예측할 수 있는 의미 있는 위험인자로서 그 가치가 있다고 하겠다.ope

Intracorporeal esophagojejunostomy using a circular stapler with a new purse-string suture technique during laparoscopic total gastrectomy

ope

METHOD FOR SUPER-RESOLUTION 3D MULTIPLEXED IMAGING WITH HIGH ACCURACY IMAGE REGISTRATION VIA DENSE LABELING OF SPECIMEN

다양한 실시예들은 밀집 염색을 매개로 한 3차원 이미지 정합 및 이를 이용한 초고해상도 멀티 마커 동시 이미징 방법에 관한 것으로, 밀집 염색을 통해, 생체 조직의 내부 구조에 적어도 하나의 기점 마커를 설정하고, 기점 마커가 설정된 생체 조직 내 적어도 하나의 표적 분자에 부착되는 형광 표지를 교체하면서 생체 조직을 반복적으로 이미징하여, 복수의 이미지들을 획득하고, 기점 마커를 기준으로 상기 이미지들을 정합하여, 표적 분자에 대한 최종 이미지를 획득하도록 구성된다

Minimally invasive surgery as a treatment option for gastric cancer in the elderly: comparison with open surgery for patients 80 years and older

BACKGROUND: As life expectancy is increasing, the use of minimally invasive surgery (MIS) in the elderly is gaining interest. The aim of this study was to identify the impact of minimally invasive gastrectomy by comparing the procedure to open surgery in octogenarians. In addition, we also evaluated the role of gastrectomy in elderly gastric cancer patients by assessing long-term outcomes. METHODS: We retrospectively analyzed data from 99 gastric cancer patients aged 80 years or older, who underwent gastrectomy by either MIS or open surgery from 2005 to 2010. Patient characteristics, operative outcomes, pathologic results, morbidity, mortality, and follow-up data (including survival) were compared. RESULTS: Thirty patients underwent gastrectomy with MIS (19 laparoscopic and 11 robotic) and 69 patients underwent open gastrectomy. MIS demonstrated significantly less blood loss, lower analgesic consumption, faster time to first flatus and soft diet, and a shorter post-operative hospital stay. Multivariate analysis revealed that the type of operation had no effect on the occurrence of complications. There were two postoperative mortalities, both in the open group. Excluding these patients, the overall and disease-specific 5-year survival rates were 57.4 and 70.0 %, respectively. The overall (MIS 70.0 %; open 52.0 %) and disease-specific (MIS 81.8 %; open 65.1 %) 5-year survival rates were similar for the two groups. When we analyzed the 85 patients underwent curative resection only, the overall (MIS 71.4 %; open 58.4 %) and disease-specific (MIS 84.1 %; open 73.6 %) 5-year survival rates were similar for the two groups. CONCLUSIONS: MIS for gastric cancer may be performed safely and maintains the advantages of minimal invasiveness, even in extremely old patients. Furthermore, gastrectomy by either by MIS or open surgery can reduce gastric cancer-related deaths, even in patients 80 years or older.ope

Comparison of perioperative surgical outcomes between a bipolar device and an ultrasonic device during laparoscopic gastrectomy for gastric cancer

BACKGROUND: The use of energy devices during laparoscopic gastrectomy for gastric cancer has increased as the frequency of laparoscopic surgery has increased. Our aim was to compare the perioperative surgical outcomes between using a bipolar device and an ultrasonic device during laparoscopic gastrectomy. METHODS: Retrospective review of a prospectively maintained database identified 186 patients who underwent laparoscopic gastrectomy performed by a single surgeon between November 2010 and August 2013. A bipolar device was used for 116 patients, and an ultrasonic device was used for 70 patients. Patient characteristics and perioperative surgical outcomes were compared between groups. RESULTS: Clinicopathologic characteristics were similar for both groups. The bipolar group had a significantly shorter operation time (154.9 vs. 167.8 min, p = 0.028) and higher rate of D2 lymph node dissection (29.3 vs. 15.7 %, p = 0.012). The bipolar device group experienced significantly less pain at 12 h [visual analog scale (VAS) pain score: 3.9 vs. 4.7, p = 0.027) and 18 h (VAS pain score: 3.5 vs. 4.1, p = 0.036) postoperatively. The bipolar group had earlier abdominal drain removal (p = 0.001) and a shorter hospital stay (p = 0.024). No significant differences in laboratory value changes, morbidity, or mortality were observed between the groups. CONCLUSION: Compared with the ultrasonic device, the bipolar device provided advantages in operation time, degree of postoperative pain, time of drain removal, and length of hospital stay. The bipolar device may be a useful and efficient energy device for laparoscopic gastrectomy. However, larger studies to confirm the safety of bipolar device during laparoscopic gastrectomy are warranted.ope

Risk factors for double primary malignancies and their clinical implications in patients with sporadic gastric cancer

AIMS: We carried out a large scale study to identify the risk factors for double primary malignancy (DPM) development in gastric cancer patients and to evaluate the clinical implications for these patients. METHODS: A total of 2593 patients who underwent gastrectomy for primary gastric cancer from January 2005 to November 2010 were reviewed with regard to DPM. We compared the clinicopathological characteristics, risk factors for developing DPM, and prognosis between the DPM+ group and the DPM- group. RESULTS: Of the 2593 patients, 152 (5.9%) were diagnosed with DPM. The most common accompanying malignancies were colorectal, lung and thyroid. Multivariate analysis indicated that age (p = 0.016) and MSI status (p = 0.002) were associated with a higher frequency of DPM. 30.3% of patients were diagnosed with DPM within 1 year around perioperative period and 53.3% of patients had DPM detected during 5 years of post-operative follow up periods. Although there was no significant difference in overall survival between the DPM+ and DPM- group, DPM+ patients had a worse prognosis than DPM- patients in stage I gastric cancer. CONCLUSIONS: Gastric cancer patients over the age of 60 or with a MSI-high status had an increased risk for developing DPM. Further, in stage I gastric cancer, the presence of DPM was associated with a worse prognosis. Therefore, careful pre- and postoperative surveillance is especially important in these patients.ope

Comparing the short-term outcomes of totally intracorporeal gastroduodenostomy with extracorporeal gastroduodenostomy after laparoscopic distal gastrectomy for gastric cancer: a single surgeon’s experience and a rapid systematic review with meta-analysis

BACKGROUND: Since delta-shaped gastroduodenostomy was introduced, many surgeons have utilized laparoscopic distal gastrectomy (LDG) with totally intracorporeal Billroth I (ICBI) for gastric cancer, because it is expected to have several advantages over laparoscopic-assisted distal gastrectomy with extracorporeal Billroth I (ECBI). In this study, we compared these two reconstruction options to evaluate their outcomes. METHODS: The data of 166 gastric cancer patients who underwent LDG performed by a single surgeon between April 2009 and February 2012 were analyzed retrospectively. The subjects were divided into ECBI (n = 106) and ICBI (n = 60) groups, and then the clinical characteristics, surgical outcomes, symptoms, and change in BMI at 3 months after surgery were compared. Furthermore, a rapid systematic review and meta-analysis were conducted. RESULTS: The operative time was significantly shorter in the ICBI group (197.4 ± 45.5 vs. 157.1 ± 43.9 min), but blood loss was similar between the groups. Regarding surgical outcomes, there were no significant differences in the length of hospital stay, soft diet initiation, visual analogue scale, frequency of analgesics injection, and postoperative white blood cell counts and C-reactive protein levels between the groups. The surgical complication rates were 5.7 and 13.3% in the ECBI and ICBI groups, respectively, and one case of anastomosis leakage was observed in each group. At 3 months after surgery, reflux symptoms were more frequent in the ICBI group, but other gastrointestinal symptoms and the change of BMI were similar between the groups. The meta-analysis revealed no significant differences in the operative time, time to first flatus, length of hospital stay, frequency of analgesic usages, and rates of anastomosis complications between the groups. CONCLUSIONS: We could not demonstrate the clinical superiority of ICBI over ECBI based on our data and a rapid systematic review and meta-analysis. The anastomosis method may be selected according to patient conditions and the surgeon's preference.ope