Laparoscopy-assisted distal gastrectomy for gastric cancer after liver transplantation

A case report described a 72-year-old man with a history of a deceased-donor liver transplantation (due to hepatitis B-associated end-stage liver cirrhosis) performed in 1994. The patient was diagnosed with renal cell carcinoma and pulmonary metastasis in 1997 and was successfully treated with radiofrequency ablation and thoracoscopic superior segmentectomy. There was no evidence of newly diagnosed metastatic lesions or recurrence until the 19th post-operative month. Gastric cancer was identified by endoscopy during a routine follow-up examination; the pre-pyloric antral lesion measured 1.5 cm in size and was histologically well-differentiated and confined to the submucosal layers on endoscopic ultrasound. Laparoscopic gastrectomy and lymph node dissection (D1 + β) was successfully performed in March 2009, and the patient was discharged on the 5th post-operative day without complications. This suggests that laparoscopic surgery is one of the feasible methods for resection of gastric cancer in liver transplant patients

Overexpression of p53, Mutation of hMLH1 and Microsatellite Instability in Gastric Carcinomas: Clinicopathologic Implications and Prognosis

Purpose: Mutated p53 is a tumor suppressor gene, hMLH1 is a mismatch repair gene, and hypermethylation of hMLH1 follows microsatellite instability (MSI). This research`s aim is to investigate mutated p53, inactivated hMLH1 and MSI in gastric cancer and their clinicopathologic implications. Methods: Between 2003 and 2007, 618 patients underwent curative radical gastrectomy for gastric cancer at Seoul National University Bundang Hospital in Korea. We reviewed their medical charts and the pathologic reports with immunohistochemistry for p53, hMLH1 and polymerase chain reaction for MSI in 509, 499, and 561 cases, respectively. These genetic markers were statistically compared with clinicopathologic features and postoperative survival. Results: The expression ratios of mutated p53, inactivated hMLH1, and MSI were 32.8%, 8.4%, and 8.7%, respectively. Mutation of p53 occurred more frequently in aged group (over 40), differentiated group (against the non-differentiated group), intestinal type, infiltrative type and positive lymph node metastasis group. Inactivated hMLH1 occurred more frequently in aged group, differentiated group, intestinal type and expanding growth type group. MSI was found more frequently in aged group, intestinal type and expanding growth type group. All three genetic markers had no significant associations with the 5-year survival. Conclusion: We identified significant relationships between mutated p53, inactivated hMLH1, and MSI with some clinicopathologic features of gastric cancer. However, there were no apparent relationships between p53, hMLH1, and MSI and prognosis.KU KB, 2007, J KOREAN SURG SOC, V72, P283WOERNER SM, 2006, CANCER BIOMARK, V2, P69LIU P, 2005, WORLD J GASTROENTERO, V11, P4904Lee HS, 2002, MODERN PATHOL, V15, P632Nakajima T, 2001, INT J CANCER, V94, P208Samowitz WS, 2001, AM J PATHOL, V158, P1517Rugge M, 2000, J CLIN PATHOL-MOL PA, V53, P207Wu MS, 2000, GENE CHROMOSOME CANC, V27, P403OH SH, 2000, J KOREAN SURG SOC, V59, P206Fleisher AS, 1999, CANCER RES, V59, P1090Leung SY, 1999, CANCER RES, V59, P159Monig SP, 1997, DIGEST DIS SCI, V42, P2463Thibodeau SN, 1996, CANCER RES, V56, P4836Starzynska T, 1996, CANCER, V77, P2005DosSantos NR, 1996, GASTROENTEROLOGY, V110, P38Peddanna N, 1995, ANTICANCER RES, V15, P2055TAMURA G, 1995, CANCER RES, V55, P1933SERUCA R, 1995, INT J CANCER, V64, P32CORREA P, 1994, CANCER RES, V54, pS1941BODMER W, 1994, NAT GENET, V6, P217RHYU MG, 1994, ONCOGENE, V9, P29UCHINO S, 1993, INT J CANCER, V54, P759TAHARA E, 1993, J CANCER RES CLIN, V119, P265CORREA P, 1992, CANCER RES, V52, P6735MARTIN HM, 1992, INT J CANCER, V50, P859HOLLSTEIN MC, 1991, CANCER RES, V51, P4102YONISHROUACH E, 1991, NATURE, V352, P345HARRIS AL, 1990, J PATHOL, V162, P5

Risk Factors for Operative Complications in Elderly Patients During Laparoscopy-Assisted Gastrectomy

BACKGROUND: We evaluated the feasibility of laparoscopy-assisted gastrectomy in elderly patients with gastric cancer. STUDY DESIGN: We performed a retrospective analysis of 632 patients who underwent laparoscopy-assisted gastrectomy from May 2003 to December 2007 at Seoul National University Bundang Hospital. Postoperative complication rates were compared between patients older and younger than 70 years of age. RESULTS: Of the 632 patients, 515 (81.5%) were younger than 70 years and 117 (18.5%) were aged 70 years or older. Significant differences in the prevalence of cardiovascular disease and hypertension were observed in patients older than 70 years (p < 0.05). Although the overall complication rates of the patients younger and older than 70 years were 12.6% and 17.9%, respectively, there was no statistically significant difference between groups (p = 0.12). Multiple logistic regression analysis revealed that comorbidities with hypertension or with liver cirrhosis were the only variables that correlated independently with postoperative complications. CONCLUSIONS: Complications after laparoscopy-assisted gastrectomy for patients older than 70 years of age with gastric cancer were similar to those of younger patients. But a careful approach is required when patients older than 70 years of age have hypertension or liver cirrhosis. (J Am Coll Surg 2009;208:186-192. (C) 2009 by the American College of Surgeons)Tokunaga M, 2008, J GASTROINTEST SURG, V12, P1502, DOI 10.1007/s11605-008-0567-yMemon MA, 2008, SURG ENDOSC, V22, P1781, DOI 10.1007/s00464-008-9925-9Lee WJ, 2008, SURG LAPARO ENDO PER, V18, P369Fujiwara M, 2008, J AM COLL SURGEONS, V206, P138, DOI 10.1016/j.jamcollsurg.2007.07.013Alves A, 2007, ANN SURG, V246, P91, DOI 10.1097/SLA.0b013e3180602ff5Kim MC, 2007, DIGEST DIS SCI, V52, P543, DOI 10.1007/s10620-006-9317-8Gretschel S, 2006, WORLD J SURG, V30, P1468, DOI 10.1007/s00268-005-0633-5Lee SI, 2006, J AM COLL SURGEONS, V202, P874, DOI 10.1016/j.jamcollsurg.2006.02.028Kunisaki C, 2006, AM J SURG, V191, P216, DOI 10.1016/j.amjsurg.2005.09.001Kunisaki C, 2006, J GASTROINTEST SURG, V10, P132, DOI 10.1016/j.gassur.2005.04.015Otsuji E, 2005, J SURG ONCOL, V91, P232, DOI 10.1002/jso.20330Alves A, 2005, ARCH SURG-CHICAGO, V140, P278Katai H, 2004, SURG ONCOL, V13, P235, DOI 10.1016/j.suronc.2004.09.007Yasuda K, 2004, BRIT J SURG, V91, P1061, DOI 10.1002/bjs.4615Guller U, 2004, SURGERY, V135, P479, DOI 10.1016/j.surg.2003.12.007LEE HJ, 2002, GASTRIC CANCER, V5, P177Tsugawa K, 2001, HEPATO-GASTROENTEROL, V48, P156Adachi Y, 2000, ARCH SURG-CHICAGO, V135, P806Stewart BT, 1999, BRIT J SURG, V86, P938Kitamura K, 1999, HEPATO-GASTROENTEROL, V46, P2074Lujan JA, 1998, SURG LAPAROSC ENDOSC, V8, P2081998, GASTRIC CANC, V1, P10Bittner R, 1996, ANN SURG, V224, P37WU CW, 1995, J AM COLL SURGEONS, V181, P26DAMHUIS RAM, 1995, EUR J CANCER, V31A, P928CLAVIEN PA, 1994, ANN SURG, V220, P109KITANO S, 1994, SURG LAPAROSC ENDOSC, V4, P146PACELLI F, 1991, AM SURGEON, V57, P341HABU H, 1989, HEPATO-GASTROENTEROL, V36, P711

A multi-center prospective randomized controlled trial (phase III) comparing the quality of life between laparoscopy-assisted distal gastrectomy and totally laparoscopic distal gastrectomy for gastric Cancer (study protocol)

Abstract Background KLASS (the Korean Laparoendoscopic Gastrointestinal Surgery Study) is a time-honored study group that has established laparoscopic surgery for gastrointestinal disease in Korea and has performed some important studies for the rationale of laparoscopic gastrointestinal surgery. A multi-center RCT (randomized controlled trial) to compare the quality of life (QOL) of patients undergoing totally laparoscopic distal gastrectomy (TLDG) and laparoscopy-assisted distal gastrectomy (LADG) for gastric cancer, named as KLASS 07, has been currently prepared in Korea. Methods Patients diagnosed as gastric cancer, with clinical stage IA (T1N0M0) or IB (T1N1M0 / T2N0M0) according to the 7th edition of the Americal Joint Committee on Cancer System, were randomized to receive either TLDG or LADG. For surgical quality control, the surgeons participating in this trial had to have performed at least 50 gastrectomies and at least 30 gastrectomies annually (regardless of open or laparoscopic surgery for gastric cancer). The patients who are allocated to TLDG group undergo intracorporeal anastomosis and those who are assigned to LADG undergo extracorporeal anastomosis for gastrointestinal reconstruction. Discussion Thirty-one surgeons from 26 institutions were engaged in this trial. The primary endpoint is 30-day morbidity, and secondary endpoint is QOL assessed by the questionnaire score. The KLASS 07 trial is the first multi-center RCT to investigate whether there are significant and quantifiable differences between the QOL of TLDG and LADG. The findings from this trial are expected to be the critical clues for designing the detailed procedures during laparoscopic surgery for gastric cancer. Trial registration The protocol of KLASS 07 (CKLASS 01) was registered in http://register.clinicaltrials.gov as NCT03393182 (Date of registration: January 2nd, 2018.)