Serial Comparisons of Quality of Life after Distal Subtotal or Total Gastrectomy: What Are the Rational Approaches for Quality of Life Management?

박수진,이승수,권오경,유완식,정호영 대한위암학회 2014 Journal of gastric cancer Vol.14 No.1

Purpose: The aims of this study were to make serial comparisons of the quality of life (QoL) between patients who underwent total gastrectomy and those who underwent distal subtotal gastrectomy for gastric cancer and to identify the affected scales with consistency. Materials and Methods: QoL data of 275 patients who were admitted for surgery between September 2008 and June 2011 and who underwent subtotal gastrectomy or total gastrectomy were obtained preoperatively and postoperatively at 3, 6, 9, 12, 18, and 24 months. The Korean versions of the European Organization for Research and Treatment (EORTC) Quality of Life Questionnaire Core 30 (QLQ-C30) and the gastric cancer specific module, the EORTC QLQ-STO22, were used to assess QoL. Results: QoL, as assessed by the global health status/QoL and physical functioning, revealed a brief divergence with worse QoL in the total gastrectomy group 3 months postoperatively, followed by rapid convergence. QoL related to restrictive symptoms (nausea/vomiting, dysphagia, reflux, and eating restrictions) and dry mouth was consistently worse in the total gastrectomy group during the first 2 postoperative years. Conclusions: The general QoL of patients after gastrectomy is highly congruent with subjective physical functioning, and the differences between patients who undergo total gastrectomy and subtotal gastrectomy are no longer valid several months after surgery. In order to further reduce the differences in QoL between patients who underwent total gastrectomy and subtotal gastrectomy, definitive preoperative informing, followed by postoperative symptomatic management, of restrictive symptoms in total gastrectomy patients is the most rational approach.

Serial Comparisons of Quality of Life after Distal Subtotal or Total Gastrectomy: What Are the Rational Approaches for Quality of Life Management?

Park, Sujin,Chung, Ho Young,Lee, Seung Soo,Kwon, Ohkyoung,Yu, Wansik The Korean Gastric Cancer Association 2014 Journal of gastric cancer Vol.14 No.1

Purpose: The aims of this study were to make serial comparisons of the quality of life (QoL) between patients who underwent total gastrectomy and those who underwent distal subtotal gastrectomy for gastric cancer and to identify the affected scales with consistency. Materials and Methods: QoL data of 275 patients who were admitted for surgery between September 2008 and June 2011 and who underwent subtotal gastrectomy or total gastrectomy were obtained preoperatively and postoperatively at 3, 6, 9, 12, 18, and 24 months. The Korean versions of the European Organization for Research and Treatment (EORTC) Quality of Life Questionnaire Core 30 (QLQ-C30) and the gastric cancer specific module, the EORTC QLQ-STO22, were used to assess QoL. Results: QoL, as assessed by the global health status/QoL and physical functioning, revealed a brief divergence with worse QoL in the total gastrectomy group 3 months postoperatively, followed by rapid convergence. QoL related to restrictive symptoms (nausea/vomiting, dysphagia, reflux, and eating restrictions) and dry mouth was consistently worse in the total gastrectomy group during the first 2 postoperative years. Conclusions: The general QoL of patients after gastrectomy is highly congruent with subjective physical functioning, and the differences between patients who undergo total gastrectomy and subtotal gastrectomy are no longer valid several months after surgery. In order to further reduce the differences in QoL between patients who underwent total gastrectomy and subtotal gastrectomy, definitive preoperative informing, followed by postoperative symptomatic management, of restrictive symptoms in total gastrectomy patients is the most rational approach.

만성 폐쇄성 폐질환을 동반한 위암 환자에서의 복강경 위 절제술

김종진,박도중,이혁준,김형호,양한광,이문수,이주희 대한내시경복강경외과학회 2009 Journal of Minimally Invasive Surgery Vol.12 No.2

Purpose: The aim of this study was to evaluate the safety of laparoscopic gastrectomy for gastric cancer patients with chronic obstructive pulmonary disease (COPD). Methods: The medical records of 863 patients who underwent gastrectomy for gastric cancer from January 2007 to December 2008 at Seoul National University Bundang Hospital were retrospectively reviewed. One hundred forty five patients with COPD were divided into the laparoscopic gastrectomy or open gastrectomy groups. The 362 patients who underwent laparoscopic gastrectomy were divided into the COPD or the non-CODP groups. Comparative analysis between each of the two groups was done. Results: Out of 145 patients with COPD, eighty seven patients (60.0%) underwent laparoscopic gastrectomy and 58 patients (40.0%) underwent open gastrectomy. Comparing the laparoscopic gastrectomy group with the open gastrectomy group, there was no significant differences in age, gender, the body mass index, the smoking history, the preoperative general condition, the operation time, the estimated blood loss and the preoperative pulmonary function tests (p>0.05). The postoperative hospital stay was longer in the open gastrectomy group than that in the laparoscopic gastrectomy group (9.1 days vs. 6.8 days, respectively, p<0.001). One patient in the laparoscopic gastrectomy group (1/87, 1.1%) had postoperative pulmonary complications and 6 patients in the open gastrectomy group (6/58, 10.3%) had pulmonary complications (p=0.017). On comparing the COPD with the non-COPD groups for the 363 patients who underwent laparoscopic gastrectomy, there were significant differences in gender, age, a history of tuberculosis, a smoking history, the American Society of Anesthesiologists (ASA) class and the cancer stage. Yet there was no significant difference of the postoperative pulmonary complications (p=1.000) between the groups. Conclusion: Laparoscopic gastrectomy can be performed safety for gastric cancer patients with mild COPD and it should be considered as a primary treatment method.

Incidence of gallstones after gastric resection for gastric cancer

Gi Hyeon Seo,Chang-Sup Lim,Young Jun Chai 대한외과학회 2018 Annals of Surgical Treatment and Research(ASRT) Vol.95 No.2

Purpose: Gallstone formation is one of the most common problems after gastrectomy. This retrospective cohort study used the South Korean nationwide claims database to evaluate the incidence and risk factors of gallstone after gastrectomy for gastric cancer. Methods: All consecutive patients who underwent gastrectomy for gastric cancer in South Korea in 2008-2010 were identified. Incidence of gallstone formation 5 years after gastrectomy in males and females, in various age groups, and after different types of gastrectomy was determined. Multivariate logistic regression analysis served to identify gallstone risk factors. Results: Of the 47,752 patients, 2,506 (5.2%) developed gallstone during the 5-year follow-up period. At 12, 24, 36, and 48 months, the cumulative incidences were 1.2%, 2.2%, 3.3%, and 4.3%, respectively. Males had a higher incidence than females (5.8% vs. 4.1%, P < 0.001). Older patients (60-89 years) had a higher incidence than younger patients (30-59 years) (6.1% vs. 4.3%, P < 0.001). Gallstone was most common after total gastrectomy (6.6%), followed by proximal gastrectomy (5.4%), distal gastrectomy (4.8%), and pylorus-preserving distal gastrectomy (4.0%) (P < 0.001). Multivariate analysis showed that male sex (odds ratio [OR], 1.39), an older age (OR, 1.44), and total gastrectomy (OR, 1.40 vs. distal gastrectomy) were significant independent risk factors for postgastrectomy gallstone. Conclusion: The cumulative incidence of gallstone 5 years after gastrectomy for gastric cancer was 5.2%. Male sex, an older age, and total gastrectomy were significant risk factors. More careful monitoring for gallstone may be necessary in patients with such risk factors.

Tuberculosis and gastrectomy : A Nationwide Population-based Matched Cohort Study

정원재,최수인,김병근,이은주,이상엽,인광호 대한결핵 및 호흡기학회 2018 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.126 No.-

The objective of this study was to examine the incidence and risk of tuberculosis in patients who underwent gastrectomy. This population-based matched cohort study was conducted to analyze the sample database of the National Health Insurance Coporation. There were 2223 subjects with having gasgtrectomy as the gastrectomy group between 2008 and 2012, and 8892 randomly selected subjects without gastrectomy as the non-gastrectomy group. Subjects with history of pulmonary tuberculosis or gastric cancer before the index date 1year were excluded. Both gastrectomy and non-gastrectomy groups were matched with sex, age, Diabetes, end stage renal disease, transplantation, Chronic obstructive pulmonary disease and pneumoconiosis. The incidence of tuberculosis was assessed in both groups. The multivariable Cox proportional hazards regression model was used to assess the hazard ratio and 95% confidence interval for risk of tuberculosis associated with gastrectomy. The overall incidence of tuberculosis was 1.11-fold greater in the gastrectomy group than that in the non-gastrectomy group. After adjusting for confounding factors, the adjusted hazard ratio of tuberculosis was 1.1 for the gastrectomy group, compared with the non-gastrectomy group, but it was not significant. Old age, chronic obstructive pulmonary disease, low economic status were other factors that could be related to pulmonary tuberculosis. Further study using census data will be required.

Robotic versus Laparoscopic versus Open Gastrectomy: A Meta-Analysis

Marano, Alessandra,Choi, Yoon Young,Hyung, Woo Jin,Kim, Yoo Min,Kim, Jieun,Noh, Sung Hoon The Korean Gastric Cancer Association 2013 Journal of gastric cancer Vol.13 No.3

Purpose: To define the role of robotic gastrectomy for the treatment of gastric cancer, the present systematic review with meta-analysis was performed. Materials and Methods: A comprehensive search up to July 2012 was conducted on PubMed, EMBASE, and the Cochrane Library. All eligible studies comparing robotic gastrectomy versus laparoscopic gastrectomy or open gastrectomy were included. Results: Included in our meta-analysis were seven studies of 1,967 patients that compared robotic (n=404) with open (n=718) or laparoscopic (n=845) gastrectomy. In the complete analysis, a shorter hospital stay was noted with robotic gastrectomy than with open gastrectomy (weighted mean difference: -2.92, 95% confidence interval: -4.94 to -0.89, P=0.005). Additionally, there was a significant reduction in intraoperative blood loss with robotic gastrectomy compared with laparoscopic gastrectomy (weighted mean difference: -35.53, 95% confidence interval: -66.98 to -4.09, P=0.03). These advantages were at the price of a significantly prolonged operative time for both robotic gastrectomy versus laparoscopic gastrectomy (weighted mean difference: 63.70, 95% confidence interval: 44.22 to 83.17, P<0.00001) and robotic gastrectomy versus open gastrectomy (weighted mean difference: 95.83, 95% confidence interval: 54.48 to 137.18, P<0.00001). Analysis of the number of lymph nodes retrieved and overall complication rates revealed that these outcomes did not differ significantly between the groups. Conclusions: Robotic gastrectomy for gastric cancer reduces intraoperative blood loss and the postoperative hospital length of stay compared with laparoscopic gastrectomy and open gastrectomy at a cost of a longer operating time. Robotic gastrectomy also provides an oncologically adequate lymphadenectomy. Additional high-quality prospective studies are recommended to better evaluate both short and long-term outcomes.

Comparison of Laparoscopy-Assisted and Totally Laparoscopic Distal Gastrectomy: The Short-Term Outcome at a Low Volume Center

Choi, Byung Seo,Oh, Heung-Kwon,Park, Sei Hyeog,Park, Jong-Min The Korean Gastric Cancer Association 2013 Journal of gastric cancer Vol.13 No.1

Purpose: Laparoscopic gastrectomy has been adopted for the treatment of gastric cancer, and despite the technical difficulties, totally laparoscopic distal gastrectomy has been considered less invasive than laparoscopy-assisted distal gastrectomy. Although there have been many reports regarding the feasibility and safety of totally laparoscopic distal gastrectomy at large volume centers, few reports have been conducted at low-volume centers. The purpose of this study is to try to assess the feasibility and safety of totally laparoscopic distal gastrectomy at a low volume center through the analysis of short-term outcomes of totally laparoscopic distal gastrectomy compared with laparoscopy-assisted distal gastrectomy. Materials and Methods: The clinical data and short-term surgical outcomes of 35 patients who had undergone laparoscopy-assisted distal gastrectomy between April 2007 and March 2010, and 37 patients who underwent totally laparoscopic distal gastrectomy between April 2010 and August 2012 were retrospectively reviewed. Results: There was no significant difference in the demographic and clinical data. However the reconstruction method and extent of lymphadenectomy showed statistically significant differences. Operation time and estimated blood loss did not show significant differences. Surgical and medical complications did not show significant differences but postoperative courses including time-to-first oral intake and postoperative hospital stay were significantly increased. Conclusions: Our study shows that totally laparoscopic distal gastrectomy is technically feasible at a low volume center. Therefore, totally laparoscopic distal gastrectomy can be considered as one of the surgical treatment for early gastric cancer. However the possibility that totally laparoscopic distal gastrectomy may have less benefit should also be considered.

Comparison of Laparoscopy-Assisted and Totally Laparoscopic Distal Gastrectomy: The Short-Term Outcome at a Low Volume Center

최병서,오흥권,Sei Hyeog Park,박중민 대한위암학회 2013 Journal of gastric cancer Vol.13 No.1

Purpose: Laparoscopic gastrectomy has been adopted for the treatment of gastric cancer, and despite the technical difficulties, totally laparoscopic distal gastrectomy has been considered less invasive than laparoscopy-assisted distal gastrectomy. Although there have been many reports regarding the feasibility and safety of totally laparoscopic distal gastrectomy at large volume centers, few reports have been conducted at low-volume centers. The purpose of this study is to try to assess the feasibility and safety of totally laparoscopic distal gastrectomy at a low volume center through the analysis of short-term outcomes of totally laparoscopic distal gastrectomy compared with laparoscopy-assisted distal gastrectomy. Materials and Methods: The clinical data and short-term surgical outcomes of 35 patients who had undergone laparoscopy-assisted distal gastrectomy between April 2007 and March 2010, and 37 patients who underwent totally laparoscopic distal gastrectomy between April 2010 and August 2012 were retrospectively reviewed. Results: There was no significant difference in the demographic and clinical data. However the reconstruction method and extent of lymphadenectomy showed statistically significant differences. Operation time and estimated blood loss did not show significant differences. Surgical and medical complications did not show significant differences but postoperative courses including time-to-first oral intake and postoperative hospital stay were significantly increased. Conclusions: Our study shows that totally laparoscopic distal gastrectomy is technically feasible at a low volume center. Therefore, totally laparoscopic distal gastrectomy can be considered as one of the surgical treatment for early gastric cancer. However the possibility that totally laparoscopic distal gastrectomy may have less benefit should also be considered.

Robotic versus Laparoscopic versus Open Gastrectomy: A Meta-Analysis

Alessandra Marano,형우진,최윤영,김유민,김지은,노성훈 대한위암학회 2013 Journal of gastric cancer Vol.13 No.3

Purpose: To define the role of robotic gastrectomy for the treatment of gastric cancer, the present systematic review with meta-analysis was performed. Materials and Methods: A comprehensive search up to July 2012 was conducted on PubMed, EMBASE, and the Cochrane Library. All eligible studies comparing robotic gastrectomy versus laparoscopic gastrectomy or open gastrectomy were included. Results: Included in our meta-analysis were seven studies of 1,967 patients that compared robotic (n=404) with open (n=718) or laparoscopic (n=845) gastrectomy. In the complete analysis, a shorter hospital stay was noted with robotic gastrectomy than with open gastrectomy (weighted mean difference: -2.92, 95% confidence interval: -4.94 to -0.89, P=0.005). Additionally, there was a significant reduction in intraoperative blood loss with robotic gastrectomy compared with laparoscopic gastrectomy (weighted mean difference:-35.53, 95% confidence interval: -66.98 to -4.09, P=0.03). These advantages were at the price of a significantly prolonged operative time for both robotic gastrectomy versus laparoscopic gastrectomy (weighted mean difference: 63.70, 95% confidence interval: 44.22to 83.17, P<0.00001) and robotic gastrectomy versus open gastrectomy (weighted mean difference: 95.83, 95% confidence interval:54.48 to 137.18, P<0.00001). Analysis of the number of lymph nodes retrieved and overall complication rates revealed that these outcomes did not differ significantly between the groups. Conclusions: Robotic gastrectomy for gastric cancer reduces intraoperative blood loss and the postoperative hospital length of stay compared with laparoscopic gastrectomy and open gastrectomy at a cost of a longer operating time. Robotic gastrectomy also provides an oncologically adequate lymphadenectomy. Additional high-quality prospective studies are recommended to better evaluate both short and long-term outcomes.

Effect of Previous Gastrectomy on the Performance of Postoperative Colonoscopy

김성환,최정민,김태한,공성호,서윤석,임종필,이혁준,김상균,정승용,김주성,양한광 대한위암학회 2016 Journal of gastric cancer Vol.16 No.3

Purpose: The purpose of this study was to determine the effect of a prior gastrectomy on the difficulty of subsequent colonoscopy, and to identify the surgical factors related to difficult colonoscopies. Materials and Methods: Patients with a prior gastrectomy who had undergone a colonoscopy between 2011 and 2014 (n=482) were matched (1:6) to patients with no history of gastrectomy (n=2,892). Cecal insertion time, intubation failure, and bowel clearance score were compared between the gastrectomy and control groups, as was a newly generated comprehensive parameter for a difficult/incomplete colonoscopy (cecal intubation failure, cecal insertion time >12.9 minutes, or very poor bowel preparation scale). Surgical factors including surgical approach, extent of gastrectomy, extent of lymph node dissection, and reconstruction type, were analyzed to identify risk factors for colonoscopy performance. Results: A history of gastrectomy was associated with prolonged cecal insertion time (8.7±6.4 vs. 9.7±6.5 minutes; P=0.002), an increased intubation failure rate (0.1% vs. 1.9%; P<0.001), and a poor bowel preparation rate (24.7 vs. 29.0; P=0.047). Age and total gastrectomy (vs. partial gastrectomy) were found to be independent risk factors for increased insertion time, which slowly increased throughout the postoperative duration (0.35 min/yr). Total gastrectomy was the only independent risk factor for the comprehensive parameter of difficult/incomplete colonoscopy. Conclusions: History of gastrectomy is related to difficult/incomplete colonoscopy performance, especially in cases of total gastrectomy. In any case, it may be that a pre-operative colonoscopy is desirable in selected patients scheduled for gastrectomy; however, it should be performed by an expert endoscopist each time.