The current status and future perspectives of laparoscopic surgery for gastric cancer

Hyung-Ho Kim,Sang-Hoon Ahn 대한외과학회 2011 Annals of Surgical Treatment and Research(ASRT) Vol.81 No.3

Gastric cancer is most common cancer in Korea. Surgery is still the main axis of treatment. Due to early detection of gastric cancer, the innovation of surgical instruments and technological advances, gastric cancer treatment is now shifting to a new era. One of the most astonishing changes is that minimally invasive surgery (MIS) is becoming more dominant treatment for early gastric cancer. These MIS are represented by endoscopic resection, laparoscopic surgery, robotic surgery, single-port surgery and natural orifice transluminal endoscopic surgery. Among them, laparoscopic gastrectomy is most actively performed in the field of surgery. Laparoscopy-assisted distal gastrectomy (LADG) for early gastric cancer (EGC) has already gained popularity in terms of the short-term outcomes including patient’s quality of life. We only have to wait for the long-term oncologic results of Korean Laparoscopic Gastrointestinal Surgery Study Group. Upcoming top issues following oncologic safety of LADG are function-preserving surgery for EGC, application of laparoscopy to advanced gastric cancer and sentinel lymph node navigation surgery. In the aspect of technique, laparoscopic surgery at present could reproduce almost the whole open procedures. However, the other fields mentioned above need more evidences and experiences. All these new ideas and attempts provide technical advances, which will minimize surgical insults and maximize the surgical outcomes and the quality of life of patients.

위암의 수술 치료

허훈 ( Hoon Hur ),박조현 ( Cho Hyun Park ) 대한소화기학회 2009 대한소화기학회지 Vol.54 No.2

The gastric cancer is the most common cancer in Korea. The only treatment modality showing improved survival for gastric cancer is curative surgical resection, which comprises the resection of stomach, proper lymphadenectomy, and reconstruction. However, specific surgical procedures should be decided according to the location of the cancer, advancement of the tumor, and patients` condition. Surgical treatment for gastric cancer has been developed toward two directions that are minimal invasive surgery for early gastric cancer and multi-disciplinary approach for advanced gastric cancer. Laparoscopic surgery for early gastric cancer has been accepted for minimally invasive surgery. Moreover, the advancement of diagnostic tools to assess biological aggressiveness of the tumor enables physicians to perform endoscopic resection or minimized resection for early gastric cancer. Recently, surgeons try to extend the application of laparoscopic gastric resection and D2 lymphadenectomy to advanced gastric cancer. However, technical and oncological evidences based on clinical trials should be filed up before adopting it as a standard therapy. In case of advanced gastric cancer, in addition to radical surgery, various treatment modalities including chemotherapy, radiation, and molecular target therapy also have been applied in many clinical trials. However, it should be stressed that a prerequisite for precise evaluation of the efficacy of these combined treatment modalities would be the standardization of surgical procedure. (Korean J Gastroenterol 2009;54: 83-98)

복강경수술 시 Esomeprazole 전처치가 위산도 변화에 미치는 영향

이승일 ( Seung Il Lee ),최영규 ( Young Kyoo Choi ),강화자 ( Wha Ja Kang ),박성욱 ( Sung Wook Park ),이재우 ( Jae Woo Yi ),성준경 ( Joon Kyung Sung ) 대한마취과학회 2009 Korean Journal of Anesthesiology Vol.56 No.3

Background: The use of CO2 for pneumoperitoneum during laparoscopic surgery provokes a decrement in the gastric pH. Since the incidence rate of PONV increases after laparoscopic surgery, the possibility of lung aspiration of gastric juice with a low pH during a postanesthetic emergence may increase and this could be fatal for the patient. We conducted this study to determine the effects of esomeprazole premedication on inhibiting the decrement of the gastric pH during laparoscopic surgery. Methods: 40 adult patients with no underlying diseases were chosen and 20 patients each were grouped as C (the control group) and E (the esomeprazole group). In both group, 0.2 mg glycopyrrolate was given intramuscularly 30 minutes prior to the surgery. In group E, esomeprazole was given orally 2 hours prior to the surgery. The pH, PaCO2, and P(ET)CO2 were measured via pH probe, an ABGA and an capnogram at preinsufflation and 15, 30 and 60 minutes after the CO2 insufflation and right before CO2 exhaustion (predeflation). Results: Comparing the measurements of the gastric pH between group E and group C, all the results showed a significant increase in group E (P<0.05). The difference of the PaCO2 and P(ET)CO2 in the two groups was not significance. Conclusions: In contrast to the decrease in the gastric pH as the PaCO2 and P(ET)CO2 increased in group C, the gastric pH in group E remained high until the end of the surgery despite the increase in the PaCO2 and P(ET)CO2. Esomeprazole premedication seem to have an effect for inhibiting the gastric pH decrement regardless of the increase in the PaCO2 and P(ET)CO2 during laparoscopic surgery. (Korean J Anesthesiol 2009; 56: 259~64)

위절제술 후 발생된 빈혈에 관한 고찰

노순태 ( No Sun Tae ),김영태 ( Kim Yeong Tae ),이숭구 ( Lee Sung Gu ),한영찬 ( Han Yeong Chan ),문희승 ( Mun Hui Seung ),김소연 ( Kim So Yeon ),김영중 ( Kim Yeong Jung ),이권전 ( Lee Gwon Jeon ) 대한내과학회 1992 대한내과학회지 Vol.42 No.6

연구배경 : 국내에서는 위절제술 후 발생되는 빈혈에 관한 연구가 미흡하고, 특히 술후 비타민 B_(12)결핍성 빈혈은 외국의 보고에 비해 비교적 드물어, 저자들은 위절제술을 받았던 환자를 대상으로 계속 추적관찰이 가능하였던 총 62명의 환자에서 위내시경적 생검소견과 술식에 따른 빈혈의 유형별 분류 및 발생빈도에 대해 고찰하였다. 방법 : 1963년 5윌부터 1990년 4월사이에 소화성 궤양과 위종양 및 위근종으로 수술을 받았으며, 내원당시 빈혈이 없었던 환자 62명(남자 ; 57, 여자 ; 5)을 대상으로 1987년 1월부터 1991년 8월까지 6개월에서 1년 간격으로 빈혈에 관한 검사를 시행하였다. 결과 : 1) 위절제술을 받았던 환자 62명 중 빈혈은 18예 (29.0%)에서 발생하였으며 그 중 철결핍성 빈혈은 16예에서 발생하였고, 비타민 B_(12)결핍성 빈혈은 2예에서 발생하였다. 2) 빈혈이 발생된 환자 18명 중 9예(50.0%)는 위수술 후 5년이내에 발생하였고, 5~10년과 10~15년 및 15년이후에 각각 4예, 2예 및 3예에서 발생하였다. 3) 빈혈은 위궤양으로 위수술을 받았던 환자 18명 중 2예에서 발생하였으며, 십이지장궤양 환자 27명중 7예, 위암 환자 15명중 8예, 위근종 환자 2명중 1예에서 빈혈이 발생하였다. 4) 부분위절제술과 위장공장문합술을 받은 환자 45명 중 철결핍성 빈혈은 10예(22.2%)에서 발생하였는데, 그중 5명은 술후 5년이내에 발생하였고 5~10년에는 1명, 10~15년에는 2명, 15년 이후에는 2명이 발생하였으며, 비타민 B_(12)결핍성 빈혈은 1예(2.2%)에서 8년째에 발생하였다. 전위절제술을 받은 경우에는 대상환자 4명 중 철결핍성 빈혈은 2예에서 발생하였으며, 술후 2년과 8년째에 각각 1명씩 발생하였고, 비타민 B_(12)결핍성 빈혈 은 1예에서 술후 17년째에 발생하였다. 또한 위전정부절제술과 전간미주신경절리술을 받은 환자 8명 중 철결핍성 빈혈은 3예에서 술후 5년이내에 발생하였으며, 전간미주신경절리술과 유문성형술을 받은 환자 5명중 철결핍성 빈혈이 1예에서 술후 6년째에 발생하였다. 5) 내시경적 위조직 생검이 가능하였던 철결핍성 빈혈 환자 16명 중 6예는 만성 위축성 위염, 3예는 표충성 위염, 2예는 정상 소견을 보였으며, 1예의 비타민 B_(12)결핍성 빈혈 환자에서는 만성 위축성 위염의 소견을 보였다. 결론 : 이상과 같은 결과로 보아 위수술을 받았던 장기 생존자에서 빈혈에 관하여 계속적인 추적관찰 및 관심이 주어져야 할 것으로 사료된다. Background and Purpose: The occurrence of anemia, either iron deficiency or vitamin BIZ deficiency, following gastric surgery depends on the surgical procedures, the duration after operation or the degree of atrophy on the residual gastric mucosa. In Korea, only a few studies of anemia following gastrectomy have been reported. We present the type and incidence of anemia and the duration after operation in 62 patients who underwent gastric surgery. Methods. We studied the anemia following gas-trectomy biannually or annually from Jan, 1987 to Aug, 1991. The total 62 study populations were not anemic on the 1st visit. The 62 patients experienced gastric surgery due to gastric ulcer, duodenal ulcer, gastric leiomyoma and gastric cancer from May, 1963 to Apr, 1990. Results: 1) In total 62 patients, anemia was documented in 18 cases (29.0%), of which 16 showed iron deficiency anemia and 2 showed anemia due to vitamin BIZ deficiency. 2) Of 18 patients with anemia, 9 cases were developed within 5 years, 4 within 10 years, 2 within 15 years and 3 after 15 years. 3) Anemia was developed in 2 cases out of 18 patients with gastric ulcer, 7 of 27 duodenal ulcer, 8 of 15 gastric cancer and 1 of 2 gastric leiomyoma. 4) Anemia was developed in 11 cases out of 45 patients underwent subtotal gastrectomy, 3 of 4 total gastrectomy, 3 of 8 antrectomy and 1 of 5 pyloroplasty. Conclusions: The above results may indicate that we should take an interest in anemia following gastric surgery and the occurrence of anemia due to iron or vitamin BI2 deficiency should be carefully followed and managed after gastric surgery.

Antidiabetic Effects of Gastric Banding Surgery in Morbidly Obese Patients with Type 2 Diabetes Mellitus

( Yu-jeng Kim ),( Ha-neul Choi ),( Hong-chan Lee ),( Jung-eun Yim ) 한국임상영양학회 2017 Clinical Nutrition Research Vol.6 No.3

This study was performed to investigate the effect of gastric banding surgery on the improvement of glycated hemoglobin (HbA_1c) of morbidly obese (MO) patients with type 2 diabetes mellitus (T2DM) with the consideration that obesity was associated with insulin resistance and T2DM. We retrospectively reviewed the medical records of 38 MO with T2DM patients and 50 MO patients. Pre-surgery and post-surgery data were analyzed a year later. The medical data from these patients, including sex, age, height, weight, body composition, HbA1c, triglyceride, total cholesterol, aspartate transaminase (AST), and alanine transaminase (ALT) were measured. There were significant reductions of body weight and body mass index (BMI), body fat, body fat percentage, waist-hip ratio, visceral fat, and obesity in each group before and after gastric banding surgery. Results of AST, ALT, and HbA1c had significant reductions in each group. For HbA_1c, treatment rate was 71% in the MO group with T2DM with significant reduction of 22.8%. It is thought that a gastric banding surgery is one of the breakthrough methods not only for weight loss but also for the prevention of complication of the obese patients with T2DM. Thus, gastric banding surgery could be effective in controlling HbA1c in obese patients with type 2 diabetes mellitus.

Incidence and Risk Factors for Surgical Site Infection after Gastric Surgery: A Multicenter Prospective Cohort Study

정수진,안혜원,김재경,최현,김창오,한상훈,최준용,백경란,강철인,염준섭,최영화,임승관,송영구,최희정,윤희정,김효열,김영근,김민자,박윤선,김준명 대한감염학회 2013 Infection and Chemotherapy Vol.45 No.4

Background: Surgical site infection (SSI) is a potentially morbid and costly complication of surgery. While gastrointestinal surgery isrelatively common in Korea, few studies have evaluated SSI in the context of gastric surgery. Thus, we performed a prospective cohortstudy to determine the incidence and risk factors of SSI in Korean patients undergoing gastric surgery. Materials and Methods: A prospective cohort study of 2,091 patients who underwent gastric surgery was performed in 10 hospitalswith more than 500 beds (nine tertiary hospitals and one secondary hospital). Patients were recruited from an SSI surveillance programbetween June 1, 2010, and August 31, 2011 and followed up for 1 month after the operation. The criteria used to define SSIand a patient’s risk index category were established according to the Centers for Disease Control and Prevention and the NationalNosocomial Infection Surveillance System. We collected demographic data and potential perioperative risk factors including typeand duration of the operation and physical status score in patients who developed SSIs based on a previous study protocol. Results: A total of 71 SSIs (3.3%) were identified, with hospital rates varying from 0.0 - 15.7%. The results of multivariate analysesindicated that prolonged operation time (P = 0.002), use of a razor for preoperative hair removal (P = 0.010), and absence of laminarflow in the operating room (P = 0.024) were independent risk factors for SSI after gastric surgery. Conclusions: Longer operation times, razor use, and absence of laminar flow in operating rooms were independently associatedwith significant increased SSI risk after gastric surgery.

비비만 환자와 비만 환자에서 루와이 위우회술 후 체중과 혈청 지질 농도의 변화 비교

박정환 ( Jung Hwan Park ),홍상모 ( Sang Mo Hong ),이창범 ( Chang Bum Lee ),안유헌 ( You Hern Ahn ),김동선 ( Dong Sun Kim ) 대한비만학회 2014 The Korean journal of obesity Vol.23 No.3

Background: This study was aimed to investigate the effects of bariatric surgery in non-obese patients through the comparison of the changes in body weight (BW) and serum lipid profile between non-obese and obese patients after Roux-en-Y gastric bypass. Methods: In this study, 116 patients who received laparoscopic Roux-en-Y gastric bypass due to early gastric cancer were included. Patients were divided into two groups, non-obese group (N=76), defined as body mass index <25 kg/m2, and obese group (N=40), body mass index ≥25 kg/m2. BW and serum lipid profile before surgery and at 3, 6, 9, and 12 months after surgery were examined. Results: In all groups, BW and triglyceride (TG) showed significant (P<0.05) decrease after surgery, while high-density lipoprotein cholesterol (HDL-C) showed a significant increase during the first 3 months after surgery, in obese group. Total cholesterol and low-density lipoprotein cholesterol (LDL-C) decreased. However, the effect was significant for only a limited time period after surgery. Mean percentages of BW loss and TG decrease were greater in the obese group after surgery, however, the change was significant for only a limited time period after surgery. Mean percentage of HDL-C increase in non-obese group was greater but was not statistically significant. There were no differences in mean percentages of total cholesterol and LDL-C decrease between the two groups. Conclusion: At 12 months after surgery, all groups showed significant improvement in BW and serum lipid profile. However, mean percentages in BW loss, TG decrease, and HDL-C increase between the two groups were different.

Presentation and Outcomes of Gastric Cancer at a University Teaching Hospital in Nepal

Sah, Jayant Kumar,Singh, Yogendra P,Ghimire, Bikal Asian Pacific Journal of Cancer Prevention 2015 Asian Pacific journal of cancer prevention Vol.16 No.13

Background: Gastric cancer is the most common gastrointestinal cancer and a leading cause of cancer mortality in Nepal. Survival of gastric cancer patients depends on the stage at which diagnosis is made. The aim of this study was to analyze the presentation and outcomes of gastric cancer patients treated at a tertiary care hospital in Nepal. Materials and Methods: A retrospective analysis of 140 consecutive histologically proven gastric adenocarcinoma cases managed at the Department of Surgery, Tribhuvan University Teaching Hospital, Kathmandu, Nepal for the period of January 2009 to December 2013 was carried out. Results: One hundred forty out of the total 186 patients with histologically proven gastric adenocarcinoma, were admitted for surgery. The mean age was $59.6{\pm}12.4yrs$ (range 29 to 78 yrs) and the male: female ratio was 2:1. Sixty three (45%) patients featured Tibeto-Burman descent though this ethnic group accounts for only 18% of the Nepalese population. Two-thirds or more patients presented with abdominal pain, anorexia, weight loss and/or vomiting. In 86 (61.5%) of the patients the tumor was located in the lower $3^{rd}$ of the stomach and in only 15% of the patients the tumor was located at the upper $3^{rd}$. Early gastric cancer was diagnosed postoperatively in only 4%. In 54%, the disease was locally advanced and metastatic lesions were found in 14% of the patients. Subtotal (73) or total (11) curative gastrectomies (D1, D1+ or D2) were performed in 84 (60%) patients with average lymph node retrieval of $16.6{\pm}8.2$. Palliative gastrectomies or procedures were performed in 23% of the patients and no intervention (open & close/biopsy) was employed in 15% of the patients. Perioperative morbidity was seen in 10% and mortality in 4%. Three, four and five year survival rates up to the recent follow-up were 17.9%, 11.9% and 8.3%, respectively. Conclusions: Gastric cancer in Nepal is usually diagnosed at an advanced stage and has a poor prognosis. Thus, early detection is the key to improve the survival of gastric cancer patients.

조기위암의 로봇 수술

송재원,형우진 대한의사협회 2010 대한의사협회지 Vol.53 No.4

Early gastric cancer (EGC) patients are annually increasing due to nationwide screening program. As long-term survival of EGC patients improved, the need for the surgical tool to improve the quality of life of the patient has risen, resulting in increased popularity of laparoscopic surgery. However, laparoscopic surgery has disadvantages such as limitation in vision and maneuverability, which has brought the invention of robotic surgical system. Robotic surgical system has merits over laparoscopic surgery in that it provides 3D visualization, endowrist with 7degrees of freedom, and stable camera function. With these merits, the number of operations using robotic surgical system increased continually. Its method of surgery does not differ much from laparoscopic gastrectomy. Reports regarding the postoperative outcomes of robot gastrectomy so far showed that the result was no less satisfactory than those of laparoscopic surgery. However, robot surgical system has drawbacks of high cost and undefined long term postoperative results as of yet. The lack of a unique merit that can counterbalance the high cost is also a problem that has to be solved. And because the advantages of robot surgical system as a tool of minimally invasive surgery are distinct, additional randomized trials may have to be performed in order to define its merits over laparoscopic surgery.

Clinical Outcomes of Metachronous Gastric Cancer after Endoscopic Resection for Early Gastric Cancer

( Jue Lie Kim ),( Sang Gyun Kim ),( Jung Kim ),( Jae Yong Park ),( Hyo-joon Yang ),( Hyun Ju Kim ),( Hyunsoo Chung ) 대한간학회 2020 Gut and Liver Vol.14 No.2

Background/Aims: Patients treated with endoscopic submucosal dissection (ESD) for early gastric cancer (EGC) are at risk of developing metachronous gastric cancer (MGC). The aim of this study was to evaluate the clinical outcomes of MGC after ESD for EGC between the re-ESD and surgery groups. Methods: In total, data from 1,510 patients who underwent ESD for EGC from January 2005 to May 2014 were retrospectively reviewed, and data from 112 patients with MGC were analyzed according to the type of treatment, namely, re-ESD and surgery. The clinicopathological factors affecting the subsequent treatment and outcomes of MGC were evaluated. Results: The median duration to the development of MGC was 47 months. In multivariate analysis, lower body mass index (BMI) (p=0.037) and multiplicity (p=0.014) of index cases were significantly associated with subsequent surgery for MGC. In cases of MGC, a diffuse or mixed-type Lauren classification (p=0.009), the depth of tumor mucosal invasion (p=0.001), and an upper stomach location (p=0.049) were associated with surgery. Overall survival was significantly shorter in the surgery group than in the re-ESD group after treatment for MGC (log-rank test, p=0.01). Conclusions: Lower BMI and multiplicity of index cancers were significantly associated with the surgical resection of MGC. Close follow-up is needed to minimize additional treatment for cases at high risk of advanced MGC after ESD for EGC. (Gut Liver 2020;14:190-198)