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Comments to young surgeons concerning laparoscopic spleenpreserving D2 lymph node dissection for advanced gastric cancer on the upper body

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Chinese Journal of Cancer Research 2014年第3期26卷 231-233页

作者： Yoon Young Choi Ji Yeong An woo jin hyung Sung Hoon Noh Department of Surgery Yonsei University Health System Yonsei University College of Medicine

Qualified radical gastrectomy with lymph node dissection is very important to the prognosis of patients with gastric cancer. Now D2 lymph node dissection is standard procedure for gastric cancer surgery, and spleen hilar lymph node dissection is mandatory for gastric cancer in upper body. Because the anatomy of vessels in this area is very complicated, D2 lymph node dissection is technical challenging not only for open gastrectomy but also for laparoscopic one. Adapting a new technique is important to all surgeons, but we surgeons should always consider a patient＇s safety as the most important factor during surgery and that efforts should be based on scientific rationale with oncologic principles. I hope that the recent report by Huang et al. about laparoscopic spleen preserving hilar lymph node dissection would be helpful to young surgeons who will perform laparoscpic total gastrectomy for gastric cancer.

关键词： Gastric cancer lymph node dissection laparoscopy spleen

Outcome after gastrectomy in gastric cancer patients with type 2 diabetes

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World Journal of Gastroenterology 2012年第1期18卷 49-54页

作者： Jong Won Kim Jae-Ho Cheong woo jin hyung Seung-Ho Choi Sung Hoon Noh Department of Surgery Gangnam Severance Hospital Yonsei University College of Medicine Department of Surgery Severance Hospital Yonsei University College of Medicine

AIM: To evaluate the prognosis of type Ⅱ diabetes mellitus (T2DM) after gastrectomy and related factors in gastric cancer patients. METHODS: 403 gastric cancer patients with T2DM were studied, who underwent gastrectomy between May 2003 and September 2009. A review of medica records and telephone interviews was performed in this cross-sectional study. The factors included in the statistical analysis were as follows: gender, age, type of surgery, preoperative body mass index (BMI), current BMI, BMI reduction ratio, preoperative insulin or oral diabetic medicine requirement, follow-up duration, and current state of diabetes. Assessment of diabetes status after surgery was classified into four categories according to the change in hypoglycemic agents after surgery and present status of T2DM: resolution, improvement, same, and worse.(± 20.6 mo), preoperative BMI was 24.7 kg/m2 (± 3.0 kg/m2), and BMI reduction ratio was 9.8% (± 8.6%). After surgery, T2DM was cured in 58 patients (15.1%) and was improved in 117 patients (30.4%). According to the type of surgery, the BMI reduction ratio was signif icantly higher in the total gastrectomy and Roux-en-Y reconstruction group [14.2% ± 9.2% vs 9.2% ± 7.7% (Billroth Ⅱ group), P < 0.001] and signif icantly lower in the subtotal gastrectomy and Billroth Ⅰ reconstruction group [7.6% ± 8.0%, 9.2% ± 7.7% (Billroth Ⅱ group), P < 0.001]. The BMI reduction ratio, follow-up duration after surgery, type of surgery, extent of gastrectomy, and performance of duodenal bypass were signif icantly correlated to the course of T2DM (P < 0.05). The BMI reduction ratio was the most influential factor on T2DM status. In a subgroup analysis of patients with a BMI reduction ratio of 10% or less (n = 206), T2DM was cured in 15 (7.6%) patients and was improved in 57 (28.8%) patients after surgery, and only the duration of surgery was signif icantly correlated to T2DM status (P = 0.022).

关键词： Gastric cancer Diabetes mellitus Metabolic surgery Bariatric surgery

Gastric cancer surgery in cirrhotic patients: Result of gastrectomy with D2 lymph node dissection

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World Journal of Gastroenterology 2005年第30期11卷 4623-4627页

作者： Jun Ho Lee Junuk Kim Jae Ho Cheong woo jin hyung Seung Ho Choi Sung Hoon Noh Research Institute and Hospital Department of Surgery

AIM： To explore the feasibility of performing gastrectomy with D2 lymphadenectomy in gastric cancer patients with liver cirrhosis. METHODS： A total of 7 178 patients were admitted with a diagnosis of liver cirrhosis from January 1993 to December 2003. We reviewed the records of 142 patients who were diagnosed with liver cirrhosis and gastric adenocarcinoma during the same period. Gastrectomy with D2 lymph node dissection for carcinoma of the stomach was performed in 94 patients with histologically proven hepatic cirrhosis. RESULTS： All but 12 patients were dassified as Child＇s class A. Only 35 patients （37.2%） were diagnosed with cirrhosis before operation. Seventy-three patients underwent a subtotal gastrectomy （77.7%） and 21 patients （22.3%） underwent a total gastrectomy, each with D2 or more lymph node dissection. Two patients （3.8%） who had prophylactic intra-operative drain placement, died of postoperative complications from hepatorenal failure with intractable ascites. Thirty-seven patients （39.4%） experienced postoperative complications. The extent of gastric resection did not influence the morbidity whereas serum aspartate aminotransferase level （P = 0.011） and transfusion did （P = 0.008）. The most common postoperative complication was ascites （13.9%） followed by wound infection （10.6%）. CONCLUSION： We concluded that the presence of compensated cirrhosis, i.e. Child class A, is not a contraindication against gastrectomy with D2 or more lymph node dissection, when curative resection for gastric cancer is possible. Hepatic reserve and meticulous hemostasis are the likely determinants of operative prognosis.

关键词： Gastric cancer Liver cirrhosis D2 lymph nodedissection Morbidity Mortality

Influence of a microscopic positive proximal margin in the treatment of gastric adenocarcinoma of the cardia

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World Journal of Gastroenterology 2006年第24期12卷 3883-3886页

作者： Jian-Guo Shen Jae-Ho Cheong woo-jin hyung Junuk Kim Seung-Ho Choi Sung-Hoon Noh Department of Surgery Yonsei University College ot'Medicine Seoul- 120-752 Korea ' Department of Surgical Oncology Sir Run Run Shaw Hospital College of Medicine Zhejiang University Hangzhou 310016 China

AIM： To investigate the influence of a positive proximal margin in total gastrectorny patients with gastric adenocarcinorna of the cardia. METHODS： Medical records of 191 patients with total gastrectornies for adenocarcinorna of the cardia between 1995 and 2000 were reviewed. The clinicopathologic features associated with a positive margin were determined, and the predictors for survival were analyzed. RESULTS： The incidence of positive proximal margin was 8.4% （16/191）. The positive margins were associated with advanced diseases. The tumor size and the depth of tumor invasion were independent risk factors for a positive margin. The mean survival in the positive margin group was 33.9 mo as *** 62.4 mo in the negative group （P 〈 0.001）. However, the difference in survival lost significance in subgroup analysis according to stage. Multivariate analysis identified that a positive margin was not an independent prognostic factor for survival. CONCLUSION： A positive margin is more of an indication of advanced disease in patients with gastric adenocarcinoma of the cardia rather than an independent prognostic factor for survival.

关键词： Resection margin Gastric cancer Totalgastrectomy Outcome

Neoadjuvant chemoradiotherapy followed by D2 gastrectomy in locally advanced gastric cancer

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World Journal of Gastroenterology 2015年第9期21卷 2711-2718页

作者： Mi Sun Kim Joon Seok Lim woo jin hyung Yong Chan Lee Sun Young Rha Ki Chang Keum woong Sub Koom Department of Radiation Oncology Yonsei University College of MedicineSeoul 120-752South Korea Department of Radiology Yonsei University College of MedicineSeoul 120-752South Korea Department of Surgery Yonsei University College of MedicineSeoul 120-752South Korea Department of Internal Medicine Yonsei University College of MedicineSeoul 120-752South Korea Department of Medical Oncology Yonsei University College of MedicineSeoul 120-752South Korea

AIM:To investigate the efficacy of neoadjuvant chemoradiotherapy(NACRT) for resectability of locally advanced gastric cancer(LAGC).METHODS:Between November 2007 and January 2014,29 patients with LAGC(clinically T3 with distal esophagus invasion/T4 or bulky regional node metastasis) that were treated with NACRT followed by D2 gastrectomy were included in this *** was evaluated with radiologic and endoscopic exams before and after *** threedimensional conformal radiotherapy,patients received 45 Gy,with a daily dose of 1.8 *** entire tumor extent and the regional metastatic lymph nodes were included in the gross tumor *** presenting with a resectable tumor after NACRT received a total or subtotal gastrectomy with D2 *** pathologic tumor response was evaluated using Japanese Gastric Cancer Association histologic evaluation *** morbidity was evaluated using the National Cancer Institute-Common Terminology Criteria for Adverse Events version *** survival(OS) and progression-free survival(PFS) rates were estimated using a Kaplan-Meier analysis and compared using the log-rank ***:All patients were assessed as unresectable ***-four patients(24/29; 82.8%) showed LAGC on positron emission tomography-computed tomography(CT) and contrast-enhanced CT,whereas four patients(4/29; 13.8%) with vague invasion orabutment to an adjacent organ underwent diagnostic *** patient(1/29; 3.4%),initially assessed as a resectable case,underwent an "open and closure" after the tumor was found to be *** to an adjacent organ(34.5%) was the most common reason for *** clinical response rate one month after NACRT was 44.8%.After NACRT,69%(20/29) of patients had a resectable *** the 20 patients with a resectable tumor,18 patients(62.1%) underwent a D2 *** R0 resection rate was 94.4% and two patients(2/18; 11.1%) showed a complete *** median follow-

关键词： Advanced gastric cancer D2 gastrectomy Neoadjuvant

Endoscopic and clinicopathologic characteristics of early gastric cancer with high microsatellite instability

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World Journal of Gastroenterology 2012年第27期18卷 3571-3577页

作者： Jaehoon Jahng Young Hoon Youn Kwang Hyun Kim Junghwan Yu Yong Chan Lee woo jin hyung Sung Hoon Noh Hyunki Kim Hoguen Kim Hyojin Park Sang In Lee Department of Internal Medicine Gangnam Severance HospitalYonsei University College of MedicineSeoul 135-720South Korea Department of Internal Medicine Institute of GastroenterologyYonsei University College of MedicineSeoul 100-753South Korea Department of Surgery Yonsei University College of MedicineSeoul 100-753South Korea Department of Pathology Yonsei University College of MedicineSeoul 100-753South Korea

AIM： To investigate endoscopic and clinicopathologic characteristics of early gastric cancer （EGC） according to microsatellite instability phenotype. METHODS： Data were retrospectively collected from a single tertiary referral center. Of 981 EGC patients surgically treated between December 2003 and October 2007, 73 consecutive EGC patients with two or more microsatellite instability （MSI） mutation [high MSI （MSI-H）] and 146 consecutive EGC patients with one or no MSI mutation （non-MSI-H） were selected. The endoscopic and clinicopathologic features were compared between the MSI-H and non-MSI-H EGC ***： In terms of endoscopic characteristics, MSI-H EGCs more frequently presented with elevated pattern （OR 4.38, 95% Cl： 2.40-8.01, P 〈 0.001）, moderate- to-severe atrophy in the surrounding mucosa （OR 1.91, 95% CI： 1.05-3.47, P = 0.033）, antral location （OR 3.99, 95% CI： 2.12-7.52, P 〈 0.001） and synchronous le- sions, compared to non-MSI-H EGCs （OR 2.65, 95% CI： 1.16-6.07, P = 0.021）. Other significant clinicopatholog- ic characteristics of MSI-H EGC included predominance of female sex （OR 2.77, 95% CI： 1.53-4.99, P 〈 0.001）, older age （〉 70 years）（OR 3.30, 95% CI： 1.57-6.92, P = 0.002）, better histologic differentiation （OR 2.35, 95% Cl： 1.27-4.34, P = 0.007）, intestinal type by Lau- ren classification （OR 2.34, 95% CI： 1.15-4.76, P = 0.019）, absence of a signet ring cell component （OR 2.44, 95% CI： 1.02-5.86, P = 0.046）, presence of mu- cinous component （OR 5.06, 95% Cl： 1.27-20.17, P = 0.022）, moderate-to-severe lymphoid stromal reaction （OR 3.95, 95% CI： 1.59-9.80, P = 0.003）, and co-exist- ing underlying adenoma （OR 2.66, 95% CI： 1.43-4.95, P = 0.002）. CONCLUSION： MSI-H EGC is associated with unique endoscopic and clinicopathologic characteristics includ- ing frequent presentation in protruded type, co-exist- ing underlying adenoma, and synchronous lesions.

关键词： Microsatellite instability Early gastric can-cer Endoscopic characteristic Advanced gastric cancer

Current practice of gastric cancer treatment

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Chinese Medical Journal 2014年第3期127卷 547-553页

作者： Yoon Young Choi Ji Yeong An hyung-Il Kim Jae-Ho Cheong woo jin hyung Sung Hoon Noh Department of Surgery Yonsei University Health System Yonsei University College of Medicine Seoul Republic of Korea

Objective The aim of this review was to overview the current practice of gastric cancer treatment including surgery and other adjuvant *** sources The review was based on data obtained from the published articles and main guidelines in the East and *** selection Articles with high level of evidence or current best evidence in each issue were selected to be *** Although varied adjuvant modalities have been proved to be benefit for treating gastric cancer,surgery is still the most important treatment strategy against gastric *** adapting to new technology is important but it should be balanced with an effort to establish sound scientific rationale that adheres to oncologic *** Future treatment of gastric cancer will be focused on tailored,personalized *** achieving it,collaboration across disciplines is *** the philosophy of caring for the patients with gastric cancer should be rooted in the realization of true patient benefit regardless of who is providing the *** these philosophies,we can shift the scientific and technological advances toward triumph over gastric cancer.

关键词： gastric cancer treatment oncology

Flexural Behavior of FRP-Reinforced Concrete Composite Member

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Journal of Mechanics Engineering and Automation 2012年第1期2卷 52-58页

作者： Joon-Seok Park jin-woo Choi hyung-Joong Joo Soon-Jong Yoon Department of Civil Engineering Hongik University Seoul 121-791 Korea

Concrete Filled FRP （Reinforced Polymeric Plastic） Tubes （CFFT） and Reinforced Concrete Filled FRP Tubes （RCFFT） are known to have the capability to enhance structural performance in terms of structural stability, ductility, as well as chemical resistance when compared with conventional concrete members. In this study, the authors evaluate the structural performance of the CFFT and the RCFFT through flexural tests for the purpose of applying the members as flexural ones. Moreover, the compressive behavior of the CFFT and the RCFFT members was investigated to examine their confinement effects. Based on the experimental and analytical results of the compressive behavior of the members, equations for estimating the ultimate compressive strengths of the CFFT and the RCFFT were proposed. In addition, the degree of improvement on the flexural performance of the RCFFT member strengthened by the FRP was analyzed from the flexural tests.

关键词： FRP (reinforced polymeric plastic) CFFT (concrete filled FRP tubes) confinement effect compression flexure.

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进展期胃癌的外科治疗

中华消化外科杂志 2011年第6期10卷 409-418页

作者： Kyung Min Kim 胡彦锋 Ji Yeong An Hyoung LI Kim Jae Ho Cheong woo jin hyung Sung Hoon Noh 首尔韩国延世大学医学院外科部首尔120752 广州南方医科大学南方医院普通外科广州510515

全球每年约有800000例胃癌新发病例，居于最常见的恶性肿瘤第4位，肿瘤相关死亡原因第2位。虽然胃癌发病率在西方国家持续下降，但是在亚洲、拉丁美洲和东欧依旧保持较高水平。据报道，全球大约42％的胃癌患者在中国。随着手术技术的改... 详细信息

全球每年约有800000例胃癌新发病例，居于最常见的恶性肿瘤第4位，肿瘤相关死亡原因第2位。虽然胃癌发病率在西方国家持续下降，但是在亚洲、拉丁美洲和东欧依旧保持较高水平。据报道，全球大约42％的胃癌患者在中国。随着手术技术的改进、综合治疗方法的进步以及早期诊断能力的提高，最近几十年胃癌的总体生存率得到逐步提升。

关键词：胃肿瘤手术治疗进展期