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Comparison of Clinical Outcome in Para-aortic Lymph Node Dissection (PALD) and D2 for Advanced Gastric Cancer
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Chan Dong Kim, Dae Hyun Yang, Ik Haeng Jo, Jin Pok Kim, Won Jin Choi, Il Myung Kim, Jin Youn, Sang Su Park, Byung Ook Yoo, Seung Ik Ahn, Sin Eun Choi
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J Korean Cancer Assoc. 2000;32(5):844-851.
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 Abstract
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- PURPOSE
We compared the clinical results of paraaortic lymph node dissection (PALD) with those of D2 to evaluate the survival gain and disadvantage of paraaortic lymph node dissection for advanced gastric cancer.
MATERIALS AND METHODS
We analysed the clinical data of 196 patients who underwent curative resection and D2 with or without paraaortic lymph node dissection (PALD or D2) for advanced gastric cancer from May 1990 to June 1999. The operative factors (operative time, the amounts of intraoperative transfusion and hospital stay), operative morbidity and mortality and 5 year survival rates were compared between D2 and PALD groups.
RESULTS
The operative time of subtotal gastrectomy was significantly longer in PALD group than D2 group. The operative morbidity rates were 9.2% in D2 group and 10.3% in PALD group.
There were 3 operative mortalities in D2 group and none in PALD group. The 5 year survival rates (5YSR's) of stage IB, II, IIIA, IIIB, IV were 88.9%, 92.3%, 30.2%, 24.2%, 28.9% in D2 group and 93.3%, 75.5%, 61.0%, 0%, 0% in PALD group.
CONCLUSION
The paraaortic lymph node dissection was a rather safe procedure without significant increase of morbidity and mortality. There was no statistically significant difference in survival in any stage of this retrospective study with limited cases and follow-ups.
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Clinical Results of Para-aortic Lymph Node Dissection in Advanced Gastric Cancer
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Ik Haeng Jo, Dae Hyun Yang, Jin Pok Kim, Won Jin Choi, Il Myung Kim, Jin Youn, Sang Su Park, Byung Ook Yoo, Seung Ik Ahn, Shin Eun Choi
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J Korean Cancer Assoc. 1999;31(1):31-42.
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Abstract
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- PURPOSE
In gastric cancer, metastasis to the paraaortic lymph nodes had been regarded as an incurable factor, but many cases of long term survival have been reported with dissection of metastatic paraaortic nodes. And several reports suggested survival benefit with paraaortic lymph node dissection (D4) in advanced gastric cancer. In patients with advanced gastric cancer who underwent paraaortic lymph node dissection we tried to evaluate the factors predisposing metastasis in these nodes and survival data.
MATERIALS AND METHODS
The authors analyzed retrospectively pathological features of 95 patients who underwent paraaortic lymph node dissection for advanced gastric cancer at Kangnam General Hospital Public Corporation from May 1991 to Feb. 1998. And we also analysed survival results of 72 cases among them. We excluded 18 cases of distant metastasis (3 liver metastasis, 15 peritoneal seeding), 2 operative mortalities, 1 other disease mortality, and 2 unknown causes of death in survival analysis.
RESULTS
The frequencies of paraaortic lymph node metastasis were 0.0% (0 of 32 cases) in T2, 19.2% (10 of 52 cases) in T3, 18.2% (2 of 11 cases) in T4. And those of paraaortic lymph node metastasis were 5.8% (3 of 52 cases) in antrum, 14.3% (3 fo 21 cases) in body, 20.0% (3 of 15 cases) in cardia, and 42.9% (3 of 7 cases) in whole area. The five-year survival rates (5 YSR's) in relation to the paraaortic lymph node (No16) status was 0.0% in No16 , and 57.8% in No16 with D4 of advanced gastric cancer. The 5 YSR's were 78.1%, 40.8% and 0% in T2, T3 and T4, respectively and 93.8%, 64.2%, 24.2% and 0.0% in n0, n1, n2 and n3, respectively and 88.9%, 80.5%, 57.9% and 0.0% (47.6%) and 0.0% in stage IB, II, IIIA, IIIB and IV, respectively.
CONCLUSION
The depth of gastric wall invasion and the location of primary tumor were significant predisposing factors to para-aortic lymph node metastasis in multivariate analysis (p<0.05). Survival of No16 metastasis was very poor. And three factors of T stage, n stage, and Borrmann type were also prognostically significant in terms of five year survival in cases of D4 of advanced gastric cancer in multivariate analysis (p<0.05).
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Clinicopathologic Features of Multiple Synchronous Gastric Cancer
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Jin Bok Kim, Min Kyu Choi, Joo Ho Lee, Seung Ik Ahn, Soo Jin Kim, Hang Jong Yu, Han Kwang Yang
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J Korean Cancer Assoc. 1998;30(4):652-659.
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Abstract
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With recent advances of diagnostic methods and precise histopathologic examination, the incidence of synchronous multiple gastric cancer has increased. The purpose of this study was to evaluate the clinicopathologic features of patients with synchronous multiple gastric cancer.
MATERIALS AND METHODS
We reviewed the clinicopathologic features of 189 patients with synchronous multiple gastric cancer out of 8,101 patients who underwent gastric resections for gastric cancers during 20 years from January 1977 to December 1996 at the Department of Surgery, Seoul National University Hospital, and compared them with single gastric cancer patients. The clinicopathologic features evaluated were age, sex, diagnostic method and accuracy, location of lesions, tumor size, histologic differentiation, Lauren classification, macroscopic classification, depth of invasion, lymph node metastasis, TNM stage, and type of operation and prognosis.
RESULTS
The overall incidence of multiple synchronous gastric cancer was 2.33%. The mean age was 57.2 years old (27~84) and peak incidence was sixth decade. Male was predominant, that the sex ratio was 3.9: 1. Multiple gastric cancer was more frequent in old age, male and early gastric cancer patients. The number of lesions ranged from 2 to 5.
In most cases, the lesions were located in lower two-thirds of the stomach. However, in 13 cases, lesions were located in both upper one-third and lower one-third. Only 33.3% of multiple cancer was diagnosed preoperatively, with the diagnostic accuracy of GFS was 30.0% and that of UGIS 26.1%.
The most frequently missed lesions at preoperative examination were located in upper third of stomach, posterior wall of middle third and anterior wall of lower third of stomach. The most common macroscopic type was Borrmann type III (54.5%) in advanced lesions and type IIc (47.0%) in early lesions. Regarding the histologic differentiation, 58.7% of the cases were of the same differentiation and the cases composed of well differentiated adenocarcinomas were most common. According to the Laurens classification, 66.7% of lesions were intestinal type. As to the progression of the lesions, all lesions were early cancers in 75 cases, advanced cancers in 39 cases and advanced cancers were coexist with early cancers in 75 cases. Lymph node metastasis was less frequent than in single gastric cancer. Total gastrectomy was performed more frequently in multiple cancer patients than in single gastric cancer patients. The 5-year survival rate of patients with multiple gastric cancer was 70.2%, which was not significantly different from that of patients with single gastric cancer.
CONCLUSIONS
Surgeons must keep in mind the possibility of multiple gastric lesions. More careful preoperative and intraoperative examination is mandatory to detect the possible accessory lesions, and postoperative periodic follow-up is necessary to detect any missed lesions, especially in the old age, male and early gastric cancer patients.
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Flowcytometric analysis of postoperative immunosuppression
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Seung Ik Ahn, Jin Bok Kim
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J Korean Cancer Assoc. 1993;25(6):966-974.
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Abstract
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- No abstract available.
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A clinical analysis of the thyroid nodule in male
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Gwang Suk Kim, Seung Ik Ahn, Jin Pok Kim
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J Korean Cancer Assoc. 1991;23(2):402-409.
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Abstract
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- No abstract available.
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A clinical analysis for the 92 cases of colorectal cancer in young male patients
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Young Sang Choi, Seung Ik Ahn, Jin Pok Kim
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J Korean Cancer Assoc. 1991;23(2):357-365.
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Abstract
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- No abstract available.
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Operative Treatment for Recurrent Gastrointestinal Malignancies
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Seung Ik Ahn, Sun Whe Kim, Jae Gahb Park, Jin Pok Kim
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J Korean Cancer Assoc. 1987;19(2):87-95.
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Abstract
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- Total of 146 patients, operated between January, 1974 and December, 1985 for recurrent or metastatic gastrointestinal malignancies were evaluated. Among them, the recurrent stomach cancers were 91 cases and the recurrent colorectal cancers were 37 cases. Age incidence was most prevalent in the 5th decade of life and male to female ratio was 1.1:l. In reoperated stomach cancers the recurrence was closely related to the clinical stage, histologic differentiation or number of metastatic lymph nodes, but in reoperated colorectal cancers those relations were not found. In 83 (64.8%) of 128 cases recurrences were detected within the first 2 years after primary operation and 59 (46.1%) were the local recurrences only. Clinical status due to the recurrences mainly were the intesinal obstruction and recurrence at anastomotic site. In recurrent colorectal cancers, distant metastasis were related with the higher CEA level and local recurrencies were related with the lower CEA level. In 11 (12.1%) of the recurrent stomach cancers and 10 (27.0%) of recurrent colorectal cancers, curative operations were performed. The postoperative complications were 2 cases and postoperative mortalities were 3 cases. The recurrent colorectal cancers revealed the loger survival time than the recurrent stomach cancers, and the curative resections were followed by the higer survival rates than the palliative operations.
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Clinical Study of Recurrent Colorectal Cancer
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Oh Hoong Kwon, Seung Ik Ahn, Jae Gahb Park, Jin Pok Kim
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J Korean Cancer Assoc. 1987;19(1):36-42.
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Abstract
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- Porty patients underwent reoperations for the recurred colorectal cancer at the Department of Surgery, Seoul National University Hospital, from January 1976 to December 1985, The results of reoperation for 37 cases with first pathologic report was analysed retrospectively. The overall postoperative mortality was 5% and the morbidity was 43%, Mortality was 33% after enterostomy, but nil after bypass procedure or exploratory laparotomy or resection. The mean survival time was 19+-18 months and median survival time was 14 month. The cumulative 5 year survival rate was 10+-6%. Resection gave significantly better survival figures than the other procedures. After radical resection, mean and median survival times (37+-23 months and 30 months) were significantly prolonged. Disease extent. of recurrent tumor was correlated well with survival time. The mean for local recurrence was 48+-27 months, while the means for regional and distant recurrence being, 19+-13 and 12+-10 months respectively. The authors conclade that for these recurred colorectal cancer patients, resection may offer the best outloak as regards survival, but recurrent state of the colorectal cancer should be considered.
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KCA
