Publications by authors named "Jong-Han Kim"

77 Publications

Subacute oral toxicity and bacterial mutagenicity of a mixture of and extracts.

Drug Chem Toxicol 2021 Jul 5:1-9. Epub 2021 Jul 5.

Infectious Disease Research Center, Korea Research Institute of Bioscience and Biotechnology (KRIBB), Daejeon, Republic of Korea.

The study aims to identify the safety profile of a mixed extract (KGC-02-PS) from two traditional medicinal herbs, and . In a subacute oral toxicity study, KGC-02-PS was administered orally for 28 days by gavage to Sprague Dawley rats (both sexes) at a daily dose of 0, 500, 1000, and 2000 mg/kg body weight. Bodyweight, food consumption, and clinical signs were monitored during the experimental period. After administering the final dose, this study conducted hematology, serum biochemistry, and pathological evaluations. In addition, the study performed a bacterial reverse mutation test with varying concentrations of KGC-02-PS (312.5 μg - 5,000 μg/plate) following OECD guideline No. 471, before testing five bacterial strains ( TA98, TA100, TA1535, TA1537, and WP2) in the presence or absence of metabolic activation. The preclinical evaluation of KGC-02-PS's subacute oral toxicity yielded no associated toxicological effects or any changes in clinical signs, body weight, and food consumption. Moreover, examining KGC-02-PS's hematological and serum biochemical characteristics and pathology yielded no toxicological changes in terms of organ weight measurements and gross or histopathological findings. KGC-02-PS neither increased the number of revertant colonies in all bacterial strains used in the bacterial reverse mutation test, nor did it induce genotoxicity related to bacterial reverse mutations under the study's conditions. Also, KGC-02-PS's no-observed-adverse-effect level was greater than 2000 mg/kg.
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http://dx.doi.org/10.1080/01480545.2021.1916176DOI Listing
July 2021

Appropriate Number of Adjuvant Chemotherapy Cycles for Patients with Stage 2 or 3 Gastric Cancer After Curative Gastrectomy: A Multicenter Cohort Study.

Ann Surg Oncol 2021 Aug 10;28(8):4458-4470. Epub 2021 Jan 10.

Department of Surgery, Dongnam Institute of Radiological and Medical Sciences, Cancer Center, Busan, Republic of Korea.

Background: Few studies have presented evidence pertaining to the adequate minimum number of adjuvant chemotherapy (AC) cycles required to achieve an oncologic benefit for gastric cancer.

Methods: From January 2012 to December 2013, data from patients who underwent curative radical gastrectomy and consequently received AC for pathologic stage 2 or 3 gastric cancer at 27 institutions in South Korea were analyzed.

Results: The study enrolled 925 patients, 661 patients (71.5%) who completed 8 cycles of AC and 264 patients (28.5%) who did not. Compared with the mean disease-free survival (DFS) of the patients who completed 8 AC cycles (69.3 months), the mean DFS of patients who completed 6 AC cycles (72.4 months; p = 0.531) and those who completed 7 AC cycles (63.7 months; p = 0.184) did not differ significantly. However, the mean DFS of the patients who completed 5 AC cycles (48.2 months; p = 0.016) and those who completed 1-4 AC cycles (62.9 months; p = 0.036) was significantly lower than the DFS of those who completed 8 AC cycles. In the multivariate Cox proportional hazards analysis, the mean DFS was significantly affected by advanced stage, large tumor size, positive vascular invasion, and number of completed AC cycles (1-5 cycles: hazard ratio 1.45; 95% confidence interval 1.01-2.08; p = 0.041).

Conclusion: The current multicenter observational cohort study showed that the mean DFS for 6 or 7 AC cycles was similar to that for 8 AC cycles as an adjuvant treatment for gastric cancer.
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http://dx.doi.org/10.1245/s10434-020-09504-4DOI Listing
August 2021

Optimal Cooperative Guidance Laws for Two UAVs Under Sensor Information Deficiency Constraints.

Sensors (Basel) 2020 Aug 25;20(17). Epub 2020 Aug 25.

Department of Electronic Engineering, Kyung Hee University, Yongin 17104, Korea.

This paper presents closed-form optimal cooperative guidance laws for two UAVs under information constraints that achieve the required relative approach angle. Two UAVs cooperate to optimize a common cost function under a coupled constraint on terminal velocity vectors and the information constraint which defines the sensor information availability. To handle the information constraint, a general two-player partially nested decentralized optimal control problem is considered in the continuous finite-horizon time domain. It is shown that under the state-separation principle the optimal solution of the decentralized control problem can be obtained by solving two centralized subproblems which cover the prediction problem for the information-deficient player and the prediction error minimization problem for the player with full information. Based on the solution of the decentralized optimal control problem, the explicit closed-form cooperative guidance laws that can be efficiently implemented on conventional guidance computers are derived. The performance of the proposed guidance laws is investigated on both centralized and decentralized cooperative scenarios with nonlinear engagement kinematics of networked two-UAV systems.
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http://dx.doi.org/10.3390/s20174790DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7506890PMC
August 2020

Comparison of the Clinical Outcomes Between Isoperistaltic and Antiperistaltic Anastomoses After Laparoscopic Distal Gastrectomy for Patients With Gastric Cancer.

Front Oncol 2020 31;10:1237. Epub 2020 Jul 31.

Department of Surgery, Korea University College of Medicine, Seoul, South Korea.

No consensus exists regarding the superiority of either of the two types of gastrointestinal anastomosis, which are isoperistaltic and antiperistaltic. This study aimed to compare the clinical outcomes between isoperistaltic and antiperistaltic anastomoses after total laparoscopic distal gastrectomy (TLDG) in patients with gastric cancer. We retrospectively reviewed the medical records of patients with gastric cancer who underwent TLDG with Billroth II anastomosis between January 2014 and December 2018. The patients were divided into two groups according to the peristaltic direction of gastrointestinal anastomosis after TLDG. One group underwent isoperistaltic anastomosis (Iso group), and the other underwent antiperistaltic anastomosis (Anti group). Clinical outcomes were compared between the groups. Of the 148 patients who underwent TLDG with Billroth II anastomosis, 124 were included in the Iso group and 24 were included in the Anti group. The Anti and Iso groups showed no significant difference with regard to the incidence of internal hernia (0.0 vs. 6.5%, respectively; = 0.355). The incidence of bile reflux was more frequent in the Iso group than in the Anti group ( = 0.010), but food stasis was more common in the Anti group than in the Iso group ( = 0.006). In gastric cancer patients who underwent TLDG in which postoperative adhesion was minimized, antiperistaltic anastomosis may have created a physiologic barrier in gastrointestinal continuity. However, a large-scale study is necessary to validate the relationship between the digestive stream and the peristaltic direction.
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http://dx.doi.org/10.3389/fonc.2020.01237DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7411350PMC
July 2020

Long-term Efficacy of S-1 Monotherapy or Capecitabine Plus Oxaliplatin as Adjuvant Chemotherapy for Patients with Stage II or III Gastric Cancer after Curative Gastrectomy: a Propensity Score-Matched Multicenter Cohort Study.

J Gastric Cancer 2020 Jun 23;20(2):152-164. Epub 2020 Mar 23.

Department of Surgery, Dongnam Institute of Radiological and Medical Sciences, Cancer Center, Busan, Korea.

Purpose: To compare long-term disease-free survival (DFS) between patients receiving tegafur/gimeracil/oteracil (S-1) or capecitabine plus oxaliplatin (CAPOX) adjuvant chemotherapy (AC) for gastric cancer (GC).

Materials And Methods: This retrospective multicenter observational study enrolled 983 patients who underwent curative gastrectomy with consecutive AC with S-1 or CAPOX for stage II or III GC at 27 hospitals in Korea between February 2012 and December 2013. We conducted propensity score matching to reduce selection bias. Long-term oncologic outcomes, including DFS rate over 5 years (over-5yr DFS), were analyzed postoperatively.

Results: The median and longest follow-up period were 59.0 and 87.6 months, respectively. DFS rate did not differ between patients who received S-1 and CAPOX for pathologic stage II (P=0.677) and stage III (P=0.899) GC. Moreover, hazard ratio (HR) for recurrence did not differ significantly between S-1 and CAPOX (reference) in stage II (HR, 1.846; 95% confidence interval [CI], 0.693-4.919; P=0.220) and stage III (HR, 0.942; 95% CI, 0.664-1.337; P=0.738) GC. After adjustment for significance in multivariate analysis, pT (4 vs. 1) (HR, 11.667; 95% CI, 1.595-85.351; P=0.016), pN stage (0 vs. 3) (HR, 2.788; 95% CI, 1.502-5.174; P=0.001), and completion of planned chemotherapy (HR, 2.213; 95% CI, 1.618-3.028; P<0.001) were determined as independent prognostic factors for DFS.

Conclusions: S-1 and CAPOX AC regimens did not show significant difference in over-5yr DFS after curative gastrectomy in patients with stage II or III GC. The pT, pN stage, and completion of planned chemotherapy were prognostic factors for GC recurrence.
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http://dx.doi.org/10.5230/jgc.2020.20.e13DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7311213PMC
June 2020

Integrated Guidance and Control Using Model Predictive Control with Flight Path Angle Prediction against Pull-Up Maneuvering Target.

Sensors (Basel) 2020 Jun 2;20(11). Epub 2020 Jun 2.

Department of Electronic Engineering, Kyung Hee University, Yongin 17104, Korea.

Integrated guidance and control using model predictive control against a maneuvering target is proposed. Equations of motion for terminal homing are developed with the consideration of short-period dynamics as well as actuator dynamics of a missile. The convex optimization problem is solved considering inequality constraints that consist of acceleration and look angle limits. A discrete-time extended Kalman filter is used to estimate the position of the target with a look angle as a measurement. This is utilized to form a flight-path angle of the target, and polynomial fitting is applied for prediction. Numerical simulation including a Monte Carlo simulation is performed to verify the performance of the proposed algorithm.
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http://dx.doi.org/10.3390/s20113143DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7313701PMC
June 2020

Combination of and Extracts Alleviates Postmenopausal Symptoms in Ovariectomized Rats.

J Med Food 2020 Jul 27;23(7):735-744. Epub 2020 May 27.

Division of Food and Nutrition, Chonnam National University, Gwangju, Republic of Korea.

Estrogen, produced mainly in the ovaries, plays a role in sexual development, metabolism, and bone formation. Thus, estrogen deficiency due to menopause can lead to overweight, dyslipidemia, and osteoporosis. In this study, we compared the effects of extracts of , , and their mixtures at various ratios on osteosarcoma SaOS-2 cells and investigated the effect of PS31 (:  = 3:1, KGC02PS) on postmenopausal symptoms in ovariectomized rats. PS31 supplementation, as little as 100 mg/kg BW, effectively reduced ovariectomy-induced weight gain, and total triglyceride, total cholesterol, and low-density lipoprotein-cholesterol concentrations in serum. In addition, PS31 supplementation prevented bone density loss, inhibited bone resorption, and reduced the expression of catabolic factors in bone. However, PS31 supplementation did not affect uterus weight and expression of c-Jun and c-Fos, which suggests that the mechanism of action of PS31 is distinct from that of estrogen. Taken together, we demonstrated that PS31 supplementation alleviated postmenopausal symptoms, including overweight, dyslipidemia, and osteoporosis. Therefore, PS31 could be potentially used as food supplement to prevent postmenopausal symptoms.
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http://dx.doi.org/10.1089/jmf.2019.4555DOI Listing
July 2020

Multicenter Retrospective Analysis of Intraperitoneal Paclitaxel and Systemic Chemotherapy for Advanced Gastric Cancer with Peritoneal Metastasis.

J Gastric Cancer 2020 Mar 13;20(1):50-59. Epub 2020 Feb 13.

Department of Surgery, Korea University College of Medicine, Seoul, Korea.

Purpose: The objective of the present retrospective analysis was to describe the experience of intraperitoneal (IP) paclitaxel and systemic chemotherapy in patients with peritoneal metastasis (PM) of advanced gastric cancer (AGC) in a multicenter setting in Korea.

Materials And Methods: The medical records of patients with AGC, who were diagnosed with PM between January 2015 and December 2018, were reviewed. IP catheter was placed in the pouch of Douglas and was used for the administration of IP paclitaxel chemotherapy.

Results: We reviewed the clinical outcomes of IP paclitaxel and systemic chemotherapy administration in 82 patients at six institutions in Korea. Mean number of IP chemotherapy cycles was 6.6. The mean peritoneal cancer index (PCI) was 21.9. Postoperative complications related to IP catheter and port were observed in 15 patients. The overall median survival was 20.0 months. A significant difference was observed in the survival rate according to the ascites grade (grade I and II, 24.1 months; grade III and IV, 15.3 months; P=0.014) and PCI grade (grade I, 25.6 months; grade II and III, 16.3 months; P=0.023).

Conclusions: The feasibility of IP paclitaxel and systemic chemotherapy administration was demonstrated in this experience-based retrospective analysis suggesting that the procedure is beneficial in patients with PM of AGC.
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http://dx.doi.org/10.5230/jgc.2020.20.e6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7105410PMC
March 2020

Effect of Biologic Material Reinforcement on Surgical Anastomosis After Gastrectomy-A Pilot Study.

Front Oncol 2019 6;9:1184. Epub 2019 Nov 6.

Department of Surgery, Korea University Medical Center, Anam Hospital, Seoul, South Korea.

Acellular dermal matrix is a biologic material derived from the skin of human cadaveric donors. It has been used successfully in the past to reduce complications in breast surgery and hernia repair. This investigation was aimed at assessing the feasibility of using acellular dermal matrix to support the anastomosis after gastrectomy with the aim of reducing anastomotic site leakage complications. Patients were randomly assigned to standard anastomotic reconstruction (control arm) or anastomotic reconstruction with acellular dermal matrix reinforcement (intervention arm). Surgical outcomes related to anastomotic complications were collected. Because actual anastomotic leaks found on imaging studies are infrequent and thus require a very high number of patient recruitment to detect statistically significant difference between the two groups, in this pilot investigation other clinical and laboratory measures that have been shown to correlate to or predict anastomotic leaks were also collected. Each surgical outcome was compared. A total of 94 patients (intervention arm: 50, control arm: 44), were included in the analysis. Two patients in the control arm (4.55%) and one patient in the intervention arm (2.00%) experienced anastomotic leakage ( = 0.598), a difference without statistical significance. However, average postoperative C-reactive protein (CRP) levels and NUn scores, both of which have been shown to reflect likelihood of progressing to anastomotic leakage, were significantly lower for the intervention arm. The control arm showed an average CRP level of 128.77 mg/dL (SD: 97.08) while the intervention arm showed 77.38 mg/dL (SD: 49.08, = 0.049). Leakage rate reduction with acellular dermal matrix reinforcement of anastomotic site was not detected in this investigation. However, postoperative inflammation levels and numerical predictors of anastomotic leakage development were significantly lower with acellular dermal matrix reinforcement of surgical anastomosis. This finding is worthy of further investigation, as reduction of inflammation with anastomotic site reinforcement is a novel finding, and more in-depth research may lead to discoveries on the physiologic role of the surgical anastomosis in post-gastrectomy patients. In addition, lower CRP and NUn scores for the intervention arm suggest potential for larger studies to detect reduction in clinical leak rates after acellular dermal matrix reinforcement.
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http://dx.doi.org/10.3389/fonc.2019.01184DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6851234PMC
November 2019

Laparoscopic total gastrectomy as a valid procedure to treat gastric cancer option both in early and advanced stage: A systematic review and meta-analysis.

Eur J Surg Oncol 2020 01 23;46(1):33-43. Epub 2019 Aug 23.

Division of Upper Gastrointestinal Surgery, Department of Surgery, Korea University College of Medicine, Seoul, South Korea. Electronic address:

Although laparoscopic total gastrectomy (LTG) compared to open total gastrectomy (OTG) has been widely used for advanced gastric cancer patients, its oncologic validity is yet to be proven. We performed systemic review and meta-analysis to compare LTG versus OTG for early and advanced stages of gastric cancer. Short- and long-term outcomes of both procedures were analyzed using original studies collected by searching Google Scholar, Medline, PubMed, Embase, and Cochrane library in accordance with the PRISMA guidelines. To analyze procedures more precisely, we categorized studies into advanced gastric cancer (AGC) and early gastric cancer (EGC) groups and matched lymph node (LN) dissection, and metastasis ratio. Nineteen studies with a total of 3943 patients were included. LTG required more operative time and had less dissected LNs, indicating a favorable quality of OTG. However, LTG was superior with less blood loss, a shorter postoperative hospital stay, and lower postoperative complication rates. The 5-year survival rate was similar in both groups in which extent of LN dissection and lymph node metastasis ratio were controlled. Although more LNs were removed in OTG, the discrepancy had an insignificant impact on the survival rate. To the best of our knowledge, this study is the first to employ quantitative synthesis in evaluation of long-term oncologic validity of LTG and OTG in AGC, with LN dissection and N stage controlled setting. Non-inferiority of LTG on oncologic outcome and superiority of LTG on perioperative outcome lead to a conclusion that LTG has potential as a valid treatment modality in AGC.
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http://dx.doi.org/10.1016/j.ejso.2019.08.018DOI Listing
January 2020

Meta-analysis and systematic review on laparoscopic-assisted distal gastrectomy (LADG) and totally laparoscopic distal gastrectomy (TLDG) for gastric cancer: Preliminary study for a multicenter prospective KLASS07 trial.

Eur J Surg Oncol 2019 Dec 22;45(12):2231-2240. Epub 2019 Jun 22.

Department of Surgery, Korea University College of Medicine, Seoul, South Korea. Electronic address:

Background: The curative surgical treatment of gastric cancer in the current laparoscopic surgical era relies on the surgeon's preference, technical difficulties, and concerns regarding outcome have led to the availability of totally laparoscopic distal gastrectomy (TLDG) and laparoscopic-assisted distal gastrectomy (LADG). A consensus on which of the two procedures is preferable is necessary. Therefore, the aim of this study was to evaluate the differences between LADG and TLDG in terms of surgical outcomes, postoperative recovery, pain, and complications.

Methods: PubMed, Google Scholar, Medline, Embase, and Cochrane databases were explored up to 2017 to evaluate TLDG and LADG. Parameters including surgical outcomes, postoperative recovery, and postoperative complications were subjected to meta-analysis to calculate the odds ratio and weighted mean difference with 95% confidence intervals (c.i.).

Results: Twenty-five studies (24 non-RCT and 1 RCT) with a total of 4562 gastric cancer patients were included in the meta-analysis. Under reconstruction-matched analysis, overall complications and anastomotic complications were similar for TLDG and LADG. Nevertheless, short-term outcomes such as blood loss, time to first soft diet, hospital stay, analgesic use, and CRP level were favourable for TLDG, while all other surgical outcomes showed no difference.

Conclusions: TLDG and LADG did not show significant differences in surgical outcomes and postoperative complications, including anastomotic-related morbidity. Therefore, decisive factors in selecting surgical procedures, which previously consisted of surgical outcomes, have been superseded by extra-surgical values such as cosmesis, economics, and patient's quality of life. These factors will be explored in a future multicentre prospective study (KLASS07 trial).
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http://dx.doi.org/10.1016/j.ejso.2019.06.030DOI Listing
December 2019

Multicenter results of long-limb bypass reconstruction after gastrectomy in patients with gastric cancer and type II diabetes.

Asian J Surg 2020 Jan 3;43(1):297-303. Epub 2019 May 3.

Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, South Korea. Electronic address:

Background/objective: The number of gastric cancer and type II diabetes mellitus is increasing in Korea. Metabolic surgery could be extended to gastric cancer patients with type II diabetes, especially those who are expected to achieve long-term survival. This study aimed to investigate change of diabetic status in patients undergoing long-limb Roux-en-Y bypass reconstruction compared with conventional Billroth II after curative gastrectomy. In total, 130 patients from five university hospital centers underwent long-limb Roux-en Y reconstruction after radical distal gastrectomy.

Methods: In the long-limb group, the length of biliopancreatic limbs was more than 80 cm, and the length of the Roux limb was more than 80 cm. The control group comprised 96 patients who underwent conventional Billroth II reconstruction after distal gastrectomy. Follow-up data at three, six, nine, and 12 months were compared between the two groups.

Results: Fasting blood sugar (FBS) and hemoglobin (Hb) A1c levels decreased more significantly in the long-limb Roux-en-Y group (FBS: 28.8 mg/dL; HbA1c: 0.72%). However, decreases in body mass index, albumin, and hemoglobin did not differ significantly between the two groups. Diabetes control significantly improved in the long-limb group. In multivariate analysis, long-limb bypass reconstruction was the significant factor for glycemic outcomes.

Conclusion: Roux-en-Y bypass with increased length of limbs after gastrectomy shows a favorable glycemic control for gastric cancer patients with type II diabetes without nutritional deficit and anemia. To obtain future perspectives, large-scale prospective studies with long-term outcomes are needed.
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http://dx.doi.org/10.1016/j.asjsur.2019.03.018DOI Listing
January 2020

Comparison of Short-Term Outcomes Using Three-Dimensional and Two-Dimensional Laparoscopic Gastrectomy for Gastric Cancer.

J Laparoendosc Adv Surg Tech A 2019 Jul 6;29(7):886-890. Epub 2019 May 6.

Department of Surgery, Korea University College of Medicine, Seoul, Korea.

This study investigated the oncological and technical advantages of three-dimensional (3D) versus two-dimensional (2D) laparoscopic gastric cancer surgery. This study included 68 gastric cancer patients who had undergone laparoscopic distal gastrectomy at Korea University Ansan Hospital (3D group,  = 34; 2D group,  = 34). The surgical outcomes and duration of each phase were compared between the groups. The total operative time with 3D laparoscopy was significantly shorter than with 2D laparoscopy (227.8 ± 39.0 versus 249.6 ± 45.3 minutes;  = .037). There were no significant differences between the groups in the number of gauze pads used, time to first postoperative flatus, and number of harvested lymph nodes (2.0 [1.0-2.0] versus 2.0 [1.0-2.0];  = .692; 4.0 [4.0-4.0] versus 4.0 [4.0-4.0] days;  = .196; 40.8 ± 16.6 versus 44.0 ± 15.7;  = .412, respectively). The time from omentectomy to right gastric artery ligation and the duration of the reconstruction phase were shorter with 3D than with 2D laparoscopy (62.6 ± 14.5 versus 71.9 ± 18.8 minutes;  = .027; 32.3 ± 7.6 versus 47.7 ± 16.8 minutes;  < .001). In a procedure requiring spatial perception, the operative time was shortened by introducing 3D laparoscopy. Despite the anticipation of a better view for lymph node dissection, the 3D image showed no advantage. Further study may be required by novice surgeons.
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http://dx.doi.org/10.1089/lap.2018.0765DOI Listing
July 2019

Actual compliance to adjuvant chemotherapy in gastric cancer.

Ann Surg Treat Res 2019 Apr 28;96(4):185-190. Epub 2019 Mar 28.

Department of Surgery, Dankook University Hospital, Cheonan, Korea.

Purpose: This study aims to investigate the actual compliance with chemotherapy and analyze several factors affecting the compliance in patients with gastric cancer.

Methods: From February 2012 to December 2014, we collected data of patients with gastric cancer who received adjuvant chemotherapy (TS-1 monotherapy or XELOX: capecitabine/oxaliplatin) in Korea.

Results: We collected data of 1,089 patients from 31 institutions. The completion rate and dose reduction rate by age (≥60 years <60 years) were 57.5% 76.8% (P < 0.001) and 17.9% 21.3% (P = 0.354); by body mass index (BMI) (≥23 kg/m <23 kg/m) were 70.2% 63.2% (P = 0.019) and 19.2% 19.9% (P = 0.987), respectively. The compliance by American Society of Anesthesiologists physical status (ASA PS) classification was as follows: completion rate was 74.4%, 62.8%, and 60% (P = 0.001) and the dose reduction rate was 18.4%, 20.7%, and 17.8% (P = 0.946) in ASA PS classification I, II, and III, respectively. The completion rate of TS-1 and XELOX was 65.9% 70.3% (P = 0.206) and the dose reduction rate was 15.7% 33.6% (P < 0.001). Furthermore, the completion rate of chemotherapy by surgical oncologists and medical oncologists was 69.5% 63.2% (P = 0.028) and the dose reduction rate was 17.4% 22.3% (P = 0.035), respectively.

Conclusion: The compliance was lower in patients who were older than 60 years, had BMI <23 kg/m, and had higher ASA PS classification. Furthermore, the patients showed higher compliance when they received chemotherapy from surgical oncologists rather than from medical oncologists.
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http://dx.doi.org/10.4174/astr.2019.96.4.185DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6444044PMC
April 2019

Comparison of oncological benefits of deep neuromuscular block in obese patients with gastric cancer (DEBLOQS_GC study): A study protocol for a double-blind, randomized controlled trial.

Medicine (Baltimore) 2018 Dec;97(49):e13424

Department of Surgery.

Purpose: Many studies have demonstrated the advantage of maintaining intraoperative deep neuromuscular block (NMB) with sugammadex. This trial is designed to evaluate the impact of muscle relaxation during laparoscopic subtotal gastrectomy on the oncological benefits, particularly in obese patients with gastric cancer.

Materials And Methods: This is a double-blind, randomized controlled multicenter prospective trial. Patients with clinical stage I-II gastric cancer with a body mass index of 25 and over, who undergo laparoscopic subtotal gastrectomy will be eligible for trial inclusion. The patients will be randomized into a deep NMB group or a moderate NMB group with a 1:1 ratio. A total of 196 patients (98 per group) are required. The primary endpoint is the number of harvested lymph nodes, which is a critical index of the quality of surgery in gastric cancer treatment. The secondary endpoints are surgeon's surgical condition score, patient's sedation score, and surgical outcomes including peak inspiratory pressure, operation time, postoperative pain, and morbidity.

Discussion: This is the first study that compares deep NMB with moderate NMB during laparoscopic gastrectomy in obese patients with gastric cancer. We hope to show the oncologic benefits of deep NMB compared with moderate NMB during subtotal gastrectomy.

Trial Registration Number: ClinicalTrials.gov (NCT03196791), date of registration: October 10, 2017.
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http://dx.doi.org/10.1097/MD.0000000000013424DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6310580PMC
December 2018

Nationwide survey of partial fundoplication in Korea: comparison with total fundoplication.

Ann Surg Treat Res 2018 Jun 29;94(6):298-305. Epub 2018 May 29.

Department of Surgery, Ajou University School of Medicine, Suwon, Korea.

Purpose: Laparoscopic total fundoplication is the standard surgery for gastroesophageal reflux disease. However, partial fundoplication may be a viable alternative. Here, we conducted a nationwide survey of partial fundoplication in Korea.

Methods: The Korean Anti-Reflux Surgery study group recorded 32 cases of partial fundoplication at eight hospitals between September 2009 and January 2016. The surgical outcomes and postoperative adverse symptoms in these cases were evaluated and compared with 86 cases of total fundoplication.

Results: Anterior partial fundoplication was performed in 20 cases (62.5%) and posterior in 12 (37.5%). In most cases, partial fundoplication was a secondary procedure after operations for other conditions. Half of patients who underwent partial fundoplication had typical symptoms at the time of initial diagnosis, and most of them showed excellent (68.8%), good (25.0%), or fair (6.3%) symptom resolution at discharge. Compared to total fundoplication, partial fundoplication showed no difference in the resolution rate of typical and atypical symptoms. However, adverse symptoms such as dysphagia, difficult belching, gas bloating and flatulence were less common after partial fundoplication.

Conclusion: Although antireflux surgery is not popular in Korea and total fundoplication is the primary surgical choice for gastroesophageal reflux disease, partial fundoplication may be useful in certain conditions because it has less postoperative adverse symptoms but similar efficacy to total fundoplication.
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http://dx.doi.org/10.4174/astr.2018.94.6.298DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5976570PMC
June 2018

Discrimination of Kawasaki disease with concomitant adenoviral detection differentiating from isolated adenoviral infection.

Korean J Pediatr 2018 Feb 28;61(2):43-48. Epub 2018 Feb 28.

Department of Pediatrics, Ewha Womans University College of Medicine, Seoul, Korea.

Purpose: Human adenovirus infection mimics Kawasaki disease (KD) but can be detected in KD patients. The aim of this study was to determine the clinical differences between KD with adenovirus infection and only adenoviral infection and to identify biomarkers for prediction of adenovirus-positive KD from isolated adenoviral infection.

Methods: A total of 147 patients with isolated adenovirus were identified by quantitative polymerase chain reaction. In addition, 11 patients having KD with adenovirus, who were treated with intravenous immunoglobulin therapy during the acute phase of KD were also evaluated.

Results: Compared with the adenoviral infection group, the KD with adenovirus group was significantly associated with frequent lip and tongue changes, skin rash and changes in the extremities. In the laboratory parameters, higher C-reactive protein (CRP) level and presence of hypoalbuminemia and sterile pyuria were significantly associated with the KD group. In the multivariate analysis, lip and tongue changes (odds ratio [OR], 1.416; 95% confidence interval [CI], 1.151-1.741; =0.001), high CRP level (OR, 1.039; 95% CI 1.743-1.454; = 0.021) and sterile pyuria (OR 1.052; 95% CI 0.861-1.286; =0.041) were the significant predictive factors of KD. In addition, the cutoff CRP level related to KD with adenoviral detection was 56 mg/L, with a sensitivity of 81.8% and a specificity of 75.9%.

Conclusion: Lip and tongue changes, higher serum CRP level and sterile pyuria were significantly correlated with adenovirus-positive KD.
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http://dx.doi.org/10.3345/kjp.2018.61.2.43DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5854841PMC
February 2018

Long-term Follow-up for Type 2 Diabetes Mellitus after Gastrectomy in Non-morbidly Obese Patients with Gastric Cancer: the Legitimacy of Onco-metabolic Surgery.

J Gastric Cancer 2017 Dec 15;17(4):283-294. Epub 2017 Nov 15.

Department of Surgery, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea.

Purpose: This study primarily aimed to investigate the short- and long-term remission rates of type 2 diabetes (T2D) in patients who underwent surgical treatment for gastric cancer, especially patients who were non-obese, and secondarily to determine the potential factors associated with remission.

Materials And Methods: We retrospectively reviewed the clinical records of patients with T2D who underwent radical gastrectomy for gastric cancer, from January 2008 to December 2012.

Results: T2D improved in 39 out of 70 (55.7%) patients at the postoperative 2-year follow-up and 21 of 42 (50.0%) at the 5-year follow-up. In the 2-year data analysis, preoperative body mass index (BMI) (P=0.043), glycated hemoglobin (A1C) level (P=0.039), number of anti-diabetic medications at baseline (P=0.040), reconstruction method (statistical difference was noted between Roux-en-Y reconstruction and Billroth I; P=0.035) were significantly related to the improvement in glycemic control. Unlike the results at 2 years, the 5-year data analysis revealed that only preoperative BMI (P=0.043) and A1C level (P=0.039) were statistically significant for the improvement in glycemic control; however, the reconstruction method was not.

Conclusions: All types of gastric cancer surgery can be effective in short- and long-term T2D control in non-obese patients. In addition, unless long-limb bypass is considered in gastric cancer surgery, the long-term glycemic control is not expected to be different between the reconstruction methods.
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http://dx.doi.org/10.5230/jgc.2017.17.e34DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5746650PMC
December 2017

Lymph Node Dissection Using Bipolar Vessel-Sealing Device During Reduced Port Laparoscopic Distal Gastrectomy for Gastric Cancer: Result of a Pilot Study from a Single Institute.

J Laparoendosc Adv Surg Tech A 2017 Nov 27;27(11):1101-1108. Epub 2017 Mar 27.

Department of Surgery, Korea University College of Medicine , Seoul, Korea.

Introduction: The electrothermal bipolar vessel-sealing device (BVSD) is known to supply a strong vessel-sealing power. However, only few studies have reported lymph node dissection (LND) using only BVSD during laparoscopic surgery for gastric cancer. The purpose of this study was to investigate the feasibility of LND using BVSD during reduced port laparoscopic distal gastrectomy for gastric cancer.

Methods: From May 2015, patients in whom three- or single-port laparoscopic distal gastrectomy had been engaged for gastric cancer were enrolled in this study. We performed D1+ or D2 LND using only LigaSure Maryland (Medtronics, Minneapolis, MN), a recently developed BVSD. Clinical outcomes of these patients were investigated.

Results: From May 2015 to November 2016, 20 patients were enrolled in this study. The mean operation time was 262.6 ± 36.6 (200-340) minutes. The mean time for LND was 124.7 ± 19.2 (93-171) minutes. Only one patient had a morbidity of Clavien-Dindo grade more than II. No mortality was observed in all patients. The mean number of retrieved lymph nodes was 46.8 ± 22.8 (15-105).

Conclusions: LND using the Maryland jaw type BVSD was feasible during reduced port (single- or three-port) laparoscopic distal gastrectomy for gastric cancer. Objectively evaluating the potential advantages of BVSD in reduced port laparoscopic surgery is necessary.
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http://dx.doi.org/10.1089/lap.2016.0685DOI Listing
November 2017

Is noncurative gastrectomy always a beneficial strategy for stage IV gastric cancer?

Ann Surg Treat Res 2017 Jan 30;92(1):23-27. Epub 2016 Dec 30.

Department of Surgery, Korea University Medical Center, Seoul, Korea.; Department of Surgery, Korea University College of Medicine, Seoul, Korea.

Purpose: The purpose of this study is to suggest a treatment strategy for stage IV gastric cancer by investigating the behavioral difference between initially and recurrent metastatic disease.

Methods: We reviewed the medical records of the patients who underwent chemotherapy alone for metastatic gastric cancer between January 2006 and September 2013. Patients were divided into those who underwent chemotherapy for metastatic disease since initial diagnosis (IM group) and for metastatic recurrence after curative surgery (RM group). Survival and causes of death were compared between the 2 groups, and significant prognostic factors were also investigated.

Results: A total of 170 patients were enrolled in this study. Of these patients, 104 were included in the IM group and 66 in the RM group. Overall survival of the IM group did not differ from that of RM (P = 0.569). In the comparison of the causes of death, the IM group had a greater tendency to die from bleeding (P = 0.054) and pneumonia (P = 0.055). In multivariate analysis, bone metastasis (P < 0.001; HR = 2.847), carcinoma peritonei (P = 0.047; HR = 1.766), and the frequency of chemotherapy (P < 0.001; HR = 0.777) were significantly associated with overall survival of IM group.

Conclusion: Disease-burden mainly contributes to the prognosis of metastatic gastric cancer, although noncurative gastrectomy may be helpful in reducing the mortality of initially metastatic disease. Therefore, disease-burden should be also prioritized in determining the treatment strategies for stage IV gastric cancer.
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http://dx.doi.org/10.4174/astr.2017.92.1.23DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5234432PMC
January 2017

Single-Port Laparoscopic Proximal Gastrectomy with Double Tract Reconstruction for Early Gastric Cancer: Report of a Case.

J Gastric Cancer 2016 Sep 30;16(3):200-206. Epub 2016 Sep 30.

Department of Surgery, Korea University Medical Center, Korea University College of Medicine, Seoul, Korea.

In Korea, proximal gastrectomy has recently attracted attention as a better choice of function-preserving surgery for proximal early gastric cancer than total gastrectomy. Of the various strategies to overcome reflux symptoms from remnant stomach, double tract reconstruction not only reduces the incidence of anastomosis-related complications, but is also sufficiently reproducible as a laparoscopic procedure. Catching up with the recent rise of single-port laparoscopic surgeries, we performed a pure single-port laparoscopic proximal gastrectomy with DTR. This procedure was designed by merging the function-preserving concept of proximal gastrectomy with single-port laparoscopic total gastrectomy.
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http://dx.doi.org/10.5230/jgc.2016.16.3.200DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5065951PMC
September 2016

A comparison between two methods for tumor localization during totally laparoscopic distal gastrectomy in patients with gastric cancer.

Ann Surg Treat Res 2016 Sep 29;91(3):112-7. Epub 2016 Aug 29.

Department of Surgery, Korea University Medical Center, Korea University College of Medicine, Seoul, Korea.

Purpose: The aim of this study was to compare two methods of tumor localization during totally laparoscopic distal gastrectomy (TLDG) in patients with gastric cancer.

Methods: From March 2014 to November 2014, patients in whom TLDG had been engaged for middle third gastric cancer enrolled in this study. The patients were allocated to either the radiography or endoscopy group based on the type of tumor localization technique. Clinicopathologic outcomes were compared between the 2 groups.

Results: The accrual was suspended in November 2014 when 39 patients had been enrolled because a failed localization happened in the radiography group. The radiography and endoscopy groups included 17 (43.6 %) and 22 patients (56.4 %), respectively. Mean length of the proximal resection margin did not differ between the radiography and endoscopy groups (4.0 ± 2.6 and 2.8 ± 1.2 cm, respectively; P = 0.077). Mean localization time was longer in the radiography group than in the endoscopy group (22.7 ± 11.4 and 6.9 ± 1.8 minutes, respectively, P < 0.001). There were no statistically significant differences in the incidence of severe complications between the 2 groups (5.9% and 4.5%, respectively, P = 0.851).

Conclusion: As an intraoperative tumor localization for TLDG, radiologic method was unsafe even though other comparable parameters were not different from that of endoscopy group. Moreover, intraoperative endoscopic localization may be advantageous because it is highly accurate and contributes to reducing operation time.
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http://dx.doi.org/10.4174/astr.2016.91.3.112DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5016600PMC
September 2016

Sentinel Node Mapping Using a Fluorescent Dye and Visible Light During Laparoscopic Gastrectomy for Early Gastric Cancer: Result of a Prospective Study From a Single Institute.

Ann Surg 2017 Apr;265(4):766-773

*Department of Surgery, Korea University Medical Center, Seoul, South Korea †Department of Surgery, Korea University College of Medicine, Seoul, South Korea ‡Department of Internal Medicine, Korea University Medical Center, Seoul, South Korea §Department of Internal Medicine, Korea University College of Medicine, Seoul, South Korea ¶Department of Surgery, Chungnam National University Hospital, Daejeon, South Korea ||Department of Surgery, Chungnam National University School of Medicine, Daejeon, South Korea.

Objective: The aim of this study was to investigate the feasibility of sentinel node mapping using a fluorescent dye and visible light in patients with gastric cancer.

Background: Recently, fluorescent imaging technology offers improved visibility with the possibility of better sensitivity or accuracy in sentinel node mapping.

Methods: Twenty patients with early gastric cancer, for whom laparoscopic distal gastrectomy with standard lymphadenectomy had been planned, were enrolled in this study. Before lymphadenectomy, the patients received a gastrofiberoscopic peritumoral injection of fluorescein solution. The sentinel basin was investigated via laparoscopic fluorescent imaging under blue light (wavelength of 440-490 nm) emitted from an LED curing light. The detection rate and lymph node status were analyzed in the enrolled patients. In addition, short-term clinical outcomes were also investigated.

Results: No hypersensitivity to the dye was identified in any enrolled patients. Sentinel nodes were detected in 19 of 20 enrolled patients (95.0%), and metastatic lymph nodes were found in 2 patients. The latter lymph nodes belonged to the sentinel basin of each patient. Meanwhile, 1 patient (5.0%) experienced a postoperative complication that was unrelated to sentinel node mapping. No mortality was recorded among enrolled cases.

Conclusions: Sentinel node mapping with visible light fluorescence was a feasible method for visualizing sentinel nodes in patients with early gastric cancer. In addition, this method is advantageous in terms of visualizing the concrete relationship between the sentinel nodes and surrounding structures.
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http://dx.doi.org/10.1097/SLA.0000000000001739DOI Listing
April 2017

Bakuchiol sensitizes cancer cells to TRAIL through ROS- and JNK-mediated upregulation of death receptors and downregulation of survival proteins.

Biochem Biophys Res Commun 2016 Apr 28;473(2):586-92. Epub 2016 Mar 28.

Botanical Drug Laboratory, Korea Ginseng Corporation, Yuseong-gu, Daejeon, Republic of Korea. Electronic address:

We investigated whether bakuchiol, an analog of resveratrol enhances the apoptosis ability of tumor necrosis factor (TNF)-related apoptosis-inducing ligand (TRAIL) in cancer cells. Bakuchiol enhanced expression of cell death receptor (DR) in TRAIL-sensitive and -resistant colon cancer cells in a dose-dependent manner. A combination of bakuchiol with TRAIL significantly inhibited cell growth of TRAIL sensitive HCT116 and TRAIL resistant HT-29 cells. The expression of TRAIL receptors; DR4 and DR5 was significantly increased by treatment of bakuchiol, however, the expression of survival proteins (e.g., cFLIP, survivin, XIAP and Bcl2) was suppressed. Moreover, the expression of apoptosis related proteins such as cleaved caspase-3, -8, -9 and PARP was increased by combination treatment of bakuchiol and TRAIL. Depletion of DR4 or DR5 by small interfering RNA significantly reversed the cell growth inhibitory effects of bakuchiol in HCT116 and HT-29 cells. Pretreatment with the c-Jun N-terminal kinase (JNK) inhibitor SP600125 and the reactive oxygen species (ROS) scavenger N-acetylcysteine reduced the bakuchiol induced cell growth inhibitory effects. The collective results suggest that bakuchiol facilitates TRAIL-induced apoptosis in colon cancer cells through up-regulation of the TRAIL receptors; DR4 and DR5 via ROS/JNK pathway signals.
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http://dx.doi.org/10.1016/j.bbrc.2016.03.127DOI Listing
April 2016

Ginseng total saponin attenuates myocardial injury via anti-oxidative and anti-inflammatory properties.

J Ginseng Res 2015 Jul 23;39(3):206-12. Epub 2014 Dec 23.

College of Veterinary Medicine, Biosafety Research Institute, Chonbuk National University, Jeonju City, Korea.

Background: Ginseng total saponin (GTS) contains various ginsenosides. These ginsenosides are widely used for treating cardiovascular diseases in Asian communities. The aim of this study was to study the effects of GTS on cardiac injury after global ischemia and reperfusion (I/R) in isolated guinea pig hearts.

Methods: Animals were subjected to normothermic ischemia for 60 minutes, followed by 120 minutes of reperfusion. GTS significantly increased aortic flow, coronary flow, and cardiac output. Moreover, GTS significantly increased left ventricular systolic pressure and the maximal rate of contraction (+dP/dt max) and relaxation (-dP/dt max). In addition, GTS has been shown to ameliorate electrocardiographic changes such as the QRS complex, QT interval, and RR interval.

Results: GTS significantly suppressed the biochemical parameters (i.e., lactate dehydrogenase, creatine kinase-MB fraction, and cardiac troponin I levels) and normalized the oxidative stress markers (i.e., malondialdehyde, glutathione, and nitrite). In addition, GTS also markedly inhibits the expression of interleukin-1β (IL-1β), IL-6, and nuclear factor-κB, and improves the expression of IL-10 in cardiac tissue.

Conclusion: These data indicate that GTS mitigates myocardial damage by modulating the biochemical and oxidative stress related to cardiac I/R injury.
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http://dx.doi.org/10.1016/j.jgr.2014.12.001DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4506374PMC
July 2015

Pattern, Timing and Survival in Patients with Recurrent Gastric Cancer.

Hepatogastroenterology 2014 Jun;61(132):1148-53

Background/aims: The aim of this study was to investigate the recurrence patterns, the timing of recurrence, and the survival rate in recurrent cases of gastric cancer.

Methodology: Of 1,029 patients who underwent curative resection for gastric cancer at the Department of Surgery, Korea University Guro Hospital between 2000 and 2006, 146 patients developed recurrence and were included in this study. Timing and patterns of recurrence, the recurrence pattern according to clinicopathological factors, and post-recurrence survival rate were analyzed retrospectively.

Results: The mean time to recurrence was 21.2 months. Forty-two patients (28.8%) had recurrence within 1 year, and 54 patients (37.0%) had recurrence 1-2 years after surgery. Single-site recurrence occurred in 72.6% of patients, and multiple-site recurrence in 27.4%. The most frequent pattern of recurrence was peritoneal recurrence in 39.7% of patients, hematogeneous in 24.7%, locoregional in 18.5%, and to a distant lymph node in 17.1%. In cases that showed recurrence within 1 year, the most frequent pattern of recurrence was hematogeneous recurrence, while it was peritoneal in the group with recurrence between 1 and 2 years after surgery. Patterns of recurrence significantly differed according to the sex and gross tumor morphology. The mean post-recurrence survival time was 15.7 months. There was no statistically significant difference in the post-recurrence survival time according to the pattern of recurrence.

Conclusions: The most frequent pattern of recurrence was peritoneal recurrence, and recurrence most often occurred within 2 years after curative resection. There was no significant difference in post-recurrence survival time according to the pattern of recurrence.
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June 2014

Lessons learned from a comparative analysis of surgical outcomes of and learning curves for laparoscopy-assisted distal gastrectomy.

J Gastric Cancer 2015 Mar;15(1):29-38

Department of Surgery, Korea University College of Medicine, College of Natural Sciences, Sungshin Women's University, Seoul, Korea.

Purpose: Before expanding our indications for laparoscopic gastrectomy to advanced gastric cancer and adopting reduced port laparoscopic gastrectomy, we analyzed and audited the outcomes of laparoscopy-assisted distal gastrectomy (LADG) for adenocarcinoma; this was done during the adoptive period at our institution through the comparative analysis of short-term surgical outcomes and learning curves (LCs) of two surgeons with different careers.

Materials And Methods: A detailed comparative analysis of the LCs and surgical outcomes was done for the respective first 95 and 111 LADGs performed by two surgeons between July, 2006 and June, 2011. The LCs were fitted by using the non-linear ordinary least squares estimation method.

Results: The postoperative morbidity and mortality rates were 14.6% and 0.0%, respectively, and there was no significant difference in the morbidity rates (12.6% vs. 16.2%, P=0.467). More than 25 lymph nodes were retrieved by each surgeon during LADG procedures. The LCs of both surgeons were distinct. In this study, a stable plateau of the LC was not achieved by both surgeons even after performing 90 LADGs.

Conclusions: Regardless of the experience with gastrectomy or laparoscopic surgery for other organs, or the age of surgeon, the outcome was quite acceptable; the learning process differ according to the surgeon's experience and individual characteristics.
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http://dx.doi.org/10.5230/jgc.2015.15.1.29DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4389094PMC
March 2015

Current status and scope of lymph node micrometastasis in gastric cancer.

J Gastric Cancer 2015 Mar 31;15(1):1-9. Epub 2015 Mar 31.

Department of Gastroenterologic Surgery, Korea University Medical Center, Seoul, Korea. ; Department of Surgery, Korea University College of Medicine, Seoul, Korea.

Recently, lymph node micrometastasis has been evaluated for its prognostic value in gastric cancer. Lymph node micrometastasis cannot be detected via a usual pathologic examination, but it can be detected by using some other techniques including immunohistochemistry and reverse transcription-polymerase chain reaction assay. With the development of such diagnostic techniques, the detection rate of lymph node micrometastasis is constantly increasing. Although the prognostic value of lymph node micrometastasis remains debatable, its clinical impact is apparently remarkable in both early and advanced gastric cancer. At present, studies on the prognostic value of lymph node micrometastasis are evolving to overcome its current limitations and extend the scope of its application.
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http://dx.doi.org/10.5230/jgc.2015.15.1.1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4389091PMC
March 2015

Primary gastric malignant melanoma mimicking adenocarcinoma.

J Gastric Cancer 2014 Dec;14(4):279-83

Department of Surgery, Korea University College of Medicine, Seoul, Korea.

We report a case of primary gastric malignant melanoma that was diagnosed after curative resection but initially misdiagnosed as adenocarcinoma. A 68-year-old woman was referred to our department for surgery for gastric adenocarcinoma presenting as a polypoid lesion with central ulceration located in the upper body of the stomach. The preoperative diagnosis was confirmed by endoscopic biopsy. We performed laparoscopic total gastrectomy, and the final pathologic evaluation led to the diagnosis of primary gastric malignant melanoma without a primary lesion detected in the body. To the best of our knowledge, primary gastric malignant melanoma is extremely rare, and this is the first case reported in our country. According to the literature, it has aggressive biologic activity compared with adenocarcinoma, and curative resection is the only promising treatment strategy. In our case, the patient received an early diagnosis and underwent curative gastrectomy with radical lymphadenectomy, and no recurrence was noted for about two years.
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http://dx.doi.org/10.5230/jgc.2014.14.4.279DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4286909PMC
December 2014

Should lymph node micrometastasis be considered in node staging for gastric cancer?: the significance of lymph node micrometastasis in gastric cancer.

Ann Surg Oncol 2015 Mar 9;22(3):765-71. Epub 2014 Sep 9.

Department of Gastroenterologic Surgery, Korea University Medical Center, Seoul, South Korea.

Background: In TNM staging system, lymph node staging is based on the number of metastatic lymph nodes in gastric cancer and micrometastasis is not considered. Several reports proposed the importance of lymph node micrometastasis as the causative factor for recurrence and poor survival, but it remains controversial among researchers.

Methods: A total of 482 gastric cancer patients who underwent curative resection from 2004 to 2010 at Korea University Medical Center Ansan Hospital, South Korea were prospectively enrolled. For detecting lymph node micrometastasis, immunohistochemical staining with anti-cytokeratin antibody (CAM 5.2) was performed on negative lymph nodes by hematoxylin-eosin (H-E) staining. Survival differences were compared between conventional node staging and new node staging that took micrometastasis into consideration. Also, the prognostic value of lymph node micrometastasis was investigated in multivariate analysis.

Results: A total of 156 patients (32.4%) showed lymph node micrometastasis. Overall, the micrometastatic group had more advanced tumor and lymph node stage, lymphovascular cancer cell invasion, a higher rate of recurrence, and poor survival. Furthermore, when the cumulative numbers of macro- and micrometastatic lymph nodes were calculated together, the discriminative power of survival difference between each node stage became more stratified. Also, multivariate analysis using Cox's proportional hazards model demonstrated perineural invasion, pathologic T stage, dissected lymph nodes, macro- and micrometastatic lymph nodes are independent prognostic factors.

Conclusions: Lymph node micrometastasis was clinically significant as a risk factor for recurrent gastric cancer. Lymph node micrometastasis should be considered when estimating TNM stage for determining prognosis and the best treatment strategy.
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http://dx.doi.org/10.1245/s10434-014-4073-zDOI Listing
March 2015
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