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8 "Stomach neoplasm"
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Review article
Gastric cancer and metabolic syndrome
Hyeong Ho Jo
Kosin Med J. 2024;39(1):26-34.   Published online March 22, 2024
DOI: https://doi.org/10.7180/kmj.24.108
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Abstract PDFPubReader   ePub   
Gastric cancer (GC), a prevalent disease in Asian countries, presents a substantial global health challenge. The risk factors for GC include Helicobacter pylori infection, diet, smoking, alcohol, and metabolic syndrome (MetS). This review meticulously examines the intricate connections between MetS and GC, focusing on visceral adipocytes, hormonal factors, obesity, and their impact on survival outcomes. Visceral adipocytes, which secrete inflammatory cytokines and hormones, play a pivotal role in influencing cancer development. Hormonal factors demonstrate nuanced associations with specific GC subtypes, underscoring the complexity of their impact. Large-scale studies exploring obesity-related factors reveal sex-specific nuances and underscore the importance of considering overall weight and body composition. Furthermore, the review explores the impact of eradication therapy for H. pylori infection, which is the most significant factor in the onset of GC, on the components of MetS. Additionally, the influence of MetS on postoperative outcomes and survival in GC patients highlights the interplay between therapeutic interventions and lifestyle factors. This comprehensive exploration sheds light on the multifaceted relationship between MetS and GC, providing valuable insights for future research and preventive strategies.
Case report
Primary gastric leiomyosarcoma: a case report and literature review
Yedaun Lee
Kosin Med J. 2024;39(1):60-65.   Published online August 18, 2023
DOI: https://doi.org/10.7180/kmj.23.118
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Abstract PDFPubReader   ePub   
After separating gastrointestinal (GI) stromal tumors from true smooth muscle tumors of the GI tract, leiomyosarcoma (LMS) of the GI tract has become a rare tumor. Gastric LMS is extremely rare and accounts for 0.1% of all cases of LMS in the GI tract. There are few English-language reports of gastric LMS describing radiologic findings. Here, we report a case of gastric LMS and review the recent literature focusing on radiologic findings. An 80-year-old female patient was referred for evaluation of a gastric mass accompanied by severe anemia. The physical examination revealed no specific findings except for an anemic conjunctiva. Laboratory data showed a low hemoglobin level of 5.1 g/dL. Endoscopy revealed a huge subepithelial mass in the posterior wall of the gastric body. Contrast-enhanced computed tomographic images showed an intraluminal protruding enhancing mass with an internal stalk appearance in the gastric body. There was no internal necrosis or calcification. The patient underwent subtotal gastrectomy and was diagnosed with primary gastric LMS. The diagnosis of gastric LMS is challenging due to its rarity. Our case report suggests that the presence of an internal stalk or spouting appearance can help prompt the radiologist to consider gastric LMS in the differential diagnosis.
Original articles
Intraoperative tumor localization using a titanium ring strip in totally laparoscopic distal gastrectomy for middle-third gastric cancer
Jae-Kyun Park, Chang-In Choi, Tae Yong Jeon, Hyuk Jae Jung, Si Hak Lee, Sun Hwi Hwang, Dae-Hwan Kim
Kosin Med J. 2023;38(2):126-133.   Published online June 23, 2023
DOI: https://doi.org/10.7180/kmj.23.113
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Abstract PDFPubReader   ePub   
Background
This study presents a novel technical tip for intraoperative tumor localization and determination of the proximal resection line using a titanium ring strip for totally laparoscopic distal gastrectomy in patients with middle-third gastric cancer and describes the short-term results of its application.
Methods
In total, 42 patients with middle-third gastric cancer who underwent intraoperative tumor localization using a titanium ring strip and determination of the proximal resection line through intraoperative radiography between January 2020 and December 2021 were enrolled in this study. We retrospectively analyzed patients’ prospectively collected clinical, pathological, and surgical data.
Results
Twenty-six men and 16 women with a mean age of 58.3±12.5 years were enrolled. The mean operation time and estimated blood loss were 212.6±43.0 minutes and 122.4±77.6 mL, respectively. The lengths of the proximal and distal resection margin were 2.0±0.4 cm (range, 0.8–3.7 cm) and 10.5±4.1 cm (range, 0.4–20.4 cm), respectively. Roux-en-Y anastomosis was performed in 30 patients, while Billroth II with Braun anastomosis was performed in 12 patients. There were no procedure-related complications, and the mean postoperative hospital stay was 7.2±1.9 days. For all patients, the negative proximal resection margin was confirmed by postoperative pathological examinations.
Conclusions
Intraoperative tumor localization and determination of the proximal resection line using a titanium ring strip is a useful alternative method that can be easily and safely performed. This method is especially useful for patients with middle-third gastric cancer requiring an appropriate proximal resection margin.
Hepatic steatosis changes after early gastric cancer surgery
Ki Hyun Kim, Soyoung Ock, Dohyung Lee, Yoonhong Kim, Jihoon Jo, Kyungwon Seo, Kiyoung Yoon, Sukyoung Kwon, Youngsik Choi, Bukyung Kim
Kosin Med J. 2022;37(1):68-74.   Published online March 28, 2022
DOI: https://doi.org/10.7180/kmj.22.008
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Abstract PDFPubReader   ePub   
Background
Nonalcoholic fatty liver disease dramatically improves after bariatric surgery, primarily due to improvements in hepatic insulin sensitivity. Since the procedure for gastric cancer surgery is very similar to that for bariatric surgery, we investigated changes in fatty liver following gastrectomy for gastric cancer according to the type of surgery.
Methods
We evaluated hepatic steatosis in 212 early gastric cancer patients using Hounsfield units (HUs) on non-contrast computed tomography preoperatively and 6, 12, and 24 months after surgery. We compared the preoperative and postoperative liver-to-spleen HU ratio according to the type of surgery: Billroth I, Billroth II, and total gastrectomy with Roux-en-Y reconstruction.
Results
The initial results (liver/spleen HUs and the liver-to-spleen HU ratio) did not significantly differ according to surgical group. After surgery, only patients who underwent total gastrectomy with Roux-en-Y exhibited significant changes in the liver-to-spleen HU ratio at 6 months. In 26 patients who had higher initial HU levels of the spleen than the liver, the liver-to-spleen HU ratio significantly increased from 0.836 to 1.115 at 6 months, 1.109 at 12 months, and 1.102 at 24 months (P<0.01).
Conclusion
Significant changes in hepatic steatosis were found in even normal patients (with higher liver than spleen HU values) who underwent total gastrectomy with Roux-en-Y. Patients who initially had fatty liver also showed a significant increase in the liver-to-spleen HU ratio. These results suggest that total gastrectomy with Roux-en-Y reconstruction can have a positive effect on the improvement of hepatic steatosis.
Differences in Endoscopic Findings of Primary and Secondary Gastric Lymphoma
Kyoungwon Jung, Hae Soo Jeon, Moo In Park, Il Hyeong Choe, Hyun Seung Je, Jae Hyun Kim, Sung Eun Kim, Won Moon, Seun Ja Park
Kosin Med J. 2020;35(2):114-124.   Published online December 31, 2020
DOI: https://doi.org/10.7180/kmj.2020.35.2.114
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Abstract PDFPubReader   ePub   
Objectives

: Since endoscopic findings of primary gastric lymphoma are ambiguous and diverse, it is not easy to distinguish them from gastric adenocarcinoma or secondary gastric lymphoma. The aim of this study was to investigate the difference in clinical and endoscopic features between primary gastric lymphoma and gastric involvement of lymphoma.

Methods

: Forty-eight patients were enrolled in this retrospective study between June 2008 and February 2017. The patients were divided into primary gastric lymphoma group (primary group, n = 18) and gastric involvement group (secondary group, n = 30) based on whether or not they carried gastric lesions alone. Patients’ clinical characteristics, endoscopic findings and pathologic data were retrospectively reviewed based on electronic medical records.

Results

: The mean age of patients was 63.3 ± 13.1 years and 29 patients were female (60.4%). Diffuse large B-cell lymphoma pathology (81.3%), gastric body involvement (47.9%) and ulceroinfiltrative morphology on endoscopy (43.8%) were common features. Regardless of the two groups, the initial endoscopic diagnosis was considered as lymphoma only in 41.7%. Compared with the primary group, fundus (P = 0.035) and regional lymph node (P < 0.001) were significantly associated with the secondary group. However, there was no significant difference in endoscopic findings including location, size, number, and morphology of lesion.

Conclusions

: Endoscopic diagnosis of gastric lymphoma is a challenge. There is no difference in endoscopic findings between the primary and secondary groups even when confirmed separately. However, when the lesion is present in the fundus, we keep in mind the possibility of secondary gastric lymphoma.

Citations

Citations to this article as recorded by  
  • Endoscopic and Histopathological Characteristics of Gastrointestinal Lymphoma: A Multicentric Study
    Quang Trung Tran, Thinh Nguyen Duy, Bao Song Nguyen-Tran, Tung Nguyen-Thanh, Quy Tran Ngo, Nam Phuong Tran Thi, Vi Le, Thuan Dang-Cong
    Diagnostics.2023; 13(17): 2767.     CrossRef
  • A Differential Diagnosis of Unusual Gastric Ulcer
    Soo-Yoon Sung, Hyun Ho Choi, Kyung Jin Seo
    Diagnostics.2022; 12(8): 1929.     CrossRef
Case reports
Common Hepatic Artery Originating from Left Gastric Artery: A Rare Variant Encountered in Gastric Cancer Surgery
Chang In Choi, Tae Yong Jeon
Kosin Med J. 2018;33(3):463-467.   Published online December 31, 2018
DOI: https://doi.org/10.7180/kmj.2018.33.3.463
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Abstract PDFPubReader   

The hepatic artery can have numerous variations. However, a common hepatic artery originating from the left gastric artery and the entire hepatic blood supply furnished by the left gastric artery is an extremely rare anomaly. We encountered this anomaly in a patient with advanced gastric cancer. A surgeon should recognize this image appearance and identify the anomaly. Without knowledge of this anomaly and given the strategy for extensive lesser sac dissection generally employed during gastric cancer surgery, a surgeon could easily inadvertently divide this vessel, resulting in critical liver damage. We report a case of common hepatic artery originating from left gastric artery and review of the literatures.

A Case of Retroperitoneal Fibrosis Secondary to Metastatic Stomach Cancer
Jong Chul Kim, Hyun Yul Rhew
The Journal of Kosin Medical College. 1992;8(1):87-92.
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Original article
Relationship of Histologic Types of Early Gastric Cancer and Types of Gastric Dysplasia
Hee Kyung Chang, Man-Ha Hur
The Journal of Kosin Medical College. 1992;8(2):135-156.
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KMJ : Kosin Medical Journal