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Background/aims: There are differing histologic subtypes of gastric cancer. We investigated the clinicopathological features and prognosis of: signet ring cell (SRC), mucinous (MGC), papillary (PGC), and lymphoepithelioma-like (LELC) carcinoma in advanced gastric cancer., Methodology: One hundred thirty six advanced gastric cancer patients, including 62 SRCs, 43 MGCs, 9 PGCs, and 22 LELCs, who underwent R0 gastrectomy between 2002 and 2013, were retrospectively evaluated., Results: There were significant differences in several clinicopathological features. There were found to be statistical differences in postoperative outcomes in the type of gastrectomy and type of anastomosis (p<0.001 and p<0.001, respectively). In terms of overall survival analysis, there was no statistical survival difference among the subtypes of advanced gastric cancer (p=0.088). However, LELC had a better prognosis than the other groups., Conclusions: There were some differences in several of the clinicopathological features of the subtypes advanced gastric cancer. Although there were no statistical differences in survival, those with LELC showed a better prognosis than did the other groups. Therefore, the treatment of advanced gastric cancer should be individualized, and prognosis considered, according to the subtype.

Background/aims: The goal of this study was to elucidate the risk factors for duodenal stump leakage after gastrectomy for gastric cancer. In addition, the management of duodenal stump leakage is reviewed., Methodology: From January 2002 through December 2012, 1,195 patients with gastric cancer who underwent gastric R0 resection were enrolled in this study. The clinicopathologic features, postoperative outcomes (i.e., operation time, hospital stay, surgical procedures, method of duodenal stump closure, retrieved lymph nodes), and the risk factors of duodenal stump leakage were analyzed., Results: Of the 1,195 patients, 13 patients (1.1%) suffered duodenal stump leakage. Most of the patients with duodenal stump leakage were male (92.3%). Nine patients underwent a subtotal gastrectomy with Billroth- II or Roux-en-Y anastomosis; the other four patients underwent a total gastrectomy with a Roux-en-Y anastomosis. There were two mortalities. With univariate and multivariate analysis, age was the most predictable factor for duodenal stump leakage (p= 0.034, p=0.044) CONCLUSIONS: Duodenal stump leakage was affected by the age. For older patients who undergo a radical gastrectomy for gastric cancer, the surgeon must pay meticulous attention to the transection and mobilization of the duodenum in order to prevent duodenal stump leakage.

Background/aims: The aim of this prospective trial was to observe the results of the two types of techniques., Methodology: Single port laparoscopic cholecystectomy (SPLC) (56 cases) indication was polyp disease and mild cholecystitis with gall bladder stone (no right upper quadrant tenderness in physical examination, no gall bladder wall thickening in image study). Three ports laparoscopic cholecystectomy (TPLC) (46 cases) was applied to previous laparoscopic surgery indication. There were slight differences in indication as there are still limitations in applying single port laparoscopic cholecystectomy in all patients., Results: The two groups were similar with respect to demographic characteristics. There were no significant differences in operation time, bile leakage during operation, postoperative hospital stay, pain score. Additional port(s) use in single port laparoscopic cholecystectomy were 13 cases, the reasons were difficult dissection of Calot's triangle (7 cases), incomplete ligation by Hem-o-lok clip (3 cases), cystic artery bleeding (3 cases), difficult visual due to obesity (1 case)., Conclusions: Single port laparoscopic cholecystectomy is still in its initial stages. Although many controversies remain regarding stability and possibility, it is believed that development and exchange of new instruments and techniques will form an important part of future minimal invasive surgery.

Background/aims: Laparoscopic cholecystectomy has become the gold standard modality for treating gallbladder disease. There are many techniques for the ligation of a dilated and inflamed cystic duct. The aim of this study is to assess the efficacy and applicability of an Endo-GIA for dilated cystic duct ligation., Methodology: From October 1992 to September 2009, 3413 patients underwent laparoscopic cholecystectomy for gallbladder disease at the Dong-A Medical Center, and 92 (2.7%) patients' cystic ducts were ligated by an Endo-GIA. We retrospectively analyzed these 92 cases., Results: The cystic ducts were successfully ligated with an Endo-GIA in 88 patients. Four patients required conversion to open surgery. The mean operation time was 111.9 minutes. The mean length of the hospital stay was 4.1 days. Postoperative complication occurred in 16 patients (17%). The follow-up period ranged from 0.5 to 75 months., Conclusions: Endo-GIA is safe and feasible. Postoperative complication occurred in 16 patients after application of an Endo-GIA. However, those complications were successfully managed by conservative treatment. The rate of complications was comparable to the best results from most of the large series in the West. Therefore, using an Endo-GIA could be attempted in carefully selected patients with difficult cases of laparoscopic cholecystectomy.

Background/aims: We wanted to compare the clinicopathological parameters with the immunohistochemical expression patterns and patient survival for the intestinal type (IT) and the pancreatobiliary type (PT) of ampulla of Vater carcinoma. Ampulla of Vater carcinoma can be classified histologically into either IT or PT. The biologic behavior and patient prognosis vary considerably in relation to the tumor type., Methodology: From September, 1995, to February, 2004, 34 patients with the pathologic diagnosis of ampulla of Vater carcinoma were retrospectively reviewed and the prognostic factors were analyzed. To classify the phenotypes of the tumors, the keratin types (CK7 and CK20), the type of apomucin of the mucosa (MUC2), and the glucose transporter (GLUT1) were studied for differentiating the tumor types., Results: The 5-year survival rate of the 34 patients with ampulla of Vater carcinoma was 58.8%. Histologically, 12 patients had IT and 22 had PT, and the IT patients all survived. The long-term survival after resection of the tumor was significantly greater for the patients with IT than for the patients with PT. Although these differences were not statistically significant, the prognosis of IT group seemed more favorable (p = 0.0955). On the immunohistochemical staining, MUC2 (p < 0.0001), CK20 (p = 0.0002) and CK7 (p = 0.0368) were statistically effective, but not GLUT1, for differentiating IT from PT., Conclusions: For the classification of the tumor phenotypes, performing immunohistochemical staining were helpful to differentiate the two types of tumor. A study with a larger number samples would probably elucidate the different clinical course between these two types of ampulla of Vater carcinoma.

Background/aims: Intraoperative colonic distension is associated with postoperative ileus, which contributes to delayed hospital discharge. A randomized and prospective study was conducted, to evaluate the usefulness of intraoperative needle decompression of the colon during radical gastrectomy for gastric cancer., Methodology: Fifty patients that had received subtotal or total gastrectomy for gastric cancer were randomly assigned to either a non-decompression (n=27) or a decompression group (n=23). Prior to the main procedure, the transverse or right colon was pulled up, and a 19-gauge disposable needle connected to suction was introduced to the colon through the taenia site of anterior wall. Gas collected in the colon was aspirated out. The time to the first postoperative passage of flatus or feces was measured precisely to evaluate the restoration of bowel function. Additional measures of outcome were the operation time, the complication rate, and hospital stay., Results: Demographic details, pathologic features, operation time, complication rate and hospital stay were not different between the two groups. A collapsed colon was required for good surgical exposure and easy manipulation. No unexpected complication related to this procedure was found. The first flatus was 6.8 hours sooner in the decompression group than in the non-decompression, though this result was not statistically significant., Conclusions: This technique is a simple and safe procedure for intraoperative colon decompression during radical gastrectomy.

Background/aims: The sentinel lymph node (SLN) is defined as the first draining node from the primary lesion. The objective of this study was to determine the feasibility of SLN biopsy in patients with gastric cancer for assessment of lymph node status., Methodology: From November 2001 through to July 2002, SLN biopsy was performed in twenty-two consecutive patients whose preoperative imaging studies showed T2 or T1 and no lymph node metastasis. Three hours prior to each operation, 99mTc tin-colloid (2.0ml, 1.0mCi) was injected into the submucosa of gastric tumor via endoscope. After SLN biopsy had been performed using gamma probe (NEO2000 Gamma Detection System, Neoprobe CO, 1999, USA), all the patients underwent radical gastrectomy. The SLN was cut and immediately manipulated for frozen section, and processed to make paraffin block for H&E and immunohistochemistry (IHC) staining., Results: On average, 1.8 (range 1-5) SLNs were identified per patient. The location of all SLNs was in the perigastric area. No skip metastases were found. SLNs were identified in 20 of the 22 patients (success rate, 90.9%). The sensitivity of the SLN status in the diagnosis of the lymph node status was 82.2% (5/6) and the specificity was 100.0% (14/14). The diagnostic accuracy according to SLN status was 95.0% (19 of 20)., Conclusions: SLN biopsy using radioisotope in patients with gastric cancer was a technically feasible procedure and a minimally invasive approach in the assessment of the nodal status in each patient.