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Background: Accurate intraoperative diagnosis of serosal invasion is a prerequisite for proper application of invasive procedures, such as intraperitoneal chemohyperthermia, for serosa positive gastric carcinomas. Methods: We reviewed the prospectively constructed data of 1,265 gastric cancer patients who underwent surgery between 2007 and 2009. Accuracies of macroscopic diagnoses of serosal invasion were determined by comparing with pathological findings. The risk factors of over- and underestimation of serosal invasion were analyzed in the univariate and multivariate model. Results: The accuracy of macroscopic intraoperative diagnosis of serosal invasion was 88%. Serosal invasion was underestimated in 34 of 187 serosa positive patients and overestimated in 117 of 1,078 serosa negative patients; a sensitivity and specificity of 82 and 89%, respectively. When pT1 tumors were excluded, the accuracy, sensitivity, and specificity of macroscopic diagnosis of serosal invasion were 71.5, 81.8, and 65.3%, respectively. Univariate and multivariate analysis revealed that a tumor size of >4 cm and preoperative CT finding of serosa positive were independent risk factors for macroscopic overestimation as serosal invasion in pT2 gastric cancer. Meanwhile, Borrmann type 1, preoperative CT finding of serosa negative, lesser/posterior surface location, and tumor size of <4 cm were independent risk factors for underestimation of serosal invasion in pT3 gastric carcinoma. Conclusions: The macroscopic diagnosis of serosal invasion is largely consistent with pathological findings. However, great care should be taken with regard to the risk of over- and underestimation of serosal invasion when making a decision for invasive treatments based on macroscopic findings of serosal invasion. [ABSTRACT FROM AUTHOR]

Background: The common p53 codon 72 polymorphism has been investigated as a risk factor for cancer in different populations; however, the results have been inconsistent. This study investigated the risk of developing gastric or colorectal cancer associated with the p53 codon 72 polymorphism in a Korean population. Methods: We conducted a large-scale case-control study that included 2,213 gastric cancer patients; 1,829 colorectal cancer patients; and 1,700 healthy controls. Genotyping was performed with real-time polymerase chain reaction (PCR), using a TaqMan single-nucleotide polymorphism (SNP) genotyping assay. Results: The frequencies of Arg/Arg, Arg/Pro, and Pro/Pro genotypes of the p53 codon 72 polymorphism were 43.3, 42.0, and 13.0% in the gastric cancer patients; 40.5, 45.0, and 14.0% in the colorectal cancer patients; and 43.2, 45.6, and 11.2% in the controls, respectively. The Pro/Pro genotype was associated with an increased risk of gastric [age- and sex-adjusted odds ratio (OR) = 1.25, 95% confidence interval (CI) = 1.01-1.56, P = 0.04] and colorectal cancer (OR = 1.36, 95% CI = 1.07-1.72, P = 0.01). There were no significant interactions between the p53 codon 72 polymorphism and smoking or drinking. Conclusions: Our results suggest that the Pro/Pro genotype is associated with modest increases in the risks of gastric cancer and colorectal cancer in a Korean population. [ABSTRACT FROM AUTHOR]

Background: Gastric cancer is very common in Korea and Japan, where many hospitals annually perform high numbers of gastrectomies for gastric cancer. The aim of this study was to compare the general management of gastric cancer in high-volume centers in Korea and Japan. Methods: We undertook a survey of the general management of gastric cancer at high-volume centers (over 200 cases/year) and analyzed the answers. Results: In six of 14 hospitals surveyed, antimicrobial prophylaxis for elective gastrectomy was administered until postoperative day 3. A Levin tube and an abdominal drain were routinely inserted in seven and ten hospitals, respectively. Laboratory tests, such as complete blood cell count, liver function test, electrolytes, and blood urea nitrogen/creatinine were performed frequently on postoperative days 1, 2, 3, and 5. Sips of water after open distal gastrectomy were restarted up to postoperative day 3 in twelve hospitals. The surgical pathology was reported up to postoperative day 10 in thirteen hospitals. Twelve hospitals provided a regular patient education program and only one hospital provided an integrated education program which included the participation of a surgeon, an oncologist, a nurse, and a nutritionist. Conclusions: The general management of gastric cancer in 14 high-volume centers was not so different among the centers. The general management protocols noted here are expected to provide useful information for perioperative care. [ABSTRACT FROM AUTHOR]

Purpose: To promote proper management of postoperative bleeding, we investigated the clinical manifestations, predisposing factors, diagnostic approaches, and treatments of bleeding complications after gastric cancer surgery. Methods: Using a prospectively constructed database, we reviewed retrospectively 39 patients who suffered bleeding complications from among a total 1027 patients who underwent surgery for gastric cancer between 2004 and 2008. Results: Operating time (hazard ratio [HR] 1.842, 95% confidence interval [CI] 1.524-2.367) and body mass index (HR 1.454, 95% CI 1.128-1.792) were significant predisposing factors for postoperative bleeding after gastric cancer surgery. Luminal bleeding occurred in 16 patients: as simple anastomosis site bleeding, treated successfully with conservative or endoscopic treatment, in 13; and as pseudoaneurysmal bleeding in 3, treated successfully with surgery in 2, but resulting in the death of 1. Abdominal bleeding occurred in 23 patients, requiring surgery in 9 and arterial embolization in 1. The most common finding at reoperation was bleeding from the mesocolon surface. The mean hospital stay of patients with postoperative bleeding was 21 (±20) days. Conclusions: Postoperative bleeding can be managed successfully with a tailored approach, considering its origins and clinical manifestations. Arterial pseudoaneurysms are a rare cause of luminal bleeding, but they can be fatal and should be suspected when extensive luminal bleeding presents after gastric cancer surgery. [ABSTRACT FROM AUTHOR]

Laparoscopic total gastrectomy (LTG) has not become as popular as laparoscopic distal gastrectomy (LDG) because of the more difficult reconstruction technique. Despite various modifications of reconstruction methods after LTG, an optimal procedure has yet to be established. The authors report the newly developed reconstruction technique after LTG: intracorporeal circular stapling esophagojejunostomy using the transorally inserted anvil (OrVil™; Covidien, Mansfield, MA, USA). After full mobilization of the abdominal esophagus, the esophagus is transected with an endoscopic linear stapler. The anvil is then transorally inserted into the esophagus by using the OrVil™ system. After jejunojejunostomy is performed through a 4-cm midline minilaparotomy, preparing a 50-cm Roux-en-Y jejunal limb, a circular stapler is inserted into the jejunum and introduced into the abdominal cavity. Pneumoperitoneum is established by sealing off the laparotomy wound retractor with a surgical glove attached to the circular stapler. Double-stapling esophagojejunostomy with a circular stapler is performed intracorporeally, and the jejunal stump is closed with an endoscopic linear stapler. Of the 16 patients who underwent this operation, there was no intraoperative complication or conversion to open surgery, and no patient required an extension of the initial incision for anastomosis. Mean operation time and blood loss were 194 min and 272 ml, respectively. One patient developed an intra-abdominal abscess postoperatively. Postoperative fluorography revealed no anastomosis leakage or stenosis in any of the patients. Patients resumed an oral liquid diet on postoperative day 3–5, and the mean postoperative hospital stay was 11 days. We have successfully performed LTG with Roux-en-Y reconstruction using our technique in 16 patients without any anastomosis complications. We believe that our procedure is a secure and reliable reconstruction method after LTG, which is especially useful in obese patients, in whom conventional extracorporeal anastomosis often is difficult. [ABSTRACT FROM AUTHOR]

Abstract Purpose  A number of bacteria types are known to preferentially grow in tumors. We have taken advantage of this phenomenon to target luciferase-expressing Escherichia coli to tumors and metastases in mouse models to image them noninvasively. Methods and Results  After intravenous injection of pLux-expressing E. coli (108 CFU), bioluminescence signals from the bacteria were detected exclusively in tumor tissue after 24 hours. The balanced-lethal host–vector system using the gene encoding aspartate β-semialdehyde dehydrogenase (asd) enabled stable maintenance of the pLux in the tumor-targeting E. coli. This phenomenon of selective tumor targeting and proliferation of E. coli was observed in a diverse range of tumors implanted in nude mice. More importantly, E. coli was capable of targeting both primary tumors and metastases, enabling them to be imaged noninvasively in both nude and immunocompetent mice. Conclusions  Our results suggest the potential clinical use of this technology for tumor targeting. [ABSTRACT FROM AUTHOR]

We analyzed the clinicopathologic features of node-positive gastric carcinoma patients who were long-term survivors (5 years or longer) and evaluated the predictive factors associated with long-term survival. Of 554 node-positive gastric carcinoma patients with curative resection, 161 (29.1%) were long-term survivors, and 393 died of the disease before 5 years. The long-term survivor group had a recurrence rate of 16.1%, while the recurrence rate was 95.4% in the short-term survivor group ( P < 0.05). The mean tumor size in the long-term survivors (4.5 cm) was significantly smaller than that in the short-term survivors (5.3 cm; P < 0.001). A depth of invasion greater than T3 was found more frequently in the short-term survivor group (88.1%) than in the long-term survivor group (70.1%; P < 0.001). Using Cox’s proportional hazard regression model, the only factor found to be an independent, statistically significant prognostic parameter was tumor size (risk ratio, 0.301; 95% confidence interval, 0.10–0.88; P < 0.05). The tumor size emerged as the only independent, significant factor for the prediction of long-term survival in node-positive gastric carcinoma patients with curative resection. [ABSTRACT FROM AUTHOR]

Background: Multiple primary carcinomas are increasingly being found because of the development of diagnostic techniques and the increasing incidence of early stage carcinoma. The purpose of this study was to determine the prevalence and clinicopathological features of gastric carcinoma patients with other primary carcinomas. Methods: There were 65 (incidence 2.6%) gastric carcinoma patients with other primary carcinomas compared with 2,444 patients with gastric carcinoma alone. Results: Associated primary carcinomas were often found in the gastrointestinal (GI) tract, especially in the colon (33.8%). In patients with gastric carcinoma only, poorly differentiated adenocarcinoma was the most common (43.2%), followed by moderately and well-differentiated adenocarcinoma. Similarly, poorly differentiated adenocarcinoma (33.8%) was also the prevalent histological type in gastric carcinoma patients with other primary carcinomas, although its incidence was lower. The stage of gastric carcinoma did not differ between the two groups. The estimated 5-year survival rate was 51.6% for patients with gastric carcinoma alone, and 50.7% for those with other primary carcinomas; the difference was not significant (P=0.82). Conclusion: Gastric carcinoma should be treated aggressively, since the prognosis of gastric carcinoma patients treated for other primary carcinomas is not poorer than that of patients treated for gastric carcinoma alone. [ABSTRACT FROM AUTHOR]

A correction to the article "p53 codon 72 polymorphism in patients with gastric and colorectal cancer in a Korean population," by Hye-Rim Song and colleagues is presented.