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Reim, D.,Choi, Y.S.,Yoon, H.M.,Park, B.,Eom, B.W.,Kook, M.C.,Ryu, K.W.,Choi, I.J.,Joo, J.,Kim, Y.W. Academic Press ; W.B. Saunders 2017 European journal of surgical oncology Vol.43 No.8
Background: Prognosis of alpha-fetoprotein positive gastric cancer (AFPP-GC) remains elusive so far due to disparities in cohort size and baseline characteristics in previous studies. A propensity score matching (PSM) analysis as well as multivariable model was performed for unbiased evaluation of the outcome in AFPGC. Methods: Among 3034 gastric cancer patients who underwent curative gastric cancer surgery (R0, M0) at the National Cancer Center, Korea between 2002 and 2007, we identified 97 patients being positive for AFP either by elevation of serum-AFP levels >10 μg/L or by immunohistochemical staining. Due to marked disparities in baseline characteristics and cohort size, propensity-score-matching was performed which matched 87 AFPP-GC patients to the same number of AFP-negative gastric cancer (AFPN-GC) patients. Baseline characteristics were compared using χ<SUP>2</SUP>-test. Survival curves were compared using the Kaplan-Meier-method and multivariable regression analysis was performed to evaluate the effect of AFP-positivity while adjusting the effects of confounding variables. Results: AFPP-GC and AFPN-GC patients revealed marked disparities in patient cohorts. After PSM, groups were balanced for age, sex, tumor size, BMI, tumor location, grade of differentiation, presence of lymphatic vessel infiltration (LVI), Lauren histologic type and stage distribution. In multivariable regression analysis of the PSM-groups, only AFP-positivity and pathologic stage were predictive for overall survival (HR 2.98, CI 95% {1.7-5.1}, p < 0.0001). Five-year-survival rates were significantly worse for AFPP-GC patients (57.9% vs. 76.1%, p = 0.014). Recurrence was significantly more frequent in AFPP-GC patients (p = 0.003). Conclusion: AFP can be considered as an independent negative predictor of overall and recurrence-free survival in patients with gastric cancer.
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Reim, Daniel,Novotny, Alexander,Eom, Bang Wool,Park, Yunjin,Yoon, Hong Man,Choi, II Ju,Kim, Young Woo,Nam, Byung Ho,Ryu, Keun Won Williams & Wilkins Co 2015 Medicine Vol.94 No.52
<P><B>Abstract</B></P><P>Several nomograms for survival prediction after curative gastric cancer surgery have been published over the recent years. Previous validation studies failed to prove applicability of Eastern Asian nomograms in Western patients. Here we present data on a validation analysis of a newly developed Korean nomogram in a German patient cohort.</P><P>Among a total of 2771 patients having been treated in the Department of Surgery of the Technische Universitaet Muenchen from 1982 to 2008, 908 patients were eligible to undergo this analysis. Patients were treated according to Japanese Gastric Cancer guidelines and followed up on a regular basis for at least 60 months postoperatively. Baseline characteristics were compared using χ<SUP>2</SUP>-testing. Survival analyses were computed with the Kaplan–Meier method and multivariate regression analysis models. The C-statistics and Hosmer–Lemeshow chi-square statistics were computed for comparisons of the nomogram's predictive ability.</P><P>All baseline characteristics were significantly different (<I>P</I> < 0.0001) between Korean and German patients except Union Internationale Contre le Cancer-stages (<I>P</I> = 0.427). Multivariate regression analysis revealed the same predictive factors for overall survival in the German and Korean cohorts, respectively, with the exception of tumor size >10 cm and an exclusive correlation of whole stomach spread and pN1-stage for German patients only. The C-index was 0.76, representing an adequate value for predictability of the Korea nomogram in German patients. The Hosmer–Lemeshow statistic implied applicability of the nomogram in the TUM-cohort.</P><P>A newly developed multicenter Korean nomogram for survival prediction after curative gastric cancer surgery may be applicable for estimating survival prognosis in Western (European) patients.</P>
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Experiences of multidisciplinary gastric cancer treatment at the National Cancer Center, Korea
Daniel Reim,Bang Wool Eom,Young-Woo Kim 대한종양외과학회 2013 Korean Journal of Clinical Oncology Vol.9 No.2
Multidisciplinary treatment (MDT) is considered to be beneficial for patients undergoing complex treatments for cancer. The efforts of MDT led to the initiation of nowadays well known trials in gastroesophageal cancer treatment. Here we report the experience of MDT of the Center for Gastric Cancer of the National Cancer Center, Korea. We show the management not only of oncologic treatment plans but also treatment decisions on perioperative oncologic therapy and multimodal management of postoperative and various treatment-related complications. Six cases from gastroenterology, hemato-oncology and surgery parts were presented to show function and effect of MDT conference. Those examples typically showed that even final pathological diagnosis was chnged after MDT conference for some cases, gives adequate decision for further treatment after compications, and offered optimal treatment decision for difficult metastatic disease. Also, management of complications are now more effectively resolved with multidisciplinay intervention with close communication. The local MDT conference can be considered as a fast and effective tool for adequate treatment and improving quality of the treatment. Therefore MDT is an essential component of cancer care to improve patient’s outcome.
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Neoadjuvant Treatment for Gastric Cancer
Schuhmacher, Christoph,Reim, Daniel,Novotny, Alexander The Korean Gastric Cancer Association 2013 Journal of gastric cancer Vol.13 No.2
Surgery is still considered to be the mainstay for the treatment of localized gastric cancer with negative margins (R0-resection) and an adequate lymph-node-dissection (D2-lymphadenectomy). Unfortunately, most cases of gastric cancer are only diagnosed at an advanced stage due to frequent recurrences after primary resection in curative intent. In order to improve prognosis after curative resection, in the recent past, patients with locally advanced tumors were subjected to a pre-, peri-, or postoperative treatment. Interestingly, postoperative chemotherapy has significantly improved survival after gastric resection in Asia, adjuvant radiochemotherapy is favored in North America and perioperative chemotherapy is considered as a treatment of choice in Europe indicating region specific approach towards the treatment. Recently there has also been growing evidence of positive outcomes of neoadjuvant radiochemotherapy on patient survival. In the present article, we discuss the concepts of neoadjuvant treatment approach and provide recommendations to surgeons based on current evidence.
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Neoadjuvant Treatment for Gastric Cancer
Christoph Schuhmacher,Daniel Reim,Alexander Novotny 대한위암학회 2013 Journal of gastric cancer Vol.13 No.2
Surgery is still considered to be the mainstay for the treatment of localized gastric cancer with negative margins (R0-resection) and an adequate lymph-node-dissection (D2-lymphadenectomy). Unfortunately, most cases of gastric cancer are only diagnosed at an advanced stage due to frequent recurrences after primary resection in curative intent. In order to improve prognosis after curative resection, in the recent past, patients with locally advanced tumors were subjected to a pre-, peri-, or postoperative treatment. Interestingly, postoperative chemotherapy has significantly improved survival after gastric resection in Asia, adjuvant radiochemotherapy is favored in North America and perioperative chemotherapy is considered as a treatment of choice in Europe indicating region specific approach towards the treatment. Recently there has also been growing evidence of positive outcomes of neoadjuvant radiochemotherapy on patient survival. In the present article, we discuss the concepts of neoadjuvant treatment approach and provide recommendations to surgeons based on current evidence.
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남병호,김영우,Daniel Reim,엄방울,유완식,박영규,류근원,이영준,윤홍만,이준호,정오,정상호,이상억,이상호,윤기영,서경원,정호영,권오경,김태봉,이운기,박성흠,설지영,양대현,이종석 대한위암학회 2013 Journal of gastric cancer Vol.13 No.3
Purpose: Laparoscopy-assisted distal gastrectomy for early gastric cancer has gained acceptance and popularity worldwide. However,laparoscopy-assisted distal gastrectomy for advanced gastric cancer is still controversial. Therefore, we propose this prospective randomized controlled multi-center trial in order to evaluate the safety and feasibility of laparoscopy assisted D2-gastrectomy for advanced stage gastric cancer. Materials and Methods: Patients undergoing distal gastrectomy for advanced gastric cancer staged cT2/3/4 cN0/1/2/3a cM0 by endoscopy and computed tomography are eligible for enrollment after giving their informed consent. Patients will be randomized either to laparoscopyassisted distal gastrectomy or open distal gastrectomy. Sample size calculation revealed that 102 patients are to be included per treatment arm. The primary endpoint is the non-compliance rate of D2 dissection; relevant secondary endpoints are three-year disease free survival, surgical and postoperative complications, hospital stay and unanimity rate of D2 dissection evaluated by reviewing the intraoperative video documentation. Discussion: Oncologic safety is the major concern regarding laparoscopy-assisted distal gastrectomy for advanced gastric cancer. Therefore,the non-compliance rate of clearing the N2 area was chosen as the most important parameter for the technical feasibility of the laparoscopic procedure. Furthermore, surgical quality will be carefully reviewed, that is, three independent experts will review the video records and score with a check list. For a long-term result, disease free survival is considered a secondary endpoint for this trial. This study will offer promising evidence of the feasibility and safety of Laparoscopy-assisted distal gastrectomy for advanced gastric cancer. Trial Registration: NCT01088204 (international), NCCCTS-09-448 (Korea)
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Emerging Role of Robot-assisted Gastrectomy: Analysis of Consecutive 200 Cases
박지연,김영우,류근원,은방울,윤홍만,Daniel Reim 대한위암학회 2013 Journal of gastric cancer Vol.13 No.4
Purpose: Robotic surgery for gastric cancer is a promising alternative to laparoscopic surgery, but the data are limited. We aimed to evaluate whether gaining experience in robotic gastrectomy could improve surgical outcomes in the treatment of gastric cancer.Materials and Methods: Two hundred and seven consecutive cases of patients with clinical stage I gastric cancer who underwent roboticsurgery at the National Cancer Center of Korea between February 2009 and February 2012 were retrospectively reviewed. Surgical outcomes were analyzed and compared between the initial 100 and later 100 cases.Results: Seven patients required conversion to open surgery and were excluded from further analysis. The mean operating time for all patients was 248.8 minutes, and mean length of hospitalization was 8.0 days. Twenty patients developed postoperative complications. Thirteen were managed conservatively, while 6 had major complications requiring invasive procedures. One mortality occurred owing to myocardial infarction. Operating time was significantly shorter in the latter 100 cases than in the initial 100 cases (269.9 versus 233.5 minutes, P<0.001). The number of retrieved lymph nodes was significantly greater in the latter cases (35.9 versus 39.9, P=0.032). The hospital stay of patients with complications was significantly longer in the initial cases than in the latter cases (16 versus 7 days, P=0.005).Conclusions: Increased experience with the robotic procedure for gastric cancer was associated with improved outcomes, especially in operating time, lymph node retrieval, and shortened hospital stay of complicated patients. Further development of surgical techniques and technology might enhance the role of robotic surgery for gastric cancer.
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Nam, Byung Ho,Kim, Young-Woo,Reim, Daniel,Eom, Bang Wool,Yu, Wan Sik,Park, Young Kyu,Ryu, Keun Won,Lee, Young Joon,Yoon, Hong Man,Lee, Jun Ho,Jeong, Oh,Jeong, Sang Ho,Lee, Sang Eok,Lee, Sang Ho,Yoon, The Korean Gastric Cancer Association 2013 Journal of gastric cancer Vol.13 No.3
Purpose: Laparoscopy-assisted distal gastrectomy for early gastric cancer has gained acceptance and popularity worldwide. However, laparoscopy-assisted distal gastrectomy for advanced gastric cancer is still controversial. Therefore, we propose this prospective randomized controlled multi-center trial in order to evaluate the safety and feasibility of laparoscopy assisted D2-gastrectomy for advanced stage gastric cancer. Materials and Methods: Patients undergoing distal gastrectomy for advanced gastric cancer staged cT2/3/4 cN0/1/2/3a cM0 by endoscopy and computed tomography are eligible for enrollment after giving their informed consent. Patients will be randomized either to laparoscopyassisted distal gastrectomy or open distal gastrectomy. Sample size calculation revealed that 102 patients are to be included per treatment arm. The primary endpoint is the non-compliance rate of D2 dissection; relevant secondary endpoints are three-year disease free survival, surgical and postoperative complications, hospital stay and unanimity rate of D2 dissection evaluated by reviewing the intraoperative video documentation. Discussion: Oncologic safety is the major concern regarding laparoscopy-assisted distal gastrectomy for advanced gastric cancer. Therefore, the non-compliance rate of clearing the N2 area was chosen as the most important parameter for the technical feasibility of the laparoscopic procedure. Furthermore, surgical quality will be carefully reviewed, that is, three independent experts will review the video records and score with a check list. For a long-term result, disease free survival is considered a secondary endpoint for this trial. This study will offer promising evidence of the feasibility and safety of Laparoscopy-assisted distal gastrectomy for advanced gastric cancer. Trial Registration: NCT01088204 (international), NCCCTS-09-448 (Korea).
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