BackgroundSurvival rate of patients treated for gastric cancer has increased due to early detection and improvements of surgical technique and chemotherapy. Increase in survival rate has led to an increase in the risk for remnant gastric cancer (RGC). The purpose of this study was to investigate clinicopathologic features of RGC according to previous reconstruction method and factors affecting the interval from previous curative distal gastrectomy for gastric cancer to RGC occurrence.MethodsMedical records of patients diagnosed with RGC at Yeungnam University Medical Center from January 2000 to December 2017 who had a history of distal gastrectomy with D2 LN dissection due to gastric cancer were reviewed retrospectively.ResultsForty-eight patients were enrolled in this study. The mean interval of 48 RGC patients was 105.6 months (8.8 years). RGC after Billroth II reconstruction recurred more often at anastomosis site than RGC after Billroth I reconstruction (p = 0.001). The mean interval of RGC after Billroth I reconstruction was 67 months, shorter than 119 months of RGC after Billroth II reconstruction (p = 0.003). On the contrary, interval showed no difference according to stage of previous gastric cancer, remnant gastric cancer, or sex (p = 0.810, 0.145, and 0.372, respectively).ConclusionsRGC after Billroth I reconstruction tends to arise earlier at non-anastomosis site than RGC after Billroth II. Therefore, we should examine non-anastomosis site carefully from the beginning of surveillance after gastric cancer surgery with Billroth I reconstruction for better outcome.

The authors report a case of a 78-year-old female with a history of gastric surgery 35 years ago. She was initially misdiagnosed as gastric cancer bleeding and underwent an emergency laparotomy under the diagnosis of jejunogastric intussusception (JGI), 23 hours after the onset of symptoms. We also reviewed 116 JGI case reports and analyzed clinical features and outcomes. Compared to the past, diagnosis of JGI is easier with diagnostic examinations such as an endoscopy, computed tomography, and the upper gastrointestinal series. And a good prognosis can be expected with proper fluid resuscitation and surgical reduction, even if the symptoms persist more than 48 hours.

Background: Recently, owing to significant growth in the amount of information produced by cancer research, staying abreast of the developments has become a challenging task. Artificial intelligence (AI) can learn, reason, and understand the enormous corpus of literature available to the scientific community. However, large-scale cross-validation studies comparing the recommendations of AI and multidisciplinary tumor boards (MTB) in gastric cancer treatment have rarely been performed. Therefore, we retrospectively conducted a real-world study to assess the level of concordance between AI and MTB treatment recommendations. Methods: We retrospectively analyzed the treatment recommendations of Watson for Oncology (WFO) and MTB for 322 patients with gastric cancer from January 2015 to December 2018 and compared the degree of agreement between them. The patients were divided into concordance and non-concordance groups. The factors affecting the concordance rate were analyzed. Results: The concordance rate between AI and MTB was 86.96% at consideration level (280/322). The concordance rate for stage I gastric cancer was the highest (96.93 %). The concordance rates for stages II and III were 88.89% and 90.91%, respectively, which were close to 90%; however, the concordance rate for stage IV was the lowest at 45.83%. In the multivariate analysis, age, performance status, and stage IV gastric cancer had a significant effect on concordance between MTB and WFO. Conclusions: The factors affecting the concordance rate were age, performance status, and stage IV gastric cancer. For increasing the validity of future medical AI systems for gastric cancer treatment, their supplementation of the local guidelines and the ability to comprehensively understand individual patients is essential.

Purpose: Gastric subepithelial tumor (GST) is a disease entity that includes all gastric subepithelial lesions. The oncologically safe surgical technique is complete resection with adequate resection margins. Most of the studies about laparoscopic gastric wedge rsection (LGWR) in GST focus on oncologic curability or surgical effectiveness. However, studies on the factors associated with the operation time are rare. Therefore, this study was conducted to analyze and compare the factors associated with the operation time of LGWR. Methods: From 2010 to 2019, 145 consecutive patients undergoing LGWR were reviewed retrospectively. Clinical characteristics of GST and operation time were analyzed and compared. Results: A total of 145 patients was enrolled and reviewed. There were 59 males (40.7%) and 86 females (59.3%) with a mean age of 53.6 years and mean body mass index (BMI) of 23.9 kg/m 2. Mean tumor size was 2.9 cm and mean operation time was 66.0 minutes. In statistically, the mean operation time showed significant association with tumor size, BMI, longitudinal tumor location and tumor location between lesser and greater curvature. In multivariate analysis, tumor size, BMI and longitudinal classification of tumor location are statistically significant. Conclusion: A shorter operation time is expected when there is a small tumor, low BMI and mid portion of the stomach GST. Preoperative evaluation for tumor size and body weight is important. In patients with large GST, obesity and both end stomach GST, we think that pre-operative preparation for long operation time should be considered.