Background There are no clear guidelines to determine whether to perform D1 or D1+ lymph node dissection in early gastric cancer (EGC). This study aimed to develop a nomogram for estimating the risk of extraperigastric lymph node metastasis (LNM). Materials and Methods Between 2009 and 2019, a total of 4,482 patients with pathologically confirmed T1 disease at 6 affiliated hospitals were included in this study. The basic clinicopathological characteristics of the positive and negative extraperigastric LNM groups were compared. The possible risk factors were evaluated using univariate and multivariate analyses. Based on these results, a risk prediction model was developed. A nomogram predicting extraperigastric LNM was used for internal validation. Results Multivariate analyses showed that tumor size (cut-off value 3.0 cm, odds ratio [OR]=1.886, P=0.030), tumor depth (OR=1.853 for tumors with sm2 and sm3 invasion, P=0.010), cross-sectional location (OR=0.490 for tumors located on the greater curvature, P=0.0303), differentiation (OR=0.584 for differentiated tumors, P=0.0070), and lymphovascular invasion (OR=11.125, P<0.001) are possible risk factors for extraperigastric LNM. An equation for estimating the risk of extraperigastric LNM was derived from these risk factors. The equation was internally validated by comparing the actual metastatic rate with the predicted rate, which showed good agreement. Conclusions A nomogram for estimating the risk of extraperigastric LNM in EGC was successfully developed. Although there are some limitations to applying this model because it was developed based on pathological data, it can be optimally adapted for patients who require curative gastrectomy after endoscopic submucosal dissection.

Backgrounds/AimsConsistency on risk factors for postoperative pancreatic fistula (POPF) after left-sided pancreatectomy (LP) according to the stump closure methods has not been revealed. Appropriate surgical stump closure method after LP is still in debate. This study investigates risk factors for POPF according to the closure methods in LP.MethodsA total of 49 consecutive patients underwent LP with a stapler closure (ST) or hand-sewn closure (HS) between June 2001 and September 2016. The risk factors of pancreatic fistulas were investigated in 49 LPs according to stump closure methods, HS (n=19), and ST (n=30).ResultsThere was no significant difference in the incidence of overall POPF (HS 42.1% vs. ST 50.0%) and clinical relevant POPF (CR-POPF) (HS 5.3% vs. ST 6.7%) between two groups. In the ST group, the pancreas was significantly thick in patients with CR-POPF (27 mm vs. 17 mm) and the tumor was also larger (58 mm vs. 27 mm). In the HS group, the operation time was longer in CR-POPF group (515 min vs 292 min). In univariate analysis, wider diameter of the pancreatic duct (27 mm vs 16 mm) was associated with POPF in the HS group. There was no meaningful risk factor for POPF in the ST group.ConclusionsIncidence of overall POPF between the ST and HS group were clinically insignificant in this study. The thickness of the pancreas and the tumor diameter are factors significantly associated with CR-POPF in the ST group. Long operation time was the only factor associated with CR-POPF in the HS group.

Background/Aim: The prognostic significance of biomarkers related to gastric cancer prognosis has not been fully elucidated. The aim of study was to use immunohistochemical biomarkers to reveal prognosis. Patients and Methods: A total of 682 patients who had undergone curative surgery were evaluated regarding the correlation of prognosis and immunohistochemical biomarkers. Results: The COX2-positive groups showed a poor 5-year overall and disease-free survival. Further analysis revealed that COX2 positivity was a significant risk factor for poorer disease-free survival in the group with clinical stage I disease (p=0.016). We also noted a marked trend between COX2 positivity and poorer overall survival. The COX2-positive group showed general postoperative pathological up-staging compared with the COX2-negative group. Conclusion: This study showed the potential of COX2 as a biomarker for gastric cancer prognosis. Preoperative evaluation of COX2 might be a useful tool for generating optimal treatment strategies in patients with clinical stage I gastric cancer.Despite the therapeutic advancements that have been made in recent years, in 2015, gastric cancer was ranked the fifth most common cancer and was third in terms of cancerrelated deaths (1). After patients with gastric cancer have received appropriate local treatment (e.g. endoscopic submucosal dissection and extended gastrectomy), it is common for the cancer to relapse, thereby necessitating further treatment. In some cases, cancer diagnosis is misjudged and underestimated, resulting in insufficient treatment (2). To overcome this issue, various biomarkers that may help to estimate prognosis regardless of pathological stage have been studied. Some gastric cancer biomarkers, mostly related to cell proliferation and apoptosis, have been identified (3,4). Since classic clinicopathological features cannot fully predict individual outcomes, it has been argued that molecular biomarkers might potentially be better prognostic traits for gastric cancer.Studies on the prognostic significance of different molecular markers have included tumor protein 53 (p53), which has been proven to have a significant association with cancer mortality rates (3, 5). Interestingly, Li et al. have shown that co-expression of two or more markers, including Ki67, a nuclear protein which is involved in proliferation, has a significant detrimental effect on the survival of patients with gastric cancer (6). Furthermore, cyclo-oxygenase-2 (COX2) has been linked to tumorigenesis, and much of the literature suggests that increased COX2 activity is related to more advanced stages of cancer (7). However, whether COX2 can be used as an independent prognostic factor in gastric cancer is still controversial (8).The use of biomarkers as a tool for preoperative prognosis prediction and its implications have not yet been fully studied. In current clinical circumstances, immunohistochemistry is the main method used to examine postoperative specimens. In this study, we reinvestigated the potential prognosti...