PURPOSE:The Korean Practice Guidelines for Gastric Cancer 2022 were developed using a rigorous, multidisciplinary, and evidence-based approach. However, their real-world acceptance and implementation have not yet been formally evaluated. This study assessed agreement, compliance, and practice changes associated with strong guideline recommendation statements. MATERIALS AND METHODS:A nationwide anonymous survey was conducted between August and November 2025 among specialists involved in gastric cancer care. Of the 40 recommendation statements addressing the 33 key questions, 18 strong recommendations were evaluated. Respondents rated agreement, compliance, and practice change using a 5-point Likert scale and provided quantitative estimates of compliance and practice change rates. RESULTS:A total of 103 physicians participated, and 100 specialists were included in the main analyses. Most respondents worked at tertiary hospitals (72.8%), and 61.2% had more than 10 years of experience in gastric cancer care. Overall, 93.2% agreed that the guidelines were high-quality, evidence-based documents, and 80.6% reported that they were highly useful in clinical practice. Across the 18 strong recommendation statements, qualitative agreement ranged from 78.5% to 100%, compliance from 60.0% to 100%, and reported practice changes from 11.4% to 40.9%. On average, 95.9% agreed with the recommendations, 92.1% reported compliance, and 23.2% reported a practice change. In the quantitative assessment, the mean compliance rate was 89.7%, and the mean practice change rate was 14.3%. CONCLUSIONS:The guidelines showed high agreement and compliance among the multidisciplinary specialists. Although changes in practice were relatively limited, the guidelines contributed to selected clinical improvements and promoted the standardization of evidence-based practices.

An interesting paper reporting the Chinese expert consensus for sentinel node navigation surgery (SNNS) was recently published in Chinese Journal of Cancer Research(CJCR) (1). Along with the increasing proportion of individuals with early gastric cancer (EGC),clinical interest in minimally invasive function-preserving surgeries such as SNNS,pylorus-preserving and proximal gastrectomy has gradually increased in East Asia (2). However SNNS remains controversial in clinical practice due to the limited evidence and ongoing debate regarding standardized protocols comparing pylorus-preserving and proximal gastrectomy (3). In this context,a Chinese expert consensus for SNNS is meaningful for the advancement of clinical applicability.

Background/Objective: Laparoscopic gastrectomy (LG) and robotic gastrectomy (RG) exhibit similar surgical outcomes in patients with gastric cancer (GC), except for the higher cost associated with RG. Comparative surgical outcome studies after open conversion from laparoscopic (OL) and robotic (OR) gastrectomy in GC are limited. This study aimed to evaluate clinical effectiveness while considering differences in procedural cost. Methods: This retrospective cohort study included a comparative analysis of patients with GC who underwent OL or OR. Inclusion criteria were histologically confirmed adenocarcinoma and curative resection for GC using OL or OR. Exclusion criteria included initially planned open surgery and other laparoscopic or robotic procedures without gastrectomy. Clinicopathological characteristics, as well as short- and long-term surgical outcomes, were compared between groups. Results: Overall, 118 (1.9%) of 6336 LG cases and 10 (2.6%) of 384 RG cases were included (p = 0.3308). Clinicopathological characteristics were statistically comparable between groups. Postoperative complication incidence, evaluated using the Clavien-Dindo classification, was 19.5% and 10% in the OL and OR groups, respectively (p > 0.05). The median hospital stay was 8 and 9.5 days in the OL and OR groups, respectively (p > 0.05). Reasons for open conversion were similar between groups and included adhesion, bleeding, advanced disease, and positive resection margins, among others. Overall 5-year survival was 0.79 (0.72-0.88) and 0.88 (0.67-1.0) in OL and OR, respectively (p = 0.596). Conclusions: Short- and long-term surgical outcomes after OL and OR did not differ statistically. Selection of LG versus RG should be performed with caution.

BACKGROUND:National surgical registries such as the American College of Surgeons NSQIP and Japan's National Clinical Database have shown that structured, risk-adjusted outcome monitoring improves surgical quality. However, no comparable nationwide registry has been reported in Korea. STUDY DESIGN:This interim analysis of the Korean Quality Improvement Platform in Surgery included 42,943 cases from 45 hospitals (2013 to 2023), covering gastric, colorectal, hepatic, pancreatic surgery, and kidney transplantation. Outcomes were 30-day complications, major complications (Clavien-Dindo grade III or higher), and mortality. Hierarchical generalized linear mixed models generated risk-adjusted estimates, accounting for patient- and procedure-level factors and stabilizing results for low-volume centers. RESULTS:The 30-day complication, major complication, and mortality rates were 38.7%, 12.7%, and 0.59%, respectively. Mortality was highest after pancreatic surgery (1.17%) and lowest after gastric surgery (0.16%). Pneumonia occurred in 1.74% of cases and surgical site infection (SSI) in 4.0%. Risk-adjusted benchmarking of a representative institution (H037) classified pneumonia (adjusted odds ratio [OR] 0.67) as "as expected," whereas SSI (adjusted OR 0.15) and mortality (adjusted OR 0.55) were classified as "exemplary." Multivariable analyses confirmed established risk factors: colorectal surgery and higher wound class predicted SSI, chronic pulmonary disease and emergency surgery predicted pneumonia, and higher American Society of Anesthesiologists class and age predicted mortality. CONCLUSIONS:Korean Quality Improvement Platform in Surgery demonstrates the feasibility of a nationwide, risk-adjusted surgical registry in Korea and establishes a benchmark for institutional feedback. As data collection nears completion (target: 219,200 cases), future efforts will focus on subspecialty-specific models, patient-level risk calculators, and integration with artificial intelligence-driven clinical decision-support systems.

Background Frailty is associated with biological aging, causing poor prognosis for cancer survivors, but has not been considered in life expectancy (LE) estimates. This study aims to estimate frailty-adjusted LE for patients aged ≥50 with stomach cancer, using routine blood tests. Methods We included 8,281 patients aged ≥50 diagnosed with stomach cancer in 2007-2018 at National Cancer Center (NCC), extracted from electronic health records. Frailty was assessed by 27 laboratory tests (FI-Lab) and classified as non-frail and frail. The impact of frailty on mortality was estimated by cause-specific Cox regression models with age as the timescale. The area under the survival curve was used to estimate the remaining LE adjusted for frailty. Results Frail patients (higher FI-Lab) had 1.4-fold higher risk of cancer and non-cancer mortality and shorter LE than non-frail patients (lower FI-Lab). Frailty affected 31.2% of middle-aged populations, leading to larger LE losses than in older groups. LE losses due to frailty for males at age 50 and 85 were 7.6 and 2.0 years, slightly higher than the losses in females (6.9 and 1.8 years, respectively). The mortality risk and LE loss due to frailty were largest in localized stage, at age 50: 3.9 years for males and 3.0 years for females, compared to <2 years in regional stage and 0.5 years in distant stage for both sexes. Conclusions FI-Lab-defined frailty was associated with significant LE loss, particularly in male, middle-aged survivors with early-stage stomach cancer. By capturing early signs of biological aging, FI-Lab-based LE estimates may support clinical assessment and individualized survivorship care.

Background: Gastric cancer survivors frequently encounter a “care gap” after discharge because of complex postgastrectomy syndromes. We evaluated “WECARE,” a bidirectional digital health platform designed to provide real-time symptom monitoring and multidisciplinary support. The primary goal of this study was to assess the efficacy of the platform by measuring the change in the Korean Quality of Life Questionnaire for Gastric Cancer Survivors (KOQUSS-40) total score over a six-month recovery period. Methods: This nationwide, multicenter pilot randomized controlled trial was conducted by the Korean Quality of Life in Stomach Cancer Patients Study Group (KOQUSS) across nine tertiary centers in Korea. A total of 88 patients who underwent curative gastrectomy were enrolled. Following an initial optimization phase involving 22 patients, the remaining 66 patients were randomized at a 1:1 ratio to the WECARE group or the control group. The WECARE group used a platform integrating the KOQUSS-40 algorithm for structured symptom reporting, real-time feedback on nutrition and exercise, and educational content on meal planning, symptom coping, and recovery. Assessments were performed at baseline and at 1, 3, and 6 months after discharge. Results: The WECARE group showed high feasibility and acceptability, with an adherence rate of 86.7% and an 82% satisfaction rate. At 6 months, the KOQUSS-40 total score (primary endpoint) did not differ significantly between the WECARE and control groups (85.3 ± 1.6 vs. 83.8 ± 1.6, p = 0.603). However, the WECARE group showed a numerically favorable recovery trajectory from the acute postoperative phase. Subgroup analysis revealed a positive trend in reflux symptom management in the WECARE group (p = 0.0856). In addition, more than 77% of users reported that the platform improved their self-management capabilities. Conclusions: The WECARE platform is a feasible and acceptable digital intervention for gastric cancer survivors. Although the primary endpoint was not significantly different, the favorable recovery trajectory, high adherence, and patient engagement support further evaluation in larger studies with longer follow-up and broader healthcare settings.

There are only a few whole genome sequencing studies of human gastric cancer (GC) conducted so far. We performed comprehensive whole genome, bulk RNA, and methylation sequencing analyses of 100 samples of GC and adjacent normal tissue. In a smaller non-EBV/non-MSI subset (n = 23), we also performed proteomic profiling by mass spectrometry. We validated the proteomic findings in an independent dataset. Using this unprecedented dataset of human GC samples, we examined the extent of chromothripsis, homologous recombination deficiency, and retrotransposition, and correlated these events with patient outcomes. We found that chromothripsis occurred in 22% of GCs and correlated with poor prognosis. Multichromosomal chromothripsis was associated with a particularly high risk of death. Based on copy number (CN) signature analysis, we identified a distinct non-CN9 subgroup with significantly worse outcomes. Homologous recombination deficiency was present in 4% of GCs and was associated with overexpression of immune signaling pathways. Somatic retrotransposition events were most strongly associated with global hypomethylation. We also identified BYSL as a putative oncogenic driver within the 6p21 locus whose amplification is associated with poor prognosis. Collectively, our findings provide novel insights into the dysregulation of DNA stability and repair and their clinical relevance in human GCs.

BackgroundPatients undergoing gastrectomy usually experience postgastrectomy syndrome and face difficulties adapting to a regular diet. Human health coaching via a mobile app has recently been applied to patients with chronic metabolic diseases, with significant improvements being observed in clinical outcomes. ObjectiveThis study aimed to compare the quality of life and nutritional outcomes of human health coaching via a mobile app with those of conventional face-to-face counseling in postgastrectomy patients with gastric cancer. MethodsThis was a prospective randomized controlled trial, and patients were enrolled between May 2020 and August 2022. The mobile coaching group received health coaching that provides personalized advice based on self-recorded health data via a mobile app from assigned coaches for 3 months after discharge, and the conventional counseling group underwent dietary consultations with a clinical dietitian 1 and 3 months postoperatively. The primary end point for sample size calculation was the eating restriction score on the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire gastric cancer module 1 month postoperatively. Secondary end points included changes in other subscales of the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 and gastric cancer module, as well as nutritional outcomes assessed preoperatively and 1, 3, 6, and 12 months postoperatively. ResultsData from 88.9% (160/180) of enrolled patients were analyzed after excluding dropouts. In the mobile coaching group (n=76), 66% (n=50) of patients who used the mobile app for ≥8 weeks were classified as active users. No significant difference in eating restriction 1 month postoperatively was found between the mobile coaching and conventional counseling groups. However, the mobile coaching group reported less dyspnea during the entire period (P=.01), less eating restriction at 6 months (P=.045), and less negative body image 3 months postoperatively (P=.04) than the conventional counseling group (n=84). Exploratory subgroup analyses based on age, sex, and operation type indicated that younger patients (<60 years), female patients, and those who underwent distal gastrectomy had better quality of life from mobile coaching. In the mobile coaching group, exploratory subgroup analyses based on mobile activity showed that active users had a better global health status than inactive users (P=.005). However, no significant differences in body composition or nutritional parameters were observed between the mobile coaching and conventional counseling groups or between active and inactive users in the mobile coaching group. ConclusionsAlthough this trial did not show a significant difference in eating restriction 1 month postoperatively, human coaching via a mobile app was associated with fewer symptoms in some scales compared to conventional counseling in postgastrectomy patients with gastric cancer. The intervention might help patients manage their symptoms and adapt to their diet. Trial RegistrationClinicalTrials.gov NCT04394585; https://clinicaltrials.gov/study/NCT04394585

OBJECTIVE:This study aimed to compare laparoscopic standard gastrectomy (LSG) and laparoscopic sentinel node navigation surgery (LSNNS) for EGC in terms of 5-year long-term oncologic outcomes.SUMMARY BACKGROUND DATA:The oncological safety of LSNNS for early gastric cancer (EGC) has not been confirmed. Three-year disease-free survival (DFS), which is the primary endpoint of the phase III multicenter randomized controlled clinical trial (SEntinel Node ORIented Tailored Approach [SENORITA] trial), did not show the non-inferiority of LSNNS relative to LSG.METHODS:The SENORITA trial, a multicenter randomized clinical trial, was designed to show that LSNNS is non-inferior to LSG in terms of 3-year DFS. In the present study, we collected 5-year follow-up data from 527 patients recruited in the SENORITA trial as the full analysis set (FAS). Disease-free survival (DFS), overall survival (OS), disease-specific survival (DSS), and recurrence patterns were evaluated using the FAS of both LSG (n=269) and LSNNS (n=258).RESULTS:The 5-year DFS was not significantly different between the LSG and LSNNS groups (P=0.0561). During the 5-year follow-up, gastric cancer-related events, such as metachronous cancer, were more frequent in the LSNNS group than in the LSG group. However, ten recurrent cancers in the remnant stomach of both groups were curatively resected by additional gastrectomy and one by additional endoscopic resection. Two of the 198 patients who underwent local resection for stomach preservation based on the LSNNS results developed distant metastasis. However, there was no statistically significant difference in the 5-year OS and DSS (P=0.7403 and P=0.9586, respectively) between the two groups.CONCLUSION:The 5-year DFS, DSS and OS did not differ significantly between the two groups. Considering the benefits of LSNNS on postoperative quality of life, LSNNS could be recommended as an alternative treatment option for EGC.

Gastric cancer is one of the most common cancers in both Korea and worldwide. Since 2004, the Korean Practice Guidelines for Gastric Cancer have been regularly updated, with the 4th edition published in 2022. The 4th edition was the result of a collaborative work by an interdisciplinary team, including experts in gastric surgery, gastroenterology, endoscopy, medical oncology, abdominal radiology, pathology, nuclear medicine, radiation oncology, and guideline development methodology. The current guideline is the 5th version, an updated version of the 4th edition. In this guideline, 6 key questions (KQs) were updated or proposed after a collaborative review by the working group, and 7 statements were developed, or revised, or discussed based on a systematic review using the MEDLINE, Embase, Cochrane Library, and KoreaMed database. Over the past 2 years, there have been significant changes in systemic treatment, leading to major updates and revisions focused on this area. Additionally, minor modifications have been made in other sections, incorporating recent research findings. The level of evidence and grading of recommendations were categorized according to the Grading of Recommendations, Assessment, Development and Evaluation system. Key factors for recommendation included the level of evidence, benefit, harm, and clinical applicability. The working group reviewed and discussed the recommendations to reach a consensus. The structure of this guideline remains similar to the 2022 version. Earlier sections cover general considerations, such as screening, diagnosis, and staging of endoscopy, pathology, radiology, and nuclear medicine. In the latter sections, statements are provided for each KQbased on clinical evidence, with flowcharts supporting these statements through meta-analysis and references. This multidisciplinary, evidence-based gastric cancer guideline aims to support clinicians in providing optimal care for gastric cancer patients.

Background:Patients who undergo gastrectomy for gastric cancer experience gastrointestinal symptoms, psychological responses, and social problems. These factors reduce a patient's quality of life (QoL) after surgery. A web-based platform (Wecare®) has been developed to address distress and provide solutions. This study aimed to evaluate whether Wecare® improved the QoL of patients who underwent gastrectomy. Methods:A total of 88 patients who undergo gastrectomy for gastric cancer will be randomly allocated to either the "Wecare®" group or the control group at a 1:1 ratio. After using the "Wecare®" platform for the first 22 patients and making modifications, the next 66 patients will be randomized equally. The primary outcome of this trial is the QoL among gastric cancer survivors (KOQUSS-40). The values of weight change, nutritional index change, KOQUSS-40 questionnaire compliance, self-efficacy, physical activity change, and satisfaction will be compared between the two groups as secondary outcomes. The investigator will follow-up with the patients at 1, 3, and 6 months after surgery at the outpatient clinic. Discussion:This is the first randomized controlled trial to analyze the usefulness of a symptom management platform (Wecare®) among gastric cancer survivors. This study aimed to verify the efficacy of web-based platforms in relieving discomfort after gastric cancer surgery. Future large-scale clinical trials are planned.

Background/Objectives: Delayed gastric emptying (DGE) is a well-known complication of laparoscopic pylorus-preserving gastrectomy (LPPG). Patients who underwent LPPG in the KLASS-04 trial, which was a multicenter prospective randomized control trial comparing LPPG and laparoscopic distal gastrectomy (LDG), showed an unneglectable incidence of long-term DGE compared to patients who underwent LDG. This study aimed to identify the multifactorial risk factors associated with DGE and to analyze the quality of life (QoL) of patients with DGE following LPPG. Methods: DGE was defined as “nearly normal diet residue” at least once in the endoscopic follow-up at 1, 2, and 3 years after the surgery. Clinicopathological features, surgical outcomes, and QoL were compared between the DGE and non-DGE groups. Results: DGE was observed in 21/124 patients (16.3%) who underwent LPPG. Patients without previous abdominal surgery had a higher incidence of DGE in the univariate (32% vs. 4.8%, p = 0.011) and logistic regression analyses (odds ratio: 0.106, 95% confidence interval: 0.014–0.824, p = 0.032). Patients with DGE reported more symptoms of nausea and vomiting (p = 0.004), constipation (p = 0.04), and a dry mouth (p = 0.005). Conclusions: Despite the strict protocol used to avoid well-known risk factors for DGE, such as damage to the hepatic branch of the vagus nerve, infrapyloric artery and vein, and short antral cuff, the LPPG group of the KLASS-04 trial exhibited a considerable incidence of DGE. No clinicopathological or surgical factors, other than the absence of a previous surgical history, were identified as multifactorial risk factors for DGE. However, DGE had a negative impact on the QoL of patients.

PURPOSE:Despite a growing older adult population, few studies have compared the long-term outcomes of endoscopic submucosal dissection (ESD) with those of gastrectomy. This study examines long-term survival among older patients with early gastric cancer (EGC) treated with ESD versus gastrectomy. MATERIALS AND METHODS:This retrospective cohort study used data from the Korea Clinical Data Utilization Network for Research Excellence. Patients aged ≥75 with stage IA gastric cancer (diagnosed 2014-2015) who underwent ESD or gastrectomy were followed for 5 years. All-cause and cause-specific mortality were assessed using Cox proportional hazard models and propensity score matching. RESULTS:Of the 442 patients (ESD, 269; gastrectomy, 173), the 5-year overall survival rates were 85.9% for ESD and 80.9% for gastrectomy (P=0.140). In patients aged ≥80, gastrectomy showed higher risks of total (adjusted hazard ratio [aHR], 3.29; 95% CI, 1.70-6.35) and gastric cancer-specific death (aHR, 7.18; 95% CI, 2.08-24.82) compared with ESD. In mucosa-confined lesions, gastrectomy also showed increased gastric cancer-specific mortality (aHR, 6.11; 95% CI, 1.93-19.35). The survival benefit of ESD was comparable to that of gastrectomy among patients aged 75-79 years and those with confined submucosal lesions. CONCLUSIONS:ESD may offer better outcomes than gastrectomy among older patients with stage IA gastric cancer, particularly those aged ≥80 or with mucosa-confined lesions. ESD and gastrectomy may provide similar survival outcomes among patients aged 75-79 years and those with submucosa-confined lesions. These findings support the use of adaptive treatment strategies in older patients with EGC.

PURPOSE:Since 1995, the Korean Gastric Cancer Association (KGCA) has been periodically conducting nationwide surveys on patients with surgically treated gastric cancer. This study details the results of the survey conducted in 2023. MATERIALS AND METHODS:The survey was conducted from March to December 2024 using a standardized case report form. Data were collected on 86 items, including patient demographics, tumor characteristics, surgical procedures, and surgical outcomes. The results of the 2023 survey were compared with those of previous surveys. RESULTS:Data from 12,751 cases were collected from 66 institutions. The mean patient age was 64.6 years, and the proportion of patients aged ≥71 years increased from 9.1% in 1995 to 31.7% in 2023. The proportion of upper-third tumors slightly decreased to 16.8% compared to 20.9% in 2019. Early gastric cancer accounted for 63.1% of cases in 2023. Regarding operative procedures, a totally laparoscopic approach was most frequently applied (63.2%) in 2023, while robotic gastrectomy steadily increased to 9.5% from 2.1% in 2014. The most common anastomotic method was the Billroth II procedure (48.8%) after distal gastrectomy and double-tract reconstruction (51.9%) after proximal gastrectomy in 2023. However, the proportion of esophago-gastrostomy with anti-reflux procedures increased to 30.9%. The rates of post-operative mortality and overall complications were 1.0% and 15.3%, respectively. CONCLUSIONS:The results of the 2023 nationwide survey demonstrate the current status of gastric cancer treatment in Korea. This information will provide a basis for future gastric cancer research.

PURPOSE:The aim of this study is to compare the detection ability of quality of life (QoL) changes and responsiveness of the KOrean QUality of life in Stomach cancer patients Study group (KOQUSS)-40 and European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ). MATERIALS AND METHODS:A multicenter prospective observational study was conducted to evaluate QoL changes after various gastrectomies between January 2021 and April 2022. Participants were instructed to complete the KOQUSS-40 and EORTC QLQ-C30/STO22 preoperatively and at 1, 3, 6, and 12 months postoperatively. QoL changes over time and QoL responsiveness were assessed for each questionnaire. RESULTS:Data from 491 patients who underwent curative gastrectomy for gastric cancer at 22 institutions were analyzed. The summary scores of the KOQUSS-40 and EORTC QLQ-STO22 showed significant differences between the total and proximal gastrectomy groups (p=0.044 and p=0.038, respectively), but no difference was observed for the EORTC QLQ-C30. Dysphagia on the KOQUSS-40 was significantly different between the total and proximal gastrectomy groups (p=0.031); however, dysphagia on the EORTC QLQ-STO22 did not differ. The responsiveness of the KOQUSS-40 was similar to that of the EORTC QLQ in patients who experienced ≥ 10% body weight loss, but approximately 10% less in patients receiving adjuvant chemotherapy than the EORTC QLQ. CONCLUSION:KOQUSS-40 has several advantages over EORTC QLQ-C30/STO22 when comparing QoL between the total and proximal gastrectomy groups. The findings provide information for researchers investigating the QoL of patients who have undergone curative gastrectomy for gastric cancer.

BACKGROUND:The SENORITA phase III trial demonstrated the effectiveness of laparoscopic sentinel node navigation surgery (LSNNS) in preserving stomach function for patients with early gastric cancer (EGC), although some patients experienced surgical failure or recurrence. The purpose of this study was to analyze patients' clinicopathologic features from the SENORITA trial who were allocated to LSNNS with stomach-preserving surgery but ultimately did not preserve stomach or experienced recurrence. PATIENTS AND METHODS:Patients were categorized into two groups: the failure group (stomach preservation failure or cancer recurrence after LSNNS) and the success group (stomach preservation without recurrence following LSNNS). This study analyzed the detailed clinicopathologic characteristics of patients in the failure group from the SENORITA trial. RESULTS:Among 258 patients who underwent LSNNS, 193 patients (74.8%) achieved stomach preservation, while 65 patients (25.2%) failed to preserve. Intraoperative failure was the most common cause of unsuccessful stomach preservation, occurring in 35 of 65 cases (53.8%). Advanced pathological TNM stage was the only independent risk factor by multivariate analysis, with stage IB and IIA patients showing 5.9- and 45.0-fold higher failure risks. The main causes of failure included sentinel basin detection failure, metastatic lymph nodes, positive tumors at resection margins, and complications. The failure group also included five cases of gastric cancer recurrence following LSNNS. CONCLUSION:Accurate preoperative staging and patient selection are crucial for optimizing LSNNS outcomes. Ensuring precise resection with an adequate number of harvested sentinel basin nodes is essential to succeed the stomach-preserving surgery.

BACKGROUND:Standard treatment for non-curative endoscopic submucosal dissection (ESD) of early gastric cancer is radical gastrectomy with systematic lymph node dissection. However, the actual incidence of lymph node metastasis was reported to be 5-10%. The aim of this study is to evaluate the feasibility of sentinel basin mapping after non-curative ESD for early gastric cancer. METHODS:This is a multicenter, prospective feasibility study. Patients who underwent ESD for early gastric cancer and had a non-curative resection on final pathology were included. Sentinel basin mapping was performed using one of two methods: (1) endoscopic submucosal injection of a dual tracer, including a radioisotope and indocyanine green (ICG); or (2) fluorescence imaging after ICG injection. Following dissection of the identified sentinel basins, laparoscopic gastrectomy with D1 + lymphadenectomy was performed in all patients. The primary endpoint was the detection rate; secondary endpoints were sensitivity and postoperative complications. RESULTS:A total of 243 patients were enrolled from April 2017 to July 2024, and data from 238 eligible patients were analyzed. The dual tracer and fluorescence imaging with ICG were used in 216 and 22 patients, respectively. The overall detection rate was 97.1% (231/238), and metastatic lymph nodes were observed in 23 patients (9.7%, 23/238). The sensitivity was 69.6% (16/23) with 7 false-negative cases. Univariate analysis to identify risk factors for false-negative events showed that the early study period and institution had a nonsignificant trend. The postoperative complication rate was 10.1%, and the severe complication rate (Clavien-Dindo grade ≥ III) was 2.5%. CONCLUSION:Sentinel basin mapping after non-curative ESD achieved a high detection rate of 97.1%. However, the false-negative rate of 30.4% appears to be unacceptably high from an oncological safety perspective.

PURPOSE:This study evaluated the postoperative quality of life (QoL) after various types of gastrectomy for gastric cancer. MATERIALS AND METHODS:A multicenter prospective observational study was conducted in Korea using the Korean Quality of Life in Stomach Cancer Patients Study (KOQUSS)-40, a new QoL assessment tool focusing on postgastrectomy syndrome. Overall, 496 patients with gastric cancer were enrolled, and QoL was assessed at 5 time points: preoperatively and at 1, 3, 6, and 12 months after surgery. RESULTS:Distal gastrectomy (DG) and pylorus-preserving gastrectomy (PPG) showed significantly better outcomes than total gastrectomy (TG) and proximal gastrectomy (PG) with regard to total score, indigestion, and dysphagia. DG, PPG, and TG also showed significantly better outcomes than PG in terms of dumping syndrome and worry about cancer. Postoperative QoL did not differ significantly according to anastomosis type in DG, except for Billroth I anastomosis, which achieved better bowel habit change scores than the others. No domains differed significantly when comparing double tract reconstruction and esophagogastrostomy after PG. The total QoL score correlated significantly with postoperative body weight loss (more than 10%) and extent of resection (P<0.05 for both). Reflux as assessed by KOQUSS-40 did not correlate significantly with reflux observed on gastroscopy 1 year postoperatively (P=0.064). CONCLUSIONS:Our prospective observation using KOQUSS-40 revealed that DG and PPG lead to better QoL than TG and PG. Further study is needed to compare postoperative QoL according to anastomosis type in DG and PG.

PURPOSE:The study aimed to investigate real-world surgical outcomes of minimally invasive surgery (MIS) for advanced gastric cancer using Korean Gastric Cancer Association (KGCA)-led nationwide data.MATERIALS AND METHODS:A nationwide survey of patients who underwent surgical treatment for gastric cancer in 2019 was conducted by the KGCA. A total of 14,076 patients from 68 institutions underwent surgery, and 4,953 patients diagnosed with pathological stages IB-III gastric cancer were included. Among them, 1,689 patients who underwent MIS (MIS group) and 1,689 who underwent the open approach (open group) were matched using propensity score in a 1:1 ratio. Surgical outcomes were compared, and multivariate analysis was performed to identify the independent factors for overall morbidity.RESULTS:The MIS group had a lower proportion of D2 lymphadenectomy, total omentectomy, and combined resection. However, the number of harvested lymph nodes was higher in the MIS group. Better surgical outcomes, including less blood loss and shorter hospital stay, were observed in the MIS group, and the overall morbidity rate was significantly lower in the MIS group (17.5% vs. 21.9%, P=0.001). The mortality rates did not differ significantly between the 2 groups. In the multivariate analysis, the minimally invasive approach was a significant protective factor against overall morbidity (odds ratio, 0.799; P=0.006).CONCLUSIONS:Based on the Korean nationwide data, MIS for stage IB-III gastric cancer had better short-term outcomes than the open approach, including lower rates of wound complications, intra-abdominal abscesses, and cardiac problems.

Objective:The laparoscopic approach for locally advanced gastric cancer has recently been adopted based on the results of several randomized controlled trials(RCTs).However,findings from RCTs have not been examined at the national level.This study aimed to investigate the external validity of the Korean Laparoscopic Gastrointestinal Surgery Study-02(KLASS-02)trial involving 13 tertiary hospitals,using data from the Korean Gastric Cancer Association(KGCA)-led nationwide survey involving 68 tertiary or general hospitals. Methods:Data on patients who underwent laparoscopic or open distal gastrectomy for pathological stageⅠB-ⅢC gastric cancer under the same conditions were collected from the KLASS-02 trial and the KGCA nationwide survey datasets.Surgical outcomes were assessed for each dataset and multivariable analyses were performed to examine the effect of the laparoscopic approach on surgical outcomes. Results:The laparoscopic group had a lower overall complication rate than the open group in both KLASS-02 and KGCA datasets(16.1％vs.23.5％for the KLASS-02 and 12.6％vs.19.6％for the KGCA).Moreover,the laparoscopic group had fewer wound problems,and fewer grade Ⅱ,Ⅲa,and Ⅳ complications than the open group in the KGCA data(0.8％vs.3.4％,5.8％vs.10.4％,2.3％vs.3.7％,and 0.5％vs.1.4％,respectively),which were not observed in the KLASS-02 data.Multivariable analyses revealed that the laparoscopic approach was not associated with overall complications,but reduced wound problems and more harvested lymph nodes in the KGCA survey data(adjusted odds ratios,0.19 for wound problems,adjusted β coefficient 4.39 for number of harvested lymph nodes),which were not shown in the KLASS-02 data. Conclusions:The safety and feasibility of the laparoscopic approach for locally advanced gastric cancer were validated at a national level.The laparoscopic approach for locally advanced gastric cancer can be implemented in the Republic of Korea.