KOSIN UNIVERSITY COLLEGE OF MEDICINE
Search
- Page Path
- HOME > Search
- Preoperative-pathological staging discordance in gastric cancer: predictive factors and a 10-year institutional series of 2,810 patients
- Yoonhong Kim, Seok Hwa Youn, Yeajin Moon, Seung Hun Lee, Kyung Won Seo, Ki Hyun Kim
- Kosin Med J. 2026;41(2):145-153. Published online June 16, 2026
- DOI: https://doi.org/10.7180/kmj.25.145
- 466 View
- 9 Download
- 1 Citations
-
Abstract
PDF
PubReader 
ePub
- Background
Accurate preoperative staging is crucial for determining treatment strategies in gastric cancer. However, discrepancies between clinical and pathological staging remain common. This study aimed to evaluate the frequency of preoperative staging discordance and to identify associated risk factors.
Methods
We retrospectively analyzed 2,810 patients who underwent curative gastrectomy at a tertiary center between 2012 and 2021. Staging was determined according to the American Joint Committee on Cancer 8th edition criteria. Patients were categorized into concordant, overestimated, or underestimated groups based on discrepancies between clinical and pathological staging. Multivariate logistic regression analysis was performed to identify independent predictors of staging discordance.
Results
The concordance rate between clinical and pathological staging was 81.3%. Overestimation occurred in 8.1% of cases (n=228), whereas underestimation was observed in 10.6% (n=298). Factors independently associated with overstaging included higher hemoglobin levels (odds ratio [OR], 1.14), lower tumor marker levels (carcinoembryonic antigen: OR, 0.97; carbohydrate antigen 19-9: OR, 0.99), and tumors located in the lower third of the stomach (OR, 1.79). Understaging was independently associated with decreased hemoglobin levels (OR, 0.84 per 1 g/dL increase) and involvement of the entire stomach (OR, 8.48).
Conclusions
Staging discordance occurred in approximately 18.7% of patients with gastric cancer. Identification of these key predictors may facilitate more accurate preoperative assessment and support optimization of individualized surgical and therapeutic planning. -
Citations
Citations to this article as recorded by
- Beyond accuracy: interpreting preoperative staging discordance in gastric cancer
Young Suk Park
Kosin Medical Journal.2026; 41(2): 91. CrossRef
- Beyond accuracy: interpreting preoperative staging discordance in gastric cancer
- The onco-bariatric paradigm: a tri-phasic metabolic obesity framework for synergizing glucagon-like peptide-1 receptor agonists and metabolic bariatric surgery
- Dong Jin Park, Yoonhong Kim, Dongjae Jeon, Young Suk Park, Kyung Won Seo, Ki Hyun Kim
- Kosin Med J. 2026;41(1):3-8. Published online March 23, 2026
- DOI: https://doi.org/10.7180/kmj.26.154
- 1,412 View
- 24 Download
-
Abstract
PDFPubReader ePub
- Obesity is a chronic, progressive neuroendocrine disease that warrants a shift toward an “onco-bariatric” treatment paradigm. This study introduces the tri-phasic metabolic obesity (TPMO) framework, which integrates glucagon-like peptide-1 receptor agonists (GLP-1 RAs) with metabolic bariatric surgery (MBS). Recent clinical and economic evidence—including findings from the Indiana multicenter study and the Highmark Health analysis—was reviewed to evaluate the effectiveness of the TPMO model in improving surgical and metabolic outcomes. The TPMO framework streamlines the patient journey through three synergistic phases. In the neoadjuvant phase, a 4–8-week course of GLP-1 RAs reduces liver volume and visceral fat, thereby improving surgical access, provided that treatment is discontinued 1 week before surgery to mitigate aspiration risk. During the core surgery phase, MBS provides a definitive metabolic reset and remains the most cost-effective treatment, yielding an average savings of $11,689 per patient over 2 years compared with medication alone. In the adjuvant phase, pharmacotherapy—used by 17.2% of post-bariatric patients—counteracts metabolic adaptation and supports sustained weight loss, while a high-protein intake (≥1.2 g/kg/day) is essential for preserving lean body mass. The TPMO framework represents a precision-based, synergistic standard of care designed to promote durable, cost-effective long-term metabolic health within the onco-bariatric paradigm.
- Gastric cancer with lymphoid stroma mimicking a subepithelial lesion after a 10-year disease-free interval: a case report
- Bang Ju Kim, Sung Eun Kim, Seun Ja Park, Moo In Park, Won Moon, Jae Hyun Kim, Kyoungwon Jung, Myung Hun Lee, Jung Wook Lee, Kyung Won Seo, Hee-Kyung Chang
- Kosin Med J. 2025;40(3):233-238. Published online September 23, 2025
- DOI: https://doi.org/10.7180/kmj.25.123
- 4,008 View
- 28 Download
-
Abstract
PDFPubReader ePub
- A 74-year-old male patient presented to our hospital for treatment of gastric cancer in 2021. He had previously visited our institution in 2011 for assessment of a gastric subepithelial lesion (SEL), which was discovered incidentally during a health screening esophagogastroduodenoscopy (EGD). Endoscopic ultrasonography and abdominal computed tomography were conducted for evaluation of the gastric SEL, revealing an approximately 1 cm lesion arising from the muscularis propria. The lesion was initially thought to represent a mesenchymal tumor such as leiomyoma or gastrointestinal stromal tumor. Owing to its small size and absence of symptoms, no immediate intervention was undertaken, and the patient underwent regular surveillance only. Follow-up was maintained until 2018 and no notable changes in the gastric SEL were detected. The patient then voluntarily discontinued further follow-up. In 2021, a routine health screening EGD identified changes in the gastric SEL, and histopathological analysis confirmed adenocarcinoma. The patient subsequently underwent radical total gastrectomy utilizing the Roux-en-Y technique, with the final pathological diagnosis being stage I (pT2N0M0) gastric cancer with lymphoid stroma (GCLS). As of April 2025, there has been no evidence of cancer recurrence. This case illustrates a lesion initially diagnosed as SEL that later was identified as GCLS after a 10-year interval. Therefore, during EGD, clinicians should consider the potential for SEL-like gastric cancer if an SEL is observed. This report highlights the importance of close monitoring and a thorough diagnostic evaluation.
- Immediate Changes of Glucose Metabolism After Gastretomy for Early Gastric Cancer in Patients with Type 2 Diabetes
- Ki Hyun Kim, Yoon Hong Kim, Kyung Won Seo, Ki Young Yoon, Yeon Myeong Shin, Young Sik Choi, Bu Kyung Kim
- Kosin Med J. 2021;36(1):25-33. Published online June 30, 2021
- DOI: https://doi.org/10.7180/kmj.2021.36.1.25
- 5,634 View
- 19 Download
- 1 Citations
-
Abstract
PDFPubReader ePub
Objectives It is well known that type 2 diabetes (T2DM) is dramatically improved after bariatric surgery, although the mechanisms have not been clearly identified. The skill required for gastric surgery for gastric cancer is very similar to that needed in bariatric surgery. In this study, we evaluated the immediate improvement of T2DM after gastrectomy for gastric cancer.
Methods A total of nine patients who were diagnosed with early gastric cancer (EGC) and already had T2DM underwent a 75 g oral glucose tolerance test (OGTT) before surgery and within two weeks after gastrectomy. Glucose, insulin, and c-peptide were measured before, and 30 and 60 minutes after ingesting 75 g of glucose. From these trials, we calculated the HOMA-IR, insulinogenic index, Matsuda index, and area under the curve (AUC).
Results The mean age of participants was 57.23 ± 11.08 years and eight of them were men. HOMA-IR (4.2 vs. 2.3,
P = 0.012) levels were decreased after surgery. There were no significant differences of insulinogenic index, fasting blood sugar before and after surgery. The Matsuda index (3.3 vs. 8.3,P = 0.002) was significantly increased and AUC (512.9 vs. 388.7 mg-hr/dL,P > 0.001) upon 75 g OGTT was significantly decreased after surgery.Conclusions Insulin sensitivity was immediately improved after gastrectomy for early gastric cancer in patients with T2DM.
-
Citations
Citations to this article as recorded by- Remote health monitoring services in nursing homes
Jiwon Kim, Hyunsoo Kim, Sungil Im, Youngin Park, Hae-Young Lee, Sookyung Kwon, Youngsik Choi, Linda Sohn, Chulho Oak
Kosin Medical Journal.2023; 38(1): 21. CrossRef
- Remote health monitoring services in nursing homes
- Laparoscopy-assisted Distal Gastrectomy with Systemic D2 Lymphadenectomy for Gastric Cancer: Usefulness of Noncompliance Rate to Validate the Completion of D2
- Kyung Won Seo, Kae Won Park, Ki Young Yoon
- Kosin Med J. 2013;28(1):27-33. Published online January 19, 2013
- DOI: https://doi.org/10.7180/kmj.2013.28.1.27
- 2,989 View
- 4 Download
-
Abstract
PDFPubReader ePub
Objectives Laparoscopy-assisted distal gastrectomy (LADG) is a common surgical procedure that has recently been accepted as safe and feasible for the treatment of early gastric cancer. There have been many efforts to expand the indications of LADG to include the treatment of advanced gastric cancer. The aim of this study was to determine the usefulness of noncompliance rate as an indicator for D2 lymph node dissection (LND) validation in LADG.
Methods The subjects were 48 patients who underwent distal gastrectomy with D2 LND at Kosin University Gospel Hospital from October to December 2010. Of them, 28 underwent LADG and 20 underwent open distal gastrectomy (ODG). We compared several factors including noncompliance rate to validate D2 LND.
Results There were no significant differences in clinicopathologic factors except for BMI and tumor depth between the two groups. The average number of retrieved lymph nodes was significantly greater in the ODG group (45.9 ± 2.9) than in the LADG group (35.5 ± 2.0). The noncompliance rate was 43% in the LADG group and 40% in the ODG group with no significant difference.
Conclusions In terms of no difference of noncompliance rate, LADG with D2 lymph node dissection is a safe, feasible and oncologicallycamparable with open gastrectomy. A large scaled prospective randomized trial should be needed to confirm the benefit of LADG.
- Trends in Characteristics of Surgically Treated Early Gastric Cancer Patients Between Two Separate Periods
- Kyung Won Seo, Ki Young Yoon
- Kosin Med J. 2010;25(2):136-140. Published online December 31, 2010
- 724 View
- 1 Download
- Pathologic Discrepancy between Endoscopic Biopsy and Resected Sepicimen in Gastric Adenocarcinoma
- Kyung Won Seo, Sang Ho Lee
- Kosin Med J. 2009;24(2):135-140. Published online December 31, 2009
- 818 View
- 0 Download
- Mesenteric Venous Thrombosis : A Case Report
- Kyung Won Seo, Sang Ho Lee
- Kosin Med J. 2009;24(2):247-249. Published online December 31, 2009
- 667 View
- 0 Download
- Pseudoaneurysm of Proximal Splenic Artery Following Total Gastrectomy : A Case Report
- Kyung Won Seo, Yeon Myeong Shin
- Kosin Med J. 2009;24(2):257-260. Published online December 31, 2009
- 695 View
- 1 Download
- A Study on Zinc Status of Gastric Cancer Patients
- Kyung Won Seo, Ki Young Yoon
- Kosin Med J. 2008;23(4):102-106. Published online December 31, 2008
- 833 View
- 1 Download
- Two Cases of Concurrent Papillary and Follicular Carcinoma of The Same Thyroid Lobe
- Kyung Won Seo, Jae Young Choi, Jeong Hoon Kim
- Kosin Med J. 2008;23(4):271-274. Published online December 31, 2008
- 785 View
- 0 Download
- A Case of Bariatric Surgery during Gastric Cancer Operation
- Kyung Hyun Choi, Ki Young Yoon, Hyung Whan Moon, Yeon Myung Shin, Kyung Won Seo, Su Mi Ahn, Yun Mi Song, Jung Hee Seok, Kung Yeon Jeong, Eun Ha Lee
- Kosin Med J. 2008;23(3):99-101. Published online September 30, 2008
- 805 View
- 2 Download
First
Prev
