Biomedical subjects

Long-Bin Jeng

Publications and source records attributed to Long-Bin Jeng.

At least 19 recordsLinked to original sources

PubMed2006

Risk factors for developing metastatic infection from pyogenic liver abscesses.

OBJECTIVES: The aim of this study was to identify the risk factors for developing extra-hepatic metastases from pyogenic liver abscesses. METHODS: We conducted a retrospective study and reviewed 225 patients (age, 19-93 years) with a discharge diagnosis of pyogenic liver abscess from a large medical centre in Taiwan, between January 1995 and June 2000. Clinical data were collected from medical records. Of the 225 patients with a pyogenic liver abscess, 24 had extrahepatic metastases and were classified into the metastatic infection group; the remaining 201 were classified into the non-metastatic infection group and served as the control group. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated by exact logistic regression. RESULTS: After adjustment for age, sex, and the duration of symptoms before admission, diabetes mellitus (adjusted OR, 12; 95% CI, 3.3-67), alcoholism (adjusted OR, 5.2; 95% CI, 1.4-20), the time interval >7 days from the onset of symptoms to the time appropriate antibiotics were administered (adjusted OR, 3.9; 95% CI, 1.2-13), bacteraemia (adjusted OR, 5.4; 95% CI, 1.4-30), and infection (adjusted OR, 5.0; 95% CI, 1.1-47) were associated with the development of extra-hepatic metastases from pyogenic liver abscesses. On the other hand, fever (adjusted OR, 0.28; 95% CI, 0.089-0.92) and right upper quadrant pain/tenderness (adjusted OR, 0.091; 95% CI, 0.0020-0.50) were associated with the non-metastatic abscesses. We performed a multivariate analysis and found that diabetes mellitus (multivariate OR, 7.7; 95% CI, 2.1-29) and alcoholism (multivariate OR, 8.9; 95% CI, 2.6-30) were the independent risk factors for developing metastatic infections; yet right upper quadrant pain/tenderness (multivariate OR, 0.11; 95% CI, 0.014-0.87) was the predictor of no metastatic abscesses. CONCLUSIONS: Our data suggest that diabetes mellitus and alcoholism are significant risk factors for developing metastatic infections from pyogenic liver abscesses. These findings seem to imply that underlying conditions of the host influence the development of extra-hepatic metastases from pyogenic liver abscesses.

Adult↗

PubMed2006

Extensive retroperitoneal and right thigh abscess in a patient with ruptured retrocecal appendicitis: an extremely fulminant form of a common disease.

As a disease commonly encountered in daily practice, acute appendicitis is usually diagnosed and managed easily with a low mortality and morbidity rate. However, acute appendicitis may occasionally become extraordinarily complicated and life threatening. A 56-year-old man, healthy prior to this admission, was brought to the hospital due to spiking high fever, poor appetite, dysuria, progressive right flank and painful swelling of the thigh for 3 d. Significant inflammatory change of soft tissue was noted, involving the entire right trunk from the subcostal margin to the knee joint. Painful disability of the right lower extremity and apparent signs of peritonitis at the right lower abdomen were disclosed. Laboratory results revealed leukocytosis and an elevated C-reactive protein level. Abdominal CT revealed several communicated gas-containing abscesses at the right retroperitoneal region with mass effect, pushing the duodenum and the pancreatic head upward, compressing and encasing inferior vena cava, destroying psoas muscle and dissecting downward into the right thigh. Laparotomy and right thigh exploration were performed immediately and about 500 mL of frank pus was drained. A ruptured retrocecal appendix was the cause of the abscess. The patient fully recovered at the end of the third post-operation week. This case reminds us that acute appendicitis should be treated carefully on an emergency basis to avoid serious complications. CT scan is the diagnostic tool of choice, with rapid evaluation followed by adequate drainage as the key to the survival of the patient.

Abscess↗

PubMed2006

Management of right colon diverticulitis: a 10-year experience.

BACKGROUND: Controversies abound as regards the optimal treatment for patients with diverticulitis of the right colon. METHODS: This is a retrospective review of 113 patients with a diagnosis of right colonic diverticulitis who received treatment at the China Medical University Hospital from July 1994 to June 2004. RESULTS: Medical therapy was undertaken in 56 patients diagnosed preoperatively with uncomplicated diverticulitis. All but one patient was successfully treated with bowel rest and antibiotics. Of the 51 patients with a preoperative diagnosis of acute appendicitis, 32 received appendectomy along with postoperative antibiotic therapy, 8 received diverticulectomy in addition to appendectomy, and 11 received colectomy. In all, 17 patients required right hemicolectomy or ileocecal resection due to diverticulitis-related complications or suspected malignancy. Of the 87 (56-1+32) patients who responded to conservative treatment, 11 developed recurrent diverticulitis. All 11 patients were successfully treated with medical therapy, and 2 subsequently received elective right hemicolectomy. Of the 9 patients who received medical treatment alone at the second attack, 2 suffered a third attack. Both were successfully managed with medical therapy. CONCLUSIONS: For uncomplicated diverticulitis of the right colon diagnosed preoperatively, antibiotic therapy with bowel rest is an effective treatment. Once it is encountered during surgery for presumed acute appendicitis, a conservative approach involving prophylactic appendectomy and postoperative antibiotics is recommended. For patients with recurrent diseases, medical treatment is still safe and efficient. Colectomy is indicated when complications occur or when malignancy is strongly suspected.

Adolescent↗

PubMed2006

Role of fundus-first laparoscopic cholecystectomy in the management of acute cholecystitis in elderly patients.

BACKGROUND: Conversion from laparoscopic cholecystectomy to open cholecystectomy leads to the loss of the advantages of this minimally invasive procedure and significantly increases length of hospital stay as well as cost. The conversion from laparoscopic to open cholecystectomy is more frequent among patients with acute cholecystitis and in elderly patients. This study evaluated whether fundus-first laparoscopic cholecystectomy could lower the conversion rate in geriatric patients with acute cholecystitis. MATERIALS AND METHODS: During a twelve-month period, 112 patients (36 of them age 65 years or older) underwent fundus-first laparoscopic cholecystectomy for acute cholecystitis in a tertiary care university hospital in central Taiwan. RESULTS: The conversion rate in the elderly patients was 2.7% (1/36). No major perioperative complications were observed. Minor complications--port-site infection and subhepatic fluid collection-occurred in two patients (5.5%). CONCLUSION: Laparoscopic cholecystectomy with a fundus-first approach is a safe, effective operative procedure for elderly patients with acute cholecystitis when performed by an experienced laparoendoscopic surgeon.

Aged↗

PubMed2006

Seizure attack during partial hepatectomy in a living donor for liver transplantation under sevoflurane anesthesia.

We report a case of generalized convulsion during partial hepatectomy for the purpose of organ donation for syngenesioplastic liver transplantation under sevoflurane anesthesia. This 23-year-old male Taiwanese living donor had no history of epilepsy. Anesthesia was inducted with fentanyl, propofol and rocuronium was used to facilitate endotracheal intubation. Sevoflurane in the mixture of oxygen and air and rocuronium were used for maintenance of anesthesia. Generalized convulsion with mild fever was observed 11 hours after the start of surgery when the surgeons happened to take a recess pending the removal of the recipient's liver. Convulsive episode subsided after aggressive management. Another 3 hours were required to complete the operation and the patient woke up in the postanesthesia room uneventfully.

Adult↗

PubMed2005

Laparoscopic appendectomy using the LigaSure Vessel Sealing System.

BACKGROUND: Laparoscopic appendectomy is increasingly being employed to treat acute appendicitis. The aim of the present study was to evaluate the efficacy and safety of the LigaSure Vessel Sealing System (Valleylab, Boulder, CO) in laparoscopic appendectomy. PATIENTS AND METHODS: Laparoscopic appendectomy was performed using the LigaSure system in 15 patients who had a preoperative diagnosis of acute appendicitis. RESULTS: In two patients, the operation was converted to open appendectomy. The mean operative time was 47 minutes (range, 22-120 minutes). There was no evidence of any complications related to the use of the LigaSure system. Neither surgical endoclips nor an endostapler were used in any patient. CONCLUSION: Laparoscopic appendectomy using the LigaSure system is a safe and efficient procedure for acute appendicitis. Use of the LigaSure system in laparoscopic appendectomy may simplify the operative procedure and reduce the operative time.

Acute Disease↗

PubMed2005

Role of leukocyte count, neutrophil percentage, and C-reactive protein in the diagnosis of acute appendicitis in the elderly.

Leukocyte count, neutrophil percentage, and C-reactive protein (CRP) have been shown to give valuable information in the diagnosis of acute appendicitis. However, whether these laboratory tests have the same clinical applicability in the elderly as in young patients remains unclear. This retrospective study aimed to clarify the role of these tests in the diagnosis of acute appendicitis in patients aged 60 years or over. Eighty-five consecutive elderly patients underwent appendectomy for suspected acute appendicitis during a 30-month period. Histologically verified appendicitis was found in 77 of the 85 patients (90.6%). There was no significant difference in leukocyte counts or CRP values between patients with acute appendicitis and those with a normal appendix. The sensitivities of leukocyte count, neutrophil percentage, and CRP in the diagnosis of acute appendicitis were 71.4 per cent, 88.3 per cent, and 90 per cent, respectively, while the specificities were 37.5 per cent, 25 per cent, and 37.5 per cent, respectively. Of 77 patients with acute appendicitis, only two had all three tests simultaneously normal. In conclusion, patients with normal results in all three tests are highly unlikely to have acute appendicitis and should be evaluated with extra caution before surgery.

Acute Disease↗

PubMed2004

Three-dimensional ultrasound in margin evaluation for breast tumor excision using Mammotome.

Sonographic evidence of tumor removal by Mammotome excision does not confirm histological clearance. The operator finds it hard to determine if a malignant tumor has been fully removed, leaving a safe margin in the direction of each border; that is, the spatial orientation during tumor retrieval is not well-established by naked eye under sonographic guidance. We propose a computational imaging process to extract reasonable tumor contour in pre- and postoperative data sets for sonographic guidance so that Mammotome excision can help the operator to evaluate the surgical outcome. There were five tumors in the study, including three benign and two malignant. The lesion of interest was delineated after 2-D examination was completed, then it was analyzed with 3-D breast ultrasound (US). To give a reference point for correlations between pre- and postoperative images, we used a marker tape pasted on the skin within the transducer scanning area and then the preoperative 3-D US images were obtained. Subsequently, 2-D breast US was applied during Mammotome operation. After the Mammotome procedures were finished, the postoperative 3-D US images were obtained; thus, we gained two different data sets of 3-D US images that were used for later analysis for evaluating the extension of postoperative margin status. From the results, the safe margin was not satisfactory in all directions, because the minimum differences measured by the proposed algorithm were not large enough in all five cases, and this was proved from two malignant mastectomy specimens. The experimental results representing this inadequate Mammotome excision can be visualized through the computer aid. The comparison of tumor contour and excision margin may possibly be used for small malignant tumors in the future to improve the breast-conserving surgery.

Breast Neoplasms↗

PubMed2003

Prognostic factors after resection for hepatocellular carcinoma in noncirrhotic livers: univariate and multivariate analysis.

The aim of this study was to investigate the prognostic factors for hepatocellular carcinoma (HCC) in patients without cirrhosis who underwent hepatectomy. Between 1986 and 1998 a total of 197 men and 57 women with noncirrhotic HCC underwent hepatic resection in the Department of Surgery, Chang Gung Memorial Hospital, Taipei, Taiwan. We determined their surgical mortality and the disease-free and overall cumulative survival rates. The surgical mortality was 4.7% and the 5-year disease-free survival rate 24.01%. By Cox regression analysis, serum alkaline phosphatase [relative risk (RR) 1.761; 95% confidence interval (CI) 1.037-2.985)], albumin (RR 2.179; CI 1.215-3.908), multiple tumor status (RR 2.288; CI 1.272-4.115), and blood urea nitrogen (RR 4.651; CI 1.116-19.38) were shown to be independent prognostic factors for the 5-year disease-free survival rates. The 5-year overall cumulative survival rate was 25.91%. By Cox regression analysis, serum albumin (RR 1.656, CI 1.005-2.730), blood transfusion (RR 2.075, CI 1.153-3.731), resection margin (RR 2.562, CI 1.436-4.572), and multiple tumors (RR 2.801, CI 1.727-4.545) were shown to be significant independent factors that influenced cumulative survival rates. Hence in patients with a noncirrhotic HCC who underwent hepatectomy the prognosis depended on preoperative hepatic function, the presence of multiple tumors, the need for blood transfusion, and the surgical resection margin.

Adult↗

PubMed2003

3-D US frame positioning using speckle decorrelation and image registration.

In this paper, a new positioning system is proposed for the 3-D ultrasound (US). This system combines the image registration technique and speckle decorrelation algorithm to accurately position sequential ultrasonic images without any additional positioning hardware. The speckle decorrelation algorithm estimates the relative distance of two neighboring frames and the image registration technique gets the range of the whole 3-D ultrasonic data set and makes slight modification on each frame's position. The image registration technique is based on the reference image, which is perpendicular to the 3-D ultrasonic data set. This reference image intersects each frame of the 3-D ultrasonic data set in a line. For each frame, the intersectional line is first found and then the location in the reference image can be used to estimate the position of this frame. This system uses the data set of consecutive 2-D freehand-scanned US B-mode images to construct the 3-D US volume data, and it can be integrated into the 3-D US volume rendering system.

Algorithms↗

PubMed2003

Clinical experience of hepatic hemangioma undergoing hepatic resection.

The indications for surgery on cavernous hemangiomas, the most common benign tumors of the liver, remain unclear. This study reviewed 43 patients with cavernous hemangioma of the liver who underwent hepatic resection from 1984 to 2000. Patients were divided into three groups based on the reasons for surgery. Group I comprised 13 patients whose lesions presented symptoms and dimensions that were the main indications for operation. Group II consisted of 28 patients diagnosed with malignant tumors or who displayed malignant growth that could not be ruled out preoperatively. Group III comprised 2 patients with tumors found incidentally at laparotomy for other malignancies. No surgical mortality related to hepatectomy was noted. Postoperative bile leak was found in 2 (morbidity rate: 4.7%). Patients were followed up from 6 months to 12 years. Thirteen residual tumors progressed in size. The clinical status or symptoms changed only slightly in 10 patients with recurrence. The results suggest that resection therapy is an effective indicator for patients with symptoms and a questionable diagnosis. Hepatic resection may and should be carried out with no mortality and minimal morbidity risks since the lesion is benign.

Adult↗

PubMed2002

Pedunculated hepatocellular carcinoma: clinicopathologic study of 18 surgically resected cases.

We present the clinical features and outcomes of 18 surgically treated pedunculated hepatocellular carcinomas (P-HCCs). Hepatocellular carcinoma is a notorious, hyperendemic disease in Taiwan. Pedunculated HCC, although not a novel finding, has been recognized and diagnosed early by various imaging modalities. However, the clinicopathologic picture has not been fully clarified, and the prognosis varies in each report. From 1986 to 1998 the clinical features of 18 surgically treated cases of P-HCC were reviewed, including demographics, laboratory data, operative findings, pathologic features, and follow-up results. Factors that may influence the outcomes were also analyzed. Clinical features and outcomes of 414 patients with nonpedunculated hepatocellular (HCC) were summarized for comparison. Of 432 surgical resected hepatocellular carcinomas, 18 (4.2%) were P-HCCs. Larger tumor size, more capsule formation, less vascular invasion, and wider resection margins were significantly prominent in the patients in P-HCC group compared with those in the NP-HCC group. Multivariate stepwise logistic regression analysis revealed that the P-HCC group had significantly larger tumors and wider resection margins. The 1-, 3-, and 5-year survival rates of P-HCC patients were 88.3%, 77.4%, and 45.6%, respectively. A significant difference in survival was found between the P-HCC and NP-HCC groups. P-HCC patients without vascular invasion might have a significantly better survival demonstrated by log-rank analysis stratified by capsular invasion, vascular invasion, resection, and tumor size. We present the clinical features and outcomes of 18 surgically treated pedunculated HCCs. Pedunculated HCCs might have a better survival than conventional HCCs after hepatic resection, especially if there is no vascular invasion.

Adolescent↗

PubMed2002

Surgical results in patients with hepatitis virus-related hepatocellular carcinoma in Taiwan.

To investigate the surgical results of hepatectomy for hepatocellular carcinoma in relation to hepatitis virus status in Taiwan, 252 patients (196 men and 56 women; March 1992 to August 1998) were reviewed. The patients were divided into four groups: 30 patients (11.9%) seronegative for both hepatitis B surface antigen (HBsAg) and antihepatitis C antibody (HCVAb) (N-HCC group); 133 patients (52.8%) seropositive for HBsAg and seronegative for HCVAb (B-HCC group); 66 patients (26.2%) seronegative for HBsAg and seropositive for HCVAb (C-HCC group); and 23 patients (9.1%) seropositive for both HBsAg and HCVAb (BC-HCC group). Patients in group C-HCC were older (p = 0.001) and had a higher incidence of diabetes mellitus (p = 0.004). Also, they had a higher indocyanine green retention rate at 15 minutes (p = 0.021), longer international normalization ratio for the prothrombin time (p = 0.049), and smaller tumor (p = 0.006). Postoperative complications and hospital mortality were significantly higher in patients in the C-HCC and BC-HCC groups (p = 0.046, 0.021). All patients were followed 12 to 76 months after hepatectomy (mean 23.5 +/- 16.3 months). The 1-, 3-, and 5-year overall cumulative survival rates of the 252 patients in this series were 80%, 54.3%, and 34.2%, respectively. The cumulative intrahepatic recurrence rates were 46.5%, 64.9%, and 72.9% at 1, 3, and 5 years, respectively. The mean disease-free survival time was longest in group C-HCC and shortest in group BC-HCC (p = 0.020). The overall survival time and cumulative survival rates in the four groups were not significantly different (p = 0.146).

Adult↗

PubMed2002

Prognostic factors of hepatic resection for hepatocellular carcinoma with cirrhosis: univariate and multivariate analysis.

BACKGROUND AND OBJECTIVES: The objective of this investigation was to study the clinicopathological factors influencing long-term outcome of hepatocellular carcinoma (HCC) with liver cirrhosis in patients undergoing hepatectomy. Liver cirrhosis, especially the macronodular variety, has been found in up to 90% of patients with HCC. In Asia, the incidence of liver cirrhosis in patients with HCC who had undergone hepatic resection varies from 42.5% to 73.8%. However, the optimal surgical approach for HCC patients with cirrhosis is less clearly defined. Resection of the cirrhotic liver is challenging and remains controversial in the treatment of HCC. METHODS: This study retrospectively analyzed the surgical outcomes of HCC concomitant with liver cirrhosis in 218 patients who underwent hepatic resection between 1986 and 1998. Post-resection prognostic factors were assessed using a univariate log-rank test and a multivariate Cox proportional hazards model. RESULTS: The overall postoperative complication rate was 15.6%, while the surgical mortality rate was 8.8%. Meanwhile, the 1-, 3-, and 5-year disease-free survival rates were 50.9%, 33.98%, and 27.03%, respectively, and. the overall cumulative survival rates at 1, 3, and 5 years were 63.14%, 41.88%, and 31.83%, respectively. Applying Cox's multivariate proportional hazard model indicated that significant adverse prognostic indicators included elevated alkaline phosphatase value, tumor size >2 cm, presence of satellite lesions, and vascular invasion. CONCLUSIONS: This investigation found that overall survival for HCC patients concomitant with liver cirrhosis who underwent hepatic resection should be stratified on the basis of the high value of alkaline phosphatase, tumor size, satellite lesions, and vascular invasion.

Adolescent↗

PubMed2002

Resection of peritoneal implantation from hepatocellular carcinoma.

BACKGROUND: Peritoneal implantation is a rare presentation of hepatocellular carcinoma (HCC). This article presents the clinical features and surgical outcomes of 16 patients with HCC in whom isolated peritoneal implantation from HCC was found and who underwent surgical resection. METHODS: From 1988 to 2000, 16 patients with HCC after hepatic resection who underwent resection of peritoneal implantation of HCC were retrospectively reviewed. RESULTS: Four hundred sixty-five of 749 patients (62.1%) had recurrence of HCC after hepatic resection. Sixteen (3.4%) developed isolated peritoneal implantation and underwent resection. During the detection of the peritoneal implantation, the alfa fetoprotein level was increased in 13 of these 16 patients. Five of 15 patients had a peritoneal mass discovered by ultrasonography, and 14 of 15 patients had a mass discovered by computed tomography. The follow-up period ranged from 2.1 to 81.6 months (median, 16 months). The median disease-free and overall survivals of the 16 patients were 7.89 and 15.98 months, respectively. CONCLUSIONS: Peritoneal implantation occurs infrequently in posthepatectomy patients. Increased alfa fetoprotein values after hepatic resection should suggest recurrence of HCC. Computed tomography is superior to ultrasonography in detection of peritoneal implantation from HCC. Surgical resection of peritoneal implantation from HCC might prolong survival in selected patients.

Adolescent↗

PubMed2002

Resectable gastric cancer: operative mortality and survival analysis.

BACKGROUND: This study evaluated the survival outcome and determined the prognostic factors for gastric cancer patients who underwent gastric resection in the past 6 years. METHODS: Between 1994 and 2000, a total of 1,322 patients with gastric cancer who underwent gastric resection in our hospital comprised the study subjects. Their mean age was 61.1 (range, 14-92) years. There were 865 male and 457 female patients. Total gastrectomy was performed in 389 (29.4%) and distal gastrectomy in 933 patients. Curative resection was performed in 961, and palliative resection in 361 patients. A D2 or greater lymphadenectomy was required for curative resection. Patients received postoperative chemotherapy if they underwent palliative resection. RESULTS: Early or pT1 gastric cancer accounted for 17.7% and lymph node metastasis for 62.1% of all resected cases. The overall operative mortality and morbidity rates were 3.3% and 18.0%, respectively. The operative mortality for palliative total gastrectomy was particularly high (8.5%). The overall cumulative 5-year survival rate of all resected patients was 45.6%, and it was 57.0% after curative resection. Multivariate analysis revealed that lymph node metastasis, serosal invasion, peritoneal seeding, positive resection margin, liver metastasis, old age, tumor size, and lymphatic invasion were independent prognostic factors. CONCLUSION: The most important prognostic factors for survival were lymph node metastasis, serosal invasion, peritoneal seeding, positive resection margin, liver metastasis, old age, tumor size, and lymphatic invasion. The operative mortality and survival outcome of our gastric cancer patients after gastric resection compared favorably with those of other series in other countries.

Adolescent↗

PubMed2002

Liver cell adenoma with concomitant hepatocellular carcinoma: report of two cases.

Malignant transformation of liver cell adenoma and unequivocal hepatocellular carcinoma in resected liver cell adenomas are rare. We report two cases of liver cell adenoma with concomitant hepatocellular carcinoma. The first occurred in a 19-year-old male with an asymptomatic liver mass and was discovered incidentally. He had a history of nephrotic syndrome treated with oral prednisolone for 15 years. The second occurred in a 46-year-old female who was admitted due to right tubo-ovarian abscess. Computerized tomography scanning incidentally found a 10-cm liver mass in the right lobe. There was no history of oral contraceptive use. Both patients were negative for serum hepatitis B surface antigen and anti-hepatitis C virus antibody. Neither had cirrhosis. These two cases imply that malignant transformation of liver cell adenoma does occur, and that liver cell adenomas should be excised when malignant transformation is suspected.

Adenoma, Liver Cell↗

PubMed2002

Benefits of palliative surgery for far-advanced gastric cancer.

BACKGROUND: The optimum strategy for palliative surgery in gastric cancer patients remains undetermined. METHODS: In total, 525 patients who had undergone palliative surgery between 1994 and 2000 were evaluated in terms of operative mortality, survival, and palliative effect. Patients were grouped according to the UICC's classification of residual tumors (R) after the operation: microscopic residual tumor (R1) (N = 104) and macroscopic residual tumor (R2) (N = 421). Gastric resection was performed in all R1 patients and in 257 of the R2 patients. Non-resection procedures were performed in 164 of the R2 patients, including gastrojejunostomies in 64, gastrostomies in 17, jejunostomies in 60, and laparotomies only in 23. RESULTS: The operative mortality did not significantly differ among R1 distal gastrectomies (4.5%), R2 distal gastrectomies (3.3%), and R1 total gastrectomies (2.9%) (p = 0.919). R2 total gastrectomies showed a particularly higher operative mortality (10.9%) than did the other resection procedures. The survival time and palliative duration were significantly longer in patients after palliative resection than after non-resection operations. Postoperative chemotherapy prolonged the survival time of patients after palliative surgery. CONCLUSION: R1 or R2 distal gastrectomies and R1 total gastrectomies have benefits of survival prolongation and symptomatic palliation. However, the use of a total gastrectomy in R2 patients must be selectively reserved for far-advanced cases, otherwise it should be replaced with less-invasive procedures to avoid a high operative mortality rate. Postoperative chemotherapy is useful for prolonging survival time.

Female↗