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Purpose: Although reports suggest that the pancreatic volume decreases after gastrectomy for gastric cancer, the relationship between the pancreatic volume and secretory function after gastrectomy remains unclear. In this study, we examined the relationship between the pancreatic volume and exocrine and endocrine functions after total gastrectomy., Methods: The pancreatic volumes of 18 distal gastrectomy and 15 total gastrectomy patients were retrospectively measured using computed tomography volumetry up to 5 years postoperatively. Ten low anterior resection patients were selected as controls. In addition, the pancreatic volume and exocrine function evaluated by fecal elastase and the insulin secretory function evaluated by glucagon tolerance testing were prospectively examined before and one year after surgery in nine cases of total gastrectomy., Results: After low anterior resection, the pancreatic volume did not change, but after distal and total gastrectomy, the pancreatic volume decreased continuously until the fifth year. After total gastrectomy, fecal elastase decreased significantly from 865.8 μg/g to 603.2 μg/g in the first year (p = 0.0316), and the insulin secretion capacity also decreased significantly from 3.83 ng/mL to 2.26 ng/mL (p = 0.0019)., Conclusions: The pancreatic volume decreases continuously after gastrectomy for gastric cancer, and the pancreatic exocrine and endocrine functions decrease along with pancreatic atrophy after total gastrectomy., (© 2023. The Author(s).)

Background/aims: Stapled esophagogastrostomy is simple and safe reconstruction after proximal gastrectomy. However, this reconstruction is often concomitant with severe reflux esophagitis because of the loss of cardiac function; simple esophagogastrostomy is not preferred reconstruction after proximal gastrectomy. To prevent reflux esophagitis, we established the fundoplication under the endoscopic stent after proximal gastrectomy., Methodology: After proximal gastrectomy with lymph node dissection, end-to-side esophago-gastrostomy was done with circular suturing instrument. To prevent gastric juice reflux from the remnant stomach, the stomach was rolling around the abdominal esophagus and tightly under the endoscopical stenting. To make renewal His angle and fornix, the stump of greater curvature was fixed to the left side of diaphragmatic crus with some sutures., Results: We performed this type of fudplication for 18 patients with early gastric cancers and gastric submucosal tumors. Almost all patients postoperative course was uneventful. Three patients needed an endoscopic dilatation for the stricture of esophago-gastrostomy. One case revealed asymptomatic reflux esophagitis because of the looseness of the anastomosis. Weight loss was limited, almost all patients recovered preoperative weight., Conclusions: Simple esophagogastrostomy plus this fundoplication with endoscopic stent is safe and satisfactory reconstruction procedure after proximal gastrectomy.

Roux-en-Y reconstruction after total gastrectomy is a simple and safe procedure; however, it eliminates the gastric reservoir function and markedly changes the postoperative digestive physiology. The patients therefore suffer from insufficient food intake and malabsorption. It has been reported that jejunal pouch reconstruction increases food intake and improves the nutritional status. We established a novel Roux-en-Y reconstruction with stapled distal jejunal pouch after total gastrectomy. A jejunal pouch, 8 cm in size, was attached at the jejunojejunostomy. We performed this novel reconstruction for 20 gastric cancer patients after total gastrectomy with lymph node dissection as a feasible study. One year after operation, the average percentage weight was maintained in more than 90 per cent and 17 (85%) of these patients were in the normal range of the body mass index. This procedure may improve postoperative malnutrition after total gastrectomy according to our feasible study. A multicenter randomized trial of this approach comparing with Roux-en-Y reconstruction without a pouch is ongoing.

Background and Aim: We investigated the clinical benefits of salvage gastrectomy for stage IV gastric cancer patients whose distant lesions showed complete response after chemotherapy., Methods: We enrolled 18 stage IV gastric cancer patients whose distant metastases had disappeared or were controlled by a combination of biweekly paclitaxel (PTX) and S-1. After chemotherapy, these patients received gastrectomy with lymph node dissection. The postoperative outcome was analyzed with respect to both the histological effects of chemotherapy and tumor behavior., Results: Of the 18 patients, 8 had distant lymph node metastases, 9 had peritoneal dissemination, and five had multiple liver metastases prior to chemotherapy. Fourteen patients received curative surgery (R0). No severe postoperative complications were encountered. Pathological evaluation revealed grade 3 and grade 2 tumor regression in the primary lesion in one and five patients, respectively, and grade 3 and grade 2 tumor regression in the lymph nodes in one and six patients, respectively. Univariate analysis of the patients' prognosis identified R number, gross tumor type, histological grade of tumor regression, and gender as significant factors. Multivariate analysis showed that only the R number was an independent prognostic factor., Conclusion: R0 salvage gastrectomy following a combination of biweekly PTX and S-1 may have significant clinical efficacy for advanced gastric cancer patients.

Background/aims: Five patients having early gastric cancer were treated using laparoscopic partial gastrectomy combined with sentinel lymph node biopsy., Methodology: Preoperatively, 3.5 mq of Tc-labeled tin colloid was endoscopically injected near the tumor. Under general anesthesia, laparoscopic partial gastrectomy was then performed. Radioisotope (RI)-positive nodes were explored before performing laparoscopic partial gastrectomy., Results: An average of 2.6 sentinel nodes was detected in this way. All patients were found to be free from nodal involvement both histologically and immunohistologically during surgery. Four patients had mucosal cancer and one patient had submucosal cancer, which agreed with the preoperative diagnosis of tumor depth., Conclusions: Sentinel node biopsy in conjunction with laparoscopy in early gastric cancer surgery may allow confirmation of complete removal of risk nodes in early gastric cancer.

Background/aims: Transabdominal ultrasound sonography (TUS) is considered a useful diagnostic tool ascertaining depth of cancer invasion, but there are few detailed studies on its accuracy in preoperative estimations of depth of invasion in early gastric cancer (mucosal and submucosal cancer). We retrospectively analyzed the clinical efficacy of preoperative evaluation by TUS in early gastric cancer in comparison with endoscopic ultrasound sonography (EUS)., Methodology: A total of 101 patients preoperatively diagnosed as early gastric cancer were enrolled in the current study. Patients were given 300cc of water subsequent to administration of an anti-peristaltic agent to facilitate filling the gastric lesion with water and TUS was performed. All patients were preoperatively examined by both EUS and TUS., Results: The depth accuracy in mucosal cancer was 59% with EUS and 66% with TUS. When submucosal cancers were subdivided into shallow and deep submucosal cancers, the depth of mucosal and shallow-submucosal (SM1) cancers were correctly assessed 80% and 78% by EUS and TUS, respectively. Accuracy increased by 12% in mucosal cancer by combining EUS and TUS diagnoses., Conclusions: The diagnostic value of TUS is comparable to that of EUS in assessing depth of invasion of early gastric cancer, however, TUS had a possibility of misdiagnosing the depth of tumors located at the anterior wall. To ensure an accurate estimation of the depth of tumor invasion, it is recommended that TUS and EUS be done simultaneously.

Neo-expression of N-cadherin in cancer cells is regarded as a significant event in tumor progression via epithelial-mesenchymal transition (EMT). No reports have detailed the clinical impact of N-cadherin expression in gastric cancer. We retrospectively examined the co-expression of N-cadherin and E-cadherin in human gastric carcinoma and analyzed the clinicopathological significance of N-cadherin expression. One hundred and forty-six gastric cancer patients who received curative gastrectomy were enrolled. E-cadherin and N-cadherin immunoreactivity in cancer tissue was evaluated by the avidin-biotin-peroxidase complex technique. The correlation between N-cadherin and E-cadherin expression and clinicopathological parameters were analyzed. N-cadherin-positive and -negative expression were found in 31 and 115 patients, respectively. N-cadherin expression positively correlated with hematogenous recurrence ( P < 0.01) and negatively correlated with patients' postoperative outcomes ( P < 0.05). Moreover, only in the E-cadherin-preserved group was prognostic significance found according to N-cadherin expression ( P < 0.01). We could not show a significant relationship between N-cadherin expression and EMT in gastric cancer. However, neo N-cadherin expression significantly affected patient's survival in gastric cancer. Therefore, we concluded that neo N-cadherin expression may be a useful prognostic marker independent of E-cadherin expression. [ABSTRACT FROM AUTHOR]

The sentinel node (SN) is regarded as the first drainage lymph node, and tumor cells are considered likely to directly affect the SN. However, few reports have identified differences between SNs and non-SNs in cancer patients. Subjects in this study included 27 patients with gastric cancer who underwent curative operation and intraoperative detection of SNs by radioisotope methods. The mean number of SNs was 3.2 (range 1 to 5). Degree of infiltration of natural killer cells, dendritic cells, MIB-1 labeling index, and CD3-ζ expression of lymphocytes in SNs and non-SNs were examined by means of immunohistochemical methods. Degree of infiltration was compared according to depth of invasion and between SNs and non-SNs. Patients with early-stage cancer displayed a greater degree of infiltration of MIB-1 labeling index and CD3-ζ expression than patients with pT2 or pT3 lesions (P<0.05). The MIB-1 labeling index in SNs was significantly lower than that in non-SNs (P<0.05). However, no significant difference was observed in infiltration of natural killer cells, dendritic cells, or CD3-ζ. Morphologic changes of dendritic cells in SNs were not definite. Our results suggest that SNs in gastric cancer might not be suppressed, unlike in breast cancer and melanoma. SN paralysis may depend on tumor- and organ-specific characteristics or exogenous stimulation from the gastric mucosa. Studies in progress will help to identify immunologic paralysis of the SN in various types of cancer. Attention must therefore be paid to organ specificity. [Copyright &y& Elsevier]