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This study aimed to investigate the oncologic outcomes of video-assisted thoracoscopic (VATS) left upper trisegmentectomy (LTS) vs left upper lobectomy (LUL) for patients presenting with stage I non-small cell lung cancer (NSCLC).A retrospective analysis identified 1543 consecutive patients presenting to Shanghai Pulmonary Hospital (Shanghai, China) with NSCLC for VATS LTS or LUL from 2013 to 2017. After propensity-score matching for patient demographics and tumor characteristics, 273 pairs were identified. Disease-free survival (DFS) and overall survival (OS) were estimated by the Kaplan-Meier method and compared using the log-rank test.The median follow-up time was 51.5 months. There were no significant differences in operative duration (2.11 ± 0.64 hours vs 2.49 ± 5.96 hours; P = .30), total blood loss (106.19 ± 170.83 mL vs 97.07 ± 149.34 mL; P = .51), and operative complications (10% vs 8%; P = .37) between the LUL and LTS groups. Patients undergoing LUL had longer postoperative hospital stays (5.55 ± 3.00 days vs 4.87 ± 2.33 days; P = .003), greater tumor margin distance (3.3 ± 1.2 cm vs 3.1 ± 0.9 cm; P.001), and greater number of lymph nodes harvested (8.0 ± 3.2 vs 6.8 ± 3.3; P.001) than patients undergoing LTS, but the margin-to-tumor ratio was not statistically different (2.5 ± 1.6 vs 2.3 ± 1.1; P = 0.11). Median DFS (49.5 months vs 54.3 months; P = .77) and OS (49.5 months vs 55.0 months; P = .88) were not significantly different between patients undergoing LTS and those undergoing LUL, and similar outcomes were noted across subgroups of patients stratified by tumor stage, pathologic type, and radiographic manifestations.VATS LTS and LUL had comparable oncologic outcomes for stage I NSCLC, regardless of tumor pathologic types and radiologic findings, as long as negative margins were confirmed.

Background The clinical impact of microscopically positive tumor margin in papillary thyroid cancer is not well studied. The aim of this study is to evaluate the clinical importance of a microscopically positive margin for recurrence in papillary thyroid cancer patients and to examine whether recurrence and recurrence-free survival were affected by the location of the positive margin—anterior or posterior. Methods We conducted a retrospective cohort study at a single institution. From January 1997 to June 2015,6,293 papillary thyroid cancer patients who underwent total thyroidectomy with or without neck dissection (central and/or lateral) at the Thyroid Cancer Center of Samsung Medical Center (Seoul, South Korea) were included in the analyses. Results Of the 6,293 papillary thyroid cancer patients, an operative margin was microscopically involved in 313 (5.0%) on final pathologic report. The mean follow-up time was 77.5 months, and locoregional recurrence was observed in 244 (3.9%) patients. The presence of a microscopically positive margin did not increase the risk of locoregional recurrence (adjusted hazard ratio = 1.079, P = .140) after adjustment for other statistically significant factors in the Cox proportional hazard model. In addition, posterior positive margin was not a risk factor for locoregional recurrence as well (adjusted hazard ratio = 1.24, P = .672). In a propensity score–matching analysis, a microscopically positive margin did not increase the risk of locoregional recurrence. Conclusion Microscopic involvement of the operative margin in papillary thyroid cancer patients, whether anteriorly or posteriorly, does not appear be an independent prognostic factor in recurrence-free survival rates.

Objective Fluorescence-guided glioblastoma surgery is an intraoperative technique developed in recent years. Two main compounds have been used so far: 5-amilovelulinic acid (5-ALA) and fluorescein sodium (Fl-Na). Despite a large amount of literature on both techniques, few data are available on the use of both compounds in the same patient. Methods Three consecutive patients affected by a newly diagnosed glioblastoma underwent surgical resection using both 5-ALA and Fl-Na. 5-ALA was orally administered 3 hours before induction of anesthesia at a dosage of 20 mg/kg, whereas fluorescein was intravenously administered at induction of anesthesia at a dosage of 4 mg/kg. Tumor resection was carried out combining these fluorophores. At tumor borders, multiple samples were collected, and fluorescent pattern of each sample was registered. Samples were then analyzed by a neuropathologist blinded for intraoperative fluorescence findings. Results Eighteen samples were analyzed. At tumor margin, bright pink fluorescence was highly indicative of residual tumor (positive predictive value [PPV], 94%), and it was superior to faint pink and fluorescein (PPVs, 89% and 87%, respectively). The gradual reduction of pink fluorescence warned of the risk of gradually entering healthy tissue (specificity of 67% compared with 33% with fluorescein). Using 5-ALA, detecting no fluorescence was highly suggestive of healthy tissue (negative predictive value of 100% compared with 50% with fluorescence). Conclusions In our experience with 3 patients, the 2 techniques presented different advantages and limitations in specific steps of tumor resection, showing complementary properties. Larger studies are mandatory to investigate the synergistic use of both techniques.

Previous studies have proven that the lepidic component of lung adenocarcinoma is an independent prognostic factor and has a favorable effect on patient prognosis; however, no studies have reported the specific distribution of the lepidic component in lung cancer. In this study, we focused mainly on whether the lepidic component at the tumor margin was an independent prognostic factor for invasive lung adenocarcinoma. We reviewed 276 patients with invasive lung adenocarcinomas and divided them into 2 groups-181 with tumors of 3 cm or less and 95 with tumors of greater than 3 cm-to study their histopathologic and clinicopathological characteristics. The long lepidic structure at the tumor margin was designated as the marginal lepidic feature. In the group with tumors of 3 cm or less, the lepidic component and marginal lepidic feature were significantly associated with histologic subtype, TNM stage, and lymph node metastasis (P.05), whereas in the group with tumors of greater than 3 cm, the lepidic component and marginal lepidic feature were not correlated with histopathologic or clinicopathological characteristics. Furthermore, the patients with tumors of 3 cm or less and marginal lepidic lesions demonstrated significantly longer overall survival than did those without the structure (P.001). We concluded that the marginal lepidic feature of invasive lung adenocarcinoma is a significant histologic feature that suggests a better prognosis.

Fluorescence-guided imaging during surgery is a promising technique that is increasingly used to aid surgeons in identifying sites of tumor and surgical margins. Of the two types of fluorescent probes, always-on and activatable, activatable probes are preferred because they produce higher target-to-background ratios, thus improving sensitivity compared with always on probes that must contend with considerable background signal. There are two types of activatable probes: 1) enzyme-reactive probes that are normally quenched but can be activated after cleavage by cancer-specific enzymes (activity-based probes) and 2) molecular-binding probes which use cancer targeting moieties such as monoclonal antibodies to target receptors found in abundance on cancers and are activated after internalization and lysosomal processing (binding-based probes). For fluorescence-guided intraoperative surgery, enzyme-reactive probes are superior because they can react quickly, require smaller dosages especially for topical applications, have limited side effects, and have favorable pharmacokinetics. Enzyme-reactive probes are easier to use, fit better into existing work flows in the operating room and have minimal toxicity. Although difficult to prove, it is assumed that the guidance provided to surgeons by these probes results in more effective surgeries with better outcomes for patients. In this review, we compare these two types of activatable fluorescent probes for their ease of use and efficacy.

The objective of this study was to establish that the denaturing fixative, formalin and acetic acid (AFA), is equivalent to neutral-buffered formalin (NBF) on the nCounter system using the Prosigna assay. Twenty-five previously resected tumors from breast cancer patients were apportioned and fixed with either NBF or AFA prior to embedding in paraffin. Differentially fixed and paraffin embedded tissue pairs were sectioned and pathological review was performed according to the Prosigna assay protocol. RNA was isolated using the Prosigna assay kit and analyzed using the NanoString nCounter Dx Analysis system. 47 of the 50 blocks (94%) passed RNA quality control (QC) criteria and were collectively designated as the analysis set. We found that RNA yield and purity (A260/A280) were not significantly different between the fixatives within the analysis set. In the analysis of ROR score, the tissue pairs had a Pearson Correlation Coefficient of 0.91, similar to the correlation observed between paired tissue blocks using a single fixative in previous studies. Subtype concordance between differentially fixed tissue pairs was high (K = 0.80). No significant bias or variability in risk of recurrence (ROR) score attributable to fixative was detected in this study. Further analysis revealed that sample pairs with larger differences in ROR score were limited to nearly-depleted tissue blocks containing large amounts of normal tissue due to proximity of the tumor margin. The results of this study demonstrate that the fixative, AFA, does not contribute significantly to bias and variability of assay results.

CT-beam hardening artifact can make tumor margin visualization and its relationship to the ablation applicator tip challenging. To determine optimal scanning parameters for commonly-used applicators.Applicators were placed in ex-vivo cow livers with implanted mock tumors, surrounded by bolus gel. Various CT scans were performed at 440mA with 5mm thickness changing kVp, scan time, ASiR, scan type, pitch, and reconstruction algorithm. Four radiologists blindly scored the images for image quality and artifact quantitatively.A significant relationship between probe, kVp level, ASiR level, and reconstruction algorithm was observed concerning both image artifact and image quality (both p=0.0001). Specifically, there are certain combinations of kVp, ASiR, and reconstruction algorithm that yield better images than other combinations. In particular, one probe performed equivalently or better than any competing probe considered here, regardless of kVp, ASiR, and reconstruction algorithm combination.The findings illustrate the overall interaction of the effects of kVp, ASiR, and reconstruction algorithm within and between probes, so that radiologists may easily reference optimal imaging performance for a certain combinations of kVp, ASiR, reconstruction algorithm and probes at their disposal. Optimum combinations for each probe are provided.

Oncocytomas, which are benign epithelial tumors filled with abundant mitochondria, arise from ductal cells. Oncocytomas rarely occur in the orbit. We present a case of pathologically proven orbital oncocytoma of the lacrimal gland studied by dynamic contrast-enhanced magnetic resonance imaging (DCE MRI). DCE MRI has potential as an adjunct to conventional MRI in the differential diagnosis and tumor margin delineation of orbital oncocytoma. Simple assessments of the time-signal intensity curve, semiquantitative parameters, and post-processing positive enhancement integral images should be considered in the evaluation of orbital masses found on MRI.

An aneurysmal bone cyst (ABC) is a benign proliferative nonneoplastic lesion and accounts for 1.4% of all bone tumors. ABC can occur in any part of the bone, and approximately 20% of cases involve the spine. ABC of the spine typically presents in young patients in their second decade of life [1]. Subtotal excision of spinal lesions is associated with a high incidence of recurrence within 6e12 months. Therefore, complete surgical resection should be the goal of surgical intervention in ABC of the spine [2]. Total en bloc spondylectomy [3,4] is a surgical procedure designed to achieve complete resection of a malignant tumor with an adequate tumor margin and has been reported to decrease the local recurrence rate and prolong survival. In this procedure, a titanium mesh cage with an iliac autograft is generally used to provide mechanical stabilization for the spine after tumor resection. In this report, we present a case of ABC at T11 in a patient who underwent total spondylectomy (piecemeal total excision of laminae and en bloc corpectomy) and reconstruction using frozen tumor-bearing vertebra en bloc in place of a titanium cage. Written informed consent for the surgery and the publication was obtained from this patient and family.

This study aimed to identify preoperative MR imaging features for predicting early recurrence after curative resection of solitary hepatocellular carcinoma (HCC) without microvascular invasion (MVI).124 patients with MVI-negative HCC who underwent preoperative dynamic contrast-enhanced 1.5-T MR imaging before surgical resection were included. Liver Imaging Reporting and Data System (LI-RADS v2018) imaging features and three non-LI-RADS MR imaging features for predicting early recurrence (intrahepatic recurrence2 years) were identified by univariable and multivariable analyses. A nomogram was constructed for individualized risk estimation, and its predictive accuracy and discriminative ability were identified by concordance index (C-index) and calibration curve.In multivariable analysis, tumor size (p = 0.045), nonsmooth tumor margin (p = 0.013), and presence of mosaic architecture (p = 0.035) were independent significant variables associated with early recurrence. These were all incorporated to establish the nomogram. The C-index of the nomogram was 0.743 (95 % CI: 0.697-0.788).At dynamic contrast-enhanced MR imaging, tumor size, nonsmooth tumor margin, and presence of mosaic architecture may be helpful to predict early recurrence of solitary HCC without MVI after curative resection.

Background Bis-chloroethylnitrosourea (BCNU) wafers have been demonstrated to be effective for prolonging survival for patients with malignant glioma and have been approved worldwide. BCNU wafers are implantable and have a unique feature of delivering chemotherapeutic drug at high concentration at tumor margin over time after resection. BCNU wafers presumably, by this mechanistic rationale, have a beneficial effect on local tumor control and thus could change the pattern of recurrence, which is most frequently local. However, no studies have demonstrated such phenomenon after BCNU wafer implants. Methods To investigate whether the surgeries with BCNU wafers alter the predominant tendency of local recurrence pattern, we retrospectively reviewed 8 malignant glioma patients treated with BCNU wafers (BCNU wafer group), together with 22 glioma patients who did not receive BCNU wafers (no-BCNU wafer group) for comparison. Results Out of 6 patients in BCNU wafer group who exhibited recurrence, 1 showed local, 2 showed diffuse, and 3 showed a distant recurrence pattern, which was away from resection cavity. On the other hand, out of 18 patients in the no-BCNU wafer group who exhibited recurrence, 10 showed a local pattern, 8 showed a diffuse pattern, and no cases showed distant pattern. Distant pattern was observed significantly more frequently in the BCNU wafer group than in the no-BCNU wafer group. Conclusions These results suggest that BCNU wafers could have a beneficial effect on local tumor control and may provide BCNU wafers with a new profile that could be considered for establishing future chemotherapeutic strategy for glioma patients.

Background Dendritic cells (DC) are localized in close proximity to cancer cells in many well-known tumors, and thus maybe a useful target for tumor margin assessment. Materials and methods [ 99m Tc]- cyanine 7 (Cy7)-tilmanocept was synthesized and in vitro binding assays to bone marrow-derived DC were performed. Fifteen mice, implanted with either 4T1 mouse mammary or K1735 mouse melanoma tumors, were administered 1.0 nmol of [ 99m Tc]-Cy7-tilmanocept via tail vein injection. After fluorescence imaging 1 or 2 h after injection, the tumor, muscle, and blood were assayed for radioactivity to calculate percent-injected dose. Digital images of the tumors after immunohistochemical staining for DC were analyzed to determine DC density. Results In vitro binding demonstrated subnanomolar affinity of [ 99m Tc]-Cy7-tilmanocept to DC (K A = 0.31 ± 0.11 nM). After administration of [ 99m Tc]-Cy7-tilmanocept, fluorescence imaging showed a 5.5-fold increase in tumor signal as compared with preinjection images and a 3.3-fold difference in fluorescence activity when comparing the tumor with the surgical bed after tumor excision. Immunohistochemical staining analysis demonstrated that DC density positively correlated with tumor percent of injected dose per gram ( r = 0.672, P = 0.03), and higher DC density was observed at the periphery versus center of the tumor (186 ± 54 K versus 64 ± 16 K arbitrary units, P = 0.001). Conclusions [ 99m Tc]-Cy7-tilmanocept exhibits in vitro and in vivo tumor-specific binding to DC and maybe useful as a tumor margin targeting agent.

Purpose To determine the rate of metastasis resulting from uveal melanoma associated with congenital ocular melanocytosis (COM) and to compare it with the rate of metastasis resulting from uveal melanoma not associated with COM. Design Matched retrospective study. Participants Fifty-seven patients with uveal melanoma associated with ocular melanocytosis (melanocytosis group). Each patient in the melanocytosis group was matched with 2 patients with uveal melanoma not associated with ocular melanocytosis (no melanocytosis group) for age, gender, location of anterior tumor margin, location of tumor epicenter, tumor basal diameter, and tumor thickness. Methods Review of medical records. Main Outcome Measures Metastasis resulting from uveal melanoma. Results The mean basal diameter and thickness of tumors in the melanocytosis group were 10 and 4.9 mm, respectively, and most were located between the macula and equator (70%). The melanocytosis and no melanocytosis groups were similar with regard to all patient, ocular, and tumor features studied. Nineteen (33%) of 57 patients in the melanocytosis group and 18 (16%) of 114 patients in the no melanocytosis group demonstrated systemic metastasis during mean follow-up periods of 77 months (range, 1–402) and 64 months (range, 1–252), respectively ( P = 0.013). The Kaplan-Meier estimates for systemic metastasis in the melanocytosis group at 5 and 15 years were 27% and 59%, respectively, compared with 15% and 33%, respectively, in the no melanocytosis group (hazard ratio, 1.99; 95% confidence interval, 1.16–3.41). Conclusions In this matched study, patients with uveal melanoma associated with COM were twice as likely to have systemic metastasis compared with patients with uveal melanoma not associated with COM. Financial Disclosure(s) The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Purpose The purpose of this study is to evaluate the ability of multidetector CT (MDCT) in predicting resectability of pancreatic tumors. Patients and methods Thirty-nine patients were included in this study, there were 29 males and 10 females, and their age range was 44–73 years with a mean age of 58.3 years. All the patients were subjected to contrast enhanced biphasic examinations on 64-slice CT machine. Results Twenty-one patients (53.8%) were considered inoperable with unresected tumor, the remaining 18 patients (46.2%) were considered suitable for tumor resection according to MDCT criteria. 15 out of the 18 patients (83.3) had a successful tumor resection while the remaining 3 (16.7%) showed unresectable tumor during operation. On the basis of pathology results 12 patients out of the 18 (66.7%) had successful surgery with negative tumor margin, and a positive predictive value of 66.7% and accuracy of 66.7%. Conclusions There is better prediction of resectability of pancreatic tumors with the development of MDCT technology. As compared to Helical computed tomography (HCT) studies, there is a rise in the rate of successful surgical resection. The positive predictive value of multidetector computed tomography for resectable pancreatic tumors is decreased when pathologic results are used as a reference standard.

Background Preoperative combined-modality therapy (CMT) is considered the treatment approach of choice for rectal cancer. To examine the effect of CMT on distal intramural spread (DIS), we determined the extent of DIS in rectal cancer specimens after CMT. Methods Specimens from 20 patients after preoperative CMT and total mesorectal excision for rectal cancer were analyzed for extent of DIS. Specimens were washed, fixed in formalin, and sectioned in 5-mm cuts from the distal border of the residual tumor to the distal resection margin. Results Eleven patients (55%) had DIS. Two patients had a complete pathologic response (10%). The mean extent of DIS was 0.50 cm (standard deviation, 0.64 cm; range, 0.0 to 2.5 cm). Only 1 patient in the study had DIS beyond 1 cm from the residual tumor. Six of the patients have died at a median of 30.4 months after operation (range, 19.0 to 51.1 months). No correlation was found between the extent of residual DIS and survival. Conclusions Our study shows that the vast majority of patients with rectal cancer after neoadjuvant CMT have no tumor cells beyond 1 cm from the residual tumor. Our data suggest that a 2-cm margin of resection when feasible from the macroscopic tumor margin after neoadjuvant CMT is adequate.

This retrospective study consisted of 17 consecutive patients with oligodendrogliomas. We qualitatively and quantitatively assessed the diagnostic value of fluid-attenuated inversion-recovery (FLAIR) images compared with T2-weighted fast spin-echo (FSE) images for evaluating intracranial oligodendrogliomas. Qualitative evaluations of signal intensity, tumor conspicuity, definition of tumor margin, distinction between solid and cystic-like parts within tumor, and calcification were performed. Quantitative criteria comparing FLAIR to T2-weighted FSE images included tumor-to-background contrast and contrast-to-noise ratio (CNR) and tumor-to-cerebrospinal fluid (CSF) contrast and CNR. Our results demonstrate that the FLAIR sequence can replace the T2-weighted FSE sequence for evaluating oligodendrogliomas.

During neurosurgical procedures the objective of the neurosurgeon is to achieve the resection of as much diseased tissue as possible while achieving the preservation of healthy brain tissue. The restricted capacity of the conventional operating room to enable the surgeon to visualize critical healthy brain structures and tumor margin has lead, over the past decade, to the development of sophisticated intraoperative imaging techniques to enhance visualization. However, both rigid motion due to patient placement and nonrigid deformations occurring as a consequence of the surgical intervention disrupt the correspondence between preoperative data used to plan surgery and the intraoperative configuration of the patient's brain. Similar challenges are faced in other interventional therapies, such as in cryoablation of the liver, or biopsy of the prostate. We have developed algorithms to model the motion of key anatomical structures and system implementations that enable us to estimate the deformation of the critical anatomy from sequences of volumetric images and to prepare updated fused visualizations of preoperative and intraoperative images at a rate compatible with surgical decision making. This paper reviews the experience at Brigham and Women's Hospital through the process of developing and applying novel algorithms for capturing intraoperative deformations in support of image guided therapy.

Purpose We aimed to determine the presence of the "shoulder" sign in prediction of pericolonic fat invasion on double-contrast barium enema (DCBE) studies in colorectal cancer. Materials and methods Patients at our institution with apparent colorectal cancer were identified from a computer search of both radiological and surgical pathology records during a recent 30-month period. The presence of a shoulder sign was defined as a tumor margin having an abrupt transition from the intraluminal component to the adjacent normal mucosa, forming a shouldered edge on barium studies. Results A total of 49 patients (53 lesions) for whom the DCBE studies and surgical pathology records were available for review were proven to have colorectal carcinomas. DCBE studies revealed that 45 patients with lesions (85%) presented with a "shoulder" sign. All of these lesions were correctly diagnosed as colorectal cancer. Of these, 89% had pericolonic fat invasion and 44% had regional lymph node metastases. Of lesions without a shoulder sign, 25% had pericolonic fat invasion and 25% had nodal metastases. Conclusion The presence of shoulder sign detected with barium enema can be a useful predictor of pericolonic fat invasion in colorectal cancer.

Soft tissue sarcomas appear to be an ideal tumor type for delivering preoperative therapy. The rationale for preoperative therapy is that it is delivered to undisturbed tissue planes with well-oxygenated tissue. This is of great benefit for radiation therapy, because with new computed tomography scan treatment planning it is possible to completely delineate the tumor without surgical clips or postoperative hematoma (or both) obscuring the tumor margin.

Temperatures in the tumor on the bladder wall, tumor margin, intravesical urine, rectal cavity and pubic subcutaneous fat tissue (SCFT) were measured in a total of 48 bladder tumor patients during radiofrequency (RF)-capacitive heating of the tumors. There were close correlations (p less than 0.01) between the temperature of the tumor margin and intratumor temperature, between the intravesical temperature and the temperature of the tumor margin, between the RF power applied and the intravesical temperature and also between the thickness and the temperature of SCFT. As long as the thickness of SCFT was 20 mm or less, it was possible to raise the temperature of bladder cancer to 42.5 degrees C or above. The intravesical temperature could be regarded as an indicator for hyperthermia treatment since the intravesical urine temperature of over 42 degrees C implied a therapeutic temperature of 42.5 degrees C or more in the margin of the tumor. Since the intravesical temperature was closely related to the output power, the therapeutic magnitude of the output power could be defined at least as 400 W, by which intravesical urine temperature could exceed 42 degrees C.

dose distributions were more sensitive than I or Cs to placement uncertainties. Conclusions: The 2003 ABS report recommendation of a 2e3mm tumor margin for COMS plaque size selection may be inadequate due to insufficient dosimetric coverage of the tumor base and tumor volume when assuming prescription dose based solely on the tumor apex coverage. Better tumor coverage is achieved when using a GTV-to-PTV total basal expansion ofO3mm and/or prescribing beyond the tumor apex.

Purpose With spread of laparoscopic surgery for colon, more reliable way to find the lesion from the serosa side during the surgery became more important.We developed new technique to mark the lesion. Marking was usually done by injecting Indian ink with needle through the fiberscope from mucosal side of colon in Japan. But injection not a few failed to limit the ink within the wall of colon. We tried to apply the EMR technique to the marking. Methods The principle is first to inject 2-3ml of saline into submucosal layer with needle device, to make submucosal upheaval of about 1cm and continuously to change saline to ink and inject it. Then we could limit the ink firmly. We modified these methods to find the best way in respects of ink concentration, amount, location and period until the surgery. Baseline conditions were 11% Indian ink, 0.5ml in amount, every 2 points at both oral and anal side at a distance of 5cm from tumor margin and 2days before the surgery. Alternatives were 5%, 0.2ml, 3cm from the margin, respectively. The better conditions were examined. Subjects were 30cases in total, 5cases each in baseline and alternative of concentration, amount and distance. Injection was performed at 2days before surgery in 18cases, 3days before in 4cases and 7days before in 8cases. Results In 30cases, there were no leak of ink into peritoneal cavity, but 20%(4/20) on ordinary methods in the past. In our new technique, 5% in concentration was easier to inject smoothly. 0.2ml in amount was better on the points of size of staining on surgery. There was no difference in local spread of ink among periods from marking until the surgery. Conclusions The principle and details of our new technique for marking on laparoscopic surgery is easy and sure method.

Background and Purpose: The light induced fluorescence endoscopy (LIFEGI: Zillix and Olympus) system has been reported to facilitate detection of cancers of gastrointestinal (GI) tract. However, the marginal image of tumors by LIFE-GI is sometimes unclear, due to fluorescence-influencing biological substance such as blood pigments, porphyrin and flavins. The pharmacoendoscopy, in which noradrenaline is sprayed onto tumors is reported to emphasize the tumor margin by the decreased blood flow in tumors and adjacent tissue. In order to enhance autofluorescent tumor image, we used pharmacoendoscopy simultaneously with LIFE-GI (pharmaco LIFE-GI). Patients and Methods: Subjects were 21 cases of gastric cancers, including 16 early and 5 advanced cancers. After a conventional endoscopic examination followed by the regular LIFE-GI observation, 20 ml of 0.02 % noradrenaline was sprayed onto the tumors and LIFE-GI images were obtained 5 minutes later. In order to evaluate the enhanced detectability of cancers, three examiners scored each case independently based on the enhancement of tumor margins; 0: no or minimal enhancement, +1: moderate enhancement, +2: marked enhancement. All cancers were observed as emitting dark red color under LIFE-GI against the background normal tissue emitting green color. Results: Regarding the scores of the tumors image enhancement, 4 of 21 cases were of +2 score, 12 cases of +1 score, and the rest of the cases (5 cases) of 0 score, indicating that 76.2 % of tumors was significantly enhanced by a pharmaco LIFE-GI. Conclusion:From the result of this study, marginal images of the tumors have been well enhanced by our new technique, a pharmaco LIFE-GI, which may be useful for better detection of gastric cancers.