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For patients who have undergone gastrectomy for gastric cancer, a follow-up by upper gastrointestinal endoscopy is required. However, it is sometimes very difficult to observe the remnant stomach due to a significant amount of residual food. We evaluated the reduction of food residue by drinking water as preparation before upper gastrointestinal endoscopy in postpartial gastrectomy patients. We compared two groups. In the water group, patients drank 500 mL water after dinner on the evening before endoscopy, and on the day of endoscopy they drank 350 mL water before the examination. In the control group, patients drank nothing after dinner, and nothing on the day of endoscopy. In the water group, food residue in the remnant stomach was reduced. In patients who underwent proximal gastrectomy or pylorus-preserving gastrectomy, food residue in the remnant stomach was not reduced by drinking water. However, in patients with distal gastrectomy, food residue was reduced by drinking water. Drinking water before upper gastrointestinal endoscopy is safe with no risk of complications, and our results suggested that drinking water effectively reduced food residue in the remnant stomach before endoscopic examination.

A 47 -year-old male presented with gastric cancer, with right cervical and para-aortic lymph node metastases. The patient had not undergone a curative operation, but was treated with immunochemotherapy in combination with S-1 60 mg/m2(2 weeks administration and 2 weeks rest), paclitaxel 60 mg/m²(day 1, 8, 15), and Lentinan 2mg/body(day 1, 8, 15). After 3 courses of this treatment, no hot-spots were identified on cervical and para-aorta lymph nodes by PET-CT examination. We decided to perform total gastrectomy with D3 lymphadenectomy and Roux-en Y reconstruction. On histopathological examination, no malignancy was seen in the lymph nodes and the main tumor was judged to be grade 2. With this combined immunochemotherapy, the patient had a favorable outcome without side effects, which proved effective for far advanced gastric cancer.

Introduction: It is difficult to perform the staging of laparoscopy within the restricted time at a high-volume center. We thus started between-hospital cooperation as of April 2008. In this hospital cooperation, we perform surgery after laparoscopic examination at a cooperating hospital., Materials and Methods: Staging laparoscopy was indicated for patients with T3 or T4 gastric cancer. These patients underwent staging laparoscopy at Maki Hospital before their scheduled surgery at our own hospital., Results: Between April 2008 and January 2009, 14 patients underwent staging laparoscopy. We received the laparoscopic findings and confirmed the histopathological examination for median 11 days. The median duration from the day that we requested Maki Hospital to the day that patients underwent surgery was 34 days. No patient had laparoscopic complications. Of the 14 patients, 4 patients had peritoneal metastasis. Ten patients did not have peritoneal metastasis or positive cytology. Of these patients, 9 patients underwent surgery. R0 resection was achieved in 7 of 9 patients. False-negative results were obtained in two cases because of positive peritoneal cytology., Conclusion: Hospital cooperation may enable us to perform short-term staging laparoscopy. However, false-negative results were obtained in two cases because of positive peritoneal cytology. Further improvement must be made to assure the diagnostic accuracy of this procedure.

This study evaluated the preserved function of the remnant stomach by gastric emptying scintigraphy 1 year postoperatively in 49 patients who underwent pylorus-preserving gastrectomy (PPG), and it investigated whether this examination method is a useful tool for evaluation. The residual stomach function was classified as rapid, intermediate, and delayed emptying types according to gastric emptying curves. Then, the relationships were examined between the gastric emptying types and postprandial symptoms, food intake status, body weight changes, and endoscopic findings. Seventy-three percent of the PPG patients were classified as belonging to the intermediate emptying type, and the remainder (27%) to the delayed type. The frequencies of complaints such as epigastric fullness, nausea, and vomiting were high in the delayed emptying-type patients. The intermediate emptying-type patients consumed larger amounts of food and gained more weight than the delayed emptying-type patients. In conclusion, gastric function was evaluated by gastric emptying scintigraphy in PPG patients. This method might be useful not only for evaluating the motor function of the remnant stomach, but also for predicting postoperative status. Although PPG is a function-preserving operation, it should be considered that a quarter of the patients showed delayed emptying type which related to poor quality of life.

We performed surgical resections in 6 cases of advanced gastric cancer and 4 cases of colorectal cancer after preoperatively treating them with TS-1 at a daily dose of 80-100 mg/body for 2 weeks, and evaluated whether one can estimate their sensitivity to TS-1 by a pathological examination. Case 1 of type 3 advanced gastric cancer underwent surgery after one week interval following oral administration of TS-1 at a daily dose of 80 mg/body for 2 weeks. Surprisingly, the pathological examination revealed complete disappearance of cancer cells in the resected stomach and no cancer cells in the regional lymphnodes, judged grade 3 in pathological effectiveness. Case 2 of type 2 advanced gastric cancer was treated with TS-1 at a daily dose of 100 mg/body for 2 weeks and underwent surgery after a three-week interval due to the complication of pneumonia. The pathological effectiveness was judged grade 2 in the resected stomach, and no cancer cells were detected in the regional lymphnodes. In both cases, the postoperative course was uneventful, and no adverse effects were detected. In these cases, their high sensitivity to TS-1 was clearly confirmed, and now they have been treated with TS-1 for the postoperative adjuvant chemotherapy, and have undergone regular check-ups at our outpatient clinic in good condition. Recently, we performed the same protocol in 6 cases of advanced gastric cancer including these 2 cases and also in 4 cases of advanced colorectal cancer. This protocol was found useful for evaluating the pathological effect by TS-1. We consider the protocol quite useful and helpful in determining a suitable regimen for postoperative adjuvant chemotherapy.

A 68-year-old woman was admitted to our hospital because of type 4 gastric cancer associated with paraaortic lymph node metastasis. Considered surgically incurable, she was placed on preoperative chemotherapy consisting of Methotrexate (MTX) 50 mg (day 1), CDDP 10 mg (day 2-6), 5-FU 500 mg (day 1-6) and Leucovorin (LV) 60 mg (day 2-6). Because of severe nausea and leucopenia, she could receive only 1 course of the chemotherapy. CT on January 7, 1997 (5 weeks after the chemotherapy) showed that the gastric wall thickness and the paraaortic lymph nodes swelling had decreased remarkably. She underwent total gastrectomy on January 13, 1997 (pT2, pN2, pM1 (LYM), stage IV, TNM classification). As an outpatient, she was treated with UFT-E 300 mg/day (continuous until the present) and MTX 50 mg (day 1), 5-FU 500 mg (day 1) and LV 60 mg (day 2-3) once two weeks (total 27 cycles). Four years and 4 months after surgery, although peritoneal recurrence was suspected, she has been managed at our outpatient clinic.

A 63-year-old man was admitted to our hospital because of advanced gastric cancer associated with metastasis of the liver. He was treated with 300 mg/day of UFT-E from 18 days after total gastrectomy on July 14, 1997. The preoperative serum level of tumor marker, which had been increasing (CEA: 340 ng/ml, CA19-9: 9,094 U/ml), returned to the normal range 7 months after gastrectomy. CT scan on July 9, 1998 (1 year after gastrectomy) showed that the liver metastasis had changed to a scar (CR). As of May, 2001, 2 years and 10 months after inducing CR, we have been administering UFT-E to the patient, with no side effect or regrowth of the tumor.

Therapeutic plasmapheresis for malignant tumor was first applied scientifically to transmissible tumors in dogs in 1908 by Crile et al. In the 1970s, immunosuppressive factors in the plasma of cancer-bearing patients were described. Plasmapheresis has been widely applied to many human malignant diseases for immunosuppressive factors being removed with new plasma separating methods, sachas continuous centrifugation or membrane plasma separation. Recently more selective removal method have been developed. The effects of plasmapheresis are recognized not only from an immunological point of view but also in performance status. The latter effect perhaps depends on the replacement of fresh frozen plasma rather than the removal mechanism itself. It is thought that plasmapheresis improves not only immunological status, but also homeostasis in patients with malignancies. There are no cancer treatments which improve the performance status of advanced cancer patients except plasmapheresis. In the future, plasmapheresis is likely to receive more attention and further development as an anti-cancer therapy for immunomodulation and fundamental treatment in combined immuno-chemotherapy.