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Background/aims: Surgery is the only potentially curative treatment for gastric carcinoma. Western surgeons have recently performed extended operations while Japanese surgeons reported therapeutic value of extended lymphadenectomy (D2, D3) long before. We aimed to observe the benefits and hazards of this procedure., Methodology: We analyzed respectively 56 patients operated for gastric cancer between 2001 and 2004., Results: Thirty-five patients were male and median age was 63 years (range, 34-85 years). Subtotal and total gastrectomies were performed in 29 and 27 patients, respectively. Tumor extension and patient's physical status determined the extent of node dissection. Disease stage was III or IV in 63.2% of patients. Number of maximal nodes resected was 48 and maximal metastatic node count was 41. Splenectomy was performed in 4 (14%). Roux en Y anastomosis was performed either manually or with a circular stapler. Four patients (7.1%) had postoperative complications with no hospital mortality., Conclusions: Gastric resection with extended lymph node dissection is a safe procedure with acceptable morbidity when performed by an experienced surgeon.

Background/aims: Despite the impressive results of living donor liver transplantation, hepatic venous reconstruction remains a controversial component., Methodology: A total of 211 consecutive donor hepatectomies were performed. The proximal route of the hepatic vein was exposed by dissection of the connective tissue around the hepatic vein and by dividing and ligating all of the inferior phrenic veins that open into the hepatic vein, into the confluence of the hepatic vein and inferior vena cava, or directly into the inferior vena cava., Results: In the 114 left-side hepatectomy procedures, the number of divided left inferior phrenic veins ranged from 1 to 4 and the diameters of the left and middle hepatic veins ranged from 7 to 33mm. For the 97 right-side procedures, the number of divided right inferior phrenic veins ranged from 1 to 4 and the diameters of right hepatic veins ranged from 9 to 34mm. This maneuver safely allowed for the safe exposure of all trunks and routes of the hepatic veins and the suprahepatic portion of the inferior vena cava., Conclusions: Our technique is useful for obtaining a wide ostium and a sufficient length of the hepatic vein for grafts obtained from living donors.

Background/aims: Although the Model End-Stage Liver Disease (MELD) score has been effective in the prediction of mortality in patients awaiting liver transplantation, its predictive value of survival after living donor liver transplantation (LDLT) needs further study., Methodology: We report our experience with 142 cases of LDLT, analyzing the impact of the MELD score on the graft survival after LDLT., Results: Of 142 grafts, 18 failed during the observation period. One-, 3- and 5-year survival rates were 92%, 87% and 82%, respectively. Cox proportional hazard model revealed that MELD score did not predict graft survival (p=0.43, relative risk = 1.0)., Conclusions: The present results may indicate that the preoperative MELD score was of little help for determining the indication of LDLT.