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京都府立医科大学附属北部医療センター 消化器内科, 京都府立医科大学 消化器内科, 京都府立医科大学附属北部医療センター 外科, Department of Gastroenterology, North Medical Center,Kyoto Prefectural University of Medicine, Molecular Gastro enterology and Hepatology, Kyoto Prefectural University of Medicine, Department of Surgery, North Medical Center,Kyoto Prefectural University of Medicine, 症例は80代、男性。市民検診での胃透視で前庭部に異常所見を指摘され、精査加療目的に当院受診となった。上部消化管内視鏡検査では胃幽門部に30mm大の3型腫瘍を認めた。生検結果はadenocarcinoma tub2-porであった。胸腹部造影CT検査では所属リンパ節腫大・遠隔転移は認めず、術前診断:cT2N0M0 cStage Iとして手術加療を行った。最終病理診断はadenocarcinoma(por1>tub2>tub1)pT1b(SM2 0.7mm)Ly0V1aN0であり、腫瘍直下の筋層内に2mmの壊死を伴う肉芽腫を認めた。肉芽腫内には好酸球浸潤を認め、遺伝子解析の結果Anisakis simplexが検出された。その後術後経過良好で、現在再発なく、当院外科外来で経過観察されている。(著者抄録)

京都府立医科大学附属北部医療センター 外科, 京都府立医科大学 消化器外科, Department of Surgery, North Medical Center Kyoto Prefectural University of Medicine, Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, 症例は19歳女性。下血を主訴に当院を救急受診した。造影CTで小腸内腔にextravasationを認め、小腸内視鏡では盲端となる管腔構造を認めた。Meckel憩室による憩室出血の診断で待機的に単孔式腹腔鏡補助下手術を施行した。術中、回盲部から口側100cmの位置に隣接腸管と腸間膜を共有する腸管を認め回腸重複腸管症と診断し、重複腸管のみ切除した。今回我々は単孔式腹腔鏡手術による消化管重複症を経験したので報告する。(著者抄録)

A-69-year-old man presented with an obstructed defecation. He was diagnosed as having advanced lower rectal cancer with direct invasion of the prostate and metastases to regional and para-aortic lymph nodes. Biopsy examination of the tumor showed RAS wild-type expression and negative BRAF V600E mutation. The patient received 13 courses of mFOLFOX6 and panitumumab(Pmab)in combination and 1 course of mFOLFOX6 alone. After the chemotherapy, the size of the primary tumor and lymph node metastases decreased remarkably. 18F-fluorodeoxyglucose-positron emission tomography(18F-FDG- PET)showed no 18F-FDG accumulation in the tumor and lymph nodes. We performed laparoscopic abdominoperineal resection with D3LD2 lymph node dissection and left external iliac lymph node(293-lt)sampling. Pathological examination revealed no residual cancer at the primary tumor location and only a few malignant cells remained in the 293-lt lymph node. The patient has shown no recurrence for 1 year without adjuvant chemotherapy. We conclude that mFOLFOX6 and Pmab in combination is an effective preoperative chemotherapy against advanced RAS wild-type rectal cancer. This strategy may reduce surgical invasion and save the surrounding organs while maintaining curability.

The targeting of membrane proteins that are activated in cancer stem cells (CSCs) represents one of the key recent strategies in cancer therapy. The present study analyzed ion channel expression profiles and functions in pancreatic CSCs (PCSCs). Cells strongly expressing aldehyde dehydrogenase 1 family member A1 (ALDH1A1) were isolated from the human pancreatic PK59 cell line using fluorescence‑activated cell sorting, and PCSCs were identified based on tumorsphere formation. Microarray analysis was performed to investigate the gene expression profiles in PCSCs. ALDH1A1 messenger RNA levels were higher in PCSCs compared with non‑PCSCs. PCSCs were resistant to 5‑fluorouracil and capable of redifferentiation. The results of the microarray analysis revealed that gene expression related to ion channels, including voltage‑gated potassium channels (Kv), was upregulated in PCSCs compared with non‑PCSCs. 4‑Aminopyridine (4‑AP), a potent Kv inhibitor, exhibited greater cytotoxicity in PCSCs compared with non‑PCSCs. In a xenograft model in nude mice, tumor volumes were significantly lower in mice inoculated with PK59 cells pre‑treated with 4‑AP compared with those in mice injected with non‑treated cells. The present results identified a role of Kv in the persistence of PCSCs and suggested that the Kv inhibitor 4‑AP may have potential as a therapeutic agent for pancreatic carcinoma.

Screening colorectal endoscopy revealed a 5mm rectal neuroendocrine tumor(NET: G1)in a 72-year-old man. Endoscopic mucosal resection(EMR)was performed, and the histopathological examination demonstrated lymphatic and vessel invasion with a possible positive vertical margin. Therefore, we performed laparoscopic low anterior resection, lymphadenectomy, and ileostomy as additional surgical resections. No residual tumor was found in the specimen, but 3 metastatic lymph nodes were identified. The rate of lymph node metastasis in rectal NETs of diameter10mm is low, and additional surgery can reduce the patient's quality of life affected due to impaired anorectal function. However, in the Japanese guidelines for NET, additional surgery is adopted in cases with high-risk factors for lymph node metastasis. Therefore, it is necessary to select between additional surgery and careful follow-upfor rectal NETs of diameter10mm with high-risk factors because of possible lymph node metastasis.

BACKGROUND Physicians rarely select surgery a second time as the treatment for octogenarians with hepatocellular carcinoma (HCC) recurrence. METHODS We encountered eight male and three female octogenarians underwent surgery a second time as the treatment for HCC recurrence (octo group). We studied these cases clinically and compared them with 25 younger people underwent surgery a second time (young group). All patients of octo group have resectable HCC according to the Japanese guideline, that is HCC patients with Child-Pugh status A or B and who have solitary or only a few HCC nodules, in addition, no serious comorbidities, no serious dementia, a performance status of 0-1 and the will to receive hepatectomy. RESULTS The average maximum tumour size at the first hepatectomy was significantly larger than that at the second hepatectomy (P

A 42-year-old male was referred to our hospital with bloody feces and lower back pain. He was diagnosed with unresectable gallbladder cancer with rectal metastasis (T3aN1M1, Stage IVB). The patient was administered gemcitabine plus cisplatin (GC). After nine courses of GC, computed tomography showed regression of the tumor and the patient's tumor marker levels had decreased. Therefore, curative resection was performed. Ten months after the operation, recurrence was observed in the rectal margin and GC was restarted. Because the total dose of cisplatin was 1040mg, we stopped cisplatin and continued to administer only gemcitabine (at the same dose). A follow-up examination 2 years after the operation showed no evidence of recurrence. Conversion therapy might be an effective multidisciplinary treatment for advanced gallbladder cancer that is initially unresectable. Herein, we report the case of a patient with advanced gallbladder cancer and rectal metastasis who was successfully treated by curative resection after chemotherapy;we also review the relevant literature.

A 78-year-old woman underwent partial hepatectomy for the treatment of hepatocellular carcinoma(HCC).After surgery, she was further treated with radiofrequency ablation(RFA)and transcatheter arterial embolization(TAE)for the intrahepatic reccurence of HCC.Thirty months after surgery, her tumor marker levels increased and computed tomography (CT)revealed an intrahepatic mass and right renal tumor which extended into the renal vein.We therefore suspected a reccurence of HCC and right renal cell carcinoma which extended into the renal vein, and thus performed right nephrectomy before again performing TAE to treat the reccurence of HCC.The pathological findings showed HCC metastasis in the kidney. Nephrectomy should be performed as soon as possible in patients with a renal vein tumor thrombus in order to prevent the occurrence of a pulmonary embolism.We herein describe a very rare oncologic emergency case and review the relevant literature.

We report a case of an elderly patient diagnosed with intrahepatic cholangiocellular carcinoma with cholangitis.An 88- year-old woman presented with fever.Computed tomography examination showed a hepatic tumor and dilation of the peripheral bile duct.Cholangiocarcinoma was diagnosed.Biliary tract drainage and palliative care were suggested because of her age.However, her family asked for a second opinion about operative management and consulted our hospital.Radical operations for intrahepatic cholangiocellular carcinoma that has spread to the left lobe are usually accompanied by widespread lymph node dissection and extensive hepatectomy with biliary tract reconstruction.However, in this case, the patient was very elderly and was able to safely undergo an operation by reduction of the excision range and by omitting lymph node dissection.We conclude that appropriate surgery and postoperative care to prevent complications are necessary when performing very invasive surgery in elderly patients.

A 54-year-old man was presented at our hospital with weight loss.He diagnosed with colorectal cancer, multiple liver metastases and para-aortic lymph node metastasis.After undergoing colostomy, he was treated sequentially with mFOLFOX6 plus bevacizumab(Bmab), FOLFIRI plus Bmab or Pmab, according to the guideline.Since these chemotherapy resulted in progressive disease, regorafenib was administered as a salvage-line treatment.PET -CT showed only para-aortic lymph node swelling with high FDG uptake.Severe adverse effects were developed shortly after regorafenib treatment so he requireda reduction in dose.Three years after treatment with regorafenib, the response of the target lesion was stable disease according to the RECIST criteria.Tumor growth had been controlled for a long time.

We reported a case of early gastric cancer with submucosal heterotopic gastric glands.A 62-year-old woman presented with poor appetite, weight loss, and epigastric pain.Endoscopy examination identified giant gastric folds and a gastric ulcer on the posterior wall of the upper-middle stomach.Biopsy specimen analysis showed adenocarcinoma.We preoperatively diagnosed the lesion as type II c-like advanced cancer and performed a total gastrectomy.Pathologically, the lesion was diagnosed as gastric cancer(non-solid type poorly differentiated adenocarcinoma)located in the mucosal layer and accompanied by submucosal heterotopic gastric glands.Submucosal gastric gland heterotopia is a relatively rare disease, and it is difficult to diagnose the glands before surgery is performed.However, endoscopic ultrasonography helps to demonstrate diffuse cystic lesion preoperatively.It is often associated with multiple gastric cancers.Therefore, we must diagnose and treat the disease with great care.

Background Isolated anatomic total caudate lobectomy is indicated in patients who have liver tumors limited to the caudate lobe. However, isolated caudate lobe resection is a challenging surgical procedure that required safe and reliable techniques. All portal and hepatic veins that connect this area originate from the first branch of the portal vein or vena cava; therefore, the operator must be cautious of the potential for massive bleeding. Methods The important points regarding the safety of our procedure include creating an optimal surgical view and preparing for accidental bleeding before parenchymal dissection. Sufficient mobilization and removal of Spiegel’s lobe from the left to the right side of the vena cava allows the operator to perform parenchymal dissection under a right- or front-side view. Results We have performed this technique in two patients with HCC and one patient with primary cystadenocarcinoma. The average operative time and amount of blood loss were 435 min and 1137 ml, respectively. No operative mortalities or postoperative complications were observed in any of the patients. Our three patients are currently doing well without any recurrence. Conclusion Our modified high dorsal resection procedure can be used to safely remove the entire caudate lobe. Electronic supplementary material The online version of this article (doi:10.1186/s12957-016-0896-3) contains supplementary material, which is available to authorized users.

An 87-year-old man visited our hospital with a chief complaint of melena. Invagination caused by rectal cancer or sigmoid colon cancer was suspected as a result of physical and radiological examinations. Since there were no subjective symptoms, laparoscopic surgery was planned electively. As an operative finding, a tumor was found in the rectosigmoid colon and caused invagination. The invagination was released during an operation, and high anterior resection with D3 dissection was performed laparoscopically. The operation time was 108 minutes and the amount of blood loss was 22 mL. Although anastomotic leakage occurred as a postoperative complication, recovery was achieved conservatively by percutaneous drainage. In many cases, invagination of adults is caused by a solid tumor such as bowel carcinoma, which commonly occurs at the cecum or sigmoid colon. Although invagination of the rectosigmoid colon fixed to the retroperitoneum is relatively rare, the fragility of the supporting tissues in the pelvis accompanied by aging is considered to be a cause. In cases of a large tumor occupying the lumen of the intestine, appropriate preoperative diagnosis is needed and the method of operation should be chosen carefully.

We report successful treatment of stenosis of the portal vein caused by enlargement of the remnant liver after extended right hepatectomy with interventional radiology using an intraportal expandable metallic stent (EMS). A 75-year-old man underwent extended right hepatectomy after percutaneous transhepatic right portal embolization for advanced gallbladder cancer. His portal vein branched out into the anterior, posterior, and left branches. The main portal vein and left branch formed a sharp angle by nature. We ligated the posterior branch and sutured the cut line of the anterior branch during surgery. Several days after the surgery, icterus and massive ascites developed. Computed tomography (CT) and portography showed thrombi and stenosis of the cut line of the right branches due to enlargement of the remnant liver. A covered EMS was placed at the stenosis with interventional radiology. After stent placement, the icterus and massive ascites resolved. The patient remains well and EMS has caused no difficulty for 19 months. Intraportal EMS placement is effective in treating perioperative portal venous complications.

Colonic neuroendocrine cell carcinoma (NEC), which is a rare subtype of colon epithelial neoplasm, has been reported to show extremely aggressive characteristics with a 1-year survival rate of 20%. We report herein a resected case of NEC that manifested bacterial sepsis due to sigmoidovesical fistula. Staged surgery consisted of resecting the sigmoid colon and part of the bladder four weeks after construction of an ileostomy to alleviate septic shock. The resected specimen was histologically diagnosed as NEC invading the wall of the urinary bladder with metastasis to the regional lymph nodes. The patient underwent four cycles of FOLFOX after surgery for additional treatment of residual metastatic lymph nodes around the abdominal aorta diagnosed preoperatively. Although the patient showed stable disease measured by computed tomography scan for the first three months after surgery, he rejected additional chemotherapy thereafter, and died ten months after the initial admission due to progression of residual tumor in the urinary bladder as well as the lymph nodes. This is the first case report describing colonic NEC manifesting perforation into the urinary bladder. Although the optimal chemotherapeutic regimen for colonic NEC has not yet been established, FOLFOX may be one of the choices.

Superparamagnetic iron oxide (SPIO)-based colloid has been used clinically as a tissue-specific magnetic resonance contrast agent. We coupled monoclonal antibody A7 (Mab A7), which reacts specifically with human colorectal carcinoma, to Ferumoxides (SPIO) and examined the accumulation of this conjugate in xenografted tumours in nude mice. We examined in vitro immunoreactivity of Mab A7 coupled to Ferumoxides and its in vivo distribution in nude mice with human colorectal carcinoma. Magnetic resonance imaging of tumour-bearing nude mice was performed 72 h after injection of A7-Ferumoxides. A7-Ferumoxides retained binding activities that were nearly identical to intact Mab A7. More of the radiolabelled A7-Ferumoxides accumulated in the tumour than normal mouse IgG-Ferumoxides from 12 h onwards after injection (P

Background and Objectives The incidence of gastric cancer, in people over 70 years of age, has increased remarkably. Aggressive lymphadenectomy with gastrectomy has been reported to improve survival in patients with gastric cancer. Because complication rates following gastrectomy increase with advancing age, we sought to determine whether this procedure was merited in elderly patients with gastric cancer. Methods We performed a retrospective analysis of 202 patients who underwent total gastrectomy with extended lymphadenectomy for gastric carcinoma. Postoperative complication rates were compared between patients over and under 70 years of age. Results The 10-year survival rates of patients under and over 70 years of age following total gastrectomy with extended lymphadenectomy were not significantly different. Although medical comorbidities in each group were similar, pulmonary dysfunction was significantly more common following total gastrectomy in patients over 70 years than in patients under 70 years. Moreover, logistic regression analysis revealed that patient's age was the only variable that independently correlated with the presence of postoperative complications. Conclusions The prognosis of the gastric cancer patients over 70 years of age was similar to that of younger patients after total gastrectomy with extensive lymphadenectomy. However, pulmonary dysfunction was significantly more common in patients over 70 years old. J. Surg. Oncol. 2005;91:232–236. © 2005 Wiley-Liss, Inc.

Background One of the reasons for the poor prognosis of pancreatic carcinoma is the difficulty of obtaining an early diagnosis of pancreatic carcinoma. One possibility is the application of radioimmunoscintigraphy using radiolabeled monoclonal antibodies (Mabs). Methods We labeled chimeric (human/mouse) Fab fragments of Mab A7 (chA7Fab) with 99mTc and examined the distribution of 99mTc-labeled chA7Fab in nude mice bearing human pancreatic carcinoma. Results The tumor accumulation of 99mTc-labeled chA7Fab was larger than that of 99mTc-labeled A7 from 2 to 6 hr after injection. 99mTc-labeled chA7Fab disappeared from blood more rapidly than 99mTc-labeled A7. For all resected normal tissues except kidney, the accumulation of 99mTc-labeled chA7Fab was low and similar to that of 99mTc-labeled A7. Conclusions Because the half-life of 99mTc is short (6 hr), chA7Fab, which accumulates rapidly in tumors, may be a better carrier of 99mTc than intact Mab A7. J. Surg. Oncol. 2003;84:160–165. © 2003 Wiley-Liss, Inc.

BACK GROUND/AIM: The purpose of the present study was to clarify the clinicopathological features of non-hepatitis B and -C (NBNC) hepatocellular carcinoma (HCC), the incidence of which has been increasing.Two hundred and eighty-four patients with HCC were classified into three groups according to viral hepatitis status, namely NBNC, hepatitis B, and hepatitis C. We compared the three groups and studied related risk factors.Patients without cirrhosis who had increased number of platelets and diabetes mellitus, and a serum alpha-feto-protein (AFP) level100 ng/dl were more common in the NBNC group. The cumulative survival and disease-free survival were better in the NBNC group than in the other groups. The tumor size and hepatitis B or C viral status were found to be independent risk factors of disease-free survival and the presence of multiple lesions was the only independent risk factor of survival.Close follow-up of NBNC liver cirrhosis and early detection of NBNC-HCC can improve the prognosis after surgery.

Background: Extended lymphadenectomy performed with gastrectomy has been reported to prolong survival of patients with early gastric cancer. However, some authors question the value of extensive lymphadenectomy in these patients, especially since much recent discussion of patient quality of life after gastrectomy has favored less invasive operations. Methods: We retrospectively analyzed 485 patients who had undergone gastrectomy for early cancer in order to evaluate the effect of extended versus limited lymphadenectomy on postoperative survival. Various prognostic factors were examined for patients whose tumors were located in the distal third of the stomach. Results: Although extended radical lymphadenectomy did not prolong postoperative survival when early gastric cancer was located in the middle or proximal third of the stomach, it did when the tumor occupied the distal third. Conclusions: Performance of extended radical lymphadenectomy was a significant prognostic factor for early gastric cancer patients when tumors were located in the distal third of the stomach.

Background Hepatic resection is the only effective treatment for combined hepatocellular carcinoma and cholangiocarcinoma. Case presentation A 52-year-old man was preoperatively diagnosed with hepatocellular carcinoma in segment 2 with tumor thrombus in the segment 2 portal branch. Anatomical liver segmentectomy 2, including separation of the hepatic arteries, portal veins, and bile duct, enabled us to remove the tumor and portal thrombus completely. Modified selective hepatic vascular exclusion, which combines extrahepatic control of the left and middle hepatic veins with occlusion of left hemihepatic inflow, was used to reduce blood loss. A pathological examination revealed combined hepatocellular carcinoma and cholangiocarcinoma with tumor thrombus in the segment 2 portal branch. No postoperative liver failure occurred, and remnant liver function was adequate. Conclusion The separation method of the hepatic arteries, portal veins, and bile duct is safe and feasible for a liver cancer patient with portal vein tumor thrombus. Modified selective hepatic vascular exclusion was useful to control bleeding during liver transection. Anatomical liver segmentectomy 2 using these procedures should be considered for a patient with a liver tumor located at segment 2 arising from a damaged liver.

A new dosage formulation of methotrexate (MTX-CH) was developed to control cancer growth by local administration.BALB/c mice received a subcutaneous inoculation with transplantable Colon 26 cancer cells on the back. When cancerous tumor became 7 mm in diameter, MTX-CH or MTX aqueous solution (MTX-sol) was injected into the tumor. The MTX concentration in the tumor was compared between the MTX-CH group and the MTX-sol group. The tumor growth was assessed in single or repeated local administration experiments.The MTX concentrations were significantly higher for longer periods in the MTX-CH group than those in the MTX-sol group. Repeated MTX-CH administration was significantly more effective for suppressing the tumor growth compared with repeated MTX-sol administration.MTX-CH is superior to MTX-sol in controlling the tumor growth by local administration because of its long-acting effect.

Because the HAMA (human anti-mouse antibody) response following administration of murine monoclonal antibodies represents mainly isotypic HAMA production, idiotypic HAMA responses have not been thoroughly analyzed.In the present study we examined the effect of idiotypic HAMA that arose in patients who had repeatedly received murine monoclonal antibody conjugated to an anticancer drug against in vitro binding and antitumor activity of the conjugate. HAMA that had developed after administration of tumor-specific murine monoclonal antibody A7 conjugated with neocarzinostatin were measured in patient serum. The inhibitory effect of HAMA on tumor binding and antitumor activity of the A7-neocarzinostatin conjugate was examined in cultures of human colonic carcinoma cells.The serum concentration of idiotypic HAMA in patients administered A7-neocarzinostatin was significantly higher than that in a control group. Binding activity and antitumor activity of A7-neocarzinostatin against target cells was reduced in the presence of sera containing HAMA.Repeated use of A7-neocarzinostatin can be expected to show less antitumor effect than the first use of the conjugate.

One problem that has been encountered with the use of murine Mabs is the development of a human anti-mouse antibody (HAMA) which lead to serious problems such as anaphylaxis. In order to evaluate the decreased HAMA production after administration of Fab fragments of chimeric monoclonal antibody, Fab fragments of chimeric Mab A7 (chA7Fab) was administered as neocarzinostatin (NCS) conjugate to seven patients with colonic cancer.The in vivo pharmacokinetics of chA7Fab and HAMA production was examined. These patients received an infusion of 4,000 U: dose of NCS (18 mg: dose of chA7Fab).The plasma disappearance curves showed that chA7Fab-NCS was more rapidly cleared than A7-NCS. The chA7Fab-NCS did not elicit of HAMA in two of seven evaluable patients. The chA7Fab-NCS NCS elicited low levels of HAMA in five of seven evaluable patients. In contrast, A7-NCS elicited high levels of HAMA in all patients tested. Anti-isotype HAMA was not seen in seven evaluable patients tested with chA7Fab-NCS, while A7-NCS elicited high levels in all patients tested.This study demonstrates the reduced immunogenicity and shorter clearance time of chA7Fab-NCS compared to A7-NCS.

Because the symptoms do not appear in most cases until the tumor has grown quite large, schwannomas are often detected incidentally during work-up for some other condition. Benign schwannomas generally do not invade adjacent structures but making the diagnosis preoperatively can be difficult when the tumor is large. We report the case of a benign schwannoma which was diagnosed preoperatively by needle core biopsy under computed tomography guidance. The tumor was removed completely by partially resecting the S1 nerve root, which was subsequently reanastomosed. The postoperative course was uneventful with the exception of minimal left leg pain due to neurologic deficit.

Generally, patients with advanced rectal cancer in whom surgical treatment is contraindicated receive radiation or chemotherapy. In such patients, we have administered local injection of methotrexate and mitomycin C bound to activated carbon particles. Four patients received intratumoral injection of the dosage formulation (total dose 100-400 mg of methotrexate or 8-32 mg of mitomycin C) under colonofiberscope. After the treatment, bleeding and pain were lessened in all 4 patients. In two patients, the tumor markedly decreased in size and there was no regrowth prior to death 12-14 months after the treatment. In another patient, bleeding and pain disappeared until the patient died of pulmonary and liver metastases. The fourth patient is alive without regrowth 5 months after treatment. Side effects were not severe.

Sentinel node navigation surgery (SNNS) for gastrointestinal cancer has been examined using various methods, but the SN concept has not been established. For 18 patients who had colorectal cancer without macroscopic nodal metastases, we had attempted to detect sentinel lymph nodes (SNs) with activated carbon particles and investigate the existence of nodal metastases histologically. SNs were detected in 17 of 18 patients. Thus activated carbon particles are a useful tracer for SN detection. Three patients had microscopic nodal metastases, and two had nodal metastases in SNs. Although the remaining patient was a false negative case which had nodal metastases in non-SNs only, the nodal metastases were within the sentinel lymphatic region (SLR) which includes SNs. It is considered possible to safely perform minimally invasive lymphadenectomy for colorectal cancer without macroscopic nodal metastases, by means of SLR dissection using activated carbon particles.

BACKGROUND Prophylactic extended lymphadenectomy with gastrectomy may prolong survival in patients with early gastric carcinoma without lymph node metastasis. However, the therapeutic value of extensive lymphadenectomy in patients with early gastric carcinoma remains controversial. METHODS The authors retrospectively analyzed 423 patients with early gastric carcinoma without lymph node metastasis who underwent gastrectomy and did not die of other diseases to evaluate the effect of prophylactic extended lymphadenectomy on postoperative survival. The postoperative survival rate of patients who underwent prophylactic extended lymphadenectomy was compared with that of patients who underwent prophylactic limited lymphadenectomy. RESULTS Although extended lymphadenectomy did not appear to improve the postoperative survival rate of patients with mucosal tumors, it did improve the postoperative survival rate of patients with submucosal tumors. Whether prophylactic extended lymphadenectomy was performed significantly affected outcome in patients with early gastric carcinoma who had submucosal tumors without regional lymph node metastasis. CONCLUSIONS Extensive lymphadenectomy with gastrectomy should be performed to prolong the survival of the patients with submucosal tumors. Cancer 2000;89:1425–30. © 2000 American Cancer Society.

Background Mesohepatectomy with total resection of the caudate lobe and extrahepatic bile duct is sometimes performed for hilar cholangiocarcinoma or gallbladder carcinoma; however, only a few reports on mesohepatectomy with total caudate lobectomy of the liver for hepatocellular carcinoma are available. Methods A 71-year-old woman was preoperatively diagnosed with hepatocellular carcinoma in the central bisections (Couinaud’s segments 4, 5, and 8) and the paracaval portion of the caudate lobe. Mesohepatectomy with total caudate lobectomy of the liver permitted the removal of tumors to provide a cancer-free raw surface of the liver. Mobilization of the caudate lobe is an important procedure in this surgery. Before the liver parenchyma was dissected, all short hepatic veins were ligated and divided from the left to the right side as the left lateral section was retracted to the right, and the caudate lobe branches of the portal vein and hepatic artery were ligated and divided. After the liver parenchymal dissection, both between the left lateral and medial sections and between the right anterior and posterior sections, the Glissonean branches of the caudate lobe were ligated and divided as the central bisections were anteriorly retracted. Finally, liver parenchymal dissection was performed between the caudate lobe and the right posterior section, which was along the right side of the inferior vena cava. Results The surgery time was 538 minutes and blood loss was 1,207 mL. No blood transfusions were required during or after surgery. The postoperative course was uncomplicated. The patient is still alive 25 months after hepatectomy. Conclusion Although mesohepatectomy with total caudate lobectomy of the liver is technically more difficult than mesohepatectomy of the liver because the caudate lobe must be completely detached from the inferior vena cava and the hilar plate, it is a safe and effective treatment method in selected patients with hepatocellular carcinoma located at both the central bisections and the paracaval portion of the caudate lobe.