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The effects of alkali and alkaline earth metals such as potassium (K) and calcium (Ca) on CO 2 gasification reactivity of Japanese cypress (hinoki) char under various temperatures (1123–1223 K) and CO 2 concentration (20–80 vol.%) were studied using thermal gravimetric analysis. The presence of K and Ca compounds in char improved the reactivity of hinoki char for CO 2 gasification catalytically. It was also confirmed that K and Ca compounds can be supported on char to exhibit an enhanced catalytic effect during CO 2 gasification of K-char and Ca-char. The char gasification rate increased with the increase of CO 2 concentration at higher temperatures (1173–1223 K), however at lower temperature (1123 K) the gasification rate decreased at 80% CO 2 . The retardation of char gasification rate at higher CO 2 concentration is caused by the inhibition effect of CO: CO is disproportionated on alkali metal catalysts to CO 2 and carbon, and affected the CO 2 gasification rate. The dependence of char gasification rate on reaction temperature yielded a straight line in an Arrhenius-type plot which indicated that there was no significant change in the gasification mechanism in the temperature range of 1123–1223 K.

症例は61歳，女性．繰り返す嘔吐と腹部膨満を主訴に当院内科に精査目的にて入院．検索の結果上腸間膜動脈症候群と診断され，保存的治療にて様子をみていたが改善せず，手術目的にて外科紹介となった．手術は腹腔鏡下十二指腸・空腸吻合術施行．術後経過良好にて退院．術後１年２カ月経過するも再発はない．腹腔鏡下十二指腸・空腸吻合術は，低侵襲で本疾患には有用な方法と考えられた．

A 67-year-old woman was referred to our hospital for type 1 gastric cancer. We diagnosed the patient with advanced gastric cancer (tub2por, HER2-positive), and the clinical findings were T4aN1M1 (lung), Stage Ⅳ. The patient had cancer cachexia. As first-line chemotherapy, a regimen consisting of capecitabine (X) (1,600 mg/m2/day, days 1-14), cisplatin (P) (60 mg/m2/day, day 1), and trastuzumab (H) (8 mg/kg/day6 mg/kg/day, day 1) was administered every 3 weeks and repeated 6 times. After receiving 6 courses, the patient's general condition and cancer cachexia symptoms improved. The size of the primary lesion significantly decreased, and lung metastasis was not visible on a PET scan. Simultaneously, a new 0-Ⅱc tumor was detected in the cardia, and a biopsy revealed a malignant lymphoma. Total gastrectomy and D2 lymph node dissection without splenectomy were performed. The final diagnosis was T4aN0M0. After treatment, the tumor was histologically evaluated as Grade 1b, and the remnant cancer cells were found to be HER2-negative (loss of HER2). The patient has been alive for 5 months and is receiving adjuvant chemotherapy comprising capecitabine and trastuzumab. Following chemotherapy containing trastuzumab, the patient with cachexia who was diagnosed with unresectable HER2-positive advanced gastric cancer showed improvement in the cachexia symptoms and the disappearance of lung metastasis.

We report a case of gastric small cell carcinoma with liver and lymph node metastases responding to CPT-11 plus cisplatin (CDDP) chemotherapy. The patient was a 77-year-old woman with advanced gastric cancer, clinically diagnosed as P0H1M1CY0T4aN3. The immunostaining and pathological analysis of a biopsied specimen obtained during a gastrointestinal tract endoscopy indicated small cell carcinoma of the stomach. The patient received the following chemotherapy treatments: 11 courses of CPT-11 plus CDDP, 8 courses of docetaxel plus S-1, and 2 courses of paclitaxel. The patient is alive 2 years after the first chemotherapy treatment. We conclude that the combination of chemotherapy used was effective for treating the patient's small cell carcinoma of the stomach, which is considered to have a poor prognosis.

We report the case of a solitary pulmonary tumor, which was diagnosed as recurrent early gastric cancer by detailed pathological examinations. A 59-year old man initially underwent total gastrectomy for gastric adenocarcinoma located at the esophago-gastric junction. A pathological examination indicated a papillary adenocarcinoma (pap ) that had invaded the submucosal layer (sm²), but had not metastasized to the regional lymph nodes (n0). The final diagnosis was P0H0M0T1bN0, Stage IA. Chest computed tomography (CT) 30 months after primary surgery indicated a solitary tumor with a diameter of 9 mm at S3 of the left lung. A positron emission tomography (PET)-CT scan showed an accumulation of ¹⁸F-fluordeoxy-glucose (FDG18) at the same location. Lung cancer was suspected and the patient was given a left upper lobectomy. The resected tumor was diagnosed as gastric cancer metastatic adenocarcinoma by permanent pathological examination. The tumors showed similar histology and immuno histochemical findings for CK7, CK20, TTF-1, SP-A, CDX-2, and HER2 . Early gastric cancer is an almost curable disease and recurrence is very rare. We report the details of this case and review the literature.

In adenocarcinoma of the small intestine, delays in diagnosis are frequent. The majority of patients present with advancedstage disease, and have either lymph node involvement or distant metastatic disease. Surgical resection is a mainstay in treatment of this disease, and the effectiveness of chemotherapy for advanced-stage or metastatic disease has been reported. We report a case of adenocarcinoma of the small intestine surviving for many years after surgical resection and chemotherapy. A 47-year-old woman underwent a small intestine resection, because she had a small intestinal tumor with obstruction. Histopathological examination revealed moderately-differentiated adenocarcinoma with lymph node metastasis. Adjuvant chemotherapy with S-1 was administered for a year, but in March 2006, a recurrent lesion at the right ovary was detected, and she underwent right adnexectomy. Because the ascites cytology revealed class V, chemotherapy was administered. In December 2008, CA19-9 elevated and magnetic resonance imaging showed a tumor behind the uterus, which was diagnosed as a recurrent disease. Because the tumor invaded the rectum, she received a low anterior resection, hysterectomy, and left adnexectomy. After surgical resection, UFT/UZEL was administered for half a year. In July 2010, computed tomography showed multiple lung metastases, and chemotherapy was performed again. However, the regimen was changed because her tumor marker elevated. She is being treated using a combination of cisplatin and irinotecan.

The X- and Y-type Faujasite zeolites were modified with n-hexane plasma processing followed by thermal treatment at 600 °C to produce the carbon coated zeolites. Amount of carbon coated was up to 2.8 wt% for Ca-X zeolite, depending on the time of plasma processing. Although the pore volume of the zeolites was reduced by the carbon modification, the adsorption uptake of N2 at 30 °C increased preferentially to that of O2 and/or Ar only for the modified X-type zeolites. The increase of the N2 uptake was up to 150% for the Na-X zeolite at carbon coating around 1 wt%. Both H2O–DSC and NH3–TPD measurements supported that carbon cluster from plasma processing was present in the Faujasite cage.

A 59-year-old man visited our hospital. After examination he was diagnosed with advanced gastric cancer with multiple liver metastases. At first, chemotherapy of S-1/CDDP was administered. After two weeks, he had severe diarrhea and anorexia, so the therapy was discontinued. Weekly paclitaxel was selected as the next therapy. Depending on the leukocytopenia, doses and intervals were controlled. After 4 courses, CT and MRI revealed that the liver metastases had disappeared, while the primary lesion remained. Seven months after beginning treatment, distal gastrectomy was performed. After the operation, 6 courses of paclitaxel therapy were given at the same doses and the same intervals as before the operation. Two years have passed since the operation, and no recurrence was seen on CT and MRI. Because of the relatively low frequency of adverse events in the digestive system, continued treatment with paclitaxel is possible. These findings show that paclitaxel is an effective drug for advanced gastric cancer with liver metastasis.

Cetuximab, a monoclonal antibody used to target the epidermal growth factor receptor(EGFR), was approved for refractory and metastatic colon cancer expressing EGFR, and the EGFR expression must be confirmed. But the EGFR expression may become false negative by immunohistochemistry. When we used a past operation specimen for a search in particular, a correct evaluation may be difficult for prolonged formalin fixation. We report a case successfully treated by cetuximab, who was diagnosed as EGFR-negative by the past operation specimen, but as EGFR-positive by the liver biopsy specimen. A 51- year old woman with multiple organ metastases, who had experienced failure with prior oxaliplatin, irinotecan(CPT-11), 5- FU and bevacizumab regimens, was administered cetuximab plus CPT-11 because it was EGFR-positive by liver biopsy, and the tumor was obviously reduced. It is useful to obtain another specimen such as by liver biopsy, when the EGFR expression is negative by a past operation specimen.

Pseudomembranous colitis, an antibiotic-associated diarrhea, needs early diagnosis and treatment for the high fatality rate in severe cases. We report a case of pseudomembranous colitis following the use of antibiotics in febrile neutropenia (FN). A 74-year-old man with non-curative resected sigmoid colon cancer was treated with cefepime in FN induced by chemotherapy. Complications of diarrhea were seen on day 2. Paralytic ileus and disseminated intravascular coagulation were also complications. He was diagnosed as pseudomembranous colitis for Clostridium difficile toxin-positive. Vancomycin enemas were administered because oral administrations were impossible, and the effect was provided. Vancomycin enemas are an effective therapy for patients with severe pseudomembranous colitis unable to tolerate oral medications because of ileus.

e15031 Background: Conversion surgery could be an option for stage IV gastric cancer when distant metastasis (M1) is disappeared by palliative chemotherapy, however, feasibility, safety and efficac...

102 Background: Surgical resection is rarely indicated for pulmonary recurrence after curative gastrectomy for gastric cancer because most tumors recurred as multiple nodules or carcinomatous lymphangitis / pleuritis and prognosis is extremely poor. However, some investigators reported a sporadic case developing a solitary pulmonary metastasis which was surgically resected and resulted in a relatively favorable clinical outcome. The present study aimed to clarify contribution of surgery for solitary pulmonary recurrence to the long-term survival. Methods: We performed a systematic review of the literature by searching the words of “stomach”, “neoplasms”, “lung”, and “metastasis” in the Pubmed and Japanese ICHUSHI database, and analyzed the cases reporting on resection of solitary pulmonary metastasis after curative gastrectomy for gastric cancer together with our cases treated at our hospital. Overall survival was estimated by Kaplan-Meier method. Results: A total of 45 patients, 42 from a systematic review and 3 from our cases, were examined. Median age (range) was 67 years (31–84 years). Primary gastric cancer had the following characteristics; histologically differentiated type in 30 patients, undifferentiated type in 2, and unknown in 13 patients and tumor depth of T1 in 3, T2 in 6, T3 in 13, T4 in 9, and unknown in 6. Surgery for the primary gastric cancer was total gastrectomy in 30 patients and distal one in 15. The median (range) disease-free survival (DFS) between initial gastric resection and the detection of pulmonary metastasis was 28.0 months (5-128 months). Surgery for pulmonary tumor was lobectomies in 20 patients, segmentectomies in 3, wedge resections in 18, and unknown in 4. Only 4 patients received adjuvant chemotherapy after pulmonary resection. The median (range) follow-up period after pulmonary surgery was 20 months (3-98 months). The overall survival after pulmonary resection was 86% at 1-year, 62% at 3-year, and 56% at 5-year with the median (range) survival time of 67 months (3-98 months). Conclusions: Surgery for solitary pulmonary recurrence could contribute to the long-term survival.

206 Background: Visceral fat obesity and skeletal muscle depletion were reported to be both risk factors for complications in abdominal cancers surgery. Preoperative exercise may reduce morbidity by modifying body composition. Methods: We conducted an exploratory study attached to a prospective study (AEGES) to examine the effects of a 4-weeks exercise in stage I gastric cancer patients with metabolic syndrome. The AEGES enrolled 50 patients between 2007 and 2013, of which 18 were assigned to the exercise arm. The exercise program consisted of aerobic training 3-7 days a week, resistance training once or twice a week, and stretching. The expected energy expenditure of exercise was set at 30 kcal/kg/week. The total energy expenditure was measured using a calorie counter. After completion of the exercise, the patients received CT and endoscopy for re-staging, then underwent curative gastrectomy. Total skeletal muscle cross-sectional area (cm2) was evaluated on the average of two adjacent axial images at L3. Muscle area was expressed as lumber skeletal muscle index (cm2/m2). Total visceral fat volume was evaluated at the level of umbilicus. The changes of parameters before and after the exercise were assessed by paired Wilcoxon sign test. Results: A total of 15 patients with evaluable CT image were examined. Body weight, body mass index, and abdominal circumference were significantly decreased (-1.5 kg, -0.52 kg/m2, and -3.3 cm, respectively). The median skeletal muscle index was 48.06 cm2/m2 before and 46.85 cm2/m2 after the exercise, which was not statistically significant (p=0.41), while the median visceral fat volume was 205.2 cm2 before and 169.0 cm2 after the exercise, which was statistically significant (p=0.001). There was a weak correlation between total energy expenditure and amount of skeletal muscle index change (r=0.22 by Spearman’s correlation and p=0.427). No patient demonstrated progression of clinical cancer stage during 4 weeks. Conclusions: Preoperative exercise for 4 weeks could significantly modify body composition without progression of gastric cancer. More intensive or personalized exercise would be required to increase skeletal muscle.

38 Background: Body weight loss (BWL) is frequently observed in gastric cancer patients who underwent gastrectomy for gastric cancer. Recently, we reported that severe BWL after gastrectomy was a significant risk factor for continuation of S-1 adjuvant chemotherapy. However, risk factors of BWL after surgery remain unclear. Methods: The present study retrospectively examined the patients who electively underwent curative gastrectomy for gastric cancer between January of 2012 and June of 2014. All patients received peri-operative care of ERAS protocol. %BWL was calculated by percentile of body weight at one month after surgery to preoperative body weight. Severe BWL was defined as %BWL over 10%. Risk factors for severe BWL were determined by both univariate and multivariate logistic regression analyses. Results: Two-hundred seventy eight patients were examined. Median age (range) was 68 years (27-86). Median body mass index (range) was 22 (13.4-33.5). Thirty patients had received neoadjuvant chemotherapy. Operative procedure was total gastrectomy (TG) in 97 patients (Open in 61 and laparoscopic in 36) and distal gastrectomy (DG) in 181 patients (Open in 94 and laparoscopic in 87). Median operation time (range) was 268.5 minutes (95-554). Median blood loss (range) was 115 mL (0-1600). Morbidity of grade 2 or more defined by Clavien-Dindo classification was observed in 37 patients including pancreatic fistula in 8, anastomotic leakage in 5, and abdominal abscess in 3. No mortality was found. Completion of ERAS protocol without any variance was 95.3%. Median %BWL was 6% (-4.3% to 19.5%). Both univariate and multivariate logistic analyses demonstrated that morbidity (odds rate 3.56, p=0.001), blood loss over 300ml (odds rate 2.04, p=0.0356), and total gastrectomy (odds rate 2.1, p=0.0258) were significant risk factors for severe BWL. Conclusions: Nutritional intervention trial to inhibit BWL after gastrectomy should be focused on the patients who developed morbidity, showed blood loss over 300ml, or received total gastrectomy.

166 Background: We introduced laparoscopy-assisted distal gastrectomy (LADG) as multi-institutional feasibility study, and already reported that the overall morbidity rate was 1.6% in the study (Gastric Cancer 2012). The aim of this study is to evaluate the long-term survival results of the patients who were enrolled to the study and finished 5-year follow-up. Methods: A total of 165 c-stage I gastric cancer patients who were registered from Kanagawa Cancer Center were included to the study. The Kaplan-Meier method was used to evaluate overall survival and recurrence-free survival. Results: Median follow-up period of the patients was 1901 days. The reconstruction methods were either B-I (n=150), R-Y (n=14), or B-II (n=1). The accuracy for preoperative diagnosis of stage I was 87.2% (144/165). Among 14 patients with p-stage II/III excluding T3N0/T1N2-3, eight patients received postoperative adjuvant chemotherapy. The recurrence rates by pathological stage were 0% (0/123) for stage IA, 4.7% (1/21) for stage IB, 6.2% (1/16) for stage II, and 60% (3/5) for stage III/IV, respectively. The organ of recurrence was mainly observed in liver (n=3), followed by bone, lymph node, peritoneum (n=1). The 5-year recurrence-free survival rates were 94.5% for all patients, 97.2%/92.3%/60% for pT1/pT2/pT3/4, 98.5%/82.4%/71.4%/66.7% for pN0/pN1/pN2/pN3, 97.9%/81.3%/40% for p-stage I/p-stage II/p-stage III/IV. Conclusions: LADG for c-stage I gastric cancer was feasible in long-term result, as well as in short-term outcome.

164 Background: Conversion surgery could be an option for stage IV gastric cancer when distant metastasis (M1) is disappeared by palliative chemotherapy, however, feasibility, safety and efficacy of surgery after long-term chemotherapy remains unclear. Methods: This retrospective study examined 21 gastric cancer patients who underwent curative conversion surgery between 2001 and 2013. Postoperative complications were evaluated according to the Clavien-Dindo classification. Overall survival (OS) was estimated by Kaplan-Meier method. Results: Median follow-up period (range) was 43.9 months (7.2-72.1 months). The number of M1 factors was one in 17 patients and two in 4, including metastases to non-regional lymph node in 11, peritoneum in 11, and liver in 3. The regimen of chemotherapy was S-1/CDDP in 11 patients, S-1/docetaxel/CDDP in 5, S-1/docetaxel in 2, 5FU/leucovorin/paclitaxel in 1, CPT/CDDP in 1, and S-1 monotherapy in 1. The median duration from initiation of chemotherapy to disappearance of M1 factor was 3.5 months and the median duration from initiation of chemotherapy to the operation was 7.5 months. A total of 19 patients (90.4%) underwent over D2 lymphadenectomy including modified D2 in 2 patients, D2 in 16, and D2 plus para-aortic nodal dissection in 3. M1 tumor was not resected except para-aortic nodal dissection in 3 patients. The median operation time and bleeding were 205 minutes and 228 ml, respectively. Grade 2/3/4 morbidities were observed in 5 patients (23.8%); 2 pancreatic fistula (grade 2), 2 abdominal abscess (grade 2 and 3), and 1 anastomotic leakage (grade 3). No mortality was observed. Pathological response of the primary tumor, defined as disappearance of more than two third of the tumor cells, was 66.7% including 19.0% of complete response. The overall survival (OS) after initiation of chemotherapy was 90.5% at 1-year, 85.7% at 2-year, and 75.9% at 3-year with median survival time (MST) of 52.9 months, while OS after surgery was 90.5% at 1 year, 76.2% at 2-year, and 64.5% at 3-year with MST of 40.9 months. Conclusions: Curative conversion gastrectomy for stage IV gastric cancer was feasible and safe. Considering excellent survival, conversion surgery has a value to be evaluated in prospective studies.