Fumio Kando

Proximal gastrectomy and jejunal pouch interposition for the treatment of early cancer in the upper third of the stomach: Surgical techniques and evaluation of postoperative function

BACKGROUND Limited surgery for the treatment of early gastric cancer located in the upper third of the stomach should be based on a well-balanced reduction in the extent of lymph node dissection and gastric resection while assuring a favorable quality of life and prognosis after operation. METHODS We have used interposition of a double jejunal pouch between the esophagus and the remnant stomach after performing proximal gastrectomy. To assure anastomosis and hemostasis during this operation, we currently use a surgical stapler with a vaginoscope and our new edge clamps. This method has been used in 12 patients to date. RESULTS On histopathologic examination the 12 cases comprised 11 early cancers (seven mucosal and four submucosal cancers) and one subserosal cancer. There was no evidence of lymph node metastasis of postoperative complications such as anastomotic leakages or hemorrhage, demonstrating the low-risk nature of this procedure. CONCLUSIONS The evaluation of postoperative quality of life, in terms of clinical signs and symptoms and dietary status, yielded favorable results. Thus our method has the important advantage of allowing good organ preservation.

Synergistic Effect of Methionine‐depleting Total Parenteral Nutrition with 5‐Fluorouracil on Human Gastric Cancer: A Randomized, Prospective Clinical Trial

Methionine‐depleting total parenteral nutrition (Met‐depleting TPN), infusing AO‐90 amino acid solution (lacking both L‐methionine and L‐cysteine) as a sole nitrogen source, showed synergistic effects with 5‐fluorouracil (5‐FU) in tumor‐bearing rats and in clinical trials with gastrointestinal tract cancers. In this study, the effect of Met‐depleting TPN with 5‐FU upon thymidylate synthase (TS) activity was examined, and the histological effect of this treatment on human gastric cancer was evaluated. Fourteen preoperative advanced gastric cancer patients were divided randomly into two groups. Seven cases were given Met‐depleting TPN for 7 days before surgery with continuous intravenous administration of 5‐FU (500 mg/body per day; total 4.0 g/body) (AO‐90 group). The other 7 received conventional L‐methionine‐containing TPN with 5‐FU (control group). All patients underwent gastrectomy without complications due to these treatments. Resected materials were examined for TS kinetics, and the anti‐cancer effect was also assessed histopathologically. The specimens in the AO‐90 group showed marked degeneration of cancer, while almost no effect was seen in the control group. The free TS activity of carcinoma tissue in the AO‐90 group was decreased and the TS inhibition rate was increased in comparison with the control group (P= 0.0165 and P= 0.0243, respectively). Met‐depleting TPN appears to play a role as a biomodulator of 5‐FU in human gastric cancer.

Treatment of primary multiple early gastric cancer: from the viewpoint of clinicopathologic features.

Abstract. The treatment of multiple early gastric cancer was investigated through the clinicopathologic assessment of 61 cases of primary multiple early gastric cancer (82 accessory lesions) treated by surgical resection over a 15-year period. These cases accounted for 11.7% of all cases of early gastric cancer resected during the same period. The 61 patients included 48 men (mean age 64 years) and 13 women (61 years). Of the 82 accessory lesions, 41 (50%) were located in the same region as the main lesion. The most frequent combination of macroscopic types of the main lesion and the accessory lesion was depressed type/depressed type (28 cases). The main lesion was of the well differentiated type in 39 (64%) of the 61 cases; the accessory lesion was also well differentiated in 37 of the 39 cases. Of the 82 accessory lesions, 29 (35%) had been overlooked preoperatively; most of them were located in the middle third of the stomach and included 17 depressed and 10 flat lesions, most of which measured no more than 1 cm. Cases of multiple early gastric cancer are characterized by the predominance of male patients of advanced age (>60 years), a combination of the same macroscopic type of the main and accessory lesions, and well differentiated carcinoma. Lymph node metastasis and vascular invasion are equally or less frequent than in cases of solitary early gastric cancer. The postoperative crude survival rate in patients with multiple gastric cancer is similar to that in those with solitary gastric cancer. Therefore we believe that multiple early gastric cancer does not require extended operative procedures. Endoscopic treatment may be indicated if each lesion fits the criteria for treatment and careful follow-up is ensured.

Monocyte function associated with intermittent lentinan therapy after resection of gastric cancer

The effect of lentinan administration on monocyte function in the peripheral blood were examined in 33 patients who underwent resection of gastric cancer. As parameters of monocyte function, IL-1 production, C3b receptor, Fc gamma receptor and monocyte ratio were determined every 4 weeks for a maximum of 24 weeks. Among patients who were taking combined therapy with lentinan, an increase in IL-1 beta production of more than 50% was found 8 weeks (2 months) after the initiation of therapy in 8 of 12 patients given 2 mg at 2-week intervals, and in 11 of 16 patients given the same dose at 4-week intervals. This increase was particularly clear in stage II or more advanced cases. There were no significant changes in the other parameters studied. It has been considered that lentinen is effective when administered once a week. The results of the present study, however, suggest that lentinan given every 4 weeks also stimulates monocyte function enough to maintain immunological activity.

Basic studies of photodynamic therapy in experimentally induced canine gastric cancer

Photodynamic therapy (PDT) was used in two cases of experimental canine gastric cancer produced by the oral administration ofN-ethyl-N′-nitro-N-nitrosoguanidine (ENNG). Endoscopic examination and biospy showed the development of cancer in the gastric antrum. The cancerous lesions, a polypoid lesion and the normal epithelium were photoradiated superficially by an argon dye laser with a power of 300 to 400 mW for five to ten 30-s periods, 48 h after the intravenous injection of 3.0 mg/kg body weight of haematoporphyrin derivative (HPD). Dog 1 was killed three days after PDT, and was examined histologically. The tumour cells showed vacuolar degenerative changes in the mucosa, and the irradiated normal epithelium was less damaged. Dog 2 was followed up periodically by means of gastrofibrescope and biopsy. A wider and deeper ulcerative lesion was observed three days after PDT and it was healed by day 40. But the recurrence of a cancerous lesion was shown on day 80. The remnant of a small cancer nest was revealed histologically by means of biopsy and autopsy. The results show that PDT is suitable for superficial gastric cancer and that long-term follow-up observation is necessary for the evaluation of PDT.