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Background/aims: To evaluate the clinical benefit of pancreaticoduodenectomy in a Japanese fashion for patients with pancreatic head cancer., Methodology: One hundred and one patients underwent pancreatectomy for pancreatic head cancer between 1980 and 2001. Of these, 40 patients in the extended resection (ER) group had an extended lymphadenectomy and neural plexus dissection as a Japanese fashion, while 61 patients in the conventional resection (CR) group. Tumor status, morbidity, mortality, survival and pattern of recurrence were retrospectively studied., Results: The incidence of R0 operations in the ER group was higher than that in the CR group (p<0.01). The actuarial 5-year survival rate (30.6%) of patients with pStage IIA or IIB in the ER group was significantly higher than that (8.2%) in the CR group (p=0.04) because local recurrence (47%) in the CR group was higher than that (25%) in the ER group (p=0.02). In an immunohistochemical study of isolated tumor cells (ITCs), 13 patients (57%) with lymph node ITCs were included in the 23 pN0 patients., Conclusions: Pancreaticoduodenectomy in a Japanese fashion with an adequate extended resection might bring a survival benefit for patients with pStage IIA or IIB pancreatic head cancer.

We report the case of 67-year-old man who was given a diagnosis of advanced gastric adenocarcinoma. Complete response of multiple liver and paraaortic lymph node metastases occurred in this patient after combination chemotherapy with systemic injection of paclitaxel and oral administration of novel dihydropyrimidine- dehydrogenase- inhibitory fluoropyrimidine (S-1). Following 7 courses of the biweekly paclitaxel and S-1 combination chemotherapy, the patient underwent total gastrectomy with D3 extended lymph node dissection. According to the operative findings, the tumor was curatively removed along with the liver metastases and paraaortic lymph node metastases. Biopsy of the liver was performed and the pathological diagnosis indicated no gastric adenocarcinoma cells. The pathological report showed that the lymph node metastases had completely disappeared with single exception and minute cancerous lesions were identified in the gastric mucosa and submucosa. Therefore, the histological efficacy was evaluated as Grade 2. For postoperative chemotherapy, oral S-1 administration only was chosen. However, 6 months later, biweekly paclitaxel and S-1 combination chemotherapy was administered in sequence as a second adjuvant chemotherapy because the serum level of the tumor marker was elevated. The patient is fine and has not shown any recurrence at other sites 37 months after surgery. Salvage surgery following paclitaxel and S-1 chemotherapy may be feasible for patients with advanced gastric cancer and complete regression of distant metastases. Biweekly paclitaxel and S-1 combination chemotherapy has been used safely and its administration may be continued for a long time in an outpatient clinic setting for the treatment of advanced gastric cancer.

Background/aims: Five patients having early gastric cancer were treated using laparoscopic partial gastrectomy combined with sentinel lymph node biopsy., Methodology: Preoperatively, 3.5 mq of Tc-labeled tin colloid was endoscopically injected near the tumor. Under general anesthesia, laparoscopic partial gastrectomy was then performed. Radioisotope (RI)-positive nodes were explored before performing laparoscopic partial gastrectomy., Results: An average of 2.6 sentinel nodes was detected in this way. All patients were found to be free from nodal involvement both histologically and immunohistologically during surgery. Four patients had mucosal cancer and one patient had submucosal cancer, which agreed with the preoperative diagnosis of tumor depth., Conclusions: Sentinel node biopsy in conjunction with laparoscopy in early gastric cancer surgery may allow confirmation of complete removal of risk nodes in early gastric cancer.

Background/aims: Chemokine receptor CCR7 is a key molecule for migration of lymphocytes and dendritic cells into lymph nodes. Expression of CCR7 in tumor cells has been reported in malignancies, and CCR7 expression in tumor cells has been investigated in vitro and in vivo. However, there is little information regarding the clinical implications of CCR7-positive gastric cancer., Methodology: A total of 224 gastric cancer patients who underwent curative surgery in Kagoshima University Hospital were enrolled. CCR7 expression in the primary tumor was detected by immunohistochemically. Patients showing more than 10% positivity for CCR7 were defined as having high CCR7 expression, as previously reported., Results: CCR7 expression was detected in cytoplasm and membrane of tumor cells and inflammatory cells in the tumor nest. CCR7-positive patients exhibited deeper tumor invasion, more frequent lymph node metastasis, higher rates of lymphatic invasion (p < 0.01) and more venous invasion (p < 0.05) than CCR7-negative patients. Multivariate regression analysis showed that the most significant clinical factor for CCR7 was lymph node metastasis followed by lymphatic invasion. CCR7-positive gastric cancer patients had significantly poorer surgical outcomes than CCR7-negative patients (p < 0.01). However, CCR7 was not selected as an independent prognostic factor., Conclusions: Our results suggest that CCR7 expression in gastric cancer is related to the onset of preferential conditions for lymphatic spread, such as lymph node metastasis. Although CCR7 expression is not an independent prognostic factor, it may show strong correlations with other lymphatic factors. CCR7 expression of preoperative biopsy specimen can predict lymph node metastasis because of the close correlation with lymphatic factors.

Background/aims: Routine clinical approaches for evaluating the risk of recurrence in patients with gastrointestinal stromal tumor (GIST) of the stomach have been limited. Some biomolecular markers may yield more useful information in identifying patients having a higher risk of recurrence. In the current retrospective study, we selected MIB-1 and p53 expression as markers to detect at-risk patients., Methodology: We enrolled 31 gastric GIST patients who underwent gastrectomy at Kagoshima University Hospital. Patients were classified into two groups based on mitosis and tumor diameter. p53 and MIB-1 expression in the primary tumor were detected immunohistochemically., Results: The patients were classified as having a malignant GIST (20 cases), a benign GIST (11 cases). MIB-1 labeling index (LI) varied from 1 to 32% (average 7.8%). The MIB-1 LI for malignant GISTs was 6.3 +/- 6.4%, which was significantly higher than the 3.2 +/- 2.5% observed for benign GISTs (p < 0.01). The 3 patients positive for p53 died as a result of GIST recurrence., Conclusions: In addition to routine pathological evaluation, expression of p53 and MIB-1 may provide more accurate information regarding the risk of GIST recurrence. Especially, p53 expression of the tumor may indicate patients having a high risk of recurrence.

Background/aims: Alpha-fetoprotein (AFP)-positive gastric cancer (APGC) which occupied well-defined gastric cancer entity, reportedly has an aggressive behavior with hematogenous metastasis. However, little information regarding the clinicopathological and biological behaviors of APGC is available due to the small size of reported series., Methodology: We retrospectively analyzed the clinical features of APGC in 556 patients with gastric cancer who underwent preoperative measurement of serum AFP levels and gastrectomy in Kagoshima University Hospital. APGC was regarded as any cancer with preoperative serum AFP levels above the cutoff level of 5 ng/mL. Clinicopathological features of APGC were assessed using the General Rules of Gastric Cancer. Of the 556 patients, 97 patients underwent immunohistochemical evaluation of AFP expression in the primary tumor. Both p53 and MIB-1 expression were examined at the same time and compared with AFP expression. Biological aggressiveness of APGC was estimated., Results: Serum AFP positivity was detected in 4.3% of cases (range, 0-2202 ng/mL). Patients were divided into 25 APGC patients and 531 non-APGC patients. APGC displayed deeper tumor invasion, increased nodal involvement, increased venous invasion, and increased CEA concentrations compared to gastric cancer in non-APGC. Surgical outcomes for APGC were significantly worse than those for non-APGC (p < 0.05). All recurrences in patients with APGC involved hepatic metastasis. Abnormalities of p53 were more frequent for APGC than for non-APGC (p < 0.05)., Conclusions: APGC was strongly associated with hematogenous factors such as venous invasion, hepatic metastasis and aggressive biological factors (p53 abnormalities). Considering the aggressive biological behavior of APGC, we must closely follow up for patients with such tumor, including postoperative adjuvant therapy.

Background/aims: Transabdominal ultrasound sonography (TUS) is considered a useful diagnostic tool ascertaining depth of cancer invasion, but there are few detailed studies on its accuracy in preoperative estimations of depth of invasion in early gastric cancer (mucosal and submucosal cancer). We retrospectively analyzed the clinical efficacy of preoperative evaluation by TUS in early gastric cancer in comparison with endoscopic ultrasound sonography (EUS)., Methodology: A total of 101 patients preoperatively diagnosed as early gastric cancer were enrolled in the current study. Patients were given 300cc of water subsequent to administration of an anti-peristaltic agent to facilitate filling the gastric lesion with water and TUS was performed. All patients were preoperatively examined by both EUS and TUS., Results: The depth accuracy in mucosal cancer was 59% with EUS and 66% with TUS. When submucosal cancers were subdivided into shallow and deep submucosal cancers, the depth of mucosal and shallow-submucosal (SM1) cancers were correctly assessed 80% and 78% by EUS and TUS, respectively. Accuracy increased by 12% in mucosal cancer by combining EUS and TUS diagnoses., Conclusions: The diagnostic value of TUS is comparable to that of EUS in assessing depth of invasion of early gastric cancer, however, TUS had a possibility of misdiagnosing the depth of tumors located at the anterior wall. To ensure an accurate estimation of the depth of tumor invasion, it is recommended that TUS and EUS be done simultaneously.

We treated a 57-year-old male with liver metastasis derived from an alpha-fetoprotein-producing early gastric cancer. Eleven months after distal gastrectomy with D2 lymph node dissection, the patient underwent hepatectomy of segment 4 to resect a liver tumor 3 cm in diameter found by abdominal computed tomography. Immunohistochemical examination of the stomach and liver specimens, using anti-alpha-fetoprotein antibody, showed partial alpha-fetoprotein expression in both the primary gastric and metastatic hepatic tumors. The patient's serum alpha-fetoprotein level had been elevated at 302 ng/mL before hepatectomy, but the level remained below 5 ng/mL postoperatively. The patient remains alive without tumor recurrence 3 years after hepatectomy. There have been few previous reports of good outcome after curative resection of a metachronous liver metastasis derived from alpha-fetoprotein-producing gastric cancer. The assessment of serum alpha-fetoprotein level may be useful for detecting and monitoring liver metastasis in gastric cancer, especially for alpha-fetoprotein-producing tumors.

Background/aims: In TNM classification, carcinoma that has invaded the muscularis propria (mp) and cancer that has invaded the subserosa are both categorized as T2 cancer. However, some mp gastric cancer patients have a good postoperative course, similar to that of early gastric cancer patients. We performed a retrospective analysis of 74 patients with mp gastric cancer, based on the depth of mp invasion., Methodology: The clinicopathologic features of 74 cases of gastric cancer invading the mp (but no further) were subdivided according to depth of invasion, retrospectively reviewed and compared with surgical features of 165 patients with gastric cancer invading the submucosa (sm gastric cancer). For each tumor, we evaluated the degree of tumor invasion in the mp layer at a magnification of x100, using the section that showed the greatest extent of invasion. The patients were classified into 2 groups: mp1, tumor was limited to the first of the 3 mp layers; mp2, tumor had expanded beyond the first layer., Results: Of the 74 mp gastric cancer patients, 30 were classified as mp1 and 44 were classified as mp2. Patients with mp1 gastric cancer had significantly more macroscopic signs of early gastric cancer, a lower frequency of lymph node metastasis, and a higher rate of operative cure than patients with mp2 gastric cancer. The incidence of lymph node metastasis among mp1 gastric cancer patients was almost equal to that of the 165 sm gastric cancer patients. The 5-year survival rate of mp1 patients was significantly better than that of mp2 patients (p<0.05), but was similar to that of the 165 sm gastric cancer patients (84%) (p<0.05)., Conclusions: There were clear differences in clinical features between the mp1 and mp2 gastric cancer patients. Subdivision of mp gastric cancer according to depth of invasion may enable more precise prognosis and treatment of mp gastric cancer patients. The clinicopathological findings and surgical outcome of the mp1 patients were similar to those of the sm gastric cancer patients. Thus, mp1 patients may require treatment that is similar to treatment administered to patients with early gastric cancer.

A case of esophageal cancer associated with the right aortic arch in a 62-year-old Japanese male is described herein. Endoscopy performed after an initial complaint of dysphagia revealed cancer at the upper third of the esophagus. The right aortic arch was located by routine chest X-ray and an irregularly-shaped tumor defect and a shadow defect due to right aortic arch were detected on the right side of the thoracic esophagus by barium study. Computed tomography and magnetic resonance imaging offered useful information for surgical procedure. The patient underwent a subtotal esophagectomy and regional lymphadenectomy though a left thoracotomy. The clinical features of cases previously reported in Japan are reviewed following the presentation of this case.

Background/aims: We investigated clinical features of T-cell gastric lymphomas associated with human T-cell leukemia virus type 1 (HTLV-1)., Methodology: Ninety patients with gastric lymphoma who underwent gastrectomy were included in this study. They were divided into T-cell and B-cell gastric lymphomas according to the immunohistochemical expression of surface T-cell or B-cell markers. Clinicopathological features and surgical outcome were compared between T-cell and B-cell gastric lymphomas. Correlation between T-cell gastric lymphoma and Epstein-Barr virus, p53, MIB-1, and CD44 variant 6 on lymphoma cells was evaluated in 60 patients by in situ hybridization and immunohistochemical examination. Anti-adult T-cell leukemia antigen was evaluated in 74 patients in the blood serum were evaluated., Results: Nine of the 90 patients were classified as T-cell gastric lymphoma. Patients with T-cell gastric lymphoma had significantly more nodal involvement and poorer resectability than those with B-cell gastric lymphoma. Positivity of serum anti-adult T-cell leukemia antigen was significantly higher in T-cell lymphoma patients (100%) than in B-cell lymphoma patients (41%). However, there was no significant difference in Epstein-Barr virus positivity and expression of p53, MIB-1, CD44 variant 6 between T-cell and B-cell lymphomas. The five-year-survival rate in patients with T-cell gastric lymphomas was 0% and whereas that in B-cell gastric lymphoma was 45%, there was a significant difference between the two groups (p < 0.01). Two patients with T-cell lymphoma who underwent emergency gastrectomy died in hospital during follow-up., Conclusions: The surgical outcome of patients with T-cell lymphoma with anti-adult T-cell leukemia antigen tended to be very poor, despite curative resection. Thus, intensive chemotherapy is recommended for the patients with HTLV-1 associated T-cell gastric lymphoma.

Background/aims: Surgical removal has been accepted as a therapeutic option for hepatocellular carcinoma. However, little is known about the quality of life after hepatectomy for hepatocellular carcinoma. In this report, we describe the risk factors most affecting impaired quality of life after partial hepatectomy in patients with hepatocellular carcinoma., Methodology: Ninety-six patients who received curative resections 12-60 months previously, answered our original questionnaire, mailed to them. The questions consisted of 14 items concerning physical function, social function, psychological function, physical sensation, and recognition of the disease, with a scoring system of 1, 2, and 3. Based on the pre- and postoperative serum alanine aminotransferase or cholinesterase levels at 3-month intervals during the follow-up period, the changes were classified into three types: those staying in the favorable or unfavorable range at one year (no change, Type 1 or Type 3), and those entering the unfavorable range postoperatively (Type 2)., Results: Total quality of life score: the sum of scores to questions 1-12, displayed two peaks of normal distribution. Based on a point of intersection of the two curves: i.e., score of 22, the patients were classified into 2 groups: those with preserved quality of life (n = 75) i.e., total quality of life scores of 12-21, and impaired quality of life, scores of 22 or more (n = 21). Older age (> or = 65 y) at hepatectomy, in the course of treatment for recurrence, and Type 2 change of serum cholinesterase level were associated with the impaired quality of life. Multivariate analysis revealed that Type 2 change of serum cholinesterase levels was an independent risk factor for an impaired quality of life. Furthermore, the patients exhibiting Type 2 change of serum cholinesterase levels were clearly impaired in their physical and social functions compared to the other patients. Hepatitis-related or cancer-related factors showed no correlation with the deterioration of the quality of life., Conclusions: The quality of life after hepatectomy in patients with hepatocellular carcinoma was impaired in cases of aged patients, treatment for recurrence, and Type 2 change of the serum cholinesterase level. Postoperative maintenance of protein synthesis including cholinesterase is one measure to preserve a satisfactory quality of life after hepatectomy.

Background/aims: The appropriate choice of treatment for recurrent hepatocellular carcinoma after hepatic resection remains controversial. The aim of this study is to clarify prognostic factors and quality of life in patients with tumor recurrence after hepatic resection for hepatocellular carcinoma., Methodology: We retrospectively analyzed 188 patients with hepatocellular carcinoma who underwent curative hepatic resection between 1988 and 1997. Statistical analysis was performed to identify prognostic factors involved after recurrence. Furthermore, quality of life after treatment for recurrence was compared between patients with repeat hepatic resection or hepatic arterial infusion chemotherapy., Results: In 123 patients with recurrence, unfavorable predictors after recurrence are pTNM Stage III/IV at initial surgery, receiving chemotherapy before initial surgery and presence of extrahepatic recurrence. In contrast, favorable predictors are 3 years or more of disease-free interval and repeat hepatic resection. The incidence of deteriorated performance status in the repeat hepatic resection group was lower than in the hepatic arterial infusion chemotherapy group because of better psychological function in patients undergoing repeat hepatic resection., Conclusions: Repeat hepatic resection provides a good prognosis and a favorable quality of life in patients with recurrence after hepatic resection for hepatocellular carcinoma.

We report a rare case of eosinophilic granuloma of the stomach mimicking gastric cancer. A 49-year-old man was admitted to our hospital to undergo surgery for gastric tumor. Radiologic and endoscopic examination showed a protruding tumor with a deep ulcer at the anterior wall of the pylorus. Although malignant cells were not histologically confirmed in the biopsy specimens, subtotal gastrectomy with lymphadenectomy was performed because gastric cancer was strongly suspected. The gross appearance of the tumor seemed to be that of a gastric cancer, but the histological diagnosis was eosinophilic granuloma. If submucosal tumor of the stomach is suspected, eosinophilic granuloma should be considered as one of the differential diagnoses. Endoscopic removal of the tumor may be useful to make a precise diagnosis before surgery.

Background/aims: The aim of this study is to elucidate the feasibility of the risk assessment of hepatic resection by histological evaluation of noncancerous liver in patients with hepatocellular carcinoma., Methodology: The study involved 78 patients with hepatocellular carcinoma who had undergone a needle biopsy of noncancerous liver before hepatic resection. The histological activity index score which consists of four categories indicating the inflammatory activity and the degree of fibrosis was determined, and its association with complications after hepatic resection was examined., Results: Postoperative complications occurred in 26 of the first 52 patients that underwent hepatic resection. A logistic analysis selected histological activity index score as an independent factor related to postoperative complications (Odds ratio 1.31, P < 0.02). Postoperative complications occurred more frequently in patients with a histological activity index score > or = 6 that had undergone resection of two or more segments (P < 0.05), and also in those with histological activity index score > or = 10 that had undergone segmentectomy or subsegmentectomy (P < 0.05). When the histological activity index score was taken into consideration in deciding operative procedures for a further 20 patients, the incidence of postoperative complications reduced considerably to 10%., Conclusions: Preoperative histological evaluation of noncancerous liver by a needle biopsy may be helpful in deciding the operative procedure to avoid complications after hepatic resection for hepatocellular carcinoma.

Background/aims: Hepatocyte growth factor, a potent mitogen for hepatocytes has been reported to be a hepatrophic factor in normal livers. In this study, the effect of exogenous hepatocyte growth factor on liver regeneration in cirrhotic rats was investigated, in vitro and in vivo., Methodology: Liver cirrhosis was induced by intraperitoneal injections of an emulsion, carbon tetrachloride and olive oil, twice weekly for 10 weeks. In vitro, various amounts of exogenous hepatocyte growth factor; 0, 0.5, 1, 2.5, 5, and 10 ng/mL; were added to the hepatocytes isolated using in situ perfusion method. In vivo, partial hepatectomy (Hx), according to the procedure described by Higgins and Anderson, was performed on cirrhotic rats. Saline solution (control group) or 3 micrograms/kg of exogenous hepatocyte growth factor (HGF group) was then injected through the tail vein at intervals 12 hours after Hx., Results: In vitro, DNA synthesis in hepatocytes obtained from cirrhotic livers increased following exogenous hepatocyte growth factor in dose-dependent fashion. In vivo, the labeling index of 5-bromo-2'-deoxyuridine at 24 hours after Hx was markedly increased by exogenous hepatocyte growth factor (control, 10.0 +/- 3.1%; hepatocyte growth factor, 25.8 +/- 9.8%; P < 0.01). Furthermore, serum albumin at 24 and 72 hours and a normotest at 24 hours after Hx, were significantly higher in the HGF group than in the control group., Conclusions: These results indicate that exogenous hepatocyte growth factor may promote DNA synthesis and protein synthesis during liver regeneration after Hx with cirrhosis.

It is unknown whether the "ductectatic" mucinous cystadenoma and cystadenocarcinoma of the pancreas will develop into the classical megacystic type, and there is no report of long-term follow-up of this entity. A case of mucin-producing cystic tumor of the pancreas with pancreas divisum in a 65-year-old man is presented who was followed-up for 5 years prior to diagnosis of cancer and surgery. Computed tomography, ultrasonography and endoscopic retrograde pancreatography during the 5-year period had demonstrated insidious growth of the tumor. The histopathological diagnosis after surgery was the "ductectatic" mucinous cystadenocarcinoma of the pancreas. It was difficult for us to differentiate it from the classical megacystic type. The patient died of liver metastasis 54 months after surgery.

Background/aims: According to current TNM classification, paraaortic nodes involvement in gastric cancer is now distant metastasis. Anatomically, however, proximal gastric cancer may drain preferentially to the left-paraaortic area which represents a regional lymph-node basin., Methodology: Seventy-five patients who underwent an extended gastrectomy with paraaortic lymphadenectomy for advanced carcinoma of the upper-third of the stomach were retrospectively studied., Results: Of the 75 patients, 55 (73.3%) were positive for nodal metastasis and 21 (28.0%) had paraaortic nodes involvement. Paraaortic nodes involvement tended to be left-sided (the left side of the aorta around the left renal vein) and its incidence did not increase as the overall number of infiltrated nodes increased. Five (23.8%) of the 21 patients with paraaortic nodes involvement did not have nodal metastases in the paraceliac area. Overall survival was not different whether or not paraaortic nodes involvement was present, but was dependent on the overall number of infiltrated nodes (viz. 10 vs. > 10). Eight (22.2%) of 36 patients with 1-10 infiltrated nodes had PNI, with a 5-year survival rate of 46.9%., Conclusions: Removal of lymph nodes around the left renal vein should be included during extended gastrectomy in patients with advanced carcinoma of the upper-third of the stomach. Left-paraaortic lymphadenectomy may benefit such patients if the overall number of infiltrated nodes is low (viz. 10).

Background/aims: The prognosis of patients with esophageal carcinoma remains unsatisfactory. The purpose of this study was to clarify the clinicopathologic characteristics of asymptomatic patients., Methodology: We retrospectively compared 78 cases of asymptomatic esophageal carcinoma (AEC) with 341 cases of symptomatic esophageal carcinoma (SEC)., Results: In 47 of 78 patients with AEC, the tumors were discovered by mass screening and in 31 patents by follow-up examination for other disease. Nearly 70% of the patients with AEC had a carcinoma in situ (Tis) or T1 tumor, whereas nearly 70% of the patients with SEC had T3 or T4 tumors. The incidences of lymph node metastasis, lymphatic invasion and vascular invasion were significantly lower in patients with AEC than in those with SEC. The 5-year survival rate in AEC and SEC were 59.3% and 22.9%, respectively. With regard to the cause of death, 26.8% (11/41) of patients with AEC and 59.9% (166/277) of patients with SEC died of esophageal carcinoma., Conclusions: In order to improve the prognosis of esophageal carcinoma, an effort should be made to detect early esophageal carcinoma among patients at risk for tumors when they are still asymptomatic.

Background/aims: Close relationships between hepatocellular carcinoma (HCC) and hepatitis virus infection have been elucidated. However, clinical differences between HBV- and HCV-associated HCC remain unclear., Methodology: Four hundred and sixteen patients with HCC were examined for both HBsAg and HCV-Ab. Sixty-nine of the 416 patients (16.6%) were positive for HBsAg and negative for HCV-Ab (B-HCC), while 290 patients (69.7%) were negative for HBsAg and positive for HCV-Ab (C-HCC). Various comparisons were made between the 2 groups., Results: B-HCC patients were younger in age (p < 0.0001), and had significantly better liver function than C-HCC patients. The motivation of HCC detection was different between the 2 groups (p < 0.0001), and the tumor size of B-HCC was significantly larger when comparing groups with regard to symptoms (p < 0.05). Although B-HCC demonstrated better survival in Stage I/II treated by surgery (p < 0.05), it was associated with poorer survival in Stage III/IV receiving hepatic arterial infusion chemotherapy when compared to C-HCC (p < 0.01)., Conclusions: These results suggest that clinical differences between B-HCC and C-HCC may depend upon the difference of the natural course between HBV and HCV infection, and B-HCC may be more resistant to treatment than C-HCC in the advanced stage. This also illustrates the need for early tumor detection in B-HCC.

Background/aims: The purpose of the present study was to investigate the relationship between macroscopic appearance of superficial esophageal carcinoma, with particular attention to the horizontal and vertical extent of tumor growth, clinicopathologic findings and p53 expression., Methodology: Eighty-seven patients with superficial esophageal carcinoma were divided into three groups: 1) group A, patients with protruding or distinct depressed lesions (n = 28); 2) group B, patients with superficial and flat lesions > or = 5 cm in length (n = 45); and, group C, patients with superficial and flat lesions (5 cm in length (n = 14). Tumors were examined immunohistochemically for p53 expression., Results: The incidence of submucosal invasion, lymph node metastasis and lymphatic invasion was significantly higher in group A than in groups B and C. The rate of p53 expression was significantly lower in group B than in the other two groups. The prognosis in groups B and C was better than that in group A., Conclusions: Vertical extent was more strongly associated with tumor depth, lymph node metastasis and prognosis than was horizontal extent, although p53 overexpression was related to both the vertical and horizontal extent of tumors. Analysis of the macroscopic appearance of superficial esophageal carcinoma is useful in choosing treatment strategies.

Background/aims: There is little information about the clinical and pathological features of patients with gastric cancer aged 85 years old and older., Methodology: We analyzed data of 197 gastric cancer patients aged 75 years and older. The patients were dividing into three age groups and we retrospectively studied 25 gastric cancer patients aged 85 years old and older and compared their clinical courses with those of 94 patients in their late 70s and 78 patients in their early 80s., Results: The patients aged 85 years and older had a significantly higher rate of symptoms on admission such as gastric outlet obstruction and progressive anemia (64%), than did the other two age groups (p<0.05). Twenty-five percent of the oldest age group did not have surgery, and none had a D2 lymph node dissection. Perioperative complications were more frequent in the oldest group than in the youngest group (p<0.05). Survival in the oldest patients was not affected by surgical resection., Conclusions: These results indicate curative gastric surgery has a less positive impact in patients aged 85 years and older than younger patients. Treatment for gastric cancer in patients 85 years old and older should emphasize the palliation of symptoms but not curative resection.

Background/aims: To investigate the effect of acute hyperbaric oxygen therapy (HBOT) on post-operative sinusoidal endothelial cell (SEC) damage caused by activated neutrophils., Methodology: 12 non-cirrhotic patients (Group H), who underwent elective hepatectomy for liver cancer, were given 2 courses of HBOT: 2.0 atm with inhalation of 100% oxygen, for 60 min, at 3 hours and 24 hours after hepatectomy; they were then compared with the 12 patients (Group C) who had been treated to maintain normal hemodynamic values., Results: In group H, peak levels of polymorphonuclear leukocyte elastase (PMNE) and thrombomodulin (TM) were clearly diminished and delayed compared to Group C. All subjects in Group C showed more than a 10% increase in CD18 12 hours after surgery; however, in Group H, the elevation of CD18 expression was clearly suppressed compared to Group C. No patient in Group H had post-operative hyperbilirubinemia or hepatic failure; however, 3 had post-operative hyperbilirubinemia and 1 had intraperitoneal infection in Group C., Conclusions: Our results provide direct evidence that HBOT, especially at 3 hours after hepatectomy, has favorable effects on the activation of neutrophiles decreasing SEC injury.

Background/aims: The impact of tumor size on tumor development and long-term prognosis is still controversial for patients with ductal adenocarcinoma of the pancreas. We investigated the clinicopathological and biological features of ductal adenocarcinoma limited to the pancreas without direct histological extrapancreatic invasion (t1 tumor)., Methodology: The clinical records of 86 patients who underwent surgery for ductal adenocarcinoma of the pancreas were reviewed to determine clinical features, histopathological findings, operative management and outcomes. Immunohistochemical staining of the p53 tumor suppressor gene (p53) was performed for the resected specimens., Results: Only 10 (12%) of the 86 resected ductal adenocarcinomas of the pancreas were t1 tumors. Six of the 10 patients with t1 tumors survived for more than 5 years. The rates of nodal metastasis (10%) and neural plexus invasion (0%) in t1 tumors were significantly lower than those in non-t1 tumors, although the rates of blood-borne metastasis (30%) and p53 expression (50%) in t1 tumors were the same as those in non-t1 tumors., Conclusions: Curative resection contributes to a satisfactory long-term prognosis of patients with t1 tumor of the pancreas as a result of the low rates of both nodal metastasis and neural plexus invasion associated with this procedure. In patients with t1 tumor of the pancreas, a satisfactory long-term prognosis can be assured as a result of the low rates of both nodal metastasis and neural plexus invasion associated with curative resection.

Background/aims: The purpose of this study was to review the Clinicopathologic features of early gastric cancer in elderly patients., Methodology: Three hundred and seventy-two patients who underwent resection for early gastric cancer were divided into groups of patients younger and older than 70 years. The clinical and pathologic findings surgical treatment, and perioperative complications in the group of elderly patients with early gastric cancer were reviewed and compared to those of the younger group., Results: Gastric cancer involving the lower third of the stomach, as well as histopathologically well-differentiated carcinomas, were significantly more prevalent in the older group. Pre-operatively, the older patients had a higher incidence of respiratory dysfunction and hypertension. D1 lymph node dissections were chosen frequently for older patients. Six older patients died within 2 months of hospitalization, while no younger patients died within this period. The mortality rate mas 11% in older patients undergoing D2 or greater extents of node dissection, although the mortality rate was only 2% in older patients undergoing a D1 or less dissection. The 5-year survival rate for older patients, including deaths unrelated to cancer, was 71%, which was significantly lower than that in the younger group. However, when only mortality from gastric cancer was considered, patient survival did not differ according to age., Conclusion: Given the high mortality in elderly patients unrelated to early gastric cancer, we concluded that node dissection should be limited to perigastric nodes according to tumor location in such patients.