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This paper presents two patients with anomalous connection of pancreaticobiliary ducts without choledo-chal cysts in the bile duct (ACPBD). The first patient, a 52-year-old woman, was admitted to the hospital because of upper abdominal pain and a thickening of the gallbladder wall on ultrasonograpaphy (US) Which was pointed out at another hospital. With close examination, she was diagnosed as having an ACPBD without biliary dilatation. Cholecystectomy, resection of the bile duct, and choledo-duodenostomy were performed. The resected material showed hyperplastic mucosa and cholesterolosis of the gallbladder. The second patient, a 39-year-old woman, was admitted to the hospital because of upper abdominal pain and the gallbladder wall thickening which was detected by US. With close examination, she was diagnosed as having an ACPBD without cystic dilatation of the bile duct and adenomyomatosis of the gallbladder. Cholecystectomy, resection of the bile duct, and choledo-duodenostomy were performed. The resected material showed hyperplastic mucosa and adenomyomatosis of the gallbladder. For early detection of ACPBD without cystic dilatation, abdominal US is recommended that indicates the thickening of the gallbladder by characteristic image. And EUS or endoscopic retrograde cholangiopancreatography (ERCP) should be conducted if US revealed the characteristic image.

Background and objectives The anatomical extent of nodal metastasis has been replaced by the number of metastatic nodes as a key indicator of prognosis (pN categories) in the fifth edition of Tumor Node Metastasis Classification for gastric carcinoma by the International Union Against Cancer. The rate of metastatic nodes among all the nodes harvested is also a good prognostic factor. The object of this study is to evaluate which of the three parameters for the assessment of nodal status is the most appropriate for use in the stage classification. Methods Retrospective survival analyses were performed in 656 consecutive patients with advanced gastric carcinoma who underwent D2 lymphadenectomy and for whom histopathologic data of more than 20 lymph nodes were available. Results Although all three systems served well to classify the patients into distinct groups in terms of survival curves, stratification by the number of metastatic nodes was vulnerable to stage migration because of differences in the number of lymph nodes harvested. Such stage migration was not evident for the other two parameters. Conclusions Lymph node metastatic rate can be recommended as an internationally applicable parameter for lymph node involvement of gastric carcinoma.

Free cancer cells exfoliated from the cancer-invaded serosa contribute to peritoneal dissemination, the most frequent pattern of recurrence in gastric carcinoma patients. This study was designed to evaluate the prognostic relevance of such free cells in peritoneal washes detected by reverse transcriptase-polymerase chain reaction (RT-PCR) and cytology. RT-PCR analysis with primers specific for carcinoembryonic antigen and conventional cytologic examination by Papanicolaou staining were performed on peritoneal washes, collected at laparotomy from 148 gastric carcinoma patients. Prognostic analyses were performed with 1) death due to cancer recurrence and 2) peritoneal dissemination as endpoints. RT-PCR was found to be more sensitive than cytologic examination for detection of free cancer cells in the peritoneal washes, with a higher detection rate for each of the T categories in the tumor-node-metastasis (TNM) classification. Five patients with synchronous or recurrent peritoneal dissemination were found among 17 patients with positive RT-PCR and negative cytologic results. Both positive cytologic results and positive RT-PCR results had significant influences over the survival of patients with advanced gastric carcinomas (n = 75, p < .002). Detection of free cancer cells in peritoneal washes, most reliably by RT-PCR, is promising as a predictor of peritoneal dissemination in patients with gastric carcinoma.

It is designated that carcinoids of the rectum with the diameter of more than 1cm and less than 2cm without invasion into muscularis are candidates for local resection. We have, however, experienced 2 such cases in which lymph node metastasis was detected after radical operation. In Case 1, a 51-year-old woman had a Isp type carcinoid of Rb and 17mm in diameter with a central depression (histologicaly, sm, ly1, and v1), as well as a rectovaginal tumor (which eventually lymph node metastasis). Both tumors were locally excised. Thereafter, abdominoperineal excision of the rectum and associated resection of the uterus and vaginal posterior wall were added, when another metastasis to internal iliac lymph node was found. There have been no signs of recurrence, 8 years after the operation. In Case 2, a 37-year-old man had a Isp type carcinoid of Rs and 13mm in diameter, and underwent a low anterior resection of the rectum. Histologically, the resected material showed sm, ly1 and v0, and a metastasis in the pararectal lymph node of group I was detected. There have been no signs of recurrence, 2 years after the operation. From our experience with these cases, we may have a useful indication for the treatment of rectal carcinoids with the diameter of more than 1cm and less than 2cm without muscularis invasion: It seems likely that both a thorough preoperative exploration with EUS for pararectal lymph node metastasis and a consideration of resected material for vascular invasion are very important to select more appropriate treatment predicting possible lymph node metastasis.

A case of carcinoid of the accessory papilla which is extremely rare is reported. A 52-year-old man consulted another a hospital for hematemesis and was diagnosed as gastric ulcer. During the treatment of gastric ulcer, a submucosal tumor of the duodenum was detected and he was sent to the hospital. The tumor was located on the anterior wall of the duodenal second portion, at 2.5cm oral side of Vater papilla, measuring about 10mm in diameter. Accessory papilla was not identified on examinations. Biopsy showed carcinoid cells invaded the smooth muscle. Pancreaticoduodenectomy with adjacent lymph node dissection was performed. Resected specimen showed the carcinoid tumor invaded submucosal layer in the accessory (papilla, measuring 12×12mm, with adjacent lymoh node metastasis. The careful choice of treatment is needed in treatment of carcinoid tumor near the accessory papilla, even if, it is small in size and not invaded to muscular layer. And the smooth muscle in biopsy specimen is a special bundle of smooth muscle in the accessory papilla like a sphincter of Oddi.

We investigated the correlation between the histopathologic findings in the submucosal invasive front of early colorectal carcinoma and the regional lymph node involvement. In 144 patients who underwent curative large bowel resection against early colorectal cancer eleven patients (7.6%) had regional lymph node involvement at the initial operation. We evaluated the relationship between lymph node involvement and following seven factors: budding, vessel permeation, INF, tumor differentiation in the invasive front, mucus collection, the depth of submucosal invasion and the shape of submucosal invasion. Twenty-one percent of budding (+) patients and 16% of ly (+) patients had regional lymph node involvement. In contrast, only 5% of budding (-) patients and 4% of ly (-) patients had it (p

OBJECTIVE: The authors defined a new macroscopic classification of liver metastases from colorectal cancer. SUMMARY BACKGROUND DATA: There were different prognostic results after the same operative procedure for liver metastases with similar background factors. METHODS: Eighty-one resected liver metastases were classified into simple nodular (SN) or confluent nodular (CN) types according to the characteristics of the cut surface of the tumor. RESULTS: The 5-year survival rates after hepatectomy were 41.7% for the SN lesions (n = 39) and 23.1% for the CN lesions (n = 42). The difference between the survival curves was statistically significant (p = 0.0307). Multivariate analysis using Cox's proportional hazards model revealed that the macroscopic type (p = 0.023), the tumor diameter (p = 0.0001), and the presence of lymph node metastases (p = 0.0016) were statistically significant independent prognostic factors. CONCLUSION: The new macroscopic classification may be valuable as a prognostic factor reflecting the biologic behavior of liver metastases.

Background: Stage IV gastric carcinoma is rarely curatively resected and almost invariably carries a poor prognosis. Several clinicopathologic factors are involved, but lymphatic spread of the cancer may significantly affect survival. Study Design: A retrospective study was designed to evaluate whether the nodal metastatic rate (number of lymph node metastases/number of resected lymph nodes) is a parameter of lymphatic spread and could provide a significant prognostic factor. Several prognostic factors were assessed by multivariate analysis in 153 stage IV gastric carcinoma patients with histopathologic data on nodal metastasis. Results: A significant difference in survival was observed in the stage IV cancer patients with total nodal or gastric nodal metastatic rates 50%. Multivariate analysis revealed that a total nodal or gastric nodal metastatic rate > 50% was a highly significant prognostic factor. The gastric nodal metastatic rate can be used in patients who do not undergo an extended lymphadenectomy. Conclusions: Lymphatic spread of gastric carcinoma expressed in terms of the total nodal or gastric nodal metastatic rate is a significant prognostic factor. The latter can be calculated without pathologic data derived from extended lymphadenectomy, and so it is universally applicable.

Cytological examination of peritoneal washes is a useful predictor of peritoneal recurrence in gastric carcinoma patients. In the present study, even more sensitive detection of free cancer cells could be achieved through amplification of carcinoembryonic antigen (CEA) mRNA by means of the reverse transcriptase-polymerase chain reaction (RT-PCR). CEA was first confirmed to be present in all the gastric cancer cell lines examined, irrespective of the differentiation degree, and absent in blood and mesothelium, indicating the specificity of this approach for detection of carcinoma cells in peritoneal lavage fluid. In sensitivity tests, CEA RT-PCR proved to be capable of detecting 10 carcinoma cells per sample. Peritoneal washes of 15 of 48 gastric carcinoma patients, including all 10 patients with positive cytology results, proved positive for CEA mRNA. None of the 5 patients with benign disease was positive. Moreover, a close association with the depth of cancer invasion was established. The results indicate that the assay is more sensitive for detection of free carcinoma cells in the peritoneal cavity than conventional cytology. This is the first study to suggest the feasibility of the RT-PCR method for prediction of peritoneal recurrence in gastric cancer patients.

S状結腸癌根治術後1年7か月を経て腹壁創瘢痕に再発し, 再発腫瘤切除6年後の今なお無再発生存中の1例を経験したので報告する.症例は60歳の女性.S状結腸癌は2型, 6×4cm, SEP0H0M (-) D3, se, ly0, v0, n (-) であった.1年7か月後腹壁正中創臍部に再発した.他に転移は認めず, 腫瘍から約2cm離して, 腫瘍に癒着した小腸約10cmとともに腹壁を切除した.腹壁欠損部はマーレックスメッシュを用い補強した.腫瘍は原発結腸癌と同様の中分化腺癌であり, 転移再発と診断された.腹壁創瘢痕への転移再発形式は術中操作による腫瘍細胞の創へのimplantationと思われた.

Background The clinical significance of plasma concentration of matrix metalloproteinase 9 (MMP-9) was investigated in patients with gastric cancer. Methods Plasma was obtained from 138 healthy individuals and 70 patients who underwent gastrectomy for gastric cancer at Aichi Cancer Centre between August 1994 and July 1995. Plasma concentrations of MMP-9 were measured using a one-step sandwich enzyme immunoassay employing monoclonal antibodies. Results Patients with gastric cancer had plasma higher concentrations of MMP-9 than normal subjects. Postoperative concentrations of MMP-9 were lower than preoperative levels. In addition to patients with advanced cancer, those with early gastric cancer also exhibited higher mean values of and positivity rates for MMP-9 than healthy individuals. Preoperative plasma MMP-9 concentration correlated closely with Union Internacional Contra la Cancrum tumour node metastasis (pTNM) stage, severity of T, N and M classification, and tumour size. Conclusion Plasma MMP-9 concentration can be used for detection of primary or recurrent gastric cancer, and for estimation of tumour extent.

Treatment results and clinicopathological features of 41 myogenic tumors of the stomach resected a_??_ the institution in the past 30 years were analyzed. No difference in survival curves was observed betwee_??_ the patients who underwent distal or proximal gastrectomy and those who underwent wedge resectio_??_ A likely explanation for this was that no lymph node metastasis was observed among the cases investiga_??_ ed. Wedge resection without lymphadenectomy, therefore, is feasible, provided that the tumor be resecte_??_ en bloc without residual disease. Perfect histological separation of benign and malignant tumors by_??_conventional HE staining was not constantly attained for cases of borderline malignancy even wit_??_ well-fixed resected specimens. This denotes that preoperative diagnosis by biopsy specimens could b_??_ even more unreliable, and there is a need to establish certain criteria for selecting an adequate therapeuti_??_ strategy for each lesion through endoscopic findings and imaging studies alone. At the same time_??_ emergence of a novel prognostic factor that reflects the malignant potential of the tumors is eagerly_??_ awaited to replace the conventional histopathological diagnosis of whether the tumor be benign o_??_ malignant.

Postoperative enterocutaneous fistula is a very serious problem in abdominal surgery. Here in we report a case successfully treated for enterocutaneous fistula with two layer local flaps. Under a diagnosis of ascending colon cancer, a 78-year-old man had undergone right hemicolectomy and resection of the involved ileum and abdominal wall. On the 10th postoperative day, enterocutaneous fistula occurred at the midline incision. Although we tried various conservative treatments, the fistula had not closed six months after the first operation. Thus, we decided to attempt operative treatment. Under local anesthesia, the fistula was closed with a “donor flap”, and the new skin defect was covered with a “rhomboid flap”. Using these two layer local flaps, fistula closure was achieved, and the patient was discharged without fistula recurrence.

Advantages and disadvantages of para-aortic lymph node dissection were retrospectively studied. Of 123 cases of gastric cancer in which dissection of No. 16 was performed, metastasis to these lymph nodes was confirmed in 32 cases (26.0%). The frequencies of metastasis to No. 16 were significantly higher in cases with hepatic metastasis, peritoneal metastasis, serosal invasion of S2 and above, macroscopic lymph node metastasis of N2 and above, a tumor size of 5cm or greater. The 32 cases with histologically confirmed metastasis to No. 16 had a 5-year survival rate of 8.3%. Of these 32 cases, the 22 cases without hepatic or peritoneal metastasis had a 5-year survival rate of 12.1%, with two cases achieving relapsefree prolonged survival. Postoperative complications were studied in another 297 patiens who underwent curative B operation for advanced gastric cancer. The incidence of complications in cases with dissection of three or more areas of No. 16 was significantly higher than in those with dissection of one or two areas and those without dissection of No. 16. Therefore, No. 16 dissection should not be performed on all cases of gastric cancer, but will be useful if performed on the high risk group without hepatic and/or peritoneal metastasis.

症例は心窩部痛を主訴とする69歳の男性.内視鏡的逆行性膵管造影では膵管癒合不全が認められ, 膵頭部背側膵管に約2.5cmの不整な狭窄とその尾側膵管の途絶を認めた.腹側膵管には悪性所見は認めなかった.CTでは膵頭部に径4cmの腫瘤を認め, 門脈への浸潤が疑われた.以上より, 膵管癒合不全の背側膵から発生した膵頭部癌と診断し, 膵頭十二指腸切除術, 門脈合併切除術を施行した.切除標本では腫瘍は3.5×3.8×4.0cmの結節型の膵癌で膵頭部の大半を占め, 膵頭下部辺縁に正常な腹側膵が三日月状に残存していた.膵管癒合不全に発生した膵癌の論文報告はいまだ少なく, 本邦では自験例が25例目である.これらを集計すると, 背側膵癌が24例を占めること, 閉塞性黄疸をきたしにくいなどの特徴がみられた.

Quality of life after surgical procedures of various types of esophagogastrostomy were retrospectively evaluated. Thirty-six patients were divided into three groups; group A (16 patients): end-to-side anastomosis with pyloroplasty, group B (14 patients): end-to-side anastomosis without pyloroplasty, and group C (6 patients): end-to-end anastomosis without pyloroplasty. There were no significant differences among these three groups in the background factors such as age, sex, invasion to the esophagus, pathological type, depth of invasion, lymph node metastasis, degree of dissection and curability. In an early phase after the surgery, smaller proportion of patients complained of vomiting while period of hospitalization was shorter in group A. In a late phase after the surgery (five years postoperatively), inadequate food intake and consequent loss of body weight were frequently observed in group B patients. 25% of group A patients maintained 100% or more of preoperative body weight. Frequent and severe heartburn was observed in group C. From these results, we conclude that the surgical procedure of end-to-side anastomosis of esophagogastrostomy combined with pyloroplasty is the most adequate mode of reconstruction following proximal gastrectomy.

Background: The feasibility of the latest edition of the Japanese General Rules for Gastric Cancer Study (GRGCS) is evaluated by comparison with the TNM system. Methods: In a 5-year period from 1985 to 1989, 978 patients with gastric cancer underwent laparotomies at the Dept. of Gastroenterological Surgery, Aichi Cancer Centre, Japan. All the patients have now been followed up for 5 years or until death. These patients were retrospectively classified into appropriate clinical stages and residual tumour status on the basis of the GRGCS and the 4th edition of the TNM classification by the UICC, and survival curves for various stages and subgroups were evaluated. Results: The GRGCS classification provided useful information by splitting UICC stage IV into stages IVa and IVb, and R0 into curabilities A and B, both subgroups showing significant differences in the survival curves. Conclusions: The new edition of the GRGCS can be recommended as a useful staging manual for gastric cancer.

In a phase III randomized trial of adjuvant chemotherapy for gastric cancer, interinstitutional differences were analyzed. A trial of three regimens: mitomycin C, 5-fluorouracil(5-FU) and CA (MFC) + continuous oral 5-FU (Group C); MFC + continuous oral UFT(tegafur and uracil) (Group B); and MF + UFT (Group C) after operation was conducted in 466 patients with gastric cancer (stage II and III) at four hospitals in Japan (CIH, CAD, ACC and NCC). Patients were stratified by the institution, stage, and tumor size (8 cm). The 5-year survival rates were in the order of Group A (79.0%)B (70.0%)C (61.0%) (P = 0.1228) in total, A (95.0%)B (80.0%)C (58.0%) (P0.05) at CAD (82 patients), ACB at CIH (215), CAB at ACC (95), and BAC at NCC (78). The survival rate of patients with S2(serosal exposure), 8 cmand N0-1 cancer was higher at CIH than at the other institutions. The interinstitutional differences in patient characteristics and surgical technique were more powerful than the differences among the three groups.

Hepatocellular carcinomas occasionally grow into the bile duct, evidencing itself in symptoms such as obstructive jaundice and abdominal pain. This report discusses a case of small liver cancer grown into the bile duct which was marked by an initial symptom of r-hypochondral pain. In December 1988, a 60-year-old male experienced attacks of abdominal pain similar to that caused by gallstones and came to our hospital. Computed tomography showed liver cirrhosis and a tumor in the left intrabileduct combined with dilatation of its peripheral ducts. Endoscopic retrograde cholangiography (ERC) also revealed a polyp-like tumor in the left bile duct. Cytology of the bile showed the presence of adenocarcinoma. Based on these examinations, a diagnosis was at first made as an intrahepatic cholangiocarcinoma, and surgery was performed. During surgery, a tumor of 2 cm in diameter was found on the surface of the left lateral lobe of the liver. With the diagnosis of hepatocellular carcinoma, combining with initial bile duct tumor, left hepatic lobectomy was performed. Out surface of the excised material showed that the tumor exposed on the surface was connected to the intrabileduct tumor. The final pathological diagnosis resulted in the hepatocellular carcinoma which had grown into the bile duct.

症例は, 66歳の男性で腹痛と発熱を主訴に来院.諸検査の結果, 胆嚢総肝管瘻を合併した胆嚢癌の胆管浸潤, または胆管癌の胆嚢浸潤と診断し, 胆嚢, 胆管切除, 肝門部胆管十二指腸吻合を施行した.切除標本を検索すると, 胆嚢と総肝管は広く交通し, 瘻孔を形成しており, 腫瘍は胆嚢頚部に茎を持ち, 結節状に発育しこの瘻孔を通って総肝管内に突出していた.なお, 一部胆嚢体部で胆嚢粘膜からさらに肝床に直接浸潤していた.腫瘍と周囲組織との接合点は茎の部位と, 肝床への浸潤部のみであり, 他の胆嚢粘膜, 瘻孔壁, および総肝管粘膜との間には連続性はなかった.また胆嚢内および胆管内には同一の形状の混合石が存在していた.病理組織学的には, papillary adenocarcinomaで, リンパ節転移はなかった.以上より, この腫瘍は, 胆嚢癌で, 胆石症に続発して形成された胆嚢総肝管瘻を通じて胆管内に発育進展したものと考えられた.

BACKGROUND: Matrix metalloproteinase 9 (MMP-9) facilitates tumor invasion and metastasis via basement membrane degradation. Control of MMP-9 production by cancer-stromal cell interactions in these processes has been observed.METHODS: We measured plasma MMP-9 concentrations, using a one-step sandwich enzyme immunoassay, and also immunohistochemically localized MMP-9 in patients with small gastric cancers limited to the mucosa. The cancers were classified as intraepithelial tumor (Tis) and T1 disease according to the tumor-node-metastasis (TNM) classification of the International Union Against Cancer.RESULTS: Patients with T1 disease had a higher positivity rate for and mean value of MMP-9 than patients with Tis disease. In T1 tumors, MMP-9 expression determined immunohistochemically, was greater in cells in cancer stroma than in cells in noncancerous stroma, a situation found in only a few Tis tumors.CONCLUSIONS: These results suggest that MMP-9 is related to the initial step of gastric cancer invasion.

A comparative case-referent study was conducted using data from the Hospital-based Epidemiologic Research Program at Aichi Cancer Center (HERPACC), with the aim of clarifying whether histologic subtypes of gastric cancer exhibit different risk-factor patterns of habitual smoking. Our study comprised 995 histologically confirmed gastric-cancer cases [460 differentiated (intestinal type), 527 non-differentiated (diffuse type) and 8 unclassified], identified via hospital cancer registry and surgical records, and 43,846 non-cancer outpatients at Aichi Cancer Center Hospital over the years 1988-1995. Odds ratios (ORs) were estimated by gender using logistic regression and adjusted for potential confounding factors. In males, a significantly increased OR of gastric cancer was observed for habitual smokers, and this was higher in the differentiated type than the non-differentiated type and in younger than in older age groups. Risk patterns were less clear in females. Our results suggest that habitual smoking is associated more likely with the differentiated type of gastric cancer, particularly in younger cases.

OBJECTIVE: We evaluated the therapeutic efficacy of radical gastrectomy for primary B-cell lymphoma of the stomach and attempted to identify patients who could be adequately treated with surgery alone. SUMMARY BACKGROUND DATA: Several recent gastric lymphoma reports have discussed the therapeutic benefits of various treatment strategies for stage IE and IIE lymphoma. However, few studies have been based on patients accurately staged by systematic lymphadenectomy with subsequent pathologic examination. METHODS: A retrospective study was performed to evaluate the survival and biologic behavior of lesions in 60 patients with gastric lymphoma who were treated by radical gastrectomy alone. Tumors were classified according to the histopathologic concept of mucosa-associated lymphoid tissue (MALT)-derived lymphoma. RESULTS: A low histopathologic grade was associated with a significantly lower incidence of nodal metastasis (p = 0.07) and less extensive infiltration of the gastric wall (p < 0.005) despite larger tumor size. A 5-year survival rate of >95% was attained with surgery alone for MALT lymphoma and for true stage IE lymphoma diagnosed by pathologic examination of up to N2 lymph nodes routinely performed after radical gastrectomy. CONCLUSIONS: Surgery alone is adequate treatment for stage IE or pure MALT lymphoma, provided that the staging is performed after radical gastrectomy.

A retrospective study was conducted in search of an optimal surgical procedure for early cancer of the proximal stomach. The clinicopathological findings and survival data of 128 patients operated on during a recent period of 16 years were analyzed. Nodal metastasis was found in 12% of the patients and had a significant influence on the survival. It was more frequently observed in the undifferentiated type, regardless of the tumor size. Most metastases were found in the proximal paragastric nodes, and no metastasis was observed in the pyloric region or at the splenic hilum. These facts suggest that while the resection of paragastric nodes is advocated, neither total gastrectomy nor splenectomy is required simply for the purpose of lymphadenectomy.

Method : Clinicopathological features and prognostic factors were evaluated in 26 cases of stump carcinoma, operated on in the recent 20 years, in search of the standard surgical treatment. Background : Stump carcinoma usually emerges more than 20 years after the initial gastrectomy and is often not diagnosed in the early clinical stage, resulting in a significantly low incidence of curative resection compared with primary gastric carcinoma. Results : No improvement in the survival curves for stump carcinoma was observed between the past two decades. Nodal metastases were frequently found within the first tier nodes, and no 5-year survivor was found among the patients with nodal metastasis beyond pN1. Conclusions : Subtotal gastrectomy might suffice for the treatment of stomal cancer, and most patients might not benefit from extensive lymphadenectomy.

We studied the effects on survival time of postoperative immuno-chemotherapy, including the streptococcal preparation OK-432, in patients with gastric cancer and synchronous peritoneal dissemination. The patients were prospectively randomized and a valid statistical assessment could be made for 109. Patients randomized to group B received therapy that is widely used in Japan to treat patients with gastric cancer: mitomycin C (MMC) and UFT, a combination of tegafur and uracil in a molar ratio of 1:4, for 1 year. Patients randomized to group A received the same drugs as were given to group B patients plus OK-432 i.p. for 7 days, beginning on postoperative day 0, and OK-432 by intradermal injection for 1 year, at 2-week intervals. There were no differences between the two groups in any known prognostic factor or in the dose of any drug administered except for OK-432. There was no difference in the toxicity rate between the groups. In this negative trial, there was no improvement in survival time with the addition of OK-432 to MMC and UFT for patients with gastric cancer and peritoneal dissemination.

Eighty two patients with pathological metastasis to the lymph nodes along the splenic artery (L11) were divided into two groups (pancreato-splenectomy(PS) (+): 19 cases, PS(-):63 cases). Their backgrounds were.not different. Five year survival rate of PS(+) group was 10.5%, and that of PS(-) group was 12.8%. Residual lymph nodes were microscopically detected in the previously dissected pancreas specimen in three out of eight cases studied. Those lymph nodes were few in number, small in size and all of them were cancer negative. From these results, we concluded that dissection of L11 without PS might be a clinically satisfactory procedure against advanced gastric carcinoma.