No abstract

When compared with ODG, LADG contributes to the preservation of postsurgical Th1 cell-mediated immune function.

LDG offers particular advantages to elderly patients with early gastric cancer, including rapid return of gastrointestinal function, fewer complications and a shorter hospital stay.

Laparoscopic surgery is preferable to open surgery because it results in less impairment of systemic and intraperitoneal cell-mediated immune responses.

Background: The effect of splenectomy on hematogenous metastases of malignant tumors remains controversial. The aim of this study was to clarify the effect of splenectomy on hematogenous metastases in an animal model. Methods: Colon 26 cancer cells were inoculated into the lateral tail vein of 90 mice. The mice were then assigned to a splenectomy group or a control group. Lung weight, number of lung metastases, size of metastatic nodules, and serum vascular endothelial growth factor (VEGF) and basic fibroblast growth factor (bFGF) levels after the surgical procedure were measured and compared between the two groups. Results: The lung nodules were significantly smaller in the splenectomy group than in the control group. In both groups, the serum VEGF levels increased on day 1 and then decreased. The serum VEGF levels on day 5 were significantly lower in the splenectomy group than in the control group. The serum bFGF levels were significantly lower in the splenectomy group than in the control group on days 1 and 5. Immunohistochemical study showed that bFGF was produced by reticuloendothelial cells of the spleen. Conclusion: The growth rate of hematogenous metastatic lesions appears to decrease after splenectomy and may be associated with decreases in serum levels of VEGF and bFGF induced by splenectomy.

Background : Laparoscopy-assisted distal gastrectomy (LADG) has proved to be useful in the management of early gastric cancer. The aim of the present study was to examine the learning curve for LADG and clarify any technical problems. Methods : The study included 75 consecutive patients who underwent LADG between 1994 and 2002. All operations were performed by a single surgeon and with a surgical team who were skilled in laparoscopic procedures, but new to LADG. Patients were divided into three groups according to the surgeon's level of experience at the time of surgery: Group I ( n = 25, surgeries performed between Groups 1, 2 and 3 to reflect the surgeon's beginning, intermediate and advanced levels of experience, respectively. Operation time, blood loss and incidence of complications were analyzed and compared between groups. Results : Operation time and blood loss did not differ between Groups 1, 2 and 3 (operation time: 236 vs 258 vs 225 min; blood loss: 157 vs 198 vs 144 mg, respectively). Postoperative complications occurred in nine patients (12%); the incidence did not differ between groups. The most frequent complication was wound infection (4%), followed by anastomotic stenosis (3%). There were no intraoperative complications or conversions to open surgery. Conclusions : There is no learning curve for LADG, when it is performed by a skilled surgeon and surgical team. Proficiency in basic laparoscopic techniques and open gastric surgery is easily adapted to safe completion of LADG.

Background: Accurate staging of lymph node metastasis by sentinel node biopsy is easily achieved in conventional open gastric surgery. Staging is not easily achieved in laparoscopic surgery, however, because of the technical difficulty in identifying sentinel nodes. We developed a laparoscopic method that involves lead shielding for detection of sentinel nodes in gastric cancer and examined the efficacy of this method. Methods: Laparoscopic sentinel node biopsy was performed in 18 patients with early gastric cancer. A combined dye-and radio-guided method was used in the first 10 patients; our radio-guided lead shield method was used in the subsequent eight cases. Laparoscopy-assisted distal gastrectomy was performed in all patients, and dissected nodes were examined by routine hematoxylin and eosin staining. The detection rate was compared between the two groups. Results: The detection rate for sentinel nodes was higher with the radio-guided lead shield method (88%) than with the combined dye-and radio-guided method (40%). Regional lymph node metastasis was recognized in one of 18 patients, and the sentinel node was positive in this case. Conclusions: Use of a lead shield is beneficial for accurate laparoscopic detection of sentinel lymph nodes.

We report a rare case of four separate gastric ruptures resulting from blunt abdominal trauma that were successfully repaired by primary closure. A 22-year-old man injured in a motorcycle accident was admitted to our hospital where physical and radiological examinations confirmed the need for abdominal exploration. Laparotomy revealed four full-thickness lacerations in the anterior wall of the stomach. The lacerations were repaired primarily by a two-layer closure. The patient recovered gradually, and was discharged on hospital day 41, since when he has remained well. Although there has been no previous report of as many gastric lacerations following blunt abdominal trauma, surgeons should be aware of the possibility of multiple ruptures, which can be managed by simple closures.