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Between 1979 and 1993, 665 Japanese patients with advanced gastric cancer underwent surgery at our hospital. These patients were divided into two groups, consisting of 102 patients with Borrmann type IV carcinoma, and the remaining 563 patients with all other types of gastric carcinoma, which were then compared clinicopathologically. In the patients with Borrmann type IV carcinoma, 77.4% of the lesions demonstrated poorly differentiated adenocarcinoma, and 99 patients were classified as Stage III or IV. The resection rate was 87.2% (89/102) with only 39 curative operations despite the fact that 70 total gastrectomies were performed. The incidence of peritoneal dissemination (29.4%) and serosal invasion (97.0%) was significantly higher in these patients. Microscopic lymph node metastasis was positive in 86.5%. The 5-year survival rate was 23.4% in the patients with a curative operation and 5.0% in those with a noncurative operation (p < 0.01). Peritoneal dissemination was most frequently noted in the recurrence patterns. We conclude that early detection and a curative operation are both essential to improve the prognosis of patients with Borrmann type IV gastric cancer. The addition of a potent postoperative chemotherapy regimen is also recommended.

With the cooperation of an anesthesiologist, ESD under general anesthesia appears to be a useful method, decreasing the risk of complications.

Our results confirm the efficacy of POEM in a large patient series and support POEM as one of the first-line achalasia therapies in the near future.

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Thrombospondin-1 (TSP-1) is different from other components of the extracellular matrix (ECM) regarding its production and distribution. TSP-1 is considered to be released in large quantity in inflammatory sites and exogenously added TSP-1 does not bind to preformed ECM but instead binds to cells. To define the physiological role of TSP-1 in the immune system, we studied the influence of TSP-1 on the in vitro culture of T cells and antigen-presenting cells (APCs) in the presence of phytohemagglutinin. By adding soluble TSP-1 to the culture, T cell proliferation was suppressed and anti-inflammatory cytokine IL-10 secretion by APCs was enhanced. The enhanced expression of IL-10 was also demonstrated at the mRNA level by RT-PCR using multiprimer kit for cytokines. The suppression of T cell proliferation and the enhancement of IL-10 secretion with soluble TSP-1 was inhibited byadding RGDS peptide or heparin. This result indicates that the effect of soluble TSP-1 may be caused by binding to its ligand(s) on T cells and/or APCs, resulting in transducing regulatory signals to the cells or disturbing appropriate interaction between T cells and APCs. We therefore propose that TSP-1 is an immunosuppressive modulator which may play a role in inflammatory sites.

The start of chemotherapy treatment usually requires a delay of about 4 weeks after surgical resection in patients with primary colorectal cancer and synchronous distant metastasis. However, there is no evidence to indicate the required length of this delay interval. In addition, there is a chance that a patient may die because postoperative chemotherapy was not started soon enough and a metastatic tumor was able to develop rapidly. Here, we present a case in which combination chemotherapy with capecitabine and oxaliplatin (XELOX) was started within 1 week after a right hemicolectomy for synchronous multiple liver metastases. To our knowledge, this is the first report of the start of chemotherapy, involving treatments such as folinic acid, fluorouracil, and oxaliplatin (FOLFOX); folinic acid, fluorouracil, and irinotecan (FOLFIRI); and XELOX, within 1 week after a colorectal cancer operation with anastomosis. The findings suggest possible changes in the start time of chemotherapy after surgery in the future.