Ratio-based lymph node staging is simple and gives more precise information for prognosis with fewer problems related to stage migration than the 1997 UICC/AJCC staging system.

Gastric function was evaluated by gastric emptying scintigraphy in PPG patients. This method might be useful not only for evaluating the motor function of the remnant stomach, but also for predicting postoperative status.

We describe herein our technique of performing gastrectomy followed by side-to-end gastroduodenostomy. Because the clamp is removed at the resection line of the greater curvature, there is no need to perform an additional gastrotomy for insertion of the instrument. This feature differentiates our technique from previous methods of anastomosis using the circular stapler. We believe that our technique is superior in simplicity and security to the traditional hand-sewn anastomosis. Moreover, it allows for a shorter operative time. This technique is recommended for practical surgery over conventional techniques.

Neoadjyuvant chemotherapy (NAC) for colorectal liver metastases (CRLM) is divided into two patterns; １) NAC for resectable CRLM, ２) systemic chemotherapy for initially unresectable CRLM. The indications and safety for NAC for resectable CRLM are still undefined. The adverse and anti-tumor effects from NAC, and the timing of liver resection for resectable CRLM after NAC is required to be determined. Recent progress in chemotherapy and molecular target agents has made it possible to surgically treat initially unresectable CRLM. The disease-free and overall survival after resection of CRLM between patients with initially unresectable and resectable liver metastases were not significantly. It is recommended that liver resection is the first-line treatment in which initially unresectable CRLM has changed to resectable due to systemic chemotherapy.

Jejunal pouch interposition (JPI) reconstruction after total gastrectomy has proven effective for improving postoperative quality of life; however, evaluation of bile reflux into the esophagus shows that the reflux of digestive juice is not sufficiently prevented. Therefore, in addition to the conventional reconstruction technique, we created an artificial pouch to prevent the reflux of digestive juice from the jejunal pouch into the esophagus, and performed a new surgical technique based on the Hill's posterior gastropexy. No postoperative complications were observed and the postoperative measurement showed a decrease in the duration of bile reflux into the esophagus. Thus, our new surgical procedure seems to effectively prevent bile reflux.

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