Gastric Surgery

Introduction
In the Hospital East, there is no independent Gastric Surgery Group. Surgeons in the Hepatobiliary and Pancreatic Surgery Group and Colorectal Surgery Group operate on patients with gastric and duodenal malignancies including adenocarcinomas, non-epithelial malignant tumors and the other neoplasmas. In close cooperation of surgeons between the above upper and lower abdominal surgery groups, five to six patients are operated on every week.

Routine Activities　
Every Monday from 4:30 to 5:30 p.m., a film conference of the gastrointestinal malignancy is held, where treatment decisions of the patients especially those of surgical cases are made through the discussion among medical oncologists, endoscopists, radiologists and surgeons. Operative and pathological findings of resected specimens in the previously operated cases are reported to this conference, in which English is available when anyone of visiting doctors from overseas is present.
Every Wednesday from 5:00 to 6:00 p.m., a joint conference of digestive malignancies is held, wherein patients who have newly admitted to and discharged from wards are introduced and adequacy of the treatment which is (or was) indicated are re-confirmed. New treatment strategies are also introduced and discussed in this conference.

Research Activities
1. Assessment of combined modalities
1) JCOG trial 0001: A phase II trial to confirm the feasibility and efficacy of preoperative chemotherapy using CPT-11+Cisplatinum for the patient with bulky N2 or N3.
2) JCOG trial 0002-DI: A phase II trial to confirm the feasibility and efficacy of preoperative chemotherapy
using TS-1 for the patient with typical scirrhous gastric cancer.
3) NSAS-GC (National Surgical Adjuvant Study of Gastric Cancer) trial: a phase III trial to evaluate the efficacy(survival benefit) of adjuvant chemotherapy using UFT. This trial compares surgery alone with surgery plus adjuvant chemotherapy for patients with T2 tumor and n1or n2. This trial, however, was closed because of the necessity to move to start a new phase III trial of adjuvant chemotherapy using TS-1, of which promising efficacy against unresectable and recurrent gastric cancers had been already shown by two different phase II trials.
2. Assessment of surgical procedures
1) JCOG trials 9501: A prospective randomized study comparing the therapeutic efficacy between two different surgical approaches (with or without thoracotomy) for gastric cancer invading the esophagus. In this trial, the 5-year survival rate is the primary endpoint and postoperative morbidity, mortality and QOL will be also evaluated as secondary endpoints.
2) Laparoscopic staging: A prospective study is conducted to evaluate the accuracy of laparoscopic staging particularly for peritoneal dissemination in the patients having suspicious diagnosis of serosal invasion preoperatively. Open laparotomy is avoided when it reveals definite incurable factors like P2,P3, H2 and H3.Because of the limitation by an increasing number of operations, we limit this procedure only for scirrhous gastric cancer recently.

New Developments
In November 2001, a phase III trial of adjuvant chemotherapy using TS-1 for curatively resected gastric cancer patients (stage II-III, except for early gastric cancer patient).
Concerning the reconstruction after total or proximal gastrectomy for relatively early staged patient, we also started a non-randomized prospective study comparing the reconstructions with or without J-pouch interposition to improve reservoir function in 2001.

T. KINOSHITA

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