Gastric Surgery

Introduction
IIn 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, myogenic tumors and others neoplasms.

Routine Activities 
Daily activities
In close cooperation with surgeons in the two abdominal surgery groups, five to six patients are operated on every week.
Every Monday from 4:30 to 5:30 p.m., a film conference of the gastrointestinal malignancy is held, where treatment decisions are discussed especially for surgical cases among medical oncologists, endoscopists, radiologists and surgeons.
Operative findings and pathological findings of resected specimens are reported in this conference. This conference is held in English when any foreign guest doctor is present.
On Wednesday from 5:00 to 6:00 p.m., a joint conference for malignant diseases of abdominal digestive organs is held when necessary to introduce a new protocol and to discuss new treatment strategies.

Research Activities
1. Assessment of combined modalities
1) JCOG trial 0001: A phase II trial to confirm the feasibility and effectiveness of neo-adjuvant chemotherapy using CPT-11 + CDDP for the patient with bulky N2 or N3.
2) JCOG trial 0002-DI : A phase II trial to confirm the feasibility and effectiveness of neoadjuvant chemotherapy using TS-1 for the patient with typical scirrhous gastric cancer. This trial was closed with scheduled recruitment of 55 patients.
3) ACTS-GC trial : 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 ).
2. Assessment of surgical procedures
1) JCOG trial 9501: A randomized trial comparing two commonly used approaches 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 evaluated.
2) JCOG trial 0110: A phase III trial to confirm the efficacy of splenectomy for the patients with cancer in the upper part of the stomach.
3) Laparoscopic staging: This trial is laparoscopic staging for patients with suspected serosal invasion preoperatively. Open laparotomy is avoided when laparoscopic examination 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.

New Developments
In this year, two new JCOG trials will start, one is a trial to evaluate feasibility and accuracy of sentinel node biopsy in early gastric cancer, the other is a phase II trial to evaluate feasibility and efficacy of neoadjuvant chemotherapy using TS-1 + CDDP for large sized type 3 and type 4 gastric cancer.
Concerning the reconstruction after total or proximal gastrectomy for relatively early staged patient, we also started J-pouch interposition to improve reservoir function.

T. KINOSHITA

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