Evaluation of Surface Free Energy Inducing Interfacial Adhesion of Amphiphilic Cellulose Nanofibrils.

Cellulose nanofibrils (CNFs) have been studied extensively over the past decade. Their applications, e.g., as fillers for nanocomposites, stabilizers for Pickering emulsions, and scaffolds for cell culture, are mostly dictated by interfacial adhesion. In general, the individual surface free energy values of the constituents of a material correlate with its adsorption and desorption behaviors. In the present study, we estimated the surface free energy values of thin films composed of CNFs using traditional contact angle methods based on the Wenzel equation and van Oss-Chaudhury-Good theory. The accuracy and utility of the estimated surface free energy values were verified by close matching between the obtained adhesion energy values and the actual interfacial adsorption behaviors of the CNFs. Therefore, the evaluated surface energy values are expected to be a feasible tool for designing of interfacial interactions between CNF surfaces and other materials.

Anisotropic Frictional Properties Induced by Cellulose Nanofibril Assembly.

The alignment of geometrically anisotropic nanomaterials regulates their functions. Self-ordering of rod-like cellulose nanocrystals (CNCs) results in liquid-crystal formation, and the ordering of the CNCs exhibits unique optical properties. Native cellulose nanofibrils (CNFs) are considered to be oriented, and thus the orientation is correlated with their functions, such as their mechanical strength and cell responses. In contrast, the ordering of artificially pulverized CNFs with high aspect ratios is restricted by their long fibrous shape. Here, we propose a facile fabrication method for non-uniaxial, fingerprint-like alignment of CNFs using the Langmuir-Blodgett technique. The obtained Langmuir-Blodgett films of CNFs exhibited anisotropic frictional properties depending on the orientation direction. This process for fabrication of CNF ultrathin films is expected to be used for novel surface design with desired structure-function correlations, which provides anisotropic surface properties to the material surface.

Localized surface acetylation of aqueous counter collision cellulose nanofibrils using a Pickering emulsion as an interfacial reaction platform.

The self-organization of nano-sized fibrous building blocks is essential for the construction of biomimetic architectonics and hierarchically constructed bio-based materials. The localization of hydrophobic moieties on the surfaces of such nanofibrils is key to hierarchical assembly in aqueous systems. In this study, unique self-assembling fibrous building blocks comprising amphiphilic cellulose nanofibrils (CNFs) were prepared by aqueous counter collision (ACC). The purpose of the study was to control the surface properties of ACC-CNFs by selectively acetylating their surfaces at the oil/water interfaces of a Pickering emulsion. Localized interfacial reactions occurred when the ACC-CNFs were adsorbed onto the surfaces of oil droplets containing the reaction reagents. Such acetylation reactions were achieved whilst maintaining the crystallinity and fibrous morphology of the original CNFs. The surfaces of films cast from the acetylated ACC-CNFs described herein had unique self-aggregation properties that contrasted markedly with those of films cast from acetylated ACC-CNFs prepared in homogenous dispersions.

Effect of Daikenchuto, a Traditional Japanese Herbal Medicine, after Total Gastrectomy for Gastric Cancer: A Multicenter, Randomized, Double-Blind, Placebo-Controlled, Phase II Trial.

BACKGROUND: Daikenchuto (DKT) has widely been used to improve abdominal symptoms by being expected to accelerate bowel motility. The purpose of this study is to examine the efficacy and safety of DKT for prevention of ileus and associated gastrointestinal symptoms after total gastrectomy. STUDY DESIGN: Two hundred and forty-five gastric cancer patients who underwent total gastrectomy were enrolled. Patients received either DKT (15.0 g/d) or matching placebo from postoperative days 1 to 12. Primary end points were time to first flatus, time to first bowel movement (BM), and frequency of BM. Secondary end points included quality of life, C-reactive protein level, symptoms indicative of a severe gastrointestinal disorder, and incidence of postoperative ileus. RESULTS: A total of 195 patients (DKT, n = 96; placebo, n = 99) were included in the per-protocol set analysis. There were no significant differences between the groups in terms of patient background characteristics. Median time to first BM was shorter in the DKT group than in the placebo group (94.7 hours vs 113.9 hours; p = 0.051). In patients with high medication adherence, median time to first BM was significantly shorter in the DKT group than in the placebo group (93.8 hours vs 115.1 hours; p = 0.014). Significantly fewer patients in the DKT group had ≥2 symptoms of gastrointestinal dysfunction than those in the placebo group on postoperative day 12 (p = 0.026). CONCLUSIONS: Administration of DKT during the immediate postoperative period after total gastrectomy appears to promote early recovery of postoperative bowel function.

Platypnea-orthodeoxia syndrome associated with a thoracic vertebral fracture following a car accident.

Platypnea-orthodeoxia syndrome (POS) is a rare clinical condition defined by the presence of dyspnea and deoxygenation accompanying changing from a supine to an upright position. We experienced the case of a 75-year-old woman who developed severe acute dyspnea after a car accident. Detailed history taking and a physical examination offered important clues that helped to make an accurate diagnosis of POS. The mechanism of onset is unique and rare; however, it is important for clinical cardiologists to keep this possibility in mind when making a differential diagnosis.

Prognostic significance of IL-17 mRNA expression in peritoneal lavage in gastric cancer patients who underwent curative resection.

Peritoneal dissemination is frequently detected in patients with advanced gastric cancer. The peritoneal cavity is a compartment in which an immunologic host-tumor interaction can occur. There are no reports on the relationship between IL-17 expression in peritoneal lavage and prognosis in gastric cancer patients. Therefore, we investigated the expression of IL-17 mRNA in peritoneal lavage from gastric cancer patients and assessed the association of its expression with clinicopathological parameters and prognosis. Peritoneal lavage was obtained from 114 patients with gastric cancer at initial surgery. Seventy-nine patients underwent curative resection. Among these 79 patients, IL-17 mRNA expression was associated with the depth of tumor invasion (p<0.05). Twelve of the 79 patients who underwent curative resection died, and 9 of those 12 developed peritoneal metastasis. Notably, among the 79 patients who underwent curative resection, those with high expression of IL-17 mRNA in peritoneal lavage had significantly prolonged survival when compared to these patients with low expression of IL-17 mRNA in peritoneal lavage (p<0.05) as evidence by the survival curves. In a multivariate analysis, low expression of IL-17 mRNA in peritoneal lavage and tumor size were found to be independent significant predictive factors for prognosis (HR, 7.91; 95% CI, 1.65-38.03) in the patients who underwent curative resection. IL-17 mRNA expression in peritoneal lavage is a reliable prognostic factor for patients undergoing curative resection for gastric cancer. Low IL-17 expression in the peritoneal cavity may correlate with cancer development in the peritoneal cavity in patients with gastric cancer.

Tumor-infiltrating CD4+ Th17 cells produce IL-17 in tumor microenvironment and promote tumor progression in human gastric cancer.

Recently, a subset of IL-17 producing T cells distinct from Th1 or Th2 cells has been described as key players in inflammation and autoimmune diseases as well as cancer development. In this study, we investigated the expression level of IL-17 and T helper 17 (Th17)-related cytokines in gastric cancer tissues and assessed the association of their expression with angiogenesis and their clinicopathological parameters. Tumor and adjacent normal tissues were obtained from 82 patients with gastric cancer. IL-17, IL-21 and IL-23 mRNA expression levels were quantified by real-time RT-PCR. Th17 infiltration, microvessel density and neutrophil infiltration in tumor tissues were examined by immunohistochemistry and double immunofluorescence histochemistry. Expression of IL-17, IL-21 and IL-23 mRNA was found to be significantly up-regulated in tumor tissues compared with adjacent normal tissues. The expression level of IL-17 mRNA strongly and positively correlated with that of IL-21 mRNA in tumor tissue. The number of vascular endothelial cells and infiltrating neutrophils was significantly larger in tumors expressing a high level of IL-17 mRNA than in tumors expressing a low level of IL-17 mRNA. In tumor tissues most CD4+ cells were stained with anti-IL-17 antibody. The expression level of IL-17 mRNA in gastric tumors was associated with the depth of the tumors, lymph-vascular invasion and lymph node involvement, suggesting that IL-17 obviously was related to tumor progression. IL-17 and IL-21, which regulates IL-17, would be potential therapeutic targets for the treatment of gastric cancer.

A case of pathological complete response of advanced rectal cancer to preoperative chemoradiotherapy using S-1.

In patients with advanced rectal cancer, preoperative chemoradiotherapy is superior to postoperative chemoradiotherapy because of causing less toxicity and achieving higher rates of sphincter preservation and curative resection. We treated a patient who had advanced rectal cancer with preoperative chemotherapy using S-1 and concurrent radiotherapy. S-1 was orally administered at a dose of 100 mg/day during the first cycle (two-week on and one week off). During the third cycle, radiotherapy was initiated concurrently and a total dose of 45 Gy was given. The most severe adverse event was grade 3 leukopenia during the third cycle. On day 42 after completing radiotherapy, low anterior resection with diverting colostomy was performed. Histological examination found no viable cancer cells in the resected specimens, including the primary tumor site and lymph nodes. Thus, a pathological complete response was achieved. Postoperatively, anastomotic leakage occurred, but it was resolved with transanal drainage. Preoperative chemoradiotherapy using S-1 contributed to sphincter preservation and curative resection in this patient. This regimen was both effective and well-tolerated, suggesting that it could be useful for advanced rectal cancer.

Optimal dose of preoperative enteral immunonutrition for patients with esophageal cancer.

PURPOSE: A preoperative immunonutrition pharmaceutics diet (IMPACT) significantly reduced the incidence of postoperative infectious complications, but the optimal regimen still remains unclear. We evaluated the optimal dose of a preoperative IMPACT for patients with esophageal carcinoma and the incidence of postoperative complications based on the dose of IMPACT. METHODS: This study design was a prospective nonrandomized study. Twenty patients with thoracic esophageal carcinoma who underwent a right transthoracic subtotal esophagectomy were divided into two groups. These patients were administered immunonutrition of 500 ml/day (IMP500) or 1000 ml/day (IMP1000) for 7 days before the operation. RESULTS: The incidence of postoperative mortality and morbidity was not different between the IMP500 group and the IMP1000 group. No difference was observed in the perioperative changes in inflammatory, immunological and nutritional variables between the two groups. There were no adverse effects in the IMP500 group, but four patients (40%) had diarrhea and four patients (40%) had appetite loss in the IMP1000 group. In the IMP1000 group, only four patients (40%) could take 1000 ml, but others reduced the quantity of IMPACT because of diarrhea and discomfort. CONCLUSION: This study suggests that 500 ml of IMPACT is recommended as an optimal dose for patients with esophageal cancer.

Influence of overweight on patients with gastric cancer after undergoing curative gastrectomy: an analysis of 689 consecutive cases managed by a single center.

HYPOTHESIS: Overweight (body mass index [calculated as weight in kilograms divided by height in meters squared], > or =25.0) has an effect on surgical results, postoperative complications, and long-term survival in patients with gastric cancer who underwent curative gastrectomy. DESIGN: Retrospective study from January 1, 1992, through December 31, 2002. SETTING: Wakayama Medical University Hospital. PATIENTS: This study included 689 patients who underwent curative gastrectomy (R0). Patients who underwent laparoscopic gastrectomy, gastrectomy with pancreaticoduodenectomy, gastrectomy with another organ resection (liver, colon, or ovary), or gastrectomy with thoracotomy were not included. MAIN OUTCOME MEASURES: Duration of operation, amount of blood loss, incidence of postoperative complications, and survival analysis. RESULTS: The mean (SD) duration of the operation was longer in the overweight group (315 [75] minutes) than in the normal-weight group (277 [85] minutes) (P < .001). The mean (SD) intraoperative blood loss was larger in the overweight group (882 [764] mL) than in the normal-weight group (536 [410] mL) (P < .001). The rates of postoperative complications (anastomotic leakage, pancreatic fistula, and intra-abdominal abscess) were significantly higher in the overweight group (P < .05). Multivariate logistic regression analysis identified that postoperative complications were significantly associated with being overweight (P = .01) and with undergoing pancreatectomy (P = .03). Disease-specific and overall survival did not show any significant difference between the 2 groups. CONCLUSIONS: Being overweight is not a poor risk factor for survival in patients with gastric cancer, although it is independently predictive of postoperative complications.

High CCR7 mRNA expression of cancer cells is associated with lymph node involvement in patients with esophageal squamous cell carcinoma.

Esophageal squamous cell carcinoma (SCC) is one of the biological malignant tumors. Once a tumor invades the submucosa, an incidence of lymph node (LN) metastases is very high, thus resulting in poor survival. Recently, chemokines have been reported to play an important role in organ-specific metastases in several malignancies. In particular, CCR7 has been reported to be associated with LN metastases by immunohistochemistry. However, there have been no studies of quantitative analyses of CCR7 mRNA expression on cancer cells. In this study, we investigated the clinical significance of the expression of CCR7 in the establishment of LN metastases of esophageal SCC. A series of 78 patients with esophageal SCC who underwent esophagectomy were consecutively selected. The expression of CCR7 mRNA from tumor tissue samples was analyzed by quantitative real-time reverse transcriptase-polymerase chain reaction (qRT-PCR), and that from cancer cell samples collected using laser microdissection system was analyzed by qRT-PCR. Immunohistochemical staining of CCR7 was also performed. Although CCR7 mRNA expression in tumor tissues demonstrated no association with the LN metastases, that in cancer cells correlated with LN metastases (p<0.05) due to the fact that not only cancer cells but also infiltrating lymphocytes expressed CCR7 in tumor tissue. Multivariate logistic regression analysis revealed a high CCR7 expression in cancer cells to be an independent predictive factor for LN metastases. These results suggested that CCR7 expression might play an important role in establishing LN metastases in patients with esophageal SCC.

Analysis of the prognostic factors and evaluation of surgical treatment for synchronous liver metastases from gastric cancer.

BACKGROUND AND AIMS: Whether or not a synchronous resection of liver metastases from gastric cancer provides a survival benefit has been a key issue. We identify the significant prognostic factors and clarify the beneficial effect on the survival of liver surgical treatment. MATERIALS AND METHODS: We reviewed 72 patients who underwent a gastrectomy for gastric cancer with synchronous liver metastases and classified the liver metastases into three grades, such as H1: metastases were limited to one of the lobes, H2: there were a few scattered metastases in both lobes, and H3: there were numerous scattered metastases. RESULTS: H1, 2 metastases, and an absence of peritoneal dissemination (P0) were significantly independent prognostic factors for liver metastases of gastric cancer. In addition, the cumulative 1 and 5-year survival rates of liver surgical treatment (hepatic resection and/or microwave coagulation therapy) were 80.0% and 60.0%, whereas the survival rates for non-hepatic surgical treatment were 36.4% and 0% in 26 patients with H1, 2, and P0. In those patients, the radical operation, the solitary metastatic liver tumor, and no-distant lymph node metastases were independent prognostic determinants of survival. CONCLUSION: The radical operation including the surgical treatment for metastatic liver tumors should be performed to improve the prognosis in gastric cancer patients with synchronous H1, 2, and P0.

Multiple early gastric cancer with gastritis cystica profunda showing various histological types.

We report a case of multiple early gastric cancer showing varied histological types associated with gastritis cystica profunda (GCP). A 61-year-old man who had early gastric cancer associated with GCP underwent a distal gastrectomy with lymphadenectomy. Histological examination showed various histological types of cancer -well differentiated, moderately differentiated, poorly differentiated adenocarcinoma, mucinous adenocarcinoma and signet ring cell carcinoma- that had developed independently in the mucosal and submucosal layers of the resected specimen. Furthermore, multiple cysts with a single layer of columnar epithelium were present in the submucosa around the cancerous lesions. However, no neoplastic changes were found in those epithelial cells. Helicobacter pylori was detected in the residual stomach 3 months after surgery. Although the mechanism of the relationship between gastric carcinoma and GCPs is obscure, we speculate that repeated erosion and regeneration induced by chronic inflammation causes multicentric carcinogenesis as well as an aberration of the gastric glands. GCPs may be a risk factor for multiple gastric cancer.

Tumor vaccine therapy against recrudescent tumor using dendritic cells simultaneously transfected with tumor RNA and granulocyte macrophage colony-stimulating factor RNA.

Recently, dendritic cells (DC) transfected with tumor RNA have been used as a cancer vaccine. The efficacy of a cancer vaccine using DC transfected tumor RNA was examined. Of particular interest was whether a vaccine using DC transfected with recrudescent tumor RNA is effective for the treatment of a regrowing tumor after prior immunotherapy. In addition, the usefulness of co-transfection of granulocyte macrophage colony-stimulating factor (GM-CSF) mRNA to augment the DC vaccine was examined. CT26 tumor-bearing mice were immunized by s.c. injection with DC transfected with CT26 mRNA (DC-CT26). The cytotoxic activity against CT26 in mice immunized with DC-CT26 was significantly higher than that in the control group (P < 0.001) and was augmented by GM-CSF mRNA co-transfection (P < 0.05), resulting in remarkable therapeutic efficacy in CT26 s.c. tumor models. Cytotoxic T lymphocytes induced by the vaccination using DC transfected with mRNA from the recrudescent tumor showed a potent cytotoxicity against the recrudescent CT26 tumor cells, which was significantly higher than the cytotoxicity induced by the vaccination using DC-CT26 (P < 0.05). In addition, in a recrudescent tumor model, this vaccination suppressed the regrowing s.c. tumors, and was augmented by GM-CSF mRNA co-transfection (P < 0.05). These results suggested that vaccination therapy using DC simultaneously transfected with whole tumor RNA and GM-CSF mRNA could generate therapeutic immune responses even against recrudescent tumor after prior vaccination.

An analysis of the factors contributing to a reduction in the incidence of pulmonary complications following an esophagectomy for esophageal cancer.

BACKGROUND: Pulmonary complications occur most frequently following a transthoracic esophagectomy for esophageal cancer and would get to be lethal occasionally. In this study, we sought to determine the effect of respiratory physiotherapy, corticosteroid administration, and the use of the video-assisted thoracoscopic (VATS) esophagectomy with a small thoracotomy incision, on the incidence of pulmonary complications following a transthoracic subtotal esophagectomy. MATERIALS AND METHODS: Approximately 184 patients who had undergone a right transthoracic subtotal esophagectomy for squamous cell carcinoma of the thoracic esophagus were studied. To reduce the incidence of pulmonary complications, we performed clinical trials using respiratory physiotherapy, corticosteroid administration, and the VATS-esophagectomy surgical technique. RESULTS: The independent risk factors for pulmonary complications in the multivariate logistic regression analysis were not administering corticosteroids, blood loss greater than 630 ml, and not providing respiratory physiotherapy. In addition, the use of a small surgical incision, less than 10 cm, for the thoracotomy had no effect on the prevention of pulmonary complications. CONCLUSIONS: We concluded that patients with thoracic esophageal cancer could undergo a three-field dissection in comparative safety if the patients were provided with corticosteroid medication in the perioperative period, if the patients received sufficient respiratory physiotherapy, and if surgical blood loss was reduced.

Successful cancer vaccine therapy for carcinoembryonic antigen (CEA)-expressing colon cancer using genetically modified dendritic cells that express CEA and T helper-type 1 cytokines in CEA transgenic mice.

This study was designed to determine whether the vaccination of genetically modified dendritic cells (DCs) simultaneously expressing carcinoembryonic antigen (CEA), granulocyte macrophage colony-stimulating factor (GM-CSF) and interleukin 12 (IL-12) can overcome the peripheral T-cell tolerance to CEA and thereby elicit a therapeutic response in CEA transgenic mice. CEA transgenic mice were immunized once by subcutaneous injection with DCs adenovirally transduced with CEA and T helper-type 1 cytokine genes. The cytotoxic activity of spleen cells against CEA-expressing tumors, MC38-CEA, in the mice immunized with DCs expressing CEA (DC-AxCACEA) was higher than that in those immunized with DCs-AxCALacZ (p < 0.0001), and was augmented by the cotransduction with the GM-CSF/IL-12 gene (p < 0.05). The vaccination with DC-AxCACEA/GM-CSF/IL-12 could elicit a more potent therapeutic immunity than the vaccination with DC-AxCACEA in subcutaneous tumor models (p < 0.0001), and 4 of 5 mice showed a complete eradication of the subcutaneous tumors in these vaccination groups. Even in a large tumor model, this vaccination therapy completely eliminated the subcutaneous tumors in all mice. This antitumor activity mostly vanished with the depletion of CD8(+) T cells and NK cells in vivo and was completely abrogated with the depletion of CD4(+) T cells. A histopathological examination showed no evidence of an autoimmune reaction. No other adverse effects were observed. This vaccination strategy resulted in the generation of highly efficient therapeutic immune responses against MC38-CEA in the absence of autoimmune responses and demonstrated no adverse effects, and may therefore be useful for future clinical applications as a cancer vaccine therapy.

The boosting effect of co-transduction with cytokine genes on cancer vaccine therapy using genetically modified dendritic cells expressing tumor-associated antigen.

The T-helper 1 (Th1) immune reaction is most important in dendritic cell (DC)-based immunotherapy. Interleukin 12 (IL-12) and granulocyte macrophage colony-stimulating factor (GM-CSF) play a pivotal role in inducing Th1 and cytotoxic T lymphocyte (CTL) responses. In this study, DCs expressing the natural tumor antigen gp70 of BALB/c-derived CT26 were adenovirally transduced with the IL-12 gene and/or GM-CSF gene, and it was examined whether vaccinations using these genetically engineered DCs can induce strong therapeutic antitumor immunity. Mice were immunized once by subcutaneous (s.c.) injection with genetically modified DCs. The cytotoxic activity of splenocytes against CT26 was assayed in a 51Cr-release assay 14 days after immunization. The therapeutic efficacy of the vaccination was examined in s.c. tumor models. The cytotoxic activity of CTLs against CT26 in mice immunized with DCs expressing gp70 (DC-AxCAgp70) was significantly augmented by co-transduction with the GM-CSF/IL-12 gene (p<0.0001) and remarkably reduced by the depletion of CD4+ or CD8+ cells (p<0.01). The cytotoxic activity against CT26 of the plain spleen cells in mice immunized with DC-AxCAgp70/GM-CSF/IL-12 was significantly higher than that in mice immunized with DC-AxCAgp70 (p<0.0001), and this activity decreased to almost 50% upon the depletion of NK cells. Vaccinations using DC-AxCAgp70/GM-CSF/IL-12 or DC-AxCAgp70/IL-12 could elicit potent therapeutic immunity in s.c. tumor models; tumor-free mice were observed in these vaccination groups. However, there was no significant difference between these two groups. A vaccination therapy using DCs co-transduced with the TAA gene and Th 1-type cytokine genes, especially the IL-12 gene, is ideal for immunotherapy in terms of the activation of DCs, NK cells, CD4+ T cells and CD8+ T cells, and may be useful in the clinical application of a cancer vaccine therapy.

Surgical management of small gastrointestinal stromal tumors of the stomach.

Small gastrointestinal stromal tumors (GISTs) (< 3 cm) occasionally are found in the stomach during endoscopy. There is no consensus about the surgical management of these small tumors, although this clinical issue is crucial because some of the tumors show unexpected malignant behavior. In this study, we evaluated the clinical management of patients with gastric GISTs who underwent surgical resection. Altogether, 31 patients with gastric GISTs were examined retrospectively. Surgical resection was fundamentally indicated for the patients with gastric GISTs suspected to be malignant by endoscopy or endoscopic ultrasonography (EUS). The malignant grade of the GISTs was evaluated by the mitotic rate, tumor size, and MIB-1 index. EUS was useful for differentiating benign from malignant GISTs; but by limiting the study to patients with small tumors (< 3 cm), the diagnostic value of EUS was not satisfactory for defining the surgical indication. Tumors that were < 50 mm were successfully treated by laparoscopic surgery. Of the 31 patients, 4 had a relapse of the disease, and 1 of those 4 patients had a small tumor (30 mm). All of the recurrences were classified in the high risk category. Surgery is indicated for gastric GISTs that are > or = 20 mm or are suspected to be malignant based on EUS findings. Laparoscopic resection is feasible and is recommended as the treatment of choice for patients with tumors < 50 mm. Risk assessment can be most useful for predicting recurrence.

Individualized adjuvant chemotherapy guided by chemosensitivity test sequential to extended surgery for advanced gastric cancer.

BACKGROUND AND OBJECTIVES: Various adjuvant chemotherapy regimens have been proposed for patients with advanced gastric cancer; however, the majority of these trials failed to show a clear survival benefit over surgery alone. In this study, the feasibility and efficacy of a strategy of extended surgery combined with individualized adjuvant chemotherapy for advanced gastric cancer with serosal invasion and nodal involvement was examined. PATIENTS AND METHODS: Sixty-four patients with advanced gastric cancer underwent gastrectomy with extended lymph node dissection. After surgery, a chemosensitivity test by MTT assay, using highly purified tumor cells, was performed, and the patients received individualized adjuvant chemotherapy on the basis of the results of this chemosensitivity test. RESULTS: Overall survival in the chemosensitivity-guided chemotherapy (CSC) group was significantly better than the standard chemotherapy (SC) and the no-chemotherapy (NC) group (p<0.05). In patients with stage IV disease, the 5-year survival rate was 38.1% in the CSC group and 0% in the SC + NC group, respectively, with a significant difference being observed in the two survival curves (p<0.01). In patients with paraaortic node involvement, survival in the CSC group was significantly better than that in the SC + NC group (p<0.01). On the other hand, in patients without paraaortic node involvement, no survival difference was observed between the two groups. CONCLUSION: The strategy of extended surgery combined with individualized adjuvant chemotherapy offers a favorable survival outcome for advanced gastric cancer patients with serosal invasion and nodal involvement.