Laparoscopic-assisted total gastrectomy versus open total gastrectomy for upper and middle gastric cancer in short-term and long-term outcomes.

PURPOSE: In recent years, laparoscopy-assisted distal gastrectomy has become the recognized procedure for treatment of early gastric cancer because of improved cosmesis and reduced postoperative pain. However, there are a few reports of laparoscopic-assisted total gastrectomy (LATG) performed for gastric cancer in the upper third or middle third stomach due to the difficulties of surgical techniques and the safety of oncologic short-term and long-term outcomes. METHODS: Between January 2006 and December 2009, 84 patients with upper third or middle third gastric cancer underwent LATG or conventional open total gastrectomy (OTG). Of these patients, 34 patients underwent LATG and they were compared with patients who underwent OTG regarding short-term and long-term outcome. RESULTS: The proximal margins (P=0.343) and distal margins (P=0.685) did not differ between the LATG and OTG groups. Postoperative morbidity occurred in 8 (16.0%) OTG and 6 (17.6%) LATG cases and postoperative mortality occurred 2 (4.0%) and 0 (0.0%) cases of OTG and LATG, respectively. Recurrence occurred in 8 (16.0%) cases and 1 (2.9%) case in the OTG and LATG group, respectively (P=0.077). The 5-year survival rate in the OTG group was 77.5% and in the LATG was 93.2% with no significant difference (P=0.082). CONCLUSIONS: Our results confirm that LATG with extended lymphadenectomy for middle or upper early and locally advanced gastric cancer can achieve a radical oncologic resection equivalent to that of OTG. In addition, LATG is a feasible and safe procedure, and has several advantages over conventional OTG.

Consecutive organ transplantation in inbred rats: long-term results--Are organs recyclable?

Using 9-12-month-old Lewis rats, our laboratory performed consecutive organ transplantations to assess the technical feasibility and observe the histopathologies of prolonged transplants and implants over a rat's life span. This study includes a total of 688 cases of consecutive syngeneic organ transplantation, including pancreaticoduodenum (PD), en-bloc liver-pancreaticoduodenum-spleen-stomach (LPdSpSt), and spleen bearing ovary or testicle. A 52-month-old consecutively transplanted pancreas showed normal acini and islet cells. Consecutively transplanted LPdSpSt cases at 25-28 months preserved normal histology. After 26.5 months of ovarian follicle implantation into the spleen, the pathology of the organ exhibited typical dysgerminoma. However, 29.5-month-old infantile testicle implants in the spleen showed seminoma. Our studies suggest that transplanted organs can be reusable and retransplanted, and we hope this could be one of the clues to solve donor-organ shortages in the future.

Vanishing pancreatic grafts.

Comparison of pancreaticoduodenal transplants (PDT) and duct-ligated pancreas transplant (DLPT) were performed using syngeneic and allogeneic studies in rats. Both DLPT and PDT allogeneic grafts showed mild rejection. DLPT groups showed disorganized pathology and acini replaced by fat. Eventually, massive fibrosis was seen in the Islets of Langerhans, as well as rejection cellular infiltrates. In both PDT groups, normal histology was observed in the same period. Thus the effect of duct occlusion is highly detrimental for the grafts.