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  • 1
    Electronic Resource
    Electronic Resource
    Stomach-preserving gastric bypass for unresectable pancreatic cancer (1997)
    Springer
    Surgery today 27 (1997), S. 429-433 
    Details
    ISSN: 1436-2813
    Keywords: pancreatic cancer ; gastric bypass ; stomach-preserving ; quality of life
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract From 1992 to 1995, we treated 25 patients who had unresectable pancreatic cancer witha stomach-preserving gastric bypass (SPGB). After as much of the stomach as possible was preserved, it was bypassed to the jejunum by end-to-side anastomosis. During the same period, five patients underwent other types ofbypasses while 47similar patients did not undergo gastric bypass. Althoughthe mean operative time for SPGB was significantly longer than for other types of bypass,the mean intraoperative blood loss was similar. Operative morbidity with SPGB was 28%, and there were no operative deaths. In patients undergoing SPGB, the incidence of delayed gastric emptying was high (24%), but the comfort index (ratio of duration of good palliation to duration of survival) exceeded 50% when metastases wereeither regional or systemic but limited. The comfort index of patients undergoing other types of bypass or not undergoing bypass was less than 40%. However,the patients with extensive systemic metastases survived less than 100 days and the comfort index was less than 30%for all treatment groups. Our resultsthus suggest that SPGB is safe and effective for patients witheither regional metastases or limited systemic metastases.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02385706
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  • 2
    Electronic Resource
    Electronic Resource
    Treatment for hepatocellular carcinoma associated with tumor embolus in the inferior vena cava (1996)
    Springer
    Journal of hepato-biliary-pancreatic surgery 3 (1996), S. 280-284 
    Details
    ISSN: 1436-0691
    Keywords: hepatocellular carcinoma ; tumor embolus ; centrifugal force pump ; hepatectomy ; total hepatic vascular exclusion
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Hepatic resection and removal of the tumor embolus was performed in six patients with hepatocellular carcinoma associated with tumor embolus in the inferior vena cava, without distant metastasis. Hepatic resection was performed in five patients under total hepatic vascular exclusion (THVE) with veno-venous bypass, using a centrifugal force pump and in one patient, under simple THVE without the bypass. In one patient, partial resection of segment VIII was performed, in one, a central bi-segmentectomy, and in four, right hepatic lobectomies were performed. Surgery was safely performed in all the 5 patients under THVE using the centrifugal force pump. One patient who underwent partial hepatic resection under the simple THVE, suffered cardiac arrest during surgery, but resuscitation was successful. Three patients died of reccurence within 1 year. The other three patients survived for 10 months, 2 years and 10 months, and 3 years and 10 months, respectively, after surgery. There were recurrences in the first two, patients, in both, treated by transcatheter arterial embolization, and to date, the third patient is disease-free. Hepatic resection was safely performed in patients with hepatocellular carcinoma associated with tumor embolus in the inferior vena cava, under conditions of THVE using the centrifugal force pump. Prolonged survival can be anticipated, with favorable liver function, in those patients in whom most of the lesion is resected.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02391027
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  • 3
    Electronic Resource
    Electronic Resource
    Epithelioid hemangioendothelioma of the liver (2000)
    Springer
    Journal of hepato-biliary-pancreatic surgery 7 (2000), S. 443-447 
    Details
    ISSN: 1436-0691
    Keywords: Key words Epithelioid hemangioendothelioma ; Liver ; Resection
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Epithelioid hemangioendothelioma (EH) of the liver is a rare tumor and is difficult to differentiate from cholangiocellular carcinoma or metastatic liver tumor on image diagnosis. A case of curatively resected EH of the liver is reported. A 48-year-old woman was admitted because she had a mass in the liver. Cholangiocellular carcinoma was suspected preoperatively. Right trisegmentectomy of the liver, combined with bile duct resection and portal vein resection and reconstruction, was performed. Characteristic macro- and microscopic findings of the resected specimen revealed EH of the liver. The patient has survived for more than 6 years without recurrence. Because of the tendency of EH of the liver to appear in multiple or scattered forms, only 12 cases of resection for EH have been reported.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s005340070042
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  • 4
    Electronic Resource
    Electronic Resource
    Extended right hepatic lobectomy with resection of inferior vena cava and portal vein for intrahepatic cholangiocarcinoma (2000)
    Springer
    Journal of hepato-biliary-pancreatic surgery 7 (2000), S. 599-602 
    Details
    ISSN: 1436-0691
    Keywords: Key words Intrahepatic cholangiocarcinoma ; Hepatic resection ; Vascular resection
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract We report a case of intrahepatic cholangiocarcinoma treated by extended right lobectomy and resection of the inferior vena cava (IVC) and portal vein. A 53-year-old man was referred with elevated serum alkaline phosphatase (ALP) and γ-glutamyl transpeptidase (γ-GTP) levels on April 23, 1999. He was not jaundiced and did not have any symptoms. Endoscopic retrograde cholangiopancreatography (ERCP) revealed irregular strictures in both the anterior and posterior segmental ducts. Contrast-enhanced computed tomography (CT) scan demonstrated a low-density tumor with an unclear margin in the right lobe of the liver. The patient underwent extended right hepatic lobectomy and total caudate lobectomy. Partial resection of the IVC (6 cm) was performed under total hepatic vascular exclusion. The main portal trunk and left portal vein were resected and reconstructed with an end-to-end anastomosis. Macroscopically, a 5.0 × 5.0 × 4.5-cm periductal infiltrating-type tumor occupied the right hepatic parenchyma along the posterior and anterior segmental ducts. Histological examination revealed moderately differentiated tubular adenocarcinoma with marked perineural invasion. Lymph node metastasis was observed in the hepatoduodenal ligament and posterior surface of the pancreatic head. The resected margins of the common bile duct and left hepatic duct were free of tumor. The patient's postoperative course was uneventful, and he was discharged from hospital on the 28th postoperative day. Nine months after the operation, he suddenly developed obstructive jaundice, and died with recurrent disease. This is the first reported case of intrahepatic cholangiocarcinoma treated with major hepatectomy and resection of the IVC and portal vein except ex situ procedure. This aggressive surgical approach may offer hope for patients with intrahepatic cholangiocarcinoma involving the IVC.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s005340070010
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  • 5
    Electronic Resource
    Electronic Resource
    Pancreas-preserving total gastrectomy for proximal gastric cancer (1995)
    Springer
    World journal of surgery 19 (1995), S. 532-536 
    Details
    ISSN: 1432-2323
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Résumé L'ablation des ganglions lymphatiques au bord supérieur du pancréas est une des étapes principales de la chirurgie à visée curative pour cancer gastrique mais il est souvent nécessaire de réséquer le pancréas distal pour compléter la lymphadénectomie le long de l'artère splénique. En conséquence, la résection pancréatique peut se compliquer de fistule pancréatique, d'abcès sous-phrénique, et de diabète postopératoire. Pour éviter ces complications, K Maruyama a imaginé en 1979 une nouvelle intervention permettant de conserver le pancréas. Nous avons trouvé que les voies lymphatiques provenant de l'estomac n'entraient pas dans le parenchyme pancréatique et que la rate, l'artère splénique et le tissu adipeux contenant les ganglions lymphatiques pouvaient être enlevés complètement sans disséquer le pancréas ou la veine splénique. Le pancréas restant garde une vascularisation intacte à partir de l'artère pancréatique transverse et ceci évite le diabète post-chirurgical. Nous avons opéré 299 patients avec cette technique avec une mortalité opératoire de 0.3%, une mortalité hospitalière de 1.6% et un taux de morbidité de 19.6%. La survie cumulative à 5 ans pour les patients stade II a été de 70.5% et celle des patients du stade III, de 54.1%. Ces résultats sont supérieurs à ceux du groupe avec résection pancréatique.
    Abstract: Resumen La disección de los ganglios linfáticos ubicados sobre el borde superior del páncreas es parte esencial de la cirugía curativa para cáncer gástrico y la región distal del páncreas era frecuentemente resecada para lograr la remoción completa de los ganglios ubicados a lo largo de la arteria esplénica. Sin embargo, el escape de jugo pancreático, el absceso subfrénico y la diabetes postoperatoria fueron complicaciones comunes en los pacientes sometidos a resección pancreática. Con miras a evitar tales complicaciones, K. Maruyama desarrolló en 1979 un nuevo procedimiento quirúrgico, la operación conservadora del páncreas. Hemos encontrado que los canales linfáticos del estómago no fluyen al parénquima del páncreas y que el bazo, la arteria esplénica y el tejido conectivo graso, incluyendo los ganglios, pueden ser resecados totalmente sin necesidad de disecar el parénquima del páncreas ni la vena esplénica. El páncreas conservado recibe irrigación arterial a través de la arteria pancreática transversa, y con ello se logra prevenir la diabetes postoperatoria. 299 pacientes fueron tratados con este procedimiento con una mortalidad operatoria de 0.3%, una mortalidad hospitalaria de 1.6% y una tasa de complicaciones quirúrgicas de 19.6%. La tasa acumulativa de sobrevida a 5 años para el estado II fue 70.5% y para el estado III 53.1%. Estos resultados aparecen superiores a aquellos obtenidos en pacientes en los cuales se resecó el páncreas.
    Notes: Abstract Lymph node (LN) dissection along the upper border of the pancreas is one of the essential parts of curative surgery for gastric cancer, and the distal portion of the pancreas was frequently resected for complete removal of LNs along the splenic artery. Hoever, pancreatic juice leakage, subphrenic abscess, and postoperative diabetes were common complications in patients treated by pancreatic resection. To avoid these problems a new surgical procedure, the pancreas-preserving operation, was developed by Maruyama in 1979. We found that lymphatic channels from the stomach did not flow into the pancreas parenchyma, and that the spleen, splenic artery, and fatty connective tissue including nodes could be removed completely without dissection of the pancreas parenchyma and splenic vein. The preserved pancreas receives its arterial blood supply through the transverse pancreatic artery, and its preservation prevents postoperative diabetes. A total of 299 patients were treated by this procedure. The operative mortality rate was 0.3%, the hospital death rate 1.6%, and the surgical complications rate 19.6%. The cumulative 5-year survival rate for those with stage II was 70.5% and for those with stage III 54.1%. These results were superior to those of the pancreas resection group.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00294714
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  • 6
    Electronic Resource
    Electronic Resource
    Cancer of the stomach: A review of two hospitals in Korea and Japan (1993)
    Springer
    World journal of surgery 17 (1993), S. 777-782 
    Details
    ISSN: 1432-2323
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Résumé Les dossiers de 525 patients ayant un adénocarcinome primitif de l'estomac traités à l'Hôpital Universitaire de Corée à Séoul et de 1932 patients traités au Centre National du Cancer à Tokyo, vus sur une période de 7 ans, ont été analysés. Plus de 70% des patients avaient entre 41 et 70 ans bien que l'âge moyen était légèrement plus élevé dans l'Hôpital Japonais. En comparant les deux séries, il y avait des différences significatives en ce qui concerne le type de cancer, la taille de la tumeur, la profondeur de l'envahissement, les métastases lymphatiques, le stade et le type histologique, vraisemblabement dues à une plus grande fréquence de cancer au stade de début dans la population Japonaise (51.2%) par rapport à la population Coréenne (19%). Les patients Coréens avaient plus de tumeurs avancées, de grande taille, invasives, avec métastases lymphatiques et indifférenciées. La survie à 5 ans était de 69.5% pour les tumeurs réséquées au Japon et de 54.2% en Corée (p〉0.05). Parmi les différents facteurs clinicopathologiques, seuls le stade IIIb et la présence de cellules en bague à châton avaient une influence sur la survie. La survie à 5 ans pour les tumeurs de stade IIIb était de 18% en Corée et de 36.8% au Japon. Il semble que cette différence soit due à la dissection plus grande associée au curage lymphatique que l'on préconise au Japon. La différence de survie pour les cancers avec cellules en bague à châton (31.2% en Corée et 91% au Japon) est due au fait que 79.1% de ces cancers étaient traités au Japon au stade de cancer de début. La présente étude souligne encore une fois l'importance d'une détection et traitement précoces du cancer gastrique et suggère qu'il n'y a pas beaucoup de différences entre les deux pays en dehors des modalités thérapeutiques.
    Abstract: Resumen Con el propósito de comparar las características biológicas y los resultados del tratamiento, se revisaron retrospectivamente las historias clínicas de 525 pacientes con adenocarcinoma primario del estómago tratados en el Hospital Universitario de Corea, Seul, y de 1.932 pacientes tratados en el Hospital Centro Nacional de Cáncer de Tokyo, Japón, en un período de 7 años. Más de 70% de los pacientes tenían edades entre los 41 y los 70 años en los dos hopitales, aunque el de Corea tuvo pacientes más jovenes, y el de Tokyo más añosos. La comparación en cuanto a las características clínicas patológicas demostró diferencias significativas relativas al tipo de cáncer, tamaño del tumor, profundidad de invasión, metástasis ganglionares, estado y tipo histológico. Las diferencias se debieron principalmente a una mayor frecuencia de cáncer gástrico precoz (temprano) en Tokyo (51.2%) que en Seul (19.0%). Los pacientes Coreanos exhibieron una mayor propensión al cáncer avanzado, a los grandes tumores invasivos, a una mayor frecuencia de metástasis ganglionares, a una estadificación de grado más elevado y a mayor indiferenciación del tumor. La tasa de sobrevida a 5 años de todos los casos resecados fue de 69.5% para Tokyo y de 54.2% para Seul (p〉0.05). Aquellos factores que exhibieron diferencias significativas en las características clínicas patológicas, no afectaron la diferencia en las tasas de sobrevida entre los dos hopitales, excepto en los tumores en Estado IIIb y los tumores de células en anillo de sello. La tasa de sobrevida a 5 años en el Estado IIIb fue de 18.0% en Seul y de 36.6% en Tokyo. Parece que la diferencia en sobrevida en el Estado IIIb se relacionó con la extensa disección ganglionar que se practica en el Hospital de Tokyo. La diferencia en la sobrevida en los tumores de células en anillo de sello (31.2%) en Seul y 91.0% en Tokyo) apareció relacinada con el hecho de que el 79% de éstos casos eran cánceres precoces. El presente estudio demuestra una vez más la importancia de la detección temprana del cáncer gástrico y sugiere que el cáncer del estómago no es diferente en los dos países.
    Notes: Abstract The records of 525 patients with primary adenocarcinoma of the stomach treated at Korea University Hospital (K.U.H.), Seoul, Korea, and 1,932 patients treated at National Cancer Center Hospital (N.C.C.), Tokyo, Japan, over a 7-year period were reviewed to study biologic characteristics and treatment results in the two hospitals. More than 70% of the patients were 41 to 70 years old in both hospitals, though K.U.H. had more younger patients and N.C.C. had more older patients. Comparison in regard to clinicopathologic features showed significant differences in type of cancer, tumor size, depth of invasion, lymph node metastasis, stage, and histologic type. Such a difference mostly was due to a greater frequency of early gastric cancer in N.C.C. patients (51.2%) than in K.U.H. patients (19.0%). Patients of K.U.H. were more likely to have advanced cancer, large invasive tumors, a higher percentage of lymph node metastasis, a higher stage, and more undifferentiated tumors. The 5-year survival rate of all resected cases was 69.5% in N.C.C. and 54.2% in K.U.H. (p〉0.05). Those factors which showed a significant difference in clinicopathologic features did not affect the survival difference between the two hospitals except in stage IIIb and signet-ring-cell cancer. The 5-year survival rate for stage IIIb was 18.0% in K.U.H. and 36.8% in N.C.C. It would seem that survival difference in stage IIIb related to extensive lymph node dissection in N.C.C. Survival difference in signetring-cell gastric cancer (31.2% in K.U.H. and 91.0% in N.C.C.) was related to the fact that 79.1% of signet-ring-cell gastric cancer patients in N.C.C. had early gastric cancer. This present study once again demonstrates the importance of early detection in the treatment of gastric cancer and suggests that gastric cancer of two countries is not different.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01659094
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  • 7
    Electronic Resource
    Electronic Resource
    Causes of Death and Recurrence after Surgery for Early Gastric Cancer (1997)
    Springer
    World journal of surgery 21 (1997), S. 434-439 
    Details
    ISSN: 1432-2323
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract. The postoperative course of 172 patients with early gastric cancer (EGC) was followed for a median 7 years to evaluate the causes of death, incidence and patterns of recurrence, and characteristic findings in the recurrent cases. The cumulative 10-year mortality rate (± SE) was 22 ± 3.7%. Seven patients (4.1%) died of operative mortality, 11 (6.4%) died of a recurrence of the gastric cancer, and 13 (7.6%) died of unrelated causes. Unrelated causes of death were metachronous primary cancer (n = 6), cardiovascular disease ( n = 2), pneumonia ( n = 3), sepsis ( n = 1), and car accident ( n = 1). Four patients died from gastric stump recurrence, three from liver metastases, two from lymph node metastases, and two from peritoneal dissemination. Using Cox multivariate analysis, histologic type had the most significant effect on recurrence. Although influenced by the tumor nature, the EGC prognosis is relatively good. Based on the results of this study, particularly in Western institutions, histologic examination of resection margins and lymphadenectomy should be improved. Moreover, patients must be carefully followed for late recurrence and metachronous cancer.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/PL00012266
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  • 8
    Electronic Resource
    Electronic Resource
    Difference between Carcinoma of the Lower Esophagus and the Cardia (1996)
    Springer
    World journal of surgery 20 (1996), S. 507-511 
    Details
    ISSN: 1432-2323
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract. We analyzed the records of patients with carcinoma of the lower esophagus and cardia. Mediastinal node involvement was found in 43% of the patients with squamous cell carcinoma of the lower esophagus, and the 5-year survival after mediastinal dissection for patients with mediastinal node involvement was 27%. Mediastinal node involvement was found in 19% of the patients with adenocarcinoma of the cardia involving the esophagus, and no patients with mediastinal node involvement survived more than 2 years. When the patients had mediastinal node involvement, survival curves were significantly different. There were large differences between these tumors in terms of the extent of lymph node involvement and the survival of patients with mediastinal lymph node involvement. It is incorrect to consider the behavior of these tumors identical and to treat the conditions similarly.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s002689900080
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  • 9
    Electronic Resource
    Electronic Resource
    Progress in gastric cancer surgery in Japan and its limits of radicality (1987)
    Springer
    World journal of surgery 11 (1987), S. 418-425 
    Details
    ISSN: 1432-2323
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Résumé La chirurgie radicale pour traiter le cancer gastrique est devenue plus aggressive au fil des ans. Les thèmes a atteindre furent les suivants: dissection ganglionnaire étendue quidée par la méthode de coloration des ganglions à l'encre indienne, exentération des organes de la partie haute de l'abdomen pour le cancer évolué haut situé, et duodéno-pancréatectomie pour le cancer bas situé. Grâce aux progrès du traitement chirurgical et aux méthodes de détection précoce les résultats du traitement se sont améliorés. Employant les données du registre national (5,706 et 11,845 cas) et ceux du Centre National Hospitalier du Cancer (3,176 cas), le taux total de survie à 5 ans des cas réséqués a été de 44.3% de 1963 à 1966, de 56.3% de 1969 à 1973, et de 61.6% de 1971 à 1985. Entre la première et la troisième période, le taux de survie à 5 ans du cancer stade II s'est élevé de 60.6% à 71.7%, et celui du stade III de 32.7% à 44.3%. En outre, les limites de la chirurgie radicale ont été précisées spécialement chez les malades qui présentent une carcinose péritonéale, des métastases hépatiques, des métastases ganglionnaires à distance ou un cancer infiltrant diffus (Borrmann type IV). Chez de tels sujets la chimiothérapie, l'hormonothérapie, l'immunothérapie, la radiothérapie, l'hyperthermie doivent être également employées pour essayer d'améliorer les résultats du traitement.
    Abstract: Resumen La cirugía radical del cancer gástrico se ha extendido en el Japón. Tópicos recientes sobre cirugía del cáncer gástrico han sido la disección ganglionar amplia guiada por “el método de tinción ganglionar con tinta china,” “la exenteración de los órganos abdominales superiores izquierdos” para cáncer avanzado, y la pancreatoduodenectomía para los cánceres avanzados inferiores. Gracias al progreso en el tratamiento quirúrgico, así como en el sistema de detección precoz, se ha logrado mejorar los resultados terapéuticos. Utilizando los datos de registros nacionales (5,706 y 11,845 casos) y los del Hospital Centro Nacional de cáncer (3,176 casos), la tasa de supervivencia a 5 a∼nos del total de casos de resección primaria fue de 44.3% en el primer periodo (1963–1966), de 56.3% en el segundo periodo (1969–1973), y de 61.6% en el tercer periodo (1971–1985). Entre el primera y el tercer periodo la tasa de supervivencia a 5 anos para los estados 2 ascendió de 60.6% a 71.7%, y la de los estados 3 de 32.7% a 44.3%. Sin embargo, hemos tenido que aceptar los límites de la cirugía en cuanto a radicalidad, especialmente en pacientes con metástasis peritoneales, metástasis hepáticas, metástasis ganglionares distales y cáncer del tipo 4 (Borrman tipo 4, carcinoma de infiltración difusa). Para tales pacientes la quimioterapia, la terapia hormonal, la inmunoterapia, la radioterapia, y la hipertemia son modalidades adicionales que deben ser utilizadas con el fin de mejorar los resultados terapéuticos.
    Notes: Abstract Radical surgery of gastric cancer has become more widely utilized in Japan. Topics explored in gastric cancer surgery include the extended lymph node dissection guided by the node staining method with India ink, left upper abdominal organs exenteration for advanced cancer of the upper stomach, and pancreaticoduodenectomy for advanced cancer of the lower stomach. Through the progress of surgical treatment as well as that of the early detection system, the treatment results have been improved. Using the data from nationwide registrations (5,706 and 11,845 cases) and those from the National Cancer Center Hospital (3,176 cases), the 5-year survival rate of total primary resected cases was 44.3% in the first period (1963–1966), 56.3% in the second period (1969–1973), and 61.6% in the third period (1971–1985). Between the first and the third period, the 5-year survival rate of patients with stage 2 cancer increased from 60.6% to 71.7%, and that of stage 3 increased from 32.7% to 44.3%; however, the limits of radical surgery were also clarified, especially in patients with peritoneal dissemination, liver metastasis, distant lymph node metastasis, and diffusely infiltrating carcinoma (Borrmann type 4). For such patients, chemotherapy, hormonal therapy, immunotherapy, radiotherapy, and hyperthermia should possibly be employed in hopes of improving treatment result.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01655804
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  • 10
    Electronic Resource
    Electronic Resource
    Can sentinel node biopsy indicate rational extent of lymphadenectomy in gastric cancer surgery? (1999)
    Springer
    Langenbeck's archives of surgery 384 (1999), S. 149-157 
    Details
    ISSN: 1435-2451
    Keywords: Key words Gastric cancer ; Surgical treatment ; Lymph-node dissection ; Sentinel nodes
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Lymph-node dissection has been regarded as an effective surgical treatment for gastric cancer in Japan. It reduces local recurrence and improves survival rate. Japanese-style systematic D2 lymphadenectomy is now being introduced in western countries for treatment of gastric cancer. This surgical procedure, however, is not simple and should be performed by experienced surgeons. And it is too early to apply sentinel node biopsy for reducing extent of lymphadenectomy because of so complicated lymphatic streams from the stomach and frequent skip- and micrometastases.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004230050185
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