[A Case of Histological Response of Grade 3 Achieved by Preoperative Chemotherapy with S-1/Oxaliplatin(SOX)].

Histological response of Grade 3 is relatively rare in gastric cancer patients but has recently been observed occasionally. We report the histological response of Grade 3 achieved by S-1/oxaliplatin(SOX)therapy. A 66-year-old man had suffered from epigastralgia when hungry. After 1 month, he visited the department of gastroenterology of our hospital. Upper gastrointestinal endoscopy revealed a type 3 tumor at the lesser curvature of middle gastric body, and poorly differentiated adenocarcinoma was detected by the biopsy examination. Abdominal/pelvic enhanced CT showed wall thickening of the lower gastric body, enlarged regional lymph nodes and para-aortic lymph nodes(No. 16b1). We diagnosed it with Stage Ⅳ. He received 4 courses of SOX therapy. After chemotherapy, upper gastrointestinal endoscopy revealed a residual tumor, although biopsy showed no cancer cells. Abdominal/pelvic enhanced CT showed significantly reduced lymph nodes despite the thickening of the gastric wall. PET-CT revealed indistinct para-aortic lymph nodes. Distal gastrectomy, D2 dissection without para-aortic lymph nodes dissection, and Billroth Ⅰ reconstruction were performed. Histological findings showed no cancer cells in the main lesion or lymph nodes, with only previous cancer cells suspected. The histological response was Grade 3. SOX therapy might be employed in the future as chemotherapy before conversion surgery for Stage Ⅳ gastric cancer.

Postoperative outcomes of gastric carcinoma with lymphoid stroma.

BACKGROUND: Gastric carcinoma with lymphoid stroma (GCLS) is a rare subtype of gastric cancer. There have been several reports demonstrating the favorable prognosis of early GCLS without lymph node metastasis (LNM) compared with gastric adenocarcinomas. However, it remains unknown whether advanced GCLS (AGCLS) with LNM has a similar prognosis and clinicopathological features. This study aimed to assess the clinicopathological features of GCLS of all stages. METHODS: We retrospectively assessed 375 patients who were pathologically diagnosed with gastric cancer and underwent curative surgical resection at Tokyo Medical University, Japan, between September 2013 and October 2019. Of these patients, 357 (95.2%) patients were pathologically diagnosed with gastric adenocarcinomas, and 18 (4.8%) patients were diagnosed with GCLS. The GCLS patients (n = 18) were compared with the gastric adenocarcinoma patients (non-GCLS patients, control) (n = 357) in terms of their clinicopathological features and clinical outcome. RESULTS: The GCLS patients showed significantly predominant upper gastric locations (P = 0.003), lower number of LNM (P = 0.01), and better overall survival rate than the non-GCLS patients (P = 0.029). The predominant upper gastric locations (P = 0.0002), lower number of LNM (P = 0.003), and better overall survival rate (P = 0.04) were significantly correlated in the AGCLS with LNM patients compared with the advanced non-GCLS with LNM patients. For survival analyses, surgical procedure, tumor location, and numbers of positive LNM were adjusted by 1:1 propensity score matching. After adjustment, the overall survival rate was significantly higher in the AGCLS group than in the advanced non-GCLS group (P = 0.03). CONCLUSION: AGCLS has distinct clinicopathological features and clinical behavior that are similar to those of early GCLS. AGCLS with LNM patients showed a significantly lower number of LNM and a better survival rate than advanced non-GCLS with LNM patients. To our knowledge, this study is the first report to describe the clinicopathological features of AGCLS.

[Efficacy of Palliative Radiotherapy in Hemorrhage Control in Patients with Unresectable Gastric Cancer].

We report the case of an 80-year-old man with unresectable, advanced gastric cancer and pulmonary cancer because of multiple liver metastases. The serum hemoglobin level declined to 5.3 g/dL during fourth-line chemotherapy. Radiation therapy of 30 Gy was administered in 10 fractions. After radiation treatment was completed, the serum hemoglobin level increased to 8.5g/dL. No new adverse event was observed. Subsequently, the progression of anemia stopped, and oral intake became possible. Thus, palliative radiation therapy is useful for hemorrhage control in unresectable, advanced gastric cancer patients with a poor general condition and difficult surgical treatment.

[A Case of Goblet Cell Carcinoid].

The patient was a 26-year-old female who had undergone conservative treatment for acute appendicitis at another clinic and was referred to our hospital for interval appendectomy. We performed a single-incision laparoscopic appendectomy, and the patient was diagnosed with goblet cell carcinoid(GCC)based on the postoperative pathological examination. Since GCC is considered a high-grade tumor, we performed a laparoscopic ileocolic resection with D3 lymphadenectomy. There was no residual disease or lymph node metastasis detected in the resected specimen. Patients with advanced GCC typically have poor prognosis, because GCC is characterized by peritoneal dissemination and lymph node metastasis. However, our findings suggested that an additional laparoscopic surgery could be one of the curative and safe treatment options for selected pa- tients with GCC.

[A Case of Local Remnant Esophageal Cancer after Chemotherapy Getting Complete Response by Radiotherapy].

This is a case of a 72-year-old woman who presented without anymajor complaint. An anemia was indicated during follow-up for diabetes at the internal medicine unit and an upper gastrointestinal endoscopy(GS)was performed. A type 2 tumor was detected in the middle thoracic esophagus and biopsyrevealed a squamous cell carcinoma. A tumor was detected in the middle thoracic esophagus bycervical thoracoabdominal computed tomography(CT)scan and no invasion of surrounding organs was noted. The lymph node 104R had enlarged significantlybut no distant metastasis was observed. The patient was diagnosed with advanced esophageal cancer, Mt, type 2, cT2N2M0, stage Ⅱ. For preoperative chemotherapy, CDDP plus 5-FU(FP)therapywas administered. Lung metastasis was found on CT examination and surgical resection was not indicated. Hence, 4 courses of docetaxel plus CDDP plus 5-FU(DCF)therapywere administered. Following treatment, lung and lymph node metastases disappeared on the image. However, the main tumor remained at the GS. Radiotherapy was administered as a local additional treatment. Thereafter, GS showed mucous membrane redness and white spots of the lesion. Biopsyfrom the same site showed no malignant findings. The patient has remained malignancy-free since 18 months.

[Administering Ramucirumab Safely after Inserting an Intestinal Stent, Due to Peritoneal Metastasis of Gastric Cancer-A Case Report].

The recent phase Ⅲ trials REGARD and RAINBOW have shown survival benefits and acceptable safetyprofiles of ramucirumab( RAM)alone and RAM plus paclitaxel. Based on this result, RAM is recommended as a secondarytreatment for advanced and recurrent gastric cancer bythe Japanese Gastric Cancer Association. Although the frequencyis not high, gastrointestinal perforation has been reported as a serious side effect. RAM is a human anti-vascular endothelial growth factor receptor 2(VEGFR-2)monoclonal antibodythat acts on vascular endothelial cells to inhibit angiogenesis. The detailed mechanism has not been elucidated, but it is thought that the ischemic state and delayed wound healing due to the inhibition of vascular endothelial growth factors could be the cause of perforation. Thus, the usage of angiogenesis inhibitors such as RAM while intestinal stents are placed, mayincrease the risk of gastrointestinal perforation. We report a case in which RAM was administrated with no adverse events after multiple gastrointestinal metal stents being inserted.

[Spontaneous Disappearance of Undifferentiated Pleomorphic Primary Mesenteric Sarcoma-A Case Report].

The patient was a 49-year-old man with persistent fever since the introduction of hemodialysis(HD). Vomiting and abdominal swelling appeared 4 months after initiating hemodialysis. Computed tomography(CT)scan revealed a tumor measuring 9 cm, and disorders of passage from the jejunum. Surgery was performed, and resection was impossible because of peritoneal dissemination. Histopathological examination of the disseminated nodes suggested an undifferentiated pleomorphic sarcoma. Postoperatively, drainage from the gastric fistula was approximately 2,000mL/day. Chemotherapy was considered impossible because of HD, and palliative therapy was selected. However, the volume of drainage from the gastric fistula gradually decreased, and the disorders of passage reduced. CT scan confirmed marked reduction in the size of the intraperitoneal tumor and its subsequent disappearance. At the 2-year-and-5-month postoperative follow-up, no relapses were observed, and the course had been uneventful. Undifferentiated pleomorphic sarcomas develop in the soft tissue of adults and have a poor prognosis. However, mesenteric development is rare. Total tumorectomy is the first choice of treatment. A consensus on the usefulness of chemotherapy or radiotherapy has not been reached. Furthermore, no studies have reported spontaneous tumor disappearance in the absence of treatment. Here, we report a case of minor undifferentiated primary mesenteric sarcoma and its spontaneous disappearance and review the literature.

[A Case of Robot-Assisted Laparoscopic Lower Anterior Resection and Total Hysterectomy with Transvaginal NOSE].

Natural orifice specimen extraction(NOSE)can be considered a minimally invasive treatment method. We performed robotassisted laparoscopic lower anterior resection and total hysterectomy with transvaginal NOSE. The patient was a 44-year-old woman. When she underwent CS in the blood in 2017, the rectal Rs had a mass-like lesion. On pathological examination, sarcoma from the endometrial stroma was suspected, and an operation was planned. The surgical findings included the following: The camera port was inserted 4 cm from the navel, the first arm on the right side at the same height, the second arm on the left, the third arm in the lower left abdomen, and the 12mm port in the lower right abdomen. First, the uterus was removed, the vagina was opened, and the uterus was removed. Vacuum was maintained, and the operation for the anterior resection was performed without changing the arrangement of the arms. The IMAwas treated; the descending colon was also sufficiently peeled for NOSE surgery, and then the lower rectum was peeled until the levator muscle was exposed to secure the AW. The inter-rectal membrane was treated to secure the AW. The intestinal tract was induced from the vaginal stump, the anvil head of ILS 29 was inserted, and anal anastomosis was performed again by insufflation. The vaginal stump was closed with continuous sutures and covered with the bladder peritoneum.

Intraoperative diagnosis of lymph node metastasis by transcription-reverse transcription concerted reaction assay in gastric cancer.

BACKGROUND: Increasing evidence has been accumulated to substantiate the clinical usefulness of quantitative evaluation of gene expression. This study was undertaken to assess diagnosis of metastasis in dissected lymph nodes through quantitative evaluation of the expression of carcinoembryonic antigen mRNA (CEA mRNA) by a rapid, simple transcription-reverse transcription concerted reaction (TRC) assay using dissected lymph node washings. METHODS: A total of 110 dissected lymph nodes from 40 patients undergoing surgery for gastric cancer were studied. Each dissected lymph node was cut crosswise and washed with physiological saline. The washings were assayed for CEA mRNA and the assay results were assessed in comparison with the pathological diagnosis [hematoxylin and eosin (H&E) staining]. All lymph nodes were also subjected to immunostaining for cytokeratin (CK staining) and assessed comparatively. RESULTS: By H&E staining, 29 lymph nodes were found to be positive and 81 to be negative for metastasis. By TRC assay, 38 lymph nodes were found to be positive and 72 to be negative. According to the results of CK staining, there were 37 metastasis-positive lymph nodes and 73 negative nodes. The sensitivity and specificity of H&E staining relative to those of CK staining were 78.4 and 100 %, respectively, while the sensitivity and specificity of TRC assay relative to those of CK staining were 91.9 and 94.5 %, respectively. CONCLUSIONS: The TRC assay method using lymph node washings is a rapid, simple genetic diagnosis with greater sensitivity than conventional diagnosis by H&E staining of permanent specimens, and enables conservation of lymph nodes in toto as permanent specimens. This TRC method would enable rapid diagnosis even in town hospitals where no pathologist is ordinarily stationed, and is considered to contribute to the clinical application of the sentinel node theory of gastric cancer treatment.

Usefulness of the TRC method in the peritoneal washing cytology for gastric cancer.

BACKGROUND: Peritoneal dissemination from gastric cancer is the most frequent metastasis of advanced gastric cancer. Detection of cancer micrometastasis is required for improvement of cancer therapy. A method that can detect micrometastases more sensitively is desired. Against this background, for the purposes of making the genetic diagnosis of micrometastasis simple and rapid, TRC (transcription reverse transcription concerted reaction) was developed. METHODOLOGY: 69 patients with gastric cancer in those diagnosed with deeper than mp. At the time of surgery, peritoneal washing with saline was extracted. Having extracted the RNA therein, It was blended with a reagent responsive to CEAmRNA and was put into TRC. The cytology and TRC were compared and studied. RESULTS: The concordance rate between TRC and cytology was K=0.6552. The patients whom there was a discrepancy between the cytology and TRC are clinically validate the TRC results. In the study of prognosis, TRC obtained a sensitivity of 90.9% and a specificity of 98.3%. CONCLUSION: The measurement of CEAmRNA in peritoneal washing specimens by the TRC method is superior to Cytology. That is also equal to or superior to the RT-PCR method with respect to sensitivity and specificity, and superior with respect to simplicity and rapidity.

Analysis of the mRNA expression levels of thymidylate synthase (TS), dihydropyrimidine dehydrogenase (DPD) and orotate phosphoribosyl transferase (OPRT) in liver metastases from colorectal cancer.

BACKGROUND/AIMS: We measured the mRNA expression levels of thymidylate synthase (TS), dihydropyrimidine dehydrogenase (DPD) and orotate phosphoribosyl transferase (OPRT) in liver metastases from colorectal cancer and retrospectively analyzed their association with other clinicopathological factors and the prognosis of these patients. METHODOLOGY: The study involved 55 patients of colorectal cancer with liver metastasis who underwent surgery at our department between February 1988 and April 2003. RESULTS: Analysis of the mRNA expression levels of each of the aforementioned enzymes in the liver metastases revealed no significant differences in the mRNA expression levels of the enzymes depending on the timing of development of the liver metastasis, histological type of the cancer, or the patient gender. In the analysis of the survival period, no association was observed between the survival prognosis and the mRNA expression level of DPD or OPRT in the liver metastases; on the other hand, the prognosis was better in the group showing low TS mRNA expression (median survival period: 3.77 years) than in the group showing high TS mRNA expression (median survival period: 2.39 years) (p=0.0134). CONCLUSIONS: These results suggest that the mRNA expression level of TS in the liver metastases in colorectal cancer patients is a useful prognostic indicator.

Clinical outcome of esophagogastrostomy after proximal gastrectomy for gastric cancer.

BACKGROUND/AIMS: In order to prevent reflux esophagitis after proximal gastrectomy, reconstruction by jejunal interposition (EJ) is often performed; however, this procedure is considered to be extremely complex. The purpose of this research is to consider the indication and usefulness of esophagogastrostomy (EG), as a less-invasive method of reconstruction. METHODOLOGY: From 1999, 64 proximal gastrectomy cases have been reviewed. In 46 cases, EG combined with a reflux prevention procedure was performed while in the remaining 18 cases, EJ was performed. An endoscopic examination was conducted 1 year after surgery in all cases. RESULTS: Compared to EJ, EG required less surgical time, thus resulting in less blood loss. Reflux esophagitis was frequently present in the EG cases (22 vs. 11%). In the EG group, 36 cases involving abdominal esophagus (AE) conservation due to the site of the cancer in comparison to the resection group (10), experienced a lower probability of reflux esophagitis (5.6 vs. 60%) and endoscopic examinations showed a lower severity (Grade B,C,D; 0 vs. 50%). CONCLUSIONS: EG combined with a reflux prevention procedure is simple and less invasive. In cases in which the conservation of AE is possible, less reflux esophagitis is observed and EG is therefore recommended as an appropriate reconstruction method.

Status of tissue expression and serum levels of HER2 in gastric cancer patients in Japan.

BACKGROUND: The incidence of HER2 expression in gastric cancer varies among previous studies. Furthermore, serum HER2 levels have not been well studied in patients with gastric cancer. METHODOLOGY: Cancerous gastric tissue was analyzed by immunohistochemistry (IHC) to give an IHC score (IHC0, 1+, 2+ or 3) for HER2 expression. Fluorescence in situ hybridization (FISH) was performed to examine HER2 gene expression in IHC2+ cases. Levels of HER2 in serum collected before surgery were determined by chemiluminescent enzyme immunoassay. RESULTS: Subjects were 105 gastric cancer patients who underwent surgical resection. Tissue expression of HER2 was positive (IHC3+, or IHC2+ plus FISH+) in 6.7% of patients (7/105). All HER2-positive tumors were highly differentiated. Mean serum HER2 level was 8.7±2.1 ng/dl in patients with primary gastric cancer. The mean serum HER2 level in the highly differentiated cancer group was 9.2±2.1 ng/dl, which was significantly higher than that (8.1±1.9 ng/dl) in the poorly differentiated group. CONCLUSION: Tissue expression of HER2 was found in 6.7% of examined Japanese gastric cancer patients, and all HER2-positive tumors were highly differentiated. Serum HER2 levels were significantly higher in patients with highly differentiated cancer, in good agreement with the higher tissue expression of HER2 in highly differentiated cancer.

[Discharge planning in which a discharge planning nurse was involved in the choice of nutrition management for an elderly person with dementia].

A discharge planning nurse at an acute care hospital conducted discharge planning for an elderly person with dementia who is in his/her 90s and his/her family. The nurse was involved in the choice of nutrition management method and was able to support the family's decision-making. The family had high expectations for oral ingestion, and there was disparity between those expectations and the actual state of the disease, in which aspiration occurred frequently. The nurse respected the family's wishes, but also helped the family to correctly understand the state of the disease and to make satisfactory choices about future daily life. In order to guarantee safety, the discharge planning nurse held a conference with people related to homecare, such as the home-visiting physician, the home-visiting nurse, and the care manager. As a result of the conference, that family was able to feel satisfied with and choose gastrostomy as the nutrition method. The current situation was better understood because information was shared with the community, and the confidence in the community was strengthened by giving consideration to the family's burden. It was reconfirmed that the cooperation of local staff members is useful in discharge planning.

Postoperative relative decrease in skeletal muscle mass as a predictor of quality of life in patients with gastric cancer.

Low skeletal muscle mass reflects poor nutritional condition, which may impair the functional status and quality of life (QOL) of survivors of gastrectomy. The present cross-sectional study examined the association between a relative change in skeletal muscle mass and perceived postoperative health and QOL in patients with gastric cancer. The study comprised 74 patients (48 men and 26 women; median age, 68.5 years) who underwent surgery for stage I-III gastric cancer. Outcomes were measured using the Postgastrectomy Syndrome Assessment Scale-45, which was specifically developed to measure post-gastrectomy symptoms, living status, dissatisfaction with daily life and generic QOL. The skeletal muscle mass index (SMI) was estimated using computed tomography by tracing the area of the psoas major muscle to calculate the ΔSMI, defined as: (SMI before surgery-SMI at completion of the PGSAS-45 survey)/SMI before surgery x100. Associations between ΔSMI and health outcomes were assessed using univariate and multivariate analyses. The mean ΔSMI (SD) was 8.64% (10.6%). The effect size (Cohen's d) of ΔSMI <10% compared with ΔSMI ≥10% was 0.50 (95% CI: 0.02 to 0.97) for total symptom scores, -0.51 (-0.98 to -0.03) for general health, and -0.52 (-0.99 to -0.05) for the physical component summary (PCS). Multiple regression analysis showed that ΔSMI was significantly associated with PCS decline, and its standardized regression coefficient was -0.447 (-0.209 to -0.685). Determining ΔSMI may help clinicians to facilitate the objective evaluation of low skeletal mass, which reflects poor nutritional condition that can impair functional status and QOL of postoperative patients surviving gastrectomy.

Current status of gastrectomy and reconstruction types for patients with proximal gastric cancer in Japan.

BACKGROUND: Surgical procedures for proximal gastric cancer remain a highly debated topic. Total gastrectomy (TG) is widely accepted as a standard radical surgery. However, subtotal esophagectomy, proximal gastrectomy (PG) or even subtotal gastrectomy, when a small upper portion of the stomach can technically be preserved, are alternatives in current clinical practice. METHODS: Using a cohort of the PGSAS NEXT trial, consisting of 1909 patients responding to a questionnaire sent to 70 institutions between July 2018 and December 2019, gastrectomy type, reconstruction method, and furthermore the remnant stomach size and the anti-reflux procedures for PG were evaluated. RESULTS: TG was the procedure most commonly performed (63.0%), followed by PG (33.4%). Roux-en-Y was preferentially employed following TG irrespective of esophageal tumor invasion, while jejunal pouch was adopted in 8.5% of cases with an abdominal esophageal stump. Esophagogastrostomy was most commonly selected after PG, followed by the double-tract method. The former was preferentially employed for larger remnant stomachs (≧3/4), while being used slightly less often for tumors with as compared to those without esophageal invasion in cases with a remnant stomach 2/3 the size of the original stomach. Application of the double-tract method gradually increased as the remnant stomach size decreased. Anti-reflux procedures following esophagogastrostomy varied markedly. CONCLUSIONS: TG is the mainstream and PG remains an alternative in current Japanese clinical practice for proximal gastric cancer. Remnant stomach size and esophageal stump location appear to influence the choice of reconstruction method following PG.

Effects of emptying function of remaining stomach on QOL in postgastrectomy patients.

BACKGROUND: Attention has recently focused on decreased quality of life (QOL) that occurs in postgastrectomy patients. We verified how gastric emptying function affected QOL. METHODS: Subjects were 72 consecutive patients after gastrectomy for cancer, including 25 after distal gastrectomy (DG), 18 after proximal gastrectomy (PG), 16 after pylorus-preserving gastrectomy (PpG), and 13 after total gastrectomy (TG). Using the (13)C breath test method, (13)CO(2) levels in breath were measured over 2 h, and T (max) was determined. Questionnaires (Japanese versions of the Short-Form 36 [SF-36] and Gastrointestinal Symptom Rating Scale [GSRS]) were used to analyze QOL and correlations between questionnaire results and T (max). RESULTS: Mean T (max) (min) for each procedure was 15.4 for DG, 21.1 for PG, 41.3 for PpG, and 10.4 for TG. T (max) differed between procedures, but not between survey periods. SF-36 was not correlated with T (max), whereas GSRS showed a difference in diarrhea and total score between procedures, but not between survey periods. In addition, GSRS correlated with T (max) for abdominal pain, indigestion, and total score. The total scores showed a significant symptom aggregation in patients with T (max) less than 21 min. CONCLUSIONS: Gastrointestinal symptoms in postgastrectomy patients were associated with the function of the remaining stomach. The (13)C breath test is useful for objectively assessing such symptoms.

Granular cell tumors: a report of six cases.

Granular cell tumor is a soft tissue neoplasm that originates in the nervous system and arises at virtually any body site, but is mainly found in the skin, oral cavity or digestive tract. Most are benign and reportedly malignant cases are rare, occurring in only 1% or 2% of cases. We report on our findings in six patients who developed granular cell tumor in the mammary gland, esophagus, subcutaneous tissue and muscle. Of six patients, two had granular cell tumor located in the breast, two in the submucosa of the esophagus, and the other two under the skin of the left axillary cavity and in the right latissimus dorsi muscle, respectively. One of the two patients with tumor in the submucosa of the esophagus also had esophageal cancer. Patients' age ranged from 41 to 70 years (average, 59.1 years). Two patients with tumor in the submucosa of the esophagus were men, and the others were women. All of them were given a diagnosis of granular cell tumor by tissue biopsy and examination of excised specimens, but no evidence of malignancy was found. No recurrence has been noted in the patients who underwent surgical tumor removal.

Detection of sentinel nodes in gastric cancer by indocyanine green fluorescence imaging.

BACKGROUND/AIMS: The sentinel nodes (SN) are the first nodes to receive lymphatic drainage from a primary tumor. The SN concept is useful to avoid unnecessary resection in gastric cancer. Indocyanine green (ICG) fluorescence imaging is a new method for detecting SN and we herein examined the usefulness of this technology. METHODOLOGY: The subjects comprised 39 cT1-2N0 gastric cancer patients who underwent standard surgery from 2006 to 2009. 0.8 mL ICG (1%) was injected into the submucosa around the tumor two days preoperatively (Preop group) or intraoperatively (Intraop group) by endoscopy. SN were postoperatively identified by fluorescence imaging and the accuracy of this method compared to the dye method was investigated for 76 patients treated from 2000-2004. RESULTS: SN was detected as fluorescence-positive nodes (FN) and the mean FN number was 9.3±6.4. The specificity was 100% and all metastatic lymph nodes were detected as FN in three patients. The mean number of FNs was 7.2 in the preop group and 12.5 in the postop group (p=0.032).The FN method was associated with a low false negative rate, same as the dye method. CONCLUSIONS: SN mapping using ICG fluorescence imaging has high accuracy and this compound can be injected preoperatively to detect SN.

[The feasibility of oral fluoropyrimidines as adjuvant chemotherapy after resection and local coagulation therapy of colorectal liver metastases].

OBJECTIVE: To evaluate the feasibility of oral fluoropyrimidines after resection and microwave coagulation(MCT), or radiofrequency ablation(RFA)of liver metastases from colorectal cancer. PATIENTS AND METHODS: Background factors, fluoropyrimidine administration(S-1 or UFT/LV), and adverse events were analyzed in 20 patients(17 males, 3 females; an average of 62. 4 years)with colorectal liver metastases after resection and RFA or MCT. RESULTS: The synchronous: metachronous metastases ratio was 13:7. Fifteen patients received the recommended dose and 5 received a reduced dose. S-1 was administered for 4 weeks followed by a 2-week rest for 7 patients, and for 2 weeks followed by a 1-week rest for 9 patients. UFT/LV was administered for 4 weeks followed by a 1-week rest for 4 patients. Fourteen patients(70%)had adverse events. One patient showed grade 3 leukocyte toxicity while other patients showed grade 1 or 2. Two patients discontinued chemotherapy because of grade 2 delirium and grade 2 CPK elevation; another 2 discontinued voluntarily. Eight patients with recurrence changed the rugs, while 8 of 12(67%)continued for 1 year. Median disease-free and med ian overall survival lengths were 16. 1 and 4 7. 6 months, respectively. CONCLUSION: S-1 and UFT /LV were used safely as adjuvant chemotherapies after the resection and local coagulation therapy of liver metastases.