Impact of chest subcutaneous fat on the occurrence of central venous port-related infectious complications in cancer patients.

PURPOSE: There is no concrete evidence to support the association between the amount of subcutaneous fat area (SFA) in the central venous port-insertion site (precordium) and port-related complications. We aimed to investigate the relationship between SFA in the midclavicular line and postoperative infectious complications in patients undergoing port-insertion surgery. METHODS: This was a single-institute and historical cohort study of 174 patients who underwent first central venous port implantation surgery for chemotherapy between January 2014 and December 2018. SFA in the midclavicular line was measured using preoperative computed tomography scans. The patients were divided into three groups according to SFA amount tertiles, and we investigated the association of SFA with infectious and all-cause complication events within 1 year. RESULTS: Within a median follow-up of 306 days, the patients with intermediate SFA had significantly higher infection-free survival than those with low and high SFA (low vs. intermediate vs. high: 80.4% vs. 97.7% vs. 83.4%, respectively, p=0.034). In contrast, there was no significant difference in the overall complication-free survival among the groups (low vs. intermediate vs. high: 80.4% vs. 88.9% vs. 81.8%, respectively, p=0.29). Low SFA was independently associated with high risk of infectious complications (hazard ratio, 9.45; 95% confidence interval, 1.07-83.22, p=0.043). CONCLUSION: Low SFA in the midclavicular line was an independent risk factor for infectious complications in the chemotherapy setting. This practical indicator can be useful for optimizing patients' nutritional status and when considering other types of vascular access to support administration of intravenous chemotherapy.

Preoperative Magnetic Resonance Cholangiopancreatography for Detecting Difficult Laparoscopic Cholecystectomy in Acute Cholecystitis.

Previous studies have shown that signal intensity variations in the gallbladder wall on magnetic resonance imaging (MRI) are associated with necrosis and fibrosis in the gallbladder of acute cholecystitis (AC). However, the association between MRI findings and operative outcomes remains unclear. We retrospectively identified 321 patients who underwent preoperative magnetic resonance cholangiopancreatography (MRCP) and early laparoscopic cholecystectomy (LC) for AC. Based on the gallbladder wall signal intensity on MRI, these patients were divided into high signal intensity (HSI), intermediate signal intensity (ISI), and low signal intensity (LSI) groups. Comparisons of bailout procedure rates (open conversion and laparoscopic subtotal cholecystectomy) and operating times were performed. The recorded bailout procedure rates were 6.8% (7/103 cases), 26.7% (31/116 cases), and 40.2% (41/102 cases), and the median operating times were 95, 110, and 138 minutes in the HSI, ISI, and LSI groups, respectively (both p < 0.001). During the multivariate analysis, the LSI of the gallbladder wall was an independent predictor of both the bailout procedure (odds ratio [OR] 5.30; 95% CI 2.11-13.30; p < 0.001) and prolonged surgery (≥144 min) (OR 6.10, 95% CI 2.74-13.60, p < 0.001). Preoperative MRCP/MRI assessment could be a novel method for predicting surgical difficulty during LC for AC.

Successful weaning from veno-arterial ECMO and Impella2.5 by veno-venous and arterial ECMO (v-ECPELLA) for a patient with acute myocardial infarction complicated by severe lung injury.

The Impella™ (Abiomed, Danvers, MA, USA) is a percutaneous left ventricular assist device and is concurrently used with veno-arterial extracorporeal membrane oxygenation (VA ECMO). However, concomitantly using these two devices makes identifying the mixed zone of two opposite blood flows difficult. We report the case of an 80-year-old man with ST-elevation myocardial infarction and cardiopulmonary arrest. Emergent coronary angiography showed 99% stenosis in the left main trunk. A drug-eluting stent was placed under support of VA ECMO and the Impella2.5 for cardiogenic shock. During this support, antegrade deoxygenated blood enhanced by the Impella was sent to the right radial artery. Inadequate oxygenated blood was delivered through the native lung, which was damaged by cardiopulmonary resuscitation. We decided to convert to veno-venous and arterial ECMO (V-VA ECMO) using additional venous cannulation as drainage. Returned oxygenated blood was sent to the inferior vena cava and femoral artery bilaterally for maintaining oxygenation in the pulmonary artery. In V-VA ECMO and the Impella (v-ECPELLA), we attempted weaning from VA ECMO by only clamping VA cannulation and switching to veno-venous ECMO. We restored the setting to VA ECMO after assessment of the systemic circulation. We successfully managed and weaned our patient from simultaneous use of VA ECMO and the Impella2.5 by using v-ECPELLA. .

A case of a jejunal gastrointestinal stromal tumor with significantly elevated CA19-9 levels.

INTRODUCTION: A gastrointestinal stromal tumor (GIST) with an elevated serum tumor marker level is very rare. We report a case of jejunal GIST associated with extremely elevated levels of serum carbohydrate antigen 19-9 (CA19-9). PRESENTATION OF CASE: A 61-year-old woman was referred to our hospital for examination of an abdominal tumor. Laboratory tests revealed extremely elevated CA19-9 levels (13,498 U/mL). Enhanced abdominal computed tomography demonstrated a well-enhanced, round 40 mm tumor. The patient underwent a jejunectomy and lymph node dissection. Based on the postoperative pathological findings, the tumor was diagnosed as a GIST. Microscopically, a solid region of the resected tumor showed negative staining for CA19-9. The serum CA19-9 level drastically decreased postoperatively. DISCUSSION: Increased proliferation of epithelial cells secondary to inflammation and ulceration of epithelia may lead to increased secretion and accumulation of CA19-9, which is consequently released into the blood circulation. CONCLUSION: In cases of GIST, an isolated increase of serum CA19-9 is extremely rare; but they are not necessarily associated with malignant transformation.

Total proctocolectomy with end ileostomy for acute onset of ulcerative colitis during chemoradiotherapy for lung adenocarcinoma (successfully treated by surgery): a case report.

BACKGROUND: Ulcerative colitis (UC) developing during chemotherapy is very rare. Here, we describe a case of acute onset during chemoradiotherapy for lung adenocarcinoma, requiring a total proctocolectomy. CASE PRESENTATION: A 52-year-old man was admitted to the hospital for chemoradiotherapy of lung cancer. He had no obvious history of gastrointestinal diseases, and concurrent chemoradiotherapy was initiated. Thirteen days after 2 cycles of cisplatin and vinorelbine, he experienced persistent hematochezia. Findings of the colonoscopy revealed edematous thickening from the rectum to the transverse colon, suggesting UC, drug-induced colitis, or infectious colitis. Results from bacterial culture were negative for Clostridium difficile and methicillin-resistant Staphylococcus aureus (MRSA). Immunohistological staining for cytomegalovirus was also negative. Although he was clinically diagnosed with UC and treated with intravenous glucocorticoid, his symptoms gradually worsened and an abdominal X-ray revealed megacolon. Thirty-five days after conservative therapy, a total proctocolectomy with end permanent ileostomy was performed. Based on pathological findings and clinical course, he was diagnosed with UC. CONCLUSION: Although the pathogenesis of UC during chemotherapy has been unknown, chemotherapy could be one of the causes of UC in this case. UC should be included in the differential diagnosis in patients with progressive colitis during chemotherapy.

An Observational Study of Team Management Approach for CapeOX Therapy in Patients with Advanced and Recurrent Colorectal Cancer: SMILE Study (The Study of Metastatic colorectal cancer to investigate the Impact of Learning Effect).

OBJECTIVES: In recent years, CapeOX therapy for patients with colorectal cancer is widely used. We previously reported that a multidisciplinary approach decreases the worsening of adverse events and increases patient satisfaction. In this study, we conducted a multicenter, prospective, observational study to evaluate the incidence of adverse events, health-related quality of life (HRQOL) of the patient, and efficacy of a management (intervention) according to the support system (SMILE study). METHODS: As the interventional method, the following more than one method was carried out in each institute, 1: support with telephone, 2: dosing instruction by a pharmacist, 3: skin care instruction by a nurse, and 4: patient instruction by a doctor. The primary endpoint was the incidence of hand-foot syndrome (HFS) of more than grade 2. The secondary endpoint was the HRQOL evaluation and efficacy. The questionnaire (HADS) was administered before the start of the chemotherapy and in 1, 2, 4, 5, and 8 courses to evaluate quality of life (QOL). RESULTS: From April 2011 to September 2012, 80 patients were enrolled from 14 sites, and all patients were the subjects of analysis. The demographic background was as follows: man/woman: 46/34, age median: 63 (36-75), and management interventional method 1/2/3/4: 36/68/73/78. The overall percentage of HFS that exceeded grade 2 within 6 months was 16.3%. It was 11.1% with the telephone support group and 20.5% without the telephone support group (p = 0.26). CONCLUSIONS: A multi-professional telephone support may reduce the deterioration of HFS. Further study which includes larger cohort is needed in the future.

An Embedded, Multi-Modal Sensor System for Scalable Robotic and Prosthetic Hand Fingers.

Grasping and manipulation with anthropomorphic robotic and prosthetic hands presents a scientific challenge regarding mechanical design, sensor system, and control. Apart from the mechanical design of such hands, embedding sensors needed for closed-loop control of grasping tasks remains a hard problem due to limited space and required high level of integration of different components. In this paper we present a scalable design model of artificial fingers, which combines mechanical design and embedded electronics with a sophisticated multi-modal sensor system consisting of sensors for sensing normal and shear force, distance, acceleration, temperature, and joint angles. The design is fully parametric, allowing automated scaling of the fingers to arbitrary dimensions in the human hand spectrum. To this end, the electronic parts are composed of interchangeable modules that facilitate the mechanical scaling of the fingers and are fully enclosed by the mechanical parts of the finger. The resulting design model allows deriving freely scalable and multimodally sensorised fingers for robotic and prosthetic hands. Four physical demonstrators are assembled and tested to evaluate the approach.

Intraductal dissemination of ampullary carcinoma after pancreatoduodenectomy.

BACKGROUND: Clinical evidence of intraductal dissemination through the pancreatic duct has been rare. We herein describe a case of ampullary carcinoma that disseminated in the remnant pancreas through the pancreatic duct. CASE PRESENTATION: A 68-year-old woman underwent SSPPD for ampullary carcinoma. The tumor was diagnosed as adenocarcinoma without lymph node metastasis (T2N0M0, stage IB). Computed tomography (CT) performed 3 years later revealed a 14-mm tumor near the site of the pancreaticojejunal anastomosis. Endoscopic ultrasound-guided fine needle aspiration showed adenocarcinoma that was morphologically similar to the specimen from the first surgery. We diagnosed recurrence of ampullary carcinoma in the remnant pancreas. A total remnant pancreatectomy was performed. We found a white solid tumor at the 20-mm distal side of pancreaticojejunal anastomosis. The tumor was morphologically similar and immunostaining showed a pattern identical to that of the original tumor, suggesting that the two tumors were of the same origin. CONCLUSION: The recurrent lesion was most likely the result of tumor cells leaving the tumor and implanting in the remnant pancreatic duct epithelium. Intraductal dissemination of adenocarcinoma is thought to be a cause of remnant recurrence after SSPPD in cases of obstruction of the pancreatic duct or an iatrogenic procedure.

Laparoscopic surgery of a presacral epidermoid cyst: A case report.

INTRODUCTION: The best approach for resecting epidermoid cysts is still controversial. We describe a case of an epidermoid cyst in which laparoscopic resection was performed successfully. PRESENTATION OF CASE: 63 × 55-mm well-defined cystic mass was incidentally detected by computed tomography in the presacral cavity of a 50-year-old woman during evaluation for upper abdominal pain. Magnetic resonance imaging showed a cystic tumor with a low signal intensity on T1-weighted images and, high signal on T2-weighted images in the left dorsal side of the rectum. This tumor was diagnosed as a developmental cyst, and laparoscopic resection was performed. Resection of the tumor was performed with negative margins. This tumor was histopathologically diagnosed as an epidermoid cyst. There was no evidence of malignancy, and no postoperative event or signs of recurrence occurred 6 months postoperatively. DISCUSSION: In our patient, there was no difficulty in the field of view and forceps operability during laparoscopic surgery. Furthermore, it is possible to perform laparoscopic surgery with minimal damage to the muscles, nerves, and rectum, leading to the preservation of anal function. CONCLUSION: Laparoscopic resection of an epidermoid cyst may be a better option in carefully selected cases with consideration of the tumor size and location.

Evaluation of Hepatic Resection in Liver Metastasis of Gastric Cancer.

Gastric cancer is the second most common malignancy globally and the third most common cause of cancer-related deaths in Japan. In gastric cancer, benefit of surgical resection of liver metastasis, which was shown in colorectal cancer, is not well established. The present study aimed to examine the feasibility of hepatic resection for liver metastasis of gastric cancer. In this retrospective study, we reviewed the medical records of 10 patients with liver-only metastases of gastric cancer who underwent hepatectomy among 2043 patients with gastric cancer who underwent gastric resection between January and December 2016 at a single institution in Japan. Median 1-, 3-, and 5-year overall survival (OS) rates were 78.0%, 33.3%, and 22.2%, respectively, among 10 patients who underwent hepatic resection. There was a significant difference in OS rates between tumors measuring ≥ 5 cm and < 5 cm (hazard ratio [HR] 6.524, 95% confidence interval [CI] 1.145-37.171, p = 0.035). The longest survival was 205 months for one patient who was alive at the time of the analysis. Hepatic resection of liver metastasis in gastric cancer was associated with long-term survival in some patients. Additionally, primary tumor size was associated with long-term survival.

Efficacy of biolimus A9-eluting stent for treatment of right coronary ostial lesion with intravascular ultrasound guidance: a multi-center registry.

The aim of this study was to assess the efficacy of a biolimus A9-eluting stent in patients with a right coronary artery (RCA) ostial lesion. Ostial lesions of the RCA have been a limitation of percutaneous coronary intervention even in the drug-eluting stent (DES) era. However, clinical outcomes after the deployment of a second generation DES to an RCA ostial lesion with intravascular ultrasound (IVUS) guidance have not been fully elucidated. From September 2011 to March 2013, 74 patients were enrolled in 17 centers from Japan. RCA ostial lesion was defined as de novo significant stenotic lesion located within 15 mm from ostium. IVUS was used for all cases to confirm the location of ostium and evaluate stent coverage of ostium. Patients with hemodialysis were excluded. The primary endpoint is a major adverse cardiac event (MACE) at 1 year. Forty two percent of patients had multi-vessel disease. Angiographically severe calcification was observed in 26% of the lesions. The mean stent diameter was 3.3 ± 0.3 mm (3.5 mm, 72%, 3.0 mm, 25%, and 2.75 and 2.5 mm, 3%), stent length was 17.5 ± 5.8 mm, and dilatation pressure of stenting was 15.6 ± 4.1 atm. RCA ostium was covered by stent in all lesions in IVUS findings. Post dilatation was performed for 64% of lesions (balloon size 3.7 ± 0.6 mm). MACE rate at 1 year was 5.4% (target lesion revascularization 5.4%, myocardial infarction 1.2%, and no cardiac death). The biolimus A9-eluting stent for RCA ostial lesions with IVUS guidance showed favorable results at 1-year follow-up.

A case of gastric glomus tumor resection using laparoscopy endoscopy cooperative surgery (LECS).

INTRODUCTION: Gastric glomus tumors are rare submucosal mesenchymal tumors. Because gastric glomus tumors are submucosal tumors and resemble gastrointestinal stromal tumors (GISTs), preoperative diagnosis is difficult. We present a case of gastric glomus tumor that was removed by laparoscopy endoscopy cooperative surgery (LECS). CASE PRESENTATION: A 67-year-old female was taken to the emergency room at our hospital due to epigastric pain. An upper gastrointestinal endoscopy revealed a submucosal tumor (SMT) located in the lesser curvature of the upper body of the stomach. Endoscopic ultrasonography revealed an intraluminal hypoechoic tumor located in the third or fourth layer of the stomach wall. Contrast-enhanced computed tomography (CECT) of the abdomen showed a 20-mm, well-enhanced, intraluminal-type tumor located in the lesser curvature of the upper body of the stomach. Laparoscopy endoscopy cooperative surgery (LECS) was performed. Immunohistochemistry revealed the expression of smooth muscle actin and vimentin, but not of keratin, S-100 protein, C-kit, or CD34. The tumor was finally diagnosed as a gastric glomus tumor. CONCLUSION: Glomus tumors are rare submucosal tumors of the stomach, and they should be considered in the differential diagnosis of gastric submucosal tumors. LECS could be a less invasive and effective method for treatment of gastric glomus tumor.

Sewing needles in the abdominal cavity assumed to have been ingested and to have penetrated the GI tract 40 years ago: A case report.

A 60-year old woman had been hospitalized in a psychiatric hospital for 40 years for schizophrenia. An X-ray was performed when she fell, which showed needles in the abdominal field. After additional examinations and questioning, the patient was diagnosed with needles in the abdominal cavity, which were assumed to have been ingested and to have perforated the GI tract 40 years ago. They were removed by laparoscopic surgery. The needles were found in the omentum and near the left ovary. There were no inflammatory reactions around them. There have been previous reports about the removal of intra-abdominal foreign bodies, but foreign body reaction occurred in most of the reports. Our case had the longest period from ingestion of the foreign bodies to their removal. Laparoscopy and intraoperative fluoroscopy are useful for removing intra-abdominal foreign bodies because of their ability to help discriminate between structures and to navigate in real time.

The COMET Open-label Phase II Study of Neoadjuvant FOLFOX or XELOX Treatment Combined with Molecular Targeting Monoclonal Antibodies in Patients with Resectable Liver Metastasis of Colorectal Cancer.

BACKGROUND: Advantages of neoadjuvant chemotherapy combined with monoclonal antibodies for treating patients with resectable colorectal cancer liver metastasis (CLM) have not been established. The purpose of this study was to evaluate the efficacy and safety of oxaliplatin-based regimen (FOLFOX or XELOX) plus monoclonal antibodies (cetuximab or bevacizumab) treatment in patients with resectable CLM. METHODS: A single-arm, open-label, multicenter, phase II trial was conducted for patients aged ≥ 20 years with resectable and untreated CLM. Patients received preoperative FOLFOX (6 cycles) or XELOX (4 cycles). Cetuximab or bevacizumab was administered to patients with wild-type or mutated KRAS codons 12 and 13, respectively. The primary endpoint was progression-free survival (PFS). RESULTS: Between January 2010 and June 2012, 47 patients were enrolled from 12 institutions. Wild-type or mutant KRAS sequences were examined in 32 and 15 patients, respectively. Twenty-one (45 %) patients experienced Grades 3/4 adverse events, and 55 % of all patients responded to therapy. The sizes of tumors of patients in the wild-type KRAS group were significantly reduced compared with those of the mutant KRAS group. The overall rates of liver resection and postoperative morbidity were 83 and 14 %, respectively, and the median PFS was 15.6 months. The median PFS times of the KRAS wild-type and mutant groups were 22.5 months and 10.5 months, respectively. CONCLUSIONS: Neoadjuvant therapy using FOLFOX/XELOX combined with monoclonal antibodies did not improve PFS, although it was administered safely and had less adverse effects after liver resection.

[Surgical resection of a huge gastric gastrointestinal stromal tumor after preoperative adjuvant chemotherapy].

A 73-year-old man was referred to our hospital because of positive results on a fecal occult blood test. He had severe anemia, and abdominal computed tomography (CT) revealed a huge 18 × 11 cm tumor in the lower gastric corpus. Pathological analysis of a biopsy sample revealed a gastrointestinal stromal tumor (GIST). We improved the nutritional and physical statuses via total parenteral and enteral nutrition. At the same time, we initiated preoperative adjuvant chemotherapy with 300 mg/day of imatinib. After 4 weeks' of treatment, CT revealed a drastic reduction in the tumor size, regarded a partial response (PR). The patient underwent partial gastrectomy, distal pancreatectomy, and partial resection of the transverse colon. His postoperative course was uneventful. The patient received postoperative treatment with imatinib for 1 year, and remained recurrence free for 10 months after surgery.

Multicenter phase II study of modified FOLFOX6 as neoadjuvant chemotherapy for patients with unresectable liver-only metastases from colorectal cancer in Japan: ROOF study.

BACKGROUND: Neoadjuvant chemotherapy for unresectable colorectal liver metastases can reduce tumor size, which sometimes leads to curative resection. The aim of the present study was to identify and describe patients with initially unresectable liver-only metastases from colorectal cancer who obtained sufficient chemotherapeutic benefit that eventually lead to the removal of the metastatic diseases in the liver. METHODS: A phase II multicenter cooperative study was conducted in 38 medical institutions using modified FOLFOX6 (mFOLFOX6) as neoadjuvant chemotherapy from January 2008 to June 2009. Patients with liver-only metastases from colorectal cancer that was deemed not optimally resectable by liver surgeons received mFOLFOX6 as preoperative neoadjuvant chemotherapy for 6-8 cycles. Patients were reassessed for resectability after 6 cycles of mFOLFOX6. Surgery was carried out 3-6 weeks after chemotherapy. The primary endpoint was the rate of macroscopic curative surgery including liver resection. RESULTS: 36 patients (23 male/13 female, ECOG performance status 0-1) were enrolled. The median age of the patients was 62.5 years; 78% (28 patients) had 5 or more metastatic tumors, and 50% (18 patients) had metastatic tumors over 5 cm diameter. The mFOLFOX6 regimen was safety administered resulting in 18 partial responses (50%), 12 stable disease, and 4 progressive disease. There was no grade 3/4 neurotoxicity. Fourteen patients (38.9%) underwent surgery (R0: 13; R1: 1). Of these, thirteen patients (36.1%) underwent R0 surgery. CONCLUSIONS: Our data suggest that mFOLFOX6 has a high response rate in patients with liver-only metastases from colorectal cancer, allowing for R0 resection of liver metastases in a proportion of patients initially not judged to be optimally resectable.

Diagnostic usefulness of postexercise systolic blood pressure response for detection of coronary artery disease in patients with echocardiographic left ventricular hypertrophy.

BACKGROUND: Although exercise-induced electrocardiographic ST segment changes are used to detect coronary artery disease (CAD), their diagnostic value is markedly decreased in patients with left ventricular (LV) hypertrophy. There have been no reports concerning postexercise systolic blood pressure (SBP) response in patients with ultrasound echocardiographic (UCG) LV hypertrophy and CAD. METHODS: Sixty-six patients with both UCG-LV hypertrophy (LV mass index 134 g/m2 or greater for men or 110 g/m2 or greater for women) and positive ST depression of at least 0.1 mV during treadmill exercise testing were studied. Coronary cineangiograms showed normal coronary arteries in 19 patients (group 1) and significant CAD in 47 patients (group 2). The SBP ratio was calculated by dividing the SBP 3 min after exercise (3 min SBP) by the SBP at peak exercise (peak SBP). RESULTS: There were no significant differences between the two groups in LV mass index, SBP at rest, exercise duration, ST depression (at rest and exercise-induced) or 3 min SBP. However, the SBP ratio was significantly higher in group 2 compared with group 1 (0.87+/-0.11 versus 1.01+/-0.18; P=0.004). Analysis of relative cumulative frequency distributions revealed an SBP ratio of 0.92 as the cutoff point for distinguishing a UCG-LV hypertrophy patient with CAD from one without CAD. The sensitivity, specificity and accuracy with an SBP ratio of 0.92 and an ST segment depression of at least 0.1 mV on treadmill exercise testing for detecting CAD in patients with UCG-LV hypertrophy were 77%, 74% and 76%, respectively. CONCLUSION: These findings suggest that the ratio of early post-exercise SBP to peak exercise SBP may be diagnostically useful in detecting CAD in patients with positive ST depression during an exercise test and UCG-LV hypertrophy.

Effect of semifundoplication with subtotal gastrectomy for prevention of postoperative gastroesophageal reflux.

BACKGROUND: Postgastrectomy patients often experience reflux esophagitis and a compromised quality of life. We hypothesized that reconstructive methods with antireflux procedures at operation should prevent reflux esophagitis and improve the likelihood of a better quality of life in patients after distal gastrectomy for gastric carcinoma. Our antireflux procedure was a subdiaphragmatic semifundoplication. We aim to substantiate, with objective arguments, potential advantages of Billroth I simple reconstruction versus Billroth I with semifundoplication. STUDY DESIGN: This study evaluated 60 patients who had Billroth I reconstruction with semifundoplication (30 patients; F group) and simple Billroth I reconstruction (30 patients; B group) after distal gastrectomy for gastric cancer. Assessments were made preoperatively and 6 months or later after surgical intervention. Results of the procedure, clinical evaluation (reflux symptoms), and esophageal alkaline reflux by ambulatory 24-hour pH memory were satisfactory. RESULTS: Operative evaluation time and procedural complications did not differ significantly between the two gastrectomy groups. Reflux symptoms only occurred in 12 patients in the B group. Lower esophageal sphincter pressure of patients in the B group was significantly lower than that of patients in the F group and in preoperative states (p < 0.05). The mean appearance of alkaline esophageal reflux in the F group and the B group were 2.6% and 13.6%, respectively (p < 0.01). Patients with semifundoplication had a significantly better quality of life and less physiologic regurgitation than patients with simple Billroth I. CONCLUSIONS: This study demonstrated that Billroth I reconstruction with semifundoplication for gastric cancer is not only effective for patients with a postoperative life expectancy, but also prevents reflux esophagitis after gastrectomy. We believe that our method is an effective and simple surgical option for many patients with gastric cancer.