Effect of urine on clonal growth of human bladder cancer cell lines.

Human urine contains growth factors; their physiological roles have not been established. The effect of normal human urine was examined in vitro on clonal growth of human bladder cancer cell lines. Clonal growth of HT-1376, HT-1197, and T24 was enhanced by five different fresh human urine samples from young men. Colony stimulating activity was detected in fractions with a molecular weight greater than 5000 by ultrafiltration. Sephadex G-50 gel chromatography identified two peaks of colony stimulative activity in HT-1376 with molecular weights of approximately 6000 and greater than 12,400, respectively; these two peaks also possessed immunoreactive epidermal growth factor (EGF) and NRK-49F transforming activities. The three bladder cancer cell lines possessed large quantities of EGF specific binding sites and exogenous EGF stimulated colony formation; EGF concentrations in human urine were found to be remarkably higher than those of exogenously added EGF which stimulated clonal growth of bladder cancer cell lines. Moreover, it was demonstrated that fresh urine samples (5%) incubated with anti-human EGF monoclonal antibody (KEM-10) neutralized completely the colony stimulating effects in HT-1376. These results indicate that fresh human urine stimulates clonal growth in human bladder cancer cell lines and that a major part of the activity is represented by urinary EGF. The data promote urinary EGF as a progressive agent of human bladder cancer.

Estimation of the number of O-linked oligosaccharides per heavy chain of human serum IgA1 by matrix-assisted laser desorption ionization time-of-flight mass spectrometry (MALDI-TOFMS) analysis of the hinge glycopeptide.

In our previous study, gas-phase hydrazinolysis was used to analyze the glycoform of the O-linked oligosaccharide of human serum IgA1. All O-linked oligosaccharide chains are known to be present in the hinge portion. However, the number of O-linked oligosaccharide chains on IgA1 remained unclear. In order to determine the number of linked sugar chains, we applied matrix-assisted laser desorption ionization time-of-flight mass spectrometry (MALDI-TOFMS) to the hinge glycopeptide prepared from human serum IgA1. MALDI-TOFMS did not show clear peaks, probably due to the microheterogeneity of the structure of each sugar chain. However, elimination of peripheral sialic acid and galactose residues by sequential treatment with neuraminidase and beta-galactosidase gave clear mass spectra with several sharp peaks. On the basis of these spectra, we conclude that IgA1 prepared from normal human serum carries different numbers of sugar chains. There are two major populations, one contains five GalNAc residues and the other four GalNAc residues. On the other hand, the hinge glycopeptide prepared from myeloma IgA1 was composed mainly of one population containing four GalNAc residues. Earlier, we reported incomplete glycosylation of IgA1 isolated from the serum of an IgA1 myeloma patient. In this experiment, the presence of four O-linked oligosaccharides per heavy chain of IgA1 from a myeloma patient was found. The reason why only four out of five sites on the hinge glycopeptide were fully glycosylated in the IgA1 from the IgA1 myeloma patient is not clear.

Abundance of Gal beta 1,3GalNAc in O-linked oligosaccharide on hinge region of polymerized IgA1 and heat-aggregated IgA1 from normal human serum.

Gas-phase hydrazinolysis was used to analyze the glycoform of the O-linked oligosaccharide of human serum IgA1. In our previous report, only one glycoform was obtained from the IgA1 of healthy individuals. However, it was found to be composed of heterogeneous IgA1 components having mutually different glycoforms. First, the IgA1 was separated into two subfractions having different affinities toward jacalin. Among them, the high-affinity subfraction was mainly composed of polymerized IgA1. Comparative study of the carbohydrate chain showed a relative abundance of Gal beta 1,3GalNAc in the polymerized form. A simultaneous analysis of the N-glycan of these subfractions was also carried out. Three major components, two biantennary and one triantennary oligosaccharides, were obtained from both subfractions and the relative contents of these components were almost the same. On the other hand, IgA1 was artificially polymerized by heating at 63 degrees C for 2 h. The heat-stable IgA1 was separated from the heat-aggregated material on a Sephacryl S-300 column. The obtained heat-stable IgA1 (approximately 20%) was not further aggregated by more heating under the same conditions. The heat-stable IgA1 contained a much higher amount of the sialylated Gal beta 1,3GalNAc. Thus, it was shown that the degree of completeness of the hinge O-linked oligosaccharide might be correlated with the stability and polymerization process of the IgA1 molecule.

Feasibility of a novel weekday-on/weekend-off oral UFT schedule as postoperative adjuvant chemotherapy for colorectal cancer. UFT Compliance Study Group, Kanagawa, Japan.

PURPOSE: When oral anticancer agents are used for adjuvant chemotherapy of colorectal cancer, compliance and feasibility become issues because of the long treatment time. Appropriate studies of these issues are lacking. We investigated compliance and feasibility during a weekday-on/weekend-off schedule of oral UFT (uracil-tegafur) over a period of 1 year administered as adjuvant chemotherapy to patients with colorectal cancer. PATIENTS AND METHODS: A UFT dose of 600 mg/day was prescribed according to a weekday-on/weekend-off schedule to 87 patients after potentially curative resection. Compliance was investigated in three ways: physician interview, patient self-report, and chemical analysis of urine. The results were compared with the dose prescribed. Feasibility was evaluated on the basis of two indices: relative performance (RP), which was the ratio of the actual total dose taken to the total dose planned, and individual dose intensity (IDI), which was the ratio of the actual dose taken to the dose planned during a given period. RESULTS: The compliance assessed by physician interview and by patient self-report conformed well with the prescribed dose, the rate of agreement among the three compliance measures being more than 94%. Chemical analysis of urine in 38 of the patients revealed that they were actually taking the drug. The RP was 0.72, and the IDI was 0.8. CONCLUSION: From these results, the feasibility of the weekday-on/weekend-off schedule was judged to be good. It is suggested that the feasibility would be even better if the dose of UFT was set according to body surface area.

Thymidine phosphorylase expression and effect of doxifluridine: a phase II study.

Doxifluridine (5'-DFUR), an active intermediate metabolite of capecitabine, is converted to 5-fluorouracil by thymidine phosphorylase (TP). We used immunohistochemical staining to investigate the relation between TP expression and 5'-DFUR effects in 40 patients with advanced/recurrent lung metastases from colorectal cancer. Cox regression analysis suggested that TP-positive cancer cells (risk ratio 3.72), were independent factors in survival whereas factors in progression-free survival were TP-positive cancer cells (2.93), and TP-positive stromal cells (0.24). It is suggested that TP expression in cancer cells and in stromal cells are opposite prognostic factors in patients treated with 5'-DFUR.

Recent results in the surgical treatment of gastric cancer according to the Japanese and TNM classification.

BACKGROUND: Recent outcomes based on surgical long-term follow-up of patients with gastric cancer using current staging systems have not been fully evaluated. MATERIALS AND METHODS: A total of 1357 patients with primary gastric carcinoma (911 males and 446 females, ranging in age from 20 to 87 years; average 59.1 years) who had undergone gastric resection between 1986 and 1996 were examined with respect to their clinicopathological features, surgical procedures and patient survival according to Japanese and UICC-TNM classifications. RESULTS: The 5-year survival rate was 95.3% for stage Ia, 85.5% for stage Ib, 73.8% for stage II, 45.7% for stage IIIa, 20.9% for stage IIIb, 17.3% for stage IVa and 5.8% for stage IVb (8.8% for IVa and IVb) on the Japanese classification. By way of contrast, the 5-year survival rate was 95.6% for stage Ia, 85.0% for stage Ib, 72.1% for stage II, 49.3% for stage IIIa, 30.2% for stage IIIb and 12.0% for stage IV on the TNM classification. CONCLUSION: Although minor problems are associated with both the Japanese and TNM classification systems, both appear to be clinically significant and appropriate independent predictors of prognosis. The findings of the present study provide important information for comparing results among different institutes and for introducing new clinical trials for gastric cancer at the beginning of the new century.

Preoperative evaluation to predict technical difficulties of laparoscopic cholecystectomy on the basis of histological inflammation findings on resected gallbladder.

BACKGROUND: No papers have heretofore documented histological studies of cases involving the inflammation of resected gallbladder or examined surgical difficulties on the basis of pathological findings. METHODS: On the basis of the histological inflammation findings on the resected gallbladders of 437 patients who underwent laparoscopic cholecystectomy (LC), the factors affecting the technical difficulty of the operation were examined through preoperative clinical findings (13 items), diagnostic imaging (22 items), and blood test findings (6 items), using multivariate analysis. RESULTS: In accordance with the four-stage classification of inflammation findings for the resected gallbladder, the inflammation findings on the resected gallbladder indicated a higher correlation with the time required for gallbladder dissection (30.2 +/- 16.3 minutes) than with the operation time (77.6 +/- 32.7 minutes). Thus, the technical difficulty of the operation was judged according to the time required for gallbladder dissection. For the preoperative findings on 418 patients who underwent successful LC, the most influential factors on the time required for gallbladder dissection were the presence of abnormal findings on computed tomography, the degree of fever, obesity index, nonvisualized gallbladder cholangiography, and cystic duct length. According to the multiple regression equation of these five factors, the gallbladder dissection for the 19 patients who underwent conversion to open cholecystectomy (OC) due to extreme inflammation was calculated to require 61.9 +/- 12.3 minutes, and the patients who showed a gallbladder dissection time longer than 49.6 minutes were judged to have high technical difficulty predicted from the preoperative evaluation. In the preoperative evaluation, sensitivity was 79.6%, specificity was 97.6%, accuracy was 95.0%, positive predictive value was 85.0%, and negative predictive value was 96.6%. Next, each finding was scored on the basis of a multiple regression equation of five factors, and the technical difficulty of the operation was quantified using these scores. The score of the patients who underwent conversion to OC was 8.0 +/- 2.0, and the patients who showed a score higher than 6 were judged to have high technical difficulty. Almost the same results as in the aforementioned preoperative evaluation were obtained using these scores. CONCLUSION: The judgment using the scores was satisfactory in terms of the simplicity of evaluating the technical difficulties associated with each patient and the ease of obtaining information for each factor. The quantification of technical difficulty using the scores is useful for preoperative prediction of which patients will have difficulties in gallbladder dissection and the conversion to OC in LC. Our results suggest that the consideration of technical difficulties is important for conducting safe operations with avoiding intraoperative complications.

Laser therapy for early upper gastrointestinal carcinoma.

An invasive procedure generally is the first choice of therapy for the treatment of gastric cancer. The development of improved microimaging and innovative engineering, however, has established a new field of endoscopic laser therapy. This article discusses the use of high-power and low-power lasers in the treatment of early gastric cancer.

Typing of intraglomerular mononuclear cells associated with transplant glomerular rejection.

To investigate the pathogenesis of glomerular injury in renal allografts, we have analyzed intraglomerular mononuclear cells from 20 biopsies with typical features of transplant glomerular rejection (TGR) (segmental or global occlusion of capillaries by swollen cells). Ten biopsies showing cellular rejection but no glomerular pathology were selected as controls. Microwave fixation and an avidin-biotin immunoperoxidase technique were used with the following monoclonal antibodies; Leu1 and OKT3 (pan T cell), Leu 3 a + b and OKT4 (helper T cell), OKT8 (cytotoxic T cell), OKB7 (B cell), OKM1 (monocyte) and OKDR (DR positive cell). The results showed a significant increase of T cells, helper T cells, cytotoxic T cells and monocytes in the patients with TGR compared with the controls (all p less than 0.001, Mann-Whitney U test). Of the T cell subsets, cytotoxic T cells outnumbered helper T cells by a mean ratio of 3.2:1. In the interstitium, the distribution of mononuclear cells was not different between the two patient groups. In both, T cells and monocytes were predominant and few B cells were found. The percentage of cytotoxic T cells was similar to that of helper T cells. In this study, there were at least four TGR patients without cytomegalovirus (CMV) infection and the distribution of intraglomerular mononuclear cells in these patients was indistinguishable from that of other TGR patients. There was no significant association of the distribution of mononuclear cells with the severity of glomerular damage. These results suggest that T cells, predominantly of the cytotoxic subset and monocytes are involved in the mediation of TGR.(ABSTRACT TRUNCATED AT 250 WORDS)

Intragastric pH in postlaparotomy patients--effects of cimetidine.

Intragastric pH was continuously monitored in 21 patients who underwent colorectal surgery. Monitoring was started before surgery, and was continued for two days after surgery. Intragastric pH tended to increase during surgery, compared with measurements obtained before and after surgery, but was not affected by the duration of anesthesia or of the surgical procedure, or surgical position. After surgery, patients were divided into two groups: the cimetidine group (10 patients) received intravenous cimetidine 200 mg 4 times a day, while the control group (11 patients) received no treatment. Postoperative intragastric pH was higher than 3.0 throughout the study in the cimetidine group, but was approximately 1.3 in the control group. Upper gastrointestinal bleeding occurred in 2 patients in the control group, with intragastric pH falling abruptly during the bleeding episode. To prevent post-operative upper gastrointestinal bleeding, in addition to the administration of H2-blockers or antacids, appropriate treatments in response to changes in intragastric pH are necessary. Continuous monitoring of intragastric pH in surgical patients is considered to be of clinical importance.

Marginal ulcer on the jejunum after proximal gastrectomy by jejunal interposition.

Marginal ulcer after proximal gastrectomy has never been previously reported, despite that this procedure preserves the fundic gland area of the stomach, which secretes gastric acid. In this report, we describe a patient who developed a marginal ulcer on the oral side of the gastrojejunal anastomosis after proximal gastrectomy by jejunal interposition. This case serves as a reminder that gastric acid secretion of the remnant stomach must be carefully monitored after proximal gastrectomy in gastric cancer surgery.

Does gastrojejunostomy for unresectable cancer of the gastric antrum offer satisfactory palliation?

BACKGROUND/AIMS: Gastrojejunostomy is the procedure of choice for patients with obstruction or stenosis of the gastric outlet or duodenum. However, the palliative benefits of this procedure in gastric cancer remain uncertain. Thus, the present study was performed to address this problem. METHODOLOGY: In the present study, 52 patients who had undergone gastrojejunostomy for unresectable cancer of the gastric antrum at Kitasato University Hospital and Kitasato University East Hospital in Japan between 1972 and 1994 were examined. RESULTS: The median survival time in these 52 patients was 5.0 months. The duration of palliation ranged from 0-13 months, with an average of 2.8 months. No significant difference between clinicopathologic factors and duration of palliation was found and location of tumor was the only independent prognostic factor (coefficient: 0.890; hazard ratio: 2.435). CONCLUSIONS: Although gastrojejunostomy for unresectable cancer of the gastric antrum is the procedure most often chosen at laparotomy, the palliative benefits of gastrojejunostomy do not sufficiently compensate for the patients' limited post-operative survival and quality of life.

Is extended lymphadenectomy valuable in palliatively gastrectomized patients with gastric cancer and simultaneous peritoneal metastasis?

BACKGROUND/AIMS: The optimal extent of lymphadenectomy in patients with gastric cancer and simultaneous peritoneal metastasis upon non-curative resection remains unclear. The aim of the present study was to evaluate the efficacy of extended lymphadenectomy in palliatively gastrectomized patients with gastric cancer and simultaneous peritoneal metastasis. METHODOLOGY: The significance and limit of extended lymphadenectomy according to the extent of peritoneal metastasis was analyzed retrospectively in 110 patients with gastric cancer and simultaneous peritoneal metastasis who had undergone palliative gastrectomy. RESULTS: Of the 47 patients with P1 metastasis, the median survival period of the 23 patients who underwent extended lymphadenectomy and the 24 patients who underwent limited lymphadenectomy was 21.7 months and 17.2 months, respectively. Of the 63 patients with P2 or P3 metastasis, the median survival period of the 16 patients who underwent extended lymphadenectomy and the 47 patients who underwent limited lymphadenectomy was 10.4 months and 12.8 months, respectively. No significant differences in survival time based on extent of lymphadenectomy were observed either in the patients with P2 or P3 metastasis (P = 0.262) or in those with P1 metastasis (P = 0.277). CONCLUSIONS: The results of the present study demonstrate that extended lymphadenectomy in gastric cancer yields no positive impact on survival upon non-curative resection either in patients with gastric cancer and simultaneous metastases to the adjacent peritoneum (P1) or to the distant peritoneum (P2 or P3).

An in-vitro model of scirrhous carcinoma of the stomach using stomach fibroblasts derived from gastric cancer patients.

BACKGROUND/AIMS: The mechanisms of the particular stromal changes that occur upon cancer invasion by scirrhous carcinoma of the stomach, in particular, the relationships among cancer cells, stomach fibroblasts and collagen, a major constituent of the stroma of the invasive tumor, have yet to be clarified. METHODOLOGY: Three different human fibroblast cell lines (TIG-101, MF-2, MKF-1) and a cancer cell line derived from scirrhous carcinoma of the stomach (KATO III) were cultured three-dimensionally in collagen gels to investigate collagen gel contraction by these cells as a model of scirrhous carcinoma of the stomach. RESULTS: The gels contracted and gradually decreased in size in all of the fibroblast (TIG-101, MF-2 and MKF-1) cultures, but not in the KATO III culture, and the extent of gel contraction was not uniform among the fibroblast cell lines. The extent of gel contraction when fibroblasts derived from stomach (MF-2, MKF-1) were co-cultured with KATO III cells in collagen gel was almost similar to that of fibroblasts alone. Moreover, microscopic examination following Masson's trichrome staining revealed condensation and remodeling of collagen fibrils only around the fibroblast cells. CONCLUSIONS: The extent of collagen gel contraction by fibroblasts may depend on their in vivo origin. This property appears to be characteristic of fibroblasts, but not of malignant epithelial cells, under this culture system. Furthermore, the results of the present study demonstrate that stomach fibroblasts may play an important role in the stromal changes associated with scirrhous gastric cancer.

Three-dimensional reconstruction of colorectal tumors from serial tissue sections by computer graphics: a preliminary study.

BACKGROUND/AIMS: We present herein the three-dimensional reconstruction of colorectal tumors, with particular reference to growth pattern into each layer of the colorectal wall, and measurement of tumor volume and surface area. METHODOLOGY: Conventional tissue section images of colorectal tumors were analyzed using a computer graphics analysis program. The two-dimensional extent of invasion by each tumor into each layer of intestinal wall were determined from the images of each section. Based on data from multiple sections, tumor and surrounding normal tissue layers were reconstructed three-dimensionally, and volume and surface area of the tumors were determined. RESULTS: Using this technique, three-dimensional morphology of tumor and tumor progression into colorectal wall could be determined. Volume and surface area of the colon tumor were 4871 mm3 and 1741 mm2, respectively. Volume and surface area of the rectal tumor were 1090 mm3 and 877 mm2, respectively. CONCLUSIONS: This technique may provide a new approach for pathological analysis of colorectal carcinoma.

Surgical outcome of curative resection in patients with Borrmann type IV gastric carcinoma with particular reference to the extent of lymph node metastasis.

BACKGROUND/AIMS: The prognosis after curative resection for Borrmann type IV carcinoma, according to the extent of lymph node metastasis, is poorly understood. METHODOLOGY: The surgical outcome of curative resection was examined in 78 patients with T2-T3 Borrmann type IV gastric carcinomas, with particular reference to the extent of lymph node metastasis. RESULTS: The 5-year survival rate was 35.7% for the n0 patients, 27.8% for the n1 patients, 18.2% for the n2 patients and 0% for the n3 or n4 patients. The survival curve for the n3 or n4 patients differed significantly from those of the n0 (P < 0.0001), n1 (P = 0.0009) and n2 (P = 0.0203) patients. However, no other statistically significant differences between the curves were found. CONCLUSIONS: The results of the present study indicate that patients with Borrmann type IV carcinoma of the stomach may indeed be cured by curative surgery, and that the surgical outcome of this disease does not depend on the extent of lymph node metastasis under curative resection if lymph node metastasis is restricted to the n2 lymph nodes.

Results of resection of gastric cancer with distant metastases.

BACKGROUND/AIMS: The present study was carried out in order to examine the outcome of resection in cases of gastric cancer with distant metastases. METHODOLOGY: The survival rates of two hundred and eighty-one patients who had undergone resection for primary carcinomas of the stomach, and who had distant metastases according to the TNM classification, were studied. RESULTS: The 5-year survival rates for patients with metastasis to the peritoneum or group 3 nodes were 8.9% and 15.3% respectively and were significantly higher than the survival rates for patients with metastasis to the liver (0%), to group 4 nodes (2.2%) or to more than one site among the liver, lymph nodes and peritoneum (3.5%). Moreover, the 5-year survival rates for patients with metastasis to the peritoneum and N3 nodes increased significantly to 29.4% and 24.2%, respectively, when curative surgery was performed. CONCLUSIONS: The findings of the present study suggests that metastases to the adjacent peritoneum or group 3 nodes have a greater chance of being cured using radical surgery, and that gastrectomy with extended lymphadenectomy (D2-D3) may be used for advanced gastric cancer if there is no gross evidence of metastasis to the distant peritoneum, liver or group 4 nodes.

Gastric cancer with metastases to the distant peritoneum: a 20-year surgical experience.

BACKGROUND/AIMS: The efficacy of palliative gastrectomy in gastric cancer with peritoneal metastases remains uncertain. The aim of the present study was to evaluate the benefits of gastrectomy on the postoperative course of patients with gastric cancer and simultaneous metastases to the distant peritoneum. METHODOLOGY: A total of 122 patients who had gastric cancer and metastases to the distant peritoneum were studied with respect to survival. RESULTS: The extent of peritoneal metastases did not significantly affect the prognosis. Moreover, multivariate analysis indicated that surgery without gastrectomy was the only significant prognostic factor (relative risk, 2.587). CONCLUSIONS: Our results suggest that the decision to perform gastrectomy does not depend on the extent of peritoneal metastasis in gastric cancer. Furthermore, palliative gastrectomy, if feasible, seems to have a beneficial effect on the postoperative course and is indicated for patients regardless of metastasis to the peritoneum, if the primary tumor is surgically resectable and there is no evidence of liver metastasis.

The management of bleeding peptic ulcer in the elderly with heater probe thermocoagulation.

BACKGROUND/AIMS: The aim of this study was to compare the clinical characteristics of bleeding peptic ulcers in the elderly with those in younger patients, retrospectively. METHODOLOGY: Between 1986 and 1994, 274 patients with bleeding peptic ulcers were treated with heater probe endoscopically. They were divided into 2 groups: 48 in the elder group (70 years of age or older) and 226 in the younger group (<70). We evaluated the rate of concomitant disease, rebleeding rate, incidence of emergency surgery, mortality and blood transfusion requirement between the 2 groups. RESULTS: The incidence of concomitant disease was significantly higher in the elderly group (83.3%) than in the younger group (33.3%) (p<0.01). The rate of rebleeding (younger group 23.5% vs. elderly group 31.3%), the incidence of emergency surgery (5.8% vs. 6.3%, respectively) and the rate of mortality due to hemorrhage (2.2% vs. 4.2%, respectively) were similar in the 2 groups. There was no significant difference in the mean volume of blood transfused. CONCLUSIONS: It was revealed that aggressive endoscopic hemostasis improved the mortality rate and the incidence of emergency surgery in elderly patients as well as in younger patients, provided that their general condition was monitored carefully.

[Combined laparoscopic-endoscopic procedure in stomach carcinoma]. / Kombiniertes laparoskopisch-endoskopisches Vorgehen beim Magencarcinom.

The purpose of this review is to outline the laparoscopic-endoscopic procedures that we perform for early gastric cancer. These procedures were applied to 29 patients. Preoperative work-up included gastric endoscopy, barium X-ray examination, endoscopic ultrasonography, and histological examination, and surgery was performed in patients diagnosed as having mucosal gastric cancer for which endoscopic mucosal resection (EMR) was difficult. Laparoscopic wedge resection of the stomach using the lesion-lifting method, by which a wedge resection is made while pulling up the full-thickness gastric wall, was carried out in the 16 patients with lesions of the anterior wall, lesser curvature, and greater curvature of the stomach. On pathological examination of resected specimens, the surgical margin and lymphatic or venous invasion were negative in all these patients. The histological depth of the lesions was m (mucosal cancer) in 15 patients and sm1 (slight cancer infiltration into the submucosal layer) in one. This one patient later underwent gastrectomy but no lymph node metastases were found. Oral nutrition was resumed for a mean (+/- SD) of 2.9 +/- 0.8 days after operation, and the duration of hospitalization after operation was 12.3 +/- 3.4 days. The 13 patients with lesions of the posterior wall of the stomach and near the cardia or the pylorus received laparoscopic intragastric mucosal resection. Laparotomy was required in 1 of these patients due to intraoperative hemorrhage. The surgical margins were negative in all 12 patients in whom laparoscopic intragastric mucosal resection was successful. Lymphatic or venous invasion was positive in 2, both of whom had sm1 cancer lesions of both of these patients were located in the cardiac region, total gastrectomy was avoided, and careful observation is continued. Oral nutrition was resumed 4.0 +/- 1.6 days after operation, and the duration of hospitalization after operation was 12.0 +/- 3.5 days. In addition, no postoperative complication was noted after either procedure, and all patients have been recurrence free for a follow-up period of 460 months. Selected properly, these laparoscopic endoscopic procedures are considered to be curative and minimally invasive treatments for early gastric cancer.