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Twenty-four fresh tumors of gastric carcinoma were assessed by flow cytometric detection of P-glycoprotein (P-gp) using monoclonal antibody C219. Eight patients were P-gp positive. Differentiated gastric carcinomas contained significantly higher concentrations of P-gp positive. Incidence of P-gp positive was high in advanced stage. In 16 cases estimated chemosensitivity was test assessed by thymidine incorporation assay (TIA). Seven of nine multidrug-resistant cases according to TIA were P-gp positive and all of seven nonmultidrug resistant cases were P-gp negative. Expression of P-gp and multidrug resistance were closely correlated (P < 0.01). Also, in 89 patients with operable gastric carcinoma, the relation between in vitro chemosensitivity test (TIA) and their clinicopathologic features as well as their survival lengths were studied. Thirty-one of 89 specimens from gastric carcinoma patients were multidrug resistant according to TIA. Patients in the multidrug-resistant group had a significantly poorer cumulative survival rate than those who were not multidrug resistant (P < .05). The multivariate analysis showed that multidrug resistance is a useful indicator of prognosis (P < 0.1). We suggest that multidrug-resistant cases or P-gp-positive cases of gastric carcinoma are highly malignant, and these determinations are clinically useful.

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The authors have used a modified hemi-double-stapling (HDS) technique for reconstruction after laparoscopically assisted distal gastrectomy. The stomach is resected from the greater curvature side using a linear stapler inserted into the stomach from that side at a position vertical to the line of the greater curvature. Resection of the stomach is performed by extending the resection line to the lesser curvature using laparoscopic coagulating shears. The resected specimen is examined. After placement of a purse-string suture at the duodenal stump, an anvil is inserted into the stump, and an additional suture with 2-0 silk is placed over the purse-string suture. A curved intraluminal stapler (CDH25) is inserted into the stomach through the opening made on the lesser curvature side, and the center rod of the stapler is passed through the gastric wall on the corner of the resection line at the greater curvature. Ligation with 2-0 silk is added to the center rod by suturing the gastric tissue 5-8 mm from the center rod to encircle it. The authors call this the "one-knot setup HDS," and with this method, a large-caliber anastomosis is secured. In many cases, it is difficult to observe the anastomotic site through the small incisional opening. However, under laparoscopy with the temporal abdominal wall-lift method using the Multi Flap Gate, the anastomotic site can be easily and safely observed. One-knot setup HDS combined with the temporal abdominal wall-lift method is considered a safe and simple method for performing Billroth I anastomosis in laparoscopic distal gastrectomy.

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