[in Japanese]

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[in Japanese]

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[in Japanese]

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[in Japanese]

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[in Japanese]

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Aim：The aim of the present study was to evaluate the effects of inflammatory response and nutritional condition in patients receiving chemotherapy for advanced gastric cancer．
Methods：Two hundred and forty‐five patients who received chemotherapy for advanced gastric cancer at Kochi Medical School between 2007 and 2015 were examined. Clinicopathological information and systemic inflammatory response markers were obtained, and associations between baseline cancer‐related prognostic variables and survival were investigated．
Results：The median neutrophil to lymphocyte ratio（NLR）was 3.9（0.5–31.5），and a significant negative correlation was found between the NLR and patient survival time（r＝ ‐0.160； P ＝0.021）．The median prognostic nutritional index（PNI）was 36.1（17.0–50.1），and a significant positive correlation was found between the PNI and patient survival time（r＝0.151； P ＝0.029）．On multivariate survival analysis, a high NLR of 3.9（HR 1.550；95％CI 1.125–2.394； P ＝0.005）and diffuse‐type histology（HR 1.457；95％CI 1.043–2.598； P ＝0.042）were significant independent factors associated with a poorer prognosis．
Conclusions：The NLR and histological type are independent prognostic factors in patients receiving chemotherapy for unresectable and recurrent gastric cancer.

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Background
The clinical pathway（CP）of gastric cancer surgery at our institute was revised from a 7‐day discharge CP to a 6‐day discharge CP in October 2017. Perioperative rehabilitation was also implemented for elderly patients aged 65 years or older and patients who underwent proximal gastrectomy（PG）or total gastrectomy（TG）according to the ESSENSE concept. Perioperative rehabilitation consisted of preoperative orientation for the postoperative clinical course, rehabilitation and ambulation assistance on postoperative days 1‐3, and light‐load exercise using an ergometer on postoperative day 4 and thereafter．
Methods
The background characteristics, surgical factors, and postoperative clinical course were compared between the 7‐day discharge CP group（n＝112, consecutive patients who underwent gastrectomy at our institute between Apr 2017 and Sep 2017）and 6‐day discharge CP group（n＝142, between Oct 2017 and Mar 2018）．
Results
The laparoscopic approach was employed more often（81.3 vs. 92.3％，p＝0.012）and the operative time was significantly shorter（217 vs. 202 minutes, p＝0.020）in the 6‐day discharge CP group. The incidence of postoperative complications of Clavien‐Dindo classification grade II or higher was comparable between the 2 groups（5.4 vs. 5.6％，p＝0.92）and the postoperative length of stay was shorter in the 6‐day discharge CP group（7（6‐57）vs. 6（5‐42），p＜0.0001）．The unexpected re‐admission rate within 30 days after surgery did not increase in the 6‐day discharge CP group（3.8 vs. 2.1％，p＝0.48）．
Conclusions
A 6‐day discharge CP and perioperative rehabilitation for elderly and PG/TG patients who underwent gastric cancer surgery were safely implemented.

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In this study, we evaluated the operation outcome, disease‐free survival（DFS），and overall survival（OS）after hepatectomy in malnutrition patients with hepatocellular carcinoma（HCC）．Between June 2010 and October 2017, 283 hepatectomies for HCC were performed at our hospital. The Controlling Nutritional Status（CONUT）Score was measured in these patients and 161 HCC patients with malnutrition underwent laparoscopic hepatectomy. The Child‐Pugh classification（A/B/C）in the malnutrition group（n＝161）vs the non‐malnutrition group（n＝102）was 143/18/0 vs 102/0/0（p＜0.0001），liver damage score（A/B/C）was 91/68/2 vs 95/7/0（p＜0.0001），BMI was 23.2 kg/m2 vs 24.6 kg/m2（p＝0.0043），PNI was 43.4 vs 50.3（p＜0.0001），pStage（I/II/III/IV）was 49/67/34/10 vs 33/51/11/7（p＝0.1732），operation time was 318.2 minutes vs 356.7 minutes（p＝0.0128），blood loss volume was 356.8 ml vs 248.3 ml（p＝0.3742），and the hospital stay after the operation was 16.2 days vs 11.8 days（p＝0.3137），respectively. The 1‐year DFS rate was 72.6％and 87.5％，2‐year DFS rate was 50.9％and 70.9％（p＝0.0058），1‐year OS rate was 81.7％and 96.4％，and 2‐year OS rate was 73.5％and 88.7％（p＝0.0021），respectively. Although laparoscopic hepatectomy for malnutrition patients was safe and feasible, they had a poor prognosis.

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