日本图书馆学信息学专业教育的现状及问题

日本有２０００多所大专院校根 据图书馆法的要求开设２０学分制的图书馆 学课程，并每年为该国培养上万名合格的 图书馆员。日本文部省负责图书馆员教育 和资历的管理工作，并为符合图书馆法要 求的图书馆员颁发不同级别的资历证书。 该国有９所四年制的大学设有图书馆学信 息学的专门系别或方向。尽管如此，日本 的图书馆学信息学专业的发展仍然不够健 全。

Cutting edge of endoscopic full-thickness resection for gastric tumor

Recently,several studies have reported local full-thickness resection techniques using flexible endoscopy for gastric tumors,such as gastrointestinal stromal tumors,gastric carcinoid tumors,and early gastric cancer(EGC). These techniques have the advantage of allowing precise resection lines to be determined using intraluminal endoscopy. Thus,it is possible to minimize the resection area and subsequent deformity. Some of these methods include:(1) classical laparoscopic and endoscopic cooperative surgery(LECS);(2) inverted LECS;(3) combination of laparoscopic and endoscopic approaches to neoplasia with non-exposure technique; and(4) non-exposed endoscopic wall-inversion surgery. Furthermore,a recent prospective multicenter trial of the sentinel node navigation surgery(SNNS) for EGC has shown acceptable results in terms of sentinel node detection rate and the accuracy of nodal metastasis. Endoscopic full-thickness resection with SNNS is expected to become a treatment option that bridges the gap between endoscopic submucosal dissection and standard surgery for EGC. In the future,the indications for these procedures for gastric tumors could be expanded.

Current status and challenges in sentinel node navigation surgery for early gastric cancer

As an optimal surgical procedure to accurately evaluate lymph node(LN)metastasis during surgery with minimal surgical resection,we have been developing sentinel node(SN)biopsy for early gastric cancer since the 1990s.Twelve institutions from the Japanese Society of Sentinel Node Navigation Surgery(SNNS),including Keio University Hospital,conducted a multicenter prospective trial to validate the SN concept using the dual-tracer method with blue dye and a radioisotope.According to the results,397 patients were included in the final analysis,and the overall accuracy in detecting LN metastasis using SN biopsy was 99%(383 of 387).Based on the validation study,we are targeting cT1N0 with a primary tumor of≤4 cm in diameter as an indication for SN biopsy for gastric cancer.We are currently running a multicenter nonrandomized phaseⅢtrial to assess the safety and efficacy of SN navigation surgery.The Korean group has reported the result of a multicenter randomized phaseⅢtrial.Since meticulous gastric cancer in the remnant stomach was rescued by subsequent gastrectomy,the disease-specific survival was comparable between the two techniques,implying that SN navigation surgery can be an alternative to standard gastrectomy.With the development of SN biopsy procedure and treatment modalities,the application of SN biopsy will be expanded to achieve an individualized minimally invasive surgery.

Association of anastomotic leakage with long-term oncologic outcomes of patients with esophagogastric junction cancer

BACKGROUND Despite improvements in surgical procedures and peri-operative patients management,the postoperative complications in esophagogastric junction(EGJ)cancer remain high because of technical aspects.Several studies have indicated the negative influence of postoperative infectious complications on long-term survival after gastrointestinal surgery.However,no study has shown the association between postoperative complications and long-term survival of patients with EGJ cancer.AIM To elucidate influence of postoperative complications on the long-term outcomes of patients with EGJ cancer.METHODS A total of 122 patients who underwent surgery for EGJ cancer at the Keio University were included in this study.We examined the association between complications and long-term oncologic outcomes.RESULTS In all patients,the 3-year overall survival(OS)rate was 71.9%,and the recurrencefree survival(RFS)rate was 67.5%.Compared with patients without anastomotic leakage,those with anastomotic leakage had poor median OS(8 mo vs not reached,P=0.028)and median RFS(5 mo vs not reached,P=0.055).Among patients with cervical anastomosis,there were not significant differences between patients with and without anastomotic leakage.However,among patients who underwent intrathoracic anastomosis,patients with anastomotic leakage had significantly worse OS(P=0.002)and RFS(P=0.005).CONCLUSION Anastomotic leakage was significantly associated with long-term oncologic outcomes of patients with EGJ cancer,especially those who underwent intrathoracic anastomosis.Cervical anastomosis with subtotal esophagectomy may be an option for the patients who are at high risk for anastomotic leakage.

Laparoscopic Submucosal Dissection for Gastrointestinal Stromal Tumor of the Stomach: A Novel Technique for Local Excision with a Minimal Curative Margin

Background: Laparoscopic wedge resection is accepted as a curative treatment for small- and mediumsized gastroin-testinal stromal tumors (GISTs) of the stomach. Conventional methods involving surgical staplers require relatively large lateral margins, which may cause deformity and postoperative dysfunction of the gastric remnant. In this study, we introduce a novel technique called laparoscopic submucosal dissection (LSD) in which the defects of the stomach are minimized and a microscopic negative margin is secured. Methods: The normal seromuscular layer of the gastric wall was dissected with a 5 mm lateral margin. Then, the submucosal tissue was divided carefully using a monopolar electrosurgical device with a curved spatula tip. Results: The operation time was 170 min, and the amount of bleeding was very small. We confirmed an intact pseudo-capsule and marginal subserosal or submucosal tissue of the tumor by histological analysis. The postoperative course was uneventful with no complications. Endoscopy showed minimal deformity of the gastric remnant. Conclusions: We think that LSD is a curative and less invasive treatment for GIST of the stomach. Further investigations are necessary to evaluate the oncological and functional outcomes of this procedure.

Laparoscopic personalized function-preserving gastrectomy with sentinel node mapping for early-stage gastric cancer

Laparoscopic gastrectomy is considered as an indispensable option between endoscopic resection and standard gastrectomy with open laparotomy for patients with early-stage gastric cancer.However,the extent of gastrectomy and remnant gastric function may affect patients’quality of life(QOL)after surgery.Therefore,function-preserving gastrectomy in addition to laparoscopic surgery could be considered in patients with early-stage gastric cancer.A prospective multicenter trial and meta-analyses of sentinel node(SN)mapping and biopsy for early-stage gastric cancer have demonstrated favorable SN detection rates and accuracy of nodal metastatic status.Although a combination of radioactive colloids with blue dyes as tracers is currently considered as the promising procedure of SN mapping in early-stage gastric cancer,several new technologies,such as indocyanine green fluorescence imaging,may markedly improve its accuracy.For early-stage gastric cancer,the development of laparoscopic personalized minimized gastrectomy with SN mapping may help retain patents’QOL after surgery.A recently developed full-thickness partial gastrectomy with SN mapping and basin dissection would become a reliable minimally invasive gastrectomy for treating patients with cN0 early-stage gastric cancer.