Cancer is the leading cause of death in many countries, and digestive cancer is one of the most common types of neoplasms. Advances in research on the management of digestive cancer therefore represent an important contribution to the welfare of humankind throughout the world. The VICC Kyoto International Symposium on Recent Advances in the Management of Digestive Cancer was held in Kyoto from March 31 to April 2, 1993 under the presidency of Dr. T. Takahashi of the Kyoto Prefectural Vniversity of Medicine. At this event, leading researchers and clinicians presented new findings and the latest results of clinical trials concerning digestive cancers. The VICC President and other members of the Executive Committee of the VICC also gave speeches on their own fields, and more than 1000 participants from 28 countries were very well received. This book presents the proceedings of this symposium. In addition to 30 selected papers presented at special lectures and symposia by invited speakers, this book contains 230 free papers presented at poster sessions during this conference.

M. K. Gospodarowicz, P. Hermanek, and D. E. Henson Attention to innovations in cancer treatment has tended to eclipse the importance of prognostic assessment. However, the recognition that prognostic factors often have a greater impact on outcome than available therapies and the proliferation of biochemical, molecular, and genetic markers have resulted in renewed interest in this field. The outcome in patients with cancer is determined by a combination of numerous factors. Presently, the most widely recognized are the extent of disease, histologic type of tumor, and treatment. It has been known for some time that additional factors also influence outcome. These include histologic grade, lymphatic or vascular invasion, mitotic index, performance status, symptoms, and most recently genetic and biochemical markers. It is the aim of this volume to compile those prognostic factors that have emerged as important determinants of outcome for tumors at various sites. This compilation represents the first phase of a more extensive process to integrate all prognostic factors in cancer to further enhance the prediction of outcome following treatment. Certain issues surround ing the assessment and reporting of prognostic factors are also considered. Importance of Prognostic Factors Prognostic factors in cancer often have an immense influence on outcome, while treatment often has a much weaker effect. For example, the influence of the presence of lymph node involvement on survival of patients with metastatic breast cancer is much greater than the effect of adjuvant treatment with tamoxifen in the same group of patients [5].

A distinguished panel of world authorities reviews the current state of today's understanding, diagnosis, and treatment of pancreatic cancer. Their cutting-edge reviews discuss both medical and surgical modalities and include numerous insights into the basic molecular processes underlying the disease. Among the key topics covered are the prospects for early diagnosis using molecular techniques, the latest diagnostic and therapeutic methods, the role of laparoscopy (diagnostic and therapeutic), and nonsurgical treatment. The reviewers also address the future possibilities for clinical advances, quality of life concerns, and the value of the Japanese "extended Whipple resection." Pancreatic Cancer will become the new standard reference for all clinicians who diagnose and treat this disease, as well as for basic scientists needing a summary of the many recent advances. i

Rectal cancer is a major killer. Most of those dying after curative surgery suffer from recurrent disease in the pelvis. Local recurrence is also the only site of failure in up to 50% of patients. A disturbing fact is that the local recurrence rate shows considerably surgeon-related variances. There is now strong evidence that optimizing surgical technique by adopting the principle of total mesorectal excision (TME) will reduce local failure rate, increase the use of sphincter-saving operations, and improve functional results. Surgeons applying this surgical principle will consistently achieve similarly low recurrence rates.

Alessandro Condivilla of Bologna first attempted a resection of the head of the pan creas in 1898, but several decades of further trial-and-error attempts ensued before the prototype procedure of pancreatoduodenectomy (PD) was established by Whipple in 1935. In the half-century following that landmark, refinements of surgical technique, including pancreatico-and bilio-entero anastomosis as well as develop ment of new technology to support perioperative management and patient care have contributed to the decrease in mortality and morbidity rates for obstructive jaundice and pancreatic fistula. The improvement in mortality and morbidity rates associated with PD has led to an increase in the number of patients undergoing the procedure and in the number of institutions performing it. Indications for PD have also been expanded. In the early years after PD was established as a viable procedure, periampullary carcinoma was the most common indication; now PD is indicated for a number of benign and malignant diseases. Some surgeons believe that PD is the procedure of choice for certain types of chronic pancreatitis, pancreatico-biliary maljunction, and pancreatic and duodenal trauma. Other surgeons have reported the necessity of PD for lymph node dissection of gallbladder carcinoma. Consequently, the basic procedure has been greatly modi fied to accommodate the specific conditions of each disease. For patients with malig nancy, extended procedures have been developed to improve the curative resection rate and ensure complete lymph node dissection.

Identification and development of cancer biomarkers and targets have greatly accelerated progress towards precision medicine in oncology. Studies of tumor biology have not only provided insights into the mechanisms underlying carcinogenesis, but also led to discovery of molecules that have been developed into cancer biomarkers and targets. Multi-platforms for molecular characterization of tumors using next-generation genomic sequencing, immunohistochemistry, in situ hybridization, and blood-based biopsies have greatly expanded the portfolio of potential biomarkers and targets. These cancer biomarkers have been developed for diagnosis, early detection, prognosis, and prediction of treatment response. The molecular targets have been exploited for anti-cancer therapy and delivery of therapeutic agents. This Special Issue of Biomedicines focuses on recent advances in the discovery, characterization, translation, and clinical application of cancer biomarkers and targets in malignant diseases of the digestive system. The goal is to stimulate basic and translational research and clinical collaboration in this exciting field with the hope of developing strategies for prevention and early detection/diagnosis of cancer in digestive organs, and improving therapeutic and psychosocial outcomes in patients with these malignant diseases.

Gastrointestinal Oncology: A Critical Multidisciplinary Team Approach is the first evidence-based reference text designed for the multidisciplinary team of medical professionals involved in the investigation, diagnosis, and management of patients with gastrointestinal cancer. Written and edited by leading international experts in the field it sets the standard in clinical practice for dealing with esophageal, gastric, intestinal, colonic, hepatobiliary, pancreatic, and other GI tumors. The book is divided into twenty-five clinical chapters each addressing the specific cancers affecting the gastrointestinal tract. Each chapter is written by a team of authors, with each contributor specially chosen to represent a different role in the MDT. This multidisciplinary team approach reflects the current care of GI cancer patients and enables clinical decision making and patient management. All the chapters have been tried and tested in MDT meetings in leading cancer centers around the world. Gastrointestinal Oncology: A Critical Multidisciplinary Team Approach provides in-depth evidence-based knowledge and is well illustrated throughout with color photographs, line drawings, and diagrams. This authoritative and practical resource is an essential reference for the entire MDT including gastroenterologists, hepatologists, GI surgeons, medical oncologists, radiation therapists, interventional radiologists, pathologists, specialist nurses, and clinical scientists.

Lists selected references of monographs, journal articles, conference proceedings and abstracts, dissertations, and audiovisuals published from January 1990 through March 1995. Foreign language material is included. Arranged in subject categories following the "Healthy People 2000" initiative of the U.S. Department of Health and Human Services. Serves as a useful resource for health professionals and designed for those who are interested in gaining a better understanding of health issues.