ing of a depressed ST wave at V1–V3, and an elevated Yp ST wave at II and III. He also had elevated creatine phosphokinase (CK) (1203 IU) and CK-MB (128) levels. He was transferred to the cardiac department of hospital “B,” where an emergency cardioangiography confirmed severe myocardial infarction, and CABG (left internal thoracic artery-LAD #8, RGEA #4PD, saphenous vein graft #12) was performed, followed by an uneventful postoperative course. He visited hospital “A” again 6 months later after vomiting blood, and was diagnosed to have gastric cancer by a gastroendoscopy. He was transferred to hospital “B” again, where gastric surgery was recommended. He insisted on taking the advice of a book he had read, which stated that “early gastric cancer does not grow to advanced cancer,” and refused surgery. He started taking the alternative medicine known as Maruyama Vaccine, or Specific Substance Maruyama (SSM), thereafter. He was readmitted to hospital “A” after passing tarry stools 8 months later, and was diagnosed to have advanced gastric cancer. He presented to our hospital again a few weeks after this, where he was admitted for surgery. By this time, he was 57 years old, and on physical examination, he was 169 cm tall and weighed 74kg. No abnormal laboratory data were found, including complete blood cell count, serum chemistry, electrolytes, and liver and renal function tests. Chest X-ray findings were unremarkable, but upper gastrointestinal X-rays showed a deep and irregular open ulcer in the lesser curvature and posterior wall of the middle and lower gastric body with fold convergence (Fig. 1). He was diagnosed to have advanced gastric cancer, 7 cm in size, and located 5 cm from the esophagogastric junction, with positive serosal invasion. Gastroendoscopy was done and a histological diagnosis of adenocarcinoma with poor and moderate differentiation was confirmed. Ultrasonography, computed tomography, and magnetic resonance imaging showed a swollen Abstract Ischemic heart disorders are often treated by coronary artery bypass grafting (CABG) using the right gastroepiploic artery (RGEA). We report the case of a 57year-old man with a history of CABG using the RGEA, who underwent D2 radical total gastrectomy followed by Roux-en-Y anastomosis, with successful dissection of the #6 lymph nodes, while preserving the RGEA. The patient had a 9-month history of gastric cancer, during which time the Maruyama Vaccine (Specific Substance Maruyama, or SSM) was given as alternative therapy. This case report serves to demonstrate that radical gastrectomy can be safely performed after CABG using the RGEA, and that gastric cancer will progress in spite of SSM therapy.