Nihon Gekakei Rengo Gakkaishi (Journal of Japanese College of Surgeons)

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Since 1998, we have performed preoperative chemoradiotherapy (PCRT) for patients with advanced esophageal carcinoma. Approximately 4 weeks prior to surgery, low dose 5-fluorouracil and cisplatin (FP ;total dose : 7, 000mg/m², CDDP 100mg/m², respectively) and radiation (40Gy) were given to 55 patients with thoracic esophageal squamous carcinoma. The radiological effect to PCRT was 81.8% for primary lesions and 50.0% for lymph nodes, with cases of down staging recognized at 49.1%. Side effects included leukopenia (78.2%), anemia (21.8%), thrombocytopenia (12.7%), esophagitis (18.2%), stomatitis (7.3%), nausea and vomiting (5.5%), and so on. Postoperative complications included anastomotic leakage (16.4%), pneumonia (7.3%), liver dysfunction (3.6%), renal dysfunction (3.6%), wound infection (3.6%) and leukopenia (3.6%), and so on. The pathological effect was grade 2 or more in 81.8% of primary lesions and 71.7% of lymph nodes, and in 27.3% of these cases, no viable cancer cells were recognized in either primary lesions or lymph nodes. On the other hand, of 14 cases assessed as complete response (CR) by esophagoscopy, viable cancer cells remained in 7 cases (50%). The 3-year survival rates were 80.0% at stage II, 58.1% at stage III and 50.0% at stage IV. Moreover, based on an assessment of pathological effect, the 3-year survival rate was 24.2% at grade, 1, 74.4% at grade 2 and 86.7% at grade 3, so that cases of grade 2 and 3 had a significantly favorable prognosis compared to grade 1 (p<0.001). In conclusion, PCRT yielded high effectiveness for advanced esophageal cancer as a preoperative therapy. Nevertheless, clinical and pathological effects do not always match, and careful attention must be made in CR assessments.

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Background : We traditionally use the Pringle maneuver to avoid hemorrhage during hepatectomy.However, the mechanism of metastasis in the ischemic condition is unknown.
Method : An orthotopic model of murine colon cancer in syngeneic BALB/c mice wasused. Viable CT -26 cells were implanted into the spleen of mice. Five days after tumor implantation, mice received laparotomy and the hepato-duodenal ligament was clamped for 0 or 10 minutes (Pringle maneuver). Twelve days after tumor implantation, the mice were killed and the number of hepatic metastasis was counted.
Result : Mice which received Pringle maneuver produced a greater number of hepaticmetastasis. Immunohistochemical analysis revealed that the expression of microvessel density andVEGF were higher in hepatic metastasis with the Pringle maneuver. Also, mice which received Pringle maneuver had a higher level VEGF in the serum.
Conclusion : The Pringle maneuver induces tumor vasculature and produces a large number of liver metastasis in mice.

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