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Volume 27, Issue 4
Displaying 1-29 of 29 articles from this issue
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Kimiyoshi Shimanuki, Michio Miyata, Masamitsu Shouji, Hiroyuki Shibusa ...1994 Volume 27 Issue 4 Pages 835-840
Published: 1994
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSSeventy-six esophageal cancer patients who underwent retrosternal reconstruction of the esophagus with gastric tube were studied. Esophagogastrostomy was performed with hand suturing in all patients. The patients were divided into two groups. Group A comprised 41 patients who had suture line leakage of the esophagogastrostomy. Group B comprised 35 patients without anastomotic dehiscence. We measured various factors of thoracic inlet space on computed tomography (CT) of these patients. Between groups A and B, there were significant differences in interclavicular distance (ICD), sterno-tracheal distance (STD), thoracic inlet area (TIA: =ICD×STD) and tracheal position ratio (TPR: =STD/SVD) values. Leakage at the esophagogastric anastomoses occurred in 81.0% of 21 cases whose TIA values were below 400 mm2 and 66.7% of 45 cases whose TPR values were below 0.4. Narrow thoracic inlet space may badly influence on the healing of esophagogastric anastomosis. Preoperative evaluation of thoracic inlet space on cervico-thoracic CT provides important information to prevent anastomotic dehiscence.View full abstractDownload PDF (10642K) -
Junzo Sayama, Ryuzaburo Shineha, Ken-ichi Yokota, Katsu Hirayama, Nori ...1994 Volume 27 Issue 4 Pages 841-848
Published: 1994
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSCorticosteroid(methylprednisolone 250mg, /body) was preoperatively administered to patients with esophageal carcinoma in order to control the excessive reaction induced by surgical stress, and the steroid group(n=8) was compared with a control group(n=9) as to clinical course, changes in plasma cytokine levels and other factors. Body weight and water balance recovered earlier in the steroid group, although there were no differences in changes in cardiac index, mean pulmonary arterial pressure and pulmonary capillary wedge pressure between the two groups. In the steroid group, heart rate remained within the normal range and the number of cases with postoperative arrhythmia tended to decrease. Postoperative plasma IL-6 and G-CSF reached a very high level in the control group, but production of cytokines, especially IL-6, in the steroid group was significantly inhibited and urinary excretion of catecholamines also decreased in the steroid group. Side effects of steroid like abnormality in glucose tolerance, infection and delay in wound healing did not appear, and decrease in peripheral lymphocyte count due to surgical stress was reduced in the steroid group. These results suggest that preoperative administration of steroid reduced the postoperative excessive reaction mainly in the circulation induced by surgical stress, and is very useful for postoperative management of the patients.View full abstractDownload PDF (14177K) -
Yoshio Matsuda, Iwao Sasaki, Yasuhiko Kamiyama, Yuji Funayama, Hiroo N ...1994 Volume 27 Issue 4 Pages 849-857
Published: 1994
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSTo determine the effect of obstructive jaundice on electronmicroscopic changes of mitochondrial structures of parietal cells during water-immersion restraint stress, male Sprague-Dawley rats weighing about 200 g were used. Experiment 1, control(sham operation), 2-, 4-, 6-, and 8-week jaundiced(bile duct ligation) rats and biliary drained rats were used to study the effect of duration of jaundice. Experiment 2.2-week jaundiced rats and biliary drained rats were used to study the effect of the stress on jaundice and biliary drainage. The number of crystae was significantly higher in the 2-week jaundiced group than in the control group. Fusion and deformity of mitochondria were seen in the 4-, 6-, and 8-week jaundiced groups. In the 2-week jaundiced group, the mitochondria were restored normal by biliary drainage. Mitochondrial damage during the stress in the 2-week jaundiced group was more severe than in the control group. These results indicate that an acute gastric mucosal lesion can easily occur in obstructive jaundice owing to severe disturbance of energy metabolism, which is demonstrated by histometry of the mitochondrial structure in parietal cells. Biliary drainage will protect this ulceration by reducing mitochondrial damage.View full abstractDownload PDF (17800K) -
Kazutaka Satomoto, Hiroshi Yamagiwa, Nobuyuki Ohnishi1994 Volume 27 Issue 4 Pages 858-863
Published: 1994
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSThe malignant potential of gastric leiomyogenic tumors was studied by clinicopathological analysis and measurement of the labeling index of proliferating cell nuclear antigen (PCNA) of 47 surgically resected specimens (38 leiomyomas, 9 leiomyosarcomas including those with low-grade malignancy). An ulcerative tumor and large tumor size suggested malignancy. The labeling index of PCNA (mean±SD) was 11.5±5.4% in leiomyomas, 26.3±8.2% in leiomyosarcomas and 3.0±1.6% in normal gastric proper musclelayers. Five leiomoymas showed a labeling index of PCNA over 18%, but al leiomyosarcomas had an index of more than 18%. Only one case, in which the labeling index was 37%, was metastatic and recurrent. Therefore determination of the labeling index of PCNA may be a useful diagnostic guideline to distinguish malignant from benign gastric leiomyogenic tumors.View full abstractDownload PDF (10301K) -
Hidetoshi Suzuki, Toshinobu Iinuma, Dai Seitoh, Yasunori Mikami, Mitsu ...1994 Volume 27 Issue 4 Pages 864-868
Published: 1994
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSTo investigate the advisability of treating early cancer of the lower stomach by contracted operation without No.1 and No.4sb lymph node dissection, we reviewed 323 cases of resected cancer of the lower stomach and 354 cases of early cancer encountered in the past 21 years.(1) Out of 323 cases of resected cancer of the lower stomach, 151 cases of early cancer and 48 cases of pm cancer were negative for No.1 and No.4sb metastases, and 15.3% and 3.2%, respectively, of ss and se cancer cases were positive for these metastases.(2) From the study of two timematched groups, one with 354 early cancer cases and the other with 14 cases of early lower stomach cancer with positive lymph node metastases, it was concluded that the contracted operation without No.1 dissection was indicated in 1) elevated or depressed(differentiated) m cancer sized 3 cm or less on the anterior wall and lesser curvature, 2) the aforesaid lesion plus combined or depressed(undifferentiated) m cancer sized 2 cm or less on the posterior wall, and 3) the aforesaid lesions plus sm cancer sized 2 cm or less on the greater curvature.(3) In those cases indicated for surgery without No.1 dissection, the removal of No.4sb can also be mitted.View full abstractDownload PDF (9719K) -
Hideki Ura, Ryuichi Denno, Koichi Hirata1994 Volume 27 Issue 4 Pages 869-875
Published: 1994
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSThe indications for dissection of lymph nodes located in the splenic hilus (No.(10)) and around the splenic artery (No.(11)) was studied according to clinical stage of gastric cancer in 557 patients with primary gastric cancer located in the upper-middle or whole stomach. Dissection of those lymph nodes was not essential in patients with early gastric cancer but is indicated for all patients diagnosed with advanced gastric cancer. Pancreaticosplenectomy (PS) should be chosen for the following cases: tumor size greater than 8 cm in diameter, S2-3 a smacroscopic serosal invasion, and positive metastasis in lymph node (s) found under operation. On the other hand, pancreas-preserving operation with removal of the splenic artery (PP) might be chosen for the following cases: tumor size smaller than 4 cm, S0-1 and N (-) diagnosed preoperatively by imaging diagnosis and under operation. Five-year survival rates of the PS and PP groups were as follows: Stage I: 96.3%, 100%; stage II: 64.0%, 79.6%; stage III: 39.8%, 35.6%; stage IV: 20.8%, 0%. The PP group showed the same survival rates as the PS group in stages I, II and III. Therefore, PP might be indicated for patients in those stages. However, patients in stage III or IV were revealed to have high incidences of metastasis to No.(10) and No.(11) lymph nodes, and so PS should be chosen for those cases.View full abstractDownload PDF (13347K) -
Kunihiko Kawai1994 Volume 27 Issue 4 Pages 876-883
Published: 1994
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSViable cells of methicillin-resistant Staphylococcus aureus (MRSA) were inoculated into the intestinal tract of rats to clarify the mechanism of MRSA-induced enterocolitis and the process of progression to generalized infection. MRSA-induced enterocolitis frequently occurs after gastrectomy, and alteration of intestinal bacterial flora by treatment with an antibiotic is thought to create a condition of high susceptibility to this disease. Therefore were compared MRSA-inoculated rats by dividing them into antibiotic-treated and non-treated groups and gastrectomized and non-gastrectomized groups. Before gastrectomy, MRSA in a kanamycin-metronidazole-treated group, and was detected at 102 CFU/g up to post-inoculation day 4 and at 105 CFU/g from day 5 in the non-treated group, disclosing the presence of significantly more MRSA in the former group. After gastrectomy, there was no growth of the inoculated MRSA in the latamoxef-non-treated group. When fecal MRSA counts of the gastrectomized and non-gastrectomized groups treated with an antibiotic before and after inoculation of MRSA were compared, the gastrectomized group was found to have a significantly higher MRSA count. As for the route of transmission of MRSA to the organs, it was suggested that MRSA in the intestinal tract penetrates through the intestinal wall into the portal vein, reaches the liver, and then spreads over the entire body, resulting in systemic infection, because MRSA was detected in the liver first.View full abstractDownload PDF (13358K) -
Correlation with Stage, Liver Metastasis and PrognosisMasato Nakamura, Haruhiko Inufusa, Toshiyuki Adachi, Katsuhisa Shindo, ...1994 Volume 27 Issue 4 Pages 884-891
Published: 1994
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSImmunohistological staining (ABC method) of normal fibronectin (nor FN) and oncofetal fibronectin (onc FN) was performed on 99 cases of colorectal cancer and 12 with liver metastatic lesions to determine the character of expression and the relation to stage, metastasis and prognosis of the disease. The staining reaction was graded as (-), (+), (++), as the grade of expression. oncFN expression in colorectal cancer showed a secretory antigen-like pattern such as CEA. Histological stage and onc FN expression were positively related as follows: stage I, 42%; H, 38%; III, 67%; IV, 87%, V, 83%. In the cases with liver metastasis 53% of the primary lesions were oncFN positive, hence 13% positive without liver metastasis (p<0.05). In liver metastatic lesions, the onc FN expression was found in 92% of the 12 cases. In stage III and IV, the oncFN expression was positively correlated with the 5-year survival rate: (-), 88%; (+), 35% and (++), 25% (p<0.01). On the other hand, there was no correlation between nor NF expression and stage, liver metastasis or survival rate. These results reveal that the expression of onc FN and the biological malignant grade of the colorectal cancer are significantly correlated, and that onc FN is a useful marker for the prognosis of colorectal cancer.View full abstractDownload PDF (16696K) -
Akira Kawaguchi, Jyunsuke Shibata, Hiroyuki Naito, Yoshihiro Endo, Mas ...1994 Volume 27 Issue 4 Pages 892-896
Published: 1994
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSWe experienced a case of early basaloid carcinoma of the esophagus. the tumor was regarded as type O-Ipl in the new endoscopic classification and the histological findings in the biopsy specimen showed poorly differentiated squamous cell carcinoma. The long diameter of the tumor was 4.8 cm. The edge of the tumor was covered with normal epithelium and its surface was irregular, and the basaloid carcinoma cells extended downward to the submucosal layers histologically. Vascular invasion and the expression of epidermal growth factor receptor were observed. Mediastinal lymphnode metastases and liver metastases were found, the patient died 1 year and 2 months after the operation. Basaloid carcinoma of the esophagus is thought to have a high malignant potential; however more cases are required in the future to make the clinical and histopathological features clear.View full abstractDownload PDF (9394K) -
Funihiko Miura, Yasuhisa Abe, Fumiaki Sakaguchi, Shinichi Miyazaki, Te ...1994 Volume 27 Issue 4 Pages 897-901
Published: 1994
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSWe experienced intraluminal doudenal diverticulum (IDD) with the ampulla of Vaterinside it. A 47-year-old man was admitted to our hospital complaining of epigastralgia. Abdominal ultrasonography and computed tomography revealed a cystic mass that showed mobility. Hypotonic duodenography and endoscopic examination revealed an elevated lesion with smooth surface in the second portion of the duodenum. At laparotomy there was a cystic mass with orifice at the anal side of its surface. We performed simple excision of the mass at its base. Histological examination of the excised specimen revealed normal duodenal mucosa on each side and the lack of proprial muscle; therefore it was diagnosed as IDD.View full abstractDownload PDF (9321K) -
Hideaki Shimada, Yoshio Gunji, Takenori Ochiai, Kaichi Isono1994 Volume 27 Issue 4 Pages 902-906
Published: 1994
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSA case of duodenal cancer associated with the eggs of schistosoma japonicum is reported. A 67-year-old woman was admitted to our hospital for close examination of the upper gastrointestinal tract. Duodenal adenocarcinoma was found but she refused to be operated on that time. Two years later, she was admitted again complaining of appetite loss and upper abdominal pain. Barium X-rays and endoscopy revealed a Bormann 2 type-like tumor in the second portion of the duodenum. Tubullar adenocarcinoma cells mixed with the eggs of schistosoma japonicum in the biopsy specimen. Pancreaticoduodenectomy and lymphadenectomy were performed. Histopathologically, the tumor was moderately differentiated tubular adenocarcinoma and the part of it has invaded the pancreatic capsule. Primary duodenal cancer is uncommon among gastrointestinal cancers. To our knowledge, 472 cases of malignant duodenal tumors involving 262 cases of duodenal cancer have been reported in Japan. This is the first case of duodenal cancer associated with schistosomiasis japonica.View full abstractDownload PDF (10077K) -
Masami Mitani, Makoto Kataoka, Yoshiyuki Kuwabara, Yasuyuki Kureyama, ...1994 Volume 27 Issue 4 Pages 907-911
Published: 1994
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSA S9-year-old man suffered from carcinoma at the papilla vater which resected by pancreatoduodenectomy. Histopathologically, the tumor showed areas of endocrine cell carcinoma and tubular adenocarcinoma. The specimen was studied by Grimelius' stain, Fontana-Masson's stain and immunohistochemical stain for NSE, tcu7, chromogranin and CEA. The tumor was positive for Grimelius' stain and Leu7 in both areas, and for chromogranin and NSE only in the area of adenocarcinoma, suggesting the same origin of the two components. Furthermore, the neuroendocrine chatracters are exoressed not at the area of endocrine cell carcinoma but at the area of adenocarcinoma.View full abstractDownload PDF (9569K) -
Michiya Kobayashi, Takuro Ogata, Keijiro Araki, Kimio Matsuura, Shinic ...1994 Volume 27 Issue 4 Pages 912-916
Published: 1994
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSA case of intraperitoneal hemorrhage caused by rupture of a pseudoaneurysm into the pancreatic pseudocyst is reported. An 84-year-old man was admitted to a hospital complaining of sudden left flank pain and nausea. He had been in shock, but recovered with conservative therapy. Peritoneocentesis revealed intraperitoneal hemorrhage. He developed shock twice after that, and was sent to our department. Although he recovered from the shock, he complained of abdominal distension and tenderness in the whole abdomen. Laboratory data on admission showed severe anemia, hyperglycemia, and hypoproteinemia; however, serum amylase and tumor marker levels were normal. Abdominal ultrasonography and computed tomography demonstrated the massive ascites and mass at the tail of the pancreas. Celiac angiography revealed the extravasation and pooling of the contrast medium in the splenic artery. Bleeding to the pancreatic pseudocyst was diagnosed and he underwent emergency laparotomy. Laparotomy demonstrated 2000 ml of bloody ascites and a mass measuring 10 cm in diameter in the tail of the pancreas. The mass contained coagulation. He underwent distal pancreatectomy and splenectomy. The seven reported cases of ruptured pancreatic pseudocysts are also discussed.View full abstractDownload PDF (9610K) -
Masato Endo, Keiichi Maruyama, Taira Kinoshita, Mitsuru Sasako1994 Volume 27 Issue 4 Pages 917-921
Published: 1994
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSA patient with severe chylous ascites was experienced after extended lymphnode dissection for gastric cancer. The 51-year-old woman received a distal gastrectomy, and had continuous fluid retention in the abdominal cavity post-operatively. The puncture fluid was typical chylous ascites: milky colored fluid containing fat globules confirmed by Sudan III staining. She was treated conservatively until the 62nd postoperative day by IVH, diuretics and reinfusion of concentrated ascites. The first diagnosis was chylous abdomen caused by injury of the lymphatic vessels during the operation, but it was corrected by the second laparotomy. No leakage was observed from the major lymphatic vessels by milk drinking test or intraoperative lymphography. Severe fibrosis was found around the celiac and superior mesenteric arteries due to the complete lymphnode dissection. Severe edema was observed at the small intestine and mesenterium, and serous fluid oozed from the entire surface of the mesenterium. From these findings, we considered that the chylous ascites was cased by complete obsturaction of the lymphotic channels around the celiac and superior mesenteric arteries. No surgical treatment was indicated in this condition. The same treatment was continued after exploratory laparotomy, but the chylous ascites improved gradually, and the patient left the hospital on the 90th day after gastrectomy.View full abstractDownload PDF (10358K) -
Yukio Kamohara, Hitoshi Yamaie, Yuji Shigeoka, Hajime Yoshinaga, Fumik ...1994 Volume 27 Issue 4 Pages 922-926
Published: 1994
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSStenosis of the small bowel following abdominal blunt trauma is rare. We report a case caused by falling and discuss the previous reports. The patient, a 56-year-old man, fell from his motorcycle and sustained a blunt injury to the lower abdomen. Ultrasonography and computed tomography revealed intraabdominal bleeding when he was admitted to our hospital. Conservative therapy was administered, and the clinical findings improved. On the 14th day after admission, abdominal pain and vomiting occurred. A long tube was inserted, and the symptom improved. Enterography revealed stricture of the ileum. Surgery was performed because the ileus-like symptoms recurred. On laparotomy, it was found that the ileum was stenotic about 50cm from Bauhin's valve, and the mesentery was cicatrized. Resection was performed and the clinical course was good. Pathological examination revealed annular ulcer (UI-II), granulation with fibrosis, and inflammatory cell infiltration. It was considered that localized circulatory distrubance of the ileum due to abdominal blunt trauma caused the cicatrized stenosis.View full abstractDownload PDF (9935K) -
Toshihiko Kobayashi, Taizo Kimura, Masayuki Yoshida, Shunji Sakuramach ...1994 Volume 27 Issue 4 Pages 927-931
Published: 1994
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSThe syndrome of severe fluid and electrolyte depletion secondary to a villous tumor in the rectum or colon is rare even in Europe and America. In Japan, only several cases have been reported in the literature. We present two cases of huge villous adenoma with advanced cancer of the rectum, clinically accompanied with hypopotassemia. The first case was an 89-year-old woman with the complaint of massive mucinous diarrhea. Blood chemical studies on admission showed hypopotassemia (K 3.1 mEq/l) and hypoproteinemia (TP 5.5 g/dl), and the rectal discharge contained high level of potassium (56 mEq/l). Barium enema and endoscopic examination revealed a large villous tumor in the rectum. The resected specimen showed a flat elevated tumor, 15×7 cm in size, which was diagnosed as a villous adenoma with advanced cancer. The second case was a 68-year-old woman with the complaint of massive mucinous diarrhea and general fatigue. Laboratory data on admission showed anemia (Hb 6.0 g/dl) and severe hypopotassemia (K 2.5 mEq/l). The electrocardiogram also reflected the electrolyte depletion. A large tumor was recognized in the rectum, and endoscopic biopsies demonstrated villous adenoma with cancer. The resected specimen showed a flat elevated tumor, 16×6 cm in size, which was diagnosed as a villous adenoma with advanced cancer. The postoperative course of both patients was uneventful, and the serum potassium levels recovered normally.View full abstractDownload PDF (10555K) -
Yasuharu Izumi, Hiroaki Matsunaga, Masaaki Kijiwara, Yoshio Akashi, Ak ...1994 Volume 27 Issue 4 Pages 932-936
Published: 1994
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSTwo cases of colo-rectal endometriosis, which showed different clinical courses, are described. In case 1, the patient complained of melena during her menstrual period. A submucosal tumor was found in the sigmoid colon by fiberscopy and wasdiagnosed as colonic endometrioma from a biopsyspecimen, Hormonal therapy well controlled her symptom. In case 2, the patient complained of severe constipation. A barium enema and fiberscopy revealed marked rectal stenosis which resembled the stenosis of rectal cancer. Though repetitive biopsy did not yield a definitive diagnosis, low anterior resection of the rectum was performed. The resected specimen showed endometrial glands and fibrosis in the entire rectal wall except for the mucosa. In case 1, the symptom was caused by rupture of a submucosal endometrioma into the colon. Therapeutic problem in this type is choice of a better modality whether conservative (hormonal) therapy or the surgical one. In case 2, the symptom was caused by a fibrotic change in the colonic wall which was due to repetitive intramural hemorrhage from the endometrial glands. Therefore, this case was subtyped as diffiese endometriosis. The problem concerned with this type is the differential diagnosis from colo-rectal cancer and the prevention of the over surgery.View full abstractDownload PDF (9662K) -
Koichiro Kumai, Yoshiro Saikawa, Shinji Ogawa, Yoshihide Ohtani, Masah ...1994 Volume 27 Issue 4 Pages 937-941
Published: 1994
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSLymph node metastases were observed in only 11/456 patients (2.4%) with mucosal gastric cancer in our department. Since 1977 we have used modified surgery for mucosal gastric cancer. Our modification is 2/3 gastrectomy with D1 +No.7lymph node dissection in contrast with subtotal or total gastrectomy with D2 lymph node dissection of standard surgery. Although high long-term survival rates were observed in the modified surgery group, the postsurgical quality of life (QOL) was not sufficient as compared with the standard surgery group. Endoscopic mucosal resection (EMR) gave good QOL, but the rates of complete resection of the lesions around 2 cm in diameter were about 70%. We though that the majority of mucosal cancers could be curatively treated by local resection of the stomach. Four patients were successfully treated by laparoscopi wedge resection in a minimally invasive procedure. Our slection of surgery for early gastric cancer is as follows: 1. Standard open surgry (D2) for a lesion invading the submucosal layer. 2. Modified surgery for mucosal cancer;1) EMR for a lesion less than 1 cm in diameter, 2) laparoscopic wedge resection for an elevated lesion less than 2.5 cm and for a depressed lesion less than 2cm combined with absence of an ulcer scar, 3) modified open surgery (D1) for other mucosal cancers.View full abstractDownload PDF (9570K) -
Masatsugu Kitamura, Kuniyoshi Arai, Yoshiaki Iwasaki1994 Volume 27 Issue 4 Pages 942-946
Published: 1994
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSWe evaluated the surgical treatment of gastric cancer patients from the viwpoint of dissected lymph nodes and prognosis. Various surgical treatments, including an endoscopic procedure, were thought to be possible in mucosal cancer depending on lymph node metastasis, macroscopic type and tumor size, namely, endoscopic mucosal resection(9%), surgically local resection(35%) and gastrectomy with R1 + No.7 lymph node dissection(56%). However, R2 lymph node dissection is necessary for almost all submucosal cancer. High efficacy of dissection of second group lymph nodes was seen in tumors of the lower third of the stomach. However, this type of dissection was not effective for tumors in M and C locations. No.12 lymph node dissection among third group lymph nodes showed the best prognosis, with a 5-year survival rate of 35%. Location M cancer with No.12 lymph node metastasis showed a 5-year survival rate of 27% by removing the lymph nodes. Patients with No.16 lymph node metastasis showed a 5-year survival rate of 19% in patients without liver metastasis or peritoneal dissemination. No.16 metastasis patients with n3(-) showed a significantly better outcome than n3(+) patients. It is considered that n3(-) patients among No.16 positive patients have the benefit of prophylactic lymph node dissection in this area.View full abstractDownload PDF (8603K) -
Masahiro Hiratsuka, Hiroshi Furukawa, Takeshi Iwanaga, Shoji Nakamori, ...1994 Volume 27 Issue 4 Pages 947-951
Published: 1994
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSLymph node metastasis was observed in 80% of gastric carcinomas with serosal involvement. Patients with such gastric carcinomas were prone to develop carcinomatous peritonitis, and in case of type 4 gastric carcinoma, retroperitoneal dissemination of carcinoma cells was frequently seen. The 5-year actuarial survival rate was as low as 17.7% for gastric carcinoma patients with para-aortic lymph node involvement. Gastrectomy including removal of the para-aortic lymph node failed to improve the patient survival, indicating the necessity of developing a new modality to eradicate this disease. In order to prevent the peritoneal dissemination of carcinoma cells, 40 mg of mitomuycin C dissolved in 1000 ml of saline was intraperitoneally administered immediately after the surgery for gastric carcinomas with serosal involvement, and it was withdrawn 60 min later. This administration schedule was devised with reference to IC90(inhibition concentration 90) of mitomycin C obtained from in vitro studies, and found to be efficient in terms of prolonging the patient survival. This new method, however, did not prevent the development of carcinomatous peritonitis completely, indicating that another new modality should be devised. Invasion to adjacent organs was histologically seen in 18% of type 4 gastric carcinomas without evidence of macroscopic involvement. Left upper abdominal evisceration, i.e., extended radical gastrectomy including Appleby's method, resulted in the improvement of patient survival, especially by preventing carcinomatous peritonitis.View full abstractDownload PDF (10675K) -
Kiyoshi Sawai, Toshio Takahashi, Osamu Kojima, Toshiharu Yamaguchi, Te ...1994 Volume 27 Issue 4 Pages 952-956
Published: 1994
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSTo improve the results of gastric cancer surgery, we adopted the following six policies in 1985: 1) preoperative staging using computed tomography, echography and angiography; 2) type-oriented surgery according to the stage of the cancer; 3) surgery without blood transfusion if possible; 4) reasonable lymph node dissection using activated carbon particles (CH40); 5) intra-peritoneal administration of mitomycin C adsorbed onto activated carbon (MMCCH) for peritoneal dissemination; and 6) intraaterial infusion chemotherapy for liver metastasis. The five-year survival rare for gastric cancer patients who underwent gastrectomy under these six policies between 1985 and 1992 was 64.6%, which was significantly higher than that (46.4%) for patients who underwent gastrectomy between 1970 and 1984. 2. The differences in survival rates between the two groups were significant for patients with stage II and III gastric cancer. To secure a good quality of life after gastrectomy, we adopted pylorus preserving gastrectomy with lymph node dissection for early gastric cancer located in the middle third of the stomach in 1991. The occurrences of dumping syndrome and weight loss were lower in patients who underwent pylorus preserving gastrectomy than in patients who underwent subtotal gastrectomy. We have two future problems. Effect of para-aortic lymph node dissection should be proved by a randomized control study, and treatment for patients who have more than two unresectable factors should be developed.View full abstractDownload PDF (8602K) -
Youichi Kitamura, Hiroyoshi Suzuki, Tsuyoshi Sasagawa, Kiyotaka Yamamo ...1994 Volume 27 Issue 4 Pages 957-961
Published: 1994
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSThe treatment of liver metastasis and peritoneal dissemination of gastric cancer was studied. Concomitant hepatectomy for liver metastasis had littel effect on the survival rate, but tramscatheter arterial chemoembolization therapy was effective for liver metastasis. In the case of drug treatment, the effect of adriamycin Lipidol emulsion was enhanced when it was combined with the surfactant lecithin. Intra-aortic administration of anticancer agents to reach the peritoneum via the lumbar arteries was studied for the treatment of peritoneal dissemination. In the normal peritoneum, the intra-aortic administration of drugs produced higher concentrations than intravenous administration. When peritoneal dissemination was induced experimentally, about the same effect of drugs were achieved by intraperitoneal and intra-aortic administration. Histological examination also showed a better antitumor effect in the intra-aortic group.View full abstractDownload PDF (8850K) -
Tetsuro Nishida, Sumitaka Arima, Kitaro Futami, Koichi Yamasaki, Tasse ...1994 Volume 27 Issue 4 Pages 962-967
Published: 1994
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSWe evaluated the clinico-pathologic factors affecting the postoperative disease free interval in 354 patients who underwent curative and relative non-curative dissection for gastric cancer. The incidence of recurrence was 0/203 (0%) in stage I, 8/59 (14%) in stage II, 23/68 (34%) in stage III, and 12/24 (50%) in stage IV. We divided the patients into two groups based on recurrence or non-recurrence in each stage, and statistically significant factors associated with recurrence were selected. The factors were ps (+), INFγ, the number of metastatic lymph nodes in stage II, ps (+), INFγ, Borrmann 4, tumor size, Circ, the number of metastatic lymph nodes in stage III, ps (+), A + M, and the number of metastatic lymph nodes in stage IV. The organs of recurrent lesions were peritoneum (51%), liver (23%), lymph node (19%), and distant organs (7%) in overall stage. The shortest disease free interval was about 7 months in stage IV, and the longest was about 3 years in distant metastasis. The prognoses of the patients with the extended lymph node dissection (R3 or R2 + No.16 dissection or R3+ No.16 dissection) were favorable for the differentiated type gastric cancer in stage III, and all histologic types in stage IV. The prevention of peritoneal metastasis depends on effective adjuvant chemotherapy, for example, intraperitoneal injection of anticancer agents.View full abstractDownload PDF (11236K) -
Takashi Aikou, Tetsushi Saihara, Shuuichi Hokita, Jyunya Ishigami, Sho ...1994 Volume 27 Issue 4 Pages 968-973
Published: 1994
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSLymph node metastasis of gastric cancer is one of the most important factors influencing prognosis after surgery. It has been reported that extensive lymphadenectomy enhances the rate of curative surgery and that the outcome is good in patients with gastric cancer. However, recently in Japan more than 40% of gastric cancers, such as mucosal or submucosal carcinoma, have been detected at an early stage. The incidence of lymph node metastasis in early gastric cancer varies with the depth of penetration into the wall of the stomach. Since our data show a significantly lower rate (2.5%) of metastasis to lymph nodes of mucosal tumors or tumors smaller than 2 cm, local resection or preservation of lymph nodes is recommended. With this treatment, it is important to know to what extent we can make an accurate preoperative diagnosis of depth of cancer invasion or lesion size. In this study, we examined the biologic characteristics, of advanced gastric cancer metastasizing to the lymph nodes which have been examined by immunohistochemical study. It was suggested that immunohistochemical expression of Desmoglein antigen in tumor tissue will be useful in predicting lymph node metastases. As for extended dissection, in Japan several institutions have employed this procedure including dissection of the para-aortic nodes. In the present study, we collected data of 53 patients nationwide with para-aortic nodal involvement who survived more than five years after extended lymph node dissection. However, both advantages and disadvantages of extended dissection have been reported. It may be still to early to come to a conclusion. Finally, we propose “Location and depth-oriented therapy” for gastric cancer.View full abstractDownload PDF (11603K) -
Masatoshi Inoue, Hitoshi Shiozaki, Shigeyuki Tamura, Takatoshi Kadowak ...1994 Volume 27 Issue 4 Pages 974-978
Published: 1994
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSIn 46 esophageal cancers and 54 gastric cancers, we examined the expression of E-cadherin(E-cad), adhesion moleclues, and α-catenin(α-cat), an E-cad-associated cytoplasmic protein that regulates E-cad function, using immunohistochemical methods. We also examined the relationship between E-cad and α-cat expression and clinicopathological features. The expression of α-cat, as well as that of E-cad, was significantly reduced in esophageal cancers(80.5%) and gastric cancers(70.4%). The reductions in E-cad and α-cat were significantly correlated with invasiveness and differentiation grade, but E-cad expression was not correlated with lymph node metastasis in gastric cancers. We also examined co-expression of E-cad and α-cat. In 46 esophageal cancerous lesions, 21 cases showed dominant reduction of α-cat, and 15 of 54 gastric cancerous lesions showed the same reduction. Furthermore, the frequency of lymph node metastasis was high in these cases. These results suggest that the reduction of α-cat expression is more closely correlated with invasiveness and lymph node metastasis than that of E-cad expression, and that α-cat may be a useful factor to investigate lymph node metastasis preoperatively in esophageal and gastric cancer.View full abstractDownload PDF (10337K) -
Yoshihiko Maehara, Tatsuo Oshiro, Hisao Ohiwa, Kazuya Endo, Yoshihiro ...1994 Volume 27 Issue 4 Pages 979-982
Published: 1994
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSTo determine independent risk factors for metastasis of gastric cancer, we carried out multivariate analysis using stepwise logistic regression.The multivariate analysis revealed that the presence of serosal invasion, c-er B-2 protein expression, abnormal p53 expression and DNA high ploidy are independent risk factors for lymph node metastasis.The presence of serosal invasion and venous involvement were independent risk factors for liver metastasis.The presence of serosal invasion, undifferentiated types and the expression of c-er B-2 were independent risk factors for peritoneal dissemination.The succinate dehydrogenase inhibition (SDI) test was used to determine chemosensitivity.The sensitivities were relatively higher in poorly differentiated tissues than in well-differentiated tissues.Lymph node metastasis was more sensitive to anticancer drugs than the primary lesions, while hepatic metastasis was less sensitive than the primary lesion.The concomitant administration of OK-432 and anticancer drug for patients with gastric cancer invading the serosa significantly decreased the rates of peritoneal recurrence and improved survival rate.These data show that “type-oriented chemotherapy”is essential for highrisk gastric cancer patients based on individual biological characteristics.View full abstractDownload PDF (8177K) -
Cancer Dissemination in Gastric CancerMasataka Shimotsuma, Morio Shirasu, Akira Sakuyama, Norimasa Watanabe, ...1994 Volume 27 Issue 4 Pages 983-986
Published: 1994
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSPeritoneal metastasis is the most common type of recurrence after a gastric cancer operation. The mechanism of this metastasis has not yet been elucidated in detail. To predict peritoneal metastasis, it is important to eliminate the mechanism of cancer dissemination in the peritoneal cavity, especially in its early stage. The lymphatic system of the peritoneal cavity maintains homeostasis and also seems to participate in intraperitoneal cancer dissemination. Omental milky spots, which are also called omentum-associated lymphoid tissue, are part of the lymphatic system in the peritoneal cavity and are located along the perivascular adipose tissues of the omentum as numerous cellular aggregations around capillary convolutions. The lymphatic capillaries in the omental milky spots take part in the absorption of various substances, including cancer cells, from the peritoneal cavity. Omental milky spots contain micrometastasis even though the omentum appears normal upon visual examination. The lymphatic system may be involved in cancer metastasis via, for example, the omental milky spots. MMC-CH is adsorbed into the lymphatic system of the peritoneal cavity and releases high concentrations of MMC. Intraperitoneal chemotherapy with MMC-CH significantly improved the survival rates of gastric cancer patients with serosal infiltration in a prospective randomized study.View full abstractDownload PDF (8295K) -
Introduction of Type Oriented ChemotherapyMasayoshi Mai, Yutaka Takahashi, Toshihiro Fujimoto1994 Volume 27 Issue 4 Pages 987-993
Published: 1994
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSAlthough there has been recent progress in gastric surgery, our clinical series supports that in half of advanced gastric cancer cases of stage III and IV the tumor recurs and leads to complication of the peritoneal cavity, liver or distant organs even if curative resection might be possible. From the viewpoint of the new classification of cellular behavior gastric cancer tumors can be divided into two types: O the localized and expanding type with medullary stroma which shows hematogenous organ metastasis, most often affecting liver through venous and circulating disperson, and (2) the infiltratively penetrating type which widely infiltrates through gastric wall rather than forming a mass, often associated with peritoneal seeding. The present study was designed to assess two high-risk groups of metastatic patterns, peritoneal dissemination and liver metastasis, based on multivariate analysis of histopathology and tumor markers. First, intraperitoneal lavage of high-dose MMC and OK432 was indicated for the group of high risk for peritoneal recurrence (12 patients with excellent postoperative survival). Secondly, aone-shot infusion of MMC and 5-Fu via the hepatic artery was performed for 41 high-risk patients during surgery. Favorable results on disease-free survival were obtained in the arterial infusion group. Our result indicates that prophylactic and locoregional chemotherapy during surgery might be effective as antitumor treatment against microresidual cancer cells in gastric cancer patients of high risk for peritoneal and hepatic recurrence.View full abstractDownload PDF (13672K) -
Tsong-Hong Kuo, Tetsuro Kubota, Masahiko Watanabe, Toshiharu Furukawa, ...1994 Volume 27 Issue 4 Pages 994-997
Published: 1994
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSWe have developed a liver metastatic model of human colon cancer constructed by orthotopic onplantation in nude mice. In this model, four human colon cancer strains developed liver metastases, whereas the other four did not, although extensive local growth and vessel invasion were observed in both groups. We also used this model for experimental immunochemotherapy with 5-fluorouracil (5-FU) and OK-432. 5-FU showed significant antitumor activity against the primary tumor, whereas OK-432 significantly prevented liver metastases, suggesting different chemosensitivity according to the locality of the growing tumors. Immunochemotherapy with both drugs was effective against both the primary tumor and liver metastases. This model would be useful for further study of the metastatic process and immunochemotherapy of colon cancer.View full abstractDownload PDF (8017K)
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