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Volume 28, Issue 10
Displaying 1-31 of 31 articles from this issue
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Hideki Ura, Ryuichi Denno, Koichi Hirata, Tetsuhiro Tsuruma, Hidekazu ...1995 Volume 28 Issue 10 Pages 1973-1979
Published: 1995
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSThe significance of local therapies for early gastric cancer was studied with regard to curability from the viewpoint of accuracy of endoscopic ultrasonography (EUS) for preoperatively assessing the depth of cancer invasion. EUS was performed in 56 patients with early gastric cancer. The overall accuracy rate of EUS was 66.1%. Ten patients with mucosal cancer had been overdiagnosed as suffering invasion into the submucosa, and 9 with submucosal cancer had been underdiagnosed as having mucosal cancer. In the latter, 8 were found to have minute invasion into the submucosa (sm1). Thus it seemed difficult to discriminate between mucosal cancer and sm1. A large sample of submucosal cancers was classified into three groups by the degree of invasion into the submucosa, sm1, sm2 and sm3, and the rates of lymph node metastasis were investigated. The sample number was 223 submucosal cancers which had been resected in our department since 1975. The metastatic rates in regional lymph nodes were 11.1%, 20.8% and 18.9% for sm1-sm3, respectively. On the other hand, that of mucosal cancer was 0.5%. The rate in sm1 was clearly higher than that in mucosal cancer. In order to carry out local therapies for early gastric cancer, reliable differential diagnosis of mucosal and submucosal cancers should be supported. Although promising, EUS still does not provide sufficient discrimination between mucosal cancer and sm1. Therefore, the attending physician should avoid local therapies unless he or she can make a definite preoperative discrimination between the two.View full abstractDownload PDF (13720K) -
Hideo Katsuragawa, Ken Takasaki1995 Volume 28 Issue 10 Pages 1980-1985
Published: 1995
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSWe measured portal venous pressure during hepatectomy in 51 patients, and studied the relationship among the degrees of fibrosis of the resected liver, the growth rate of the remnant liver after hepatectomy, and pre-and postoperative changes in ICG. The portal venous presure before hepatectomy (PVB) became significantly higher as liver fibrosis increased. The portal venous pressure after hepatectomy (PVA) increased, or did not change, in all patients, but it also did not decrease. The portal pressure after hepatectomy increased according to the increase in the volume of resected liver. When the rate of change in portal pressure before and after hepatectomy was regarded as (1/ PVA-1/ PVB) / 1/ PVB, and the rate of change in ICGK before and after hepatectomy was regarded as (postoperative ICGKpreoperative ICGK) /preoperative ICGK, the rate of change in portal pressure tended to increase according to the increase in liver fibrosis and was positively correlated with rate of change in ICGK, but not with the growth rate. The portal pressure, when clamping the portal vein (Pringle maneuver), tended to be lower when the preoperative ICGR15 was higher. Such changes in portal pressure can be measured before hepatectomy by clamping Glisson's sheath of the segment which will be removed, and ICGK levels can be estimated by calculating the rate of change in portal pressure. Based on the above, intraoperative measurement of the portal pressure was considered to be useful for assessing hepatic function.View full abstractDownload PDF (11845K) -
Satoshi Nakamura, Shohachi Suzuki, Takanori Sakaguchi, Atsushi Serizaw ...1995 Volume 28 Issue 10 Pages 1986-1990
Published: 1995
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSWhen a metastatic tumor is near the confluence of the hepatic vein and inferior vena cava, the hepatic vein should be resected with the tumor. Seven patients with hepatic metastases of colorectal cancer underwent hepatectomy combined with hepatic vein reconstruction (HVR). Hepatectomy comprised the resection of segment 7+8 in 3 cases, segment 2 in 2, segments 7+8, and the upper portion of segment 4 in 1, and segment 5+6+8 and upper portion of segment 4 in 1. Right HVR was performed in 4 cases, middle in 1, and left in 2. Direct anastomosis without vein graft was carried out in 3 cases of right HVR. Hepatic venography, computed tomography, and hepatic scintigraphy were performed one month after surgery. There were no cases of mortality or in-hospital death. All 7 cases showed invasion of the tumor into the adventitia of the resected hepatic vein. The right hepatic vein was patent in all 4 cases, but 3 cases with middle or Ieft hepatic vein graft had graft obstruction due to unsuitable selection of graft and infection at the liver stump. Two of the 3 cases with an obstructed graft had increased levels of glutamyl oxaloacetic transaminase at 2 to 3 weeks after operation. Hepatic scintigram with 99mTechnetium phytate revealed decreased hepatic function in the area of an obstructed graft. Hepatic vein reconstruction in extended hepatectomy for hepatic metastases may be a useful option to preserve the function of the remnant liver.View full abstractDownload PDF (9746K) -
Jiro Nasu, Kenjiro Kotake, Yasuo Koyama, Hideaki Shimizu, Shoichi Hish ...1995 Volume 28 Issue 10 Pages 1991-1994
Published: 1995
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSTo evaluate the efficacy of identification of free cancer cells in the peritoneal cavity for predicting peritoneal recurrence after curative surgery, 188 patients with primary advanced colorectal cancer were studied using intra-operative peritoneal lavage cytology. The rates of positive cytology in patients with and without macroscopic peritoneal dissemination were 53.3% (8/15) and 5.8% (10/173), respectively (p<0.01). Of the latter, 3 had carcinoma invading to the subserosal layer and 7 beyond the serosal surface, 8 had differentiated adenocarcinoma and 2 had mucinous carcinoma. Of the 10 patients who had positive cytology without macroscopic peritoneal dissemination, peritoneal recurrence was observed in 4 (40%), while of the 163 with negative cytology, it occurred in 3 (1.8%). The 5-year survival rates of patients with and without positive cytology were 48% and 83%, respectively (p<0.01). In conclusion, this study suggests that peritoneal lavage cytology may be a useful diagnostic procedure to predict peritoneal recurrence in advanced colorectal cancer.View full abstractDownload PDF (7778K) -
Nobutaka Yasui, Masahiko Watanabe, Tatsuo Teramoto, Yukio Kawano, Kiyo ...1995 Volume 28 Issue 10 Pages 1995-2001
Published: 1995
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSThis study investigated the reasonable range of lymphadenectomy for colorectal carcinoma invading the muscularis propria (colorectal mp carcinoma). Two hundred and eighteen patients with colorectal mp carcinoma were operated on at Keio University Hospital, and the correlation between the extent of lymph node dissection and the prognosis (recurrence rate and 5-year survival rate) was evaluated. According to the operation records, lymphadenectomy was categorized as follows; D3 was lymph node dissection up to n3, D2 was other procedures except D3; L+ was lateral lymph node dissection of #262, #272 and #282, and L-was other procedures except L+. There was no significant difference in the recurrence rate and survival rate between D2 and D3 in patients with colorectal mp carcinoma after curative resection. In addition, there was no significant difference in the prognosis of lower rectal mp carcinoma between L+ and L-after curative resection. From these results, D2 lymph node dissection appears sufficient for colorectal mp carcinoma and lateral lymph node dissection is not necessary for lower rectal mp carcinoma.View full abstractDownload PDF (13398K) -
Hidetaka Shigeta, Tatsuo Hattori, Shinji Fukata, Yoichiro Kobayashi, K ...1995 Volume 28 Issue 10 Pages 2002-2006
Published: 1995
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSWe report two cases of smooth muscle tumor of the stomach in which growth was monitored and doubling time could be measured from upper gastrointestinal X-ray finding. In case 1, a 56-year-old man, a tumor was detected on the cardia by an upper gastrointestinal series. Partial resection of the stomach was performed three years later. Histopathological examination revealed a smooth muscle tumor of underterminate malignant potential (STUMP) with a doubling time of 4.5 months. Incase 2, a 43-year-old woman, a tumor on the upper segment of the stomach was detected by an upper gastrointestinal series, and partial resection was performed about 20 months after the initial discovery. Histopathological examination revealed a STUMP with a doubling time of 25.4 months. The DNA patternwas diploid in both cases. It is often difficult to determine histopathologically whether smoothmuscle tumor is benign or malignant, but some reports have shown that the growth rate, that is, the doubling time of the tumor, is a useful index for determining its biological malignancy, We conclude that case 1 should be considered a leiomyosarcoma and case 2 a leiomyoma from the clinical aspect.View full abstractDownload PDF (10267K) -
Norichika Matsui, Tomoaki Morita, Mikihiko Harada, Noriyasu Morikage, ...1995 Volume 28 Issue 10 Pages 2007-2011
Published: 1995
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSAnomalies of the portal venous system are rare. We report a very rare surgical case of the carcinoma of the bile duct associated with the portal vein, namely the prepancreatic postduodenal portal vein, being abnormally situated. A 66-year-old woman came for treatment of upper abdominal pain. On admission, she was found to have jaundice, and found after various examinations, carcinoma at the middle and inferior bile duct. The superior mesenteric-portal venogram revealed very unusual sight. The portal vein, which was deviated to the right below the margin of the head of the pancreas forming an L-shape, branched off to right and left just above the margin of the head of the pancreas and streamed in azigzag pattern into the liver. The spleno-portal venogram showed that the splenic vein was streamed in left portal vein and a tumor embolism was discerned at the confluence. Pancreaticoduodenectomy combined with resection of the portal vein was performed. The portal vein was situated in a prepancreaticpostduodenal position, and lay in a position anterior to the common bile duct in the hepatoduodenal ligament. Clinically, the portal vein is very important in digestive surgery, and therefore it is essential to recognize and be aware of anomalies in the portal venous system such as anteroposition seen in this case, in order to avoid accidental injuries during operations.View full abstractDownload PDF (10601K) -
Hiromichi Machida, Yuuzou Nakaya, Koujirou Kojima, Masao Kanzaki, Hiro ...1995 Volume 28 Issue 10 Pages 2012-2016
Published: 1995
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSFor a patient having cholelithiasis complicated with abnormality in the intrahepatic external biliary distribution, we placed an endoscopic naso-biliary drainage tube (ENBDT) and performed laparoscopic cholecystectomy (LC). This case is reported here. The subject was a 47-year-old woman with cholelithiasis. Preoperative ERCP revealed abnormalities in the intra and extra hepatic biliary distribution. Cholangiography demonstrated that the branch in the region posterior to the right hepatic duct bifurcated independently from the dorsal side of the common bile duct and the cystic duct bifurcated from the branch in the right posterior region. Moreover, it was a special type in which the anterior branch and the posterior branch in the right hepatic duct flowed together. Following drip infusion cholangiography (DIC), helical CT was conducted and the biliatry distribution was confirmed using the 3-dimensional biliary images (3D-CT). The ENBDT was placed one day prior to surgery. During LC, while cholangiography was performed using the ENBDT, the relationship between the surgical field and the cholangiograms or 3D-CT images was confirmed, and the surgery then proceeded. Cholangiography using ENBDT was effective for indentification of the bile duct and enabled completion of LC without damage to the bile duce.View full abstractDownload PDF (8248K) -
Kazuhiko Yamagami, Tadao Manabe, Nobuo Baba, Kayoko Higuchi, Noboru As ...1995 Volume 28 Issue 10 Pages 2017-2021
Published: 1995
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSWe report a case of malignant rhabdoid tumor (MRT) of the pancreatic head. A 62-year-old man was admitted from a tumor of the pancreatic head confirmed with ultrasonography and computed tomography. Findings during operation did not indicate liver metastasis, lymph nodes metastasis, or dissemination, and we performed pancreaticoduodenectomy. Despite the absolute curative operation, the patient died on the 50th postoperative day, with multiple liver metastasis and peritonitis carcinomatosa. In the hematoxylin-eosin stain, the cytoplasm contained eosino-philic hyaline-like globular inclusions and immunochemistry confirmed reactivity to vimentin but no immunoreactivity to keratin. Under electron microscopy, the most striking ultrastructural feature was the presence of cytoplasmic whorls of filaments of intermediate size. The findings above lead us to diagnose pancreatic MRT. MRT has been reported mostly as renal tumors with aggressive clinical behavior in children. However, a small number of histologically similar extrarenal MRT has been previously described. To our knowledge, this is the first case report of pancreatic MRT.View full abstractDownload PDF (10541K) -
Occlusive Disease Who Underwent Abdominal Aorta-celiac Bypass before PancreaticoduodenectomyToru Ii, Toshiaki Yasui, Hiroshi Ito, Kazuhiro Mori, Toru Kamata, Ryui ...1995 Volume 28 Issue 10 Pages 2022-2026
Published: 1995
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSWe report a patient with cancer in the head of the pancreas associated with celiac occlusive disease who underwent pancreaticoduodenectomy. A 75-year-old woman was admitted to our hospital because of upper abdominal pain, back pain and jaundice. Abdominal CT, percutaneous transhepatic cholangiogram and endoscopic pancreatogram revealed cancer in the head of the pancreas. Superior mesenteric angiogram demonstrated high-grade stenosis of the celiac axis at its origin, and the blood supply to the celiac artery was sustained through the gastroduodenal artery via the pancreaticoduodenal arcades from the superior mesenteric artery. Therefore a diagnosis of cancer in the head of the pancreas associated with high-grade stenosis of the celiac axis was made, and an autograft of saphenous vein was placed between the abdominal aorta and common hepatic artery cranially to the celiac axis before pancreaticoduodenectomy. The postoperative course was uneventful, and angiogram obtained on the 80thpostoperative day demonstrated patency of the graft. Our bypass method is safe because blood supply to the liver is not blocked during the operation. It also maintains curability beca use it does not obstruct the operative procedure or dissection of lymphnodes. Therefore we consider our bypass method to be useful.View full abstractDownload PDF (10811K) -
Tomoko Umeda, Saishiro Inaba, Yuji Kondo, Kuniyuki Tsuchiya, Kanji Kaw ...1995 Volume 28 Issue 10 Pages 2027-2031
Published: 1995
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSIt has recently been emphasized that endocrine cell tumors arising in the digestive tract should be classified into classical carcinoid of low grade malignancy and endocrine cell carcinoma (ECC) of high grade malignancy. Although the differential diagnosis is based on histological atypia, it is often difficult. Many ECCs have been reported to arise in the duodenum, lower colon and biliary duct. A rare case of ECC arising in the cecum is reported. A 70-year-old woman was admitted to the hospital complaining of abdominal discomfort. She had an appendectomy when young. Barium enema revealed an apple core sign up to 3cm at the cecum, and CT scan showed multiple metastatic lesions in the liver. We performed a right hemicolectomy to release the ileus. Histological study showed endocrine cell carcinoma, a mixed type combining oat cell carcinoma resembling small cell carcinoma of the lung with squamous cell carcinoma and adenocarcinoma. Most tumor cell showed strong positivity for p53 protein, wheares 7 classical carcinoid tumors studied showed no positivity. p53 protein stain is sugested to be useful in the differential diagnosis of ECC and classical carcinoid.View full abstractDownload PDF (8334K) -
Yoshito Akagi, Takashi Fukushima, Hiroshi Oku, Susumu Sueyoshi, Masami ...1995 Volume 28 Issue 10 Pages 2032-2036
Published: 1995
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSIt is difficult to diagnose a thrombosis in the mesenteric artery. However, it is particularly important to have a timely diagnosis to decrease the high fatality rate associated with this condition. The condition often occurs in cases of thrombophilia or basal disease such as heart disease. Here we report the case of a 51-year-old woman with no other risk factor who had a thrombotic lesion in the peripheral mesenterium artery of the ileum. In this case, an early diagnosis was not available, because symptoms had not been evident. At 15 hours after admission, we first noticed the melena, and this condition was then suspected. As the defense musculaire had already appeared, laparotomy was performed. The cause remainedu nknown in this case, but it was thought that the blood vessels and intestine were factors in the mechanism of occurrence. Even if a patient with acute abdominal pain is not old and has no basal disease, we should consider this disease in the diferential diagnosis.View full abstractDownload PDF (10183K) -
Sakae Iwakami, Kazuyuki Kawakami, Yukimitsu Kawaura1995 Volume 28 Issue 10 Pages 2037-2041
Published: 1995
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSIntussusceptions caused by anisakiasis of the small intestine are very rare, and only five cases have been reported in Japan. We report a case of intussusception due to a small intestinal anisakiasis. Patient was a 46-year-old woman who had been suffering from abdominal pain twelve hours after eating raw salmon. Endoscopic examination of upper gastrointestinal tract was considered as gastritis verrucosa and erosive duodenitis. Ultrasonography indicated multiple concentric ring sign in the upper small intestine. CT scan of the abdomen shows layer circle mass in the upper abdomen. Intussusception was manifested by ultrasonography and CT scan of the abdomen. Under a diagnosis of intussusception caused by anisakiasis of the jejunum, an operation was performed. After reducing the intussusception manually, the jejunum was excised with end to end anastomosis. Although diagnosis of intestinal intussusception was previously difficult, recently it has been possible to diagnose it by ultrasonography and computed tomography. It is important to ask the patient details of the food ingested in cases of intussusception caused by intestinal anisakiasis. Furthermore, it is necessary to bear in mind that an inflammatory mass caused by intestinal anisakiasis can induce intussusception.View full abstractDownload PDF (9539K) -
Hiromi Tokumura, Takashi Yamamoto, Takafumi Sato, Yoichi Imaoka, Akio ...1995 Volume 28 Issue 10 Pages 2042-2046
Published: 1995
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSLaparoscopic colectomy has been associated with earlier recovery and increased patient comfort like other kinds of laparoscopic surgery. We successfully performed a laparoscopic right hemicolectomy in an 18-year-old patient with remakable stenosis of the ascending colon due to Crohn's disease. After intraabdominal insufflation and introduction of 5 access ports, the terminal ileum and right sided colon were completely mobilized. The right side colon was comletely resected intracorporeally, and then a so-called functional end-to-end anastomosis was made by Endocutter. Postoperatively, bowel function and walking ability promptly returned to normal, and no complications were noted. This experience with laparoscopic right hemicolectomy leads us to believe that it will have a useful role in the surgical management of Crohn's disease. However, intracorporeal anastomosis may deserve further study.View full abstractDownload PDF (8813K) -
Masamichi Baba, Takashi Aikou, Michiyo Asatani, Shigeto Kimura, Kazuno ...1995 Volume 28 Issue 10 Pages 2047-2051
Published: 1995
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSWe reviewed a series of 285 patients with carcinoma of the thoracic esophagus undergoing curative resection via a right thoracotomy and laparotomy with cervical anastomosis pulling up the gastric tube by either the restrosternal or posterior mediastinal route. These 285 patients were divided into two groups: 88 patients without upper mediastinal lymphadenectomy operated on prior to 1982 (First Gr.), and 197 patients with upper mediastinal lymphadenectomy (Latter Gr.). In the First. Gr., survival was significantly better in patiens who died without tumor recurrence than in those with tumor recurrence. However, this benefit disappeared in the Latter Gr. with the increasing number of patients who died of either pneumonia, general debility, or sudden death. In the Latter Gr., body weight, vital capacity, and FEy1.0 on discharge from hospital were significantly better in 117 patients with the posterior mediastinal route than in 80 patients with the retrosternal route, as was body weight three years after discharge. A questionnaire administered to 54 patients who were alive between three and five years after the operation revealed benefits in patients with the posterior mediastinal route concerning the passage of food. abdominal pain, and shortness of breath. The posterior mediastinal route is thought to be the first choice when pulling up the esophageal substitution to the neck.View full abstractDownload PDF (9044K) -
Harushi Udagawa, Masahiko Tsurumaru, Yoshiaki Kajiyama, Yoshihiro Kino ...1995 Volume 28 Issue 10 Pages 2052-2056
Published: 1995
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSThe problems related to radical esophagectomy and reconstruction for esophageal carcinoma were investigated in 3 different patient groups without tumor recurrence. [Study A] The causes of death were investigated in 129 patients who died without tumor recurrence after radical esophagectomy. The most common causes of death after esophagectomy were pneumonia and general debility. Alcohol-related deaths and death due to ulceration of the transposed stomach were also unique to the postoperative patients. None of the causes of death was related to the specific pattern of esophageal reconstruction. Death due to heart failure occurred significantly more frequently in patients who underwent preoperative or postoperative radiation therapy. [Study B] The average survival time of 256 patients who had gone 5 years postoperatively without tumor recurrence was 8.35 +/-0.50 years, which was shorter than the average life expectancy (16.75 years) of a general population with the same sex and age distribution. [Study C] A questionnaire about postoperative quality of life was given to 142 patients sirviving more than 5 years without recurrence and the answers revealed postoperative problems such as frequent bile regurtitation. Regurgitation was more frequent after reconstruction via the posterior mediastinal route than via a retrosternal tunnel. However, the retrosternal and posterior mediastinal routes showed no other clear differences. Cervical dissection did not increase postoperative swallowing problems. Thus, patients who underwent radical esophagectomy and reconstruction have characteristic postoperative problems. Postoperative life expectancy was markedly shortened even in completely cured patients. No definite advantage of any particular method of reconstruction was noted.View full abstractDownload PDF (9464K) -
Hiroko Ide, Reiki Eguchi, Tsutomu Nakamura, Kazuhiko Hayashi, Hidemi N ...1995 Volume 28 Issue 10 Pages 2057-2061
Published: 1995
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSWe examined the late condition of patients after esophagectomy and reconstraction to study their problems. From 1991 to 1994, the incidence of disorders caused by endoscopy was 64% of 498 cases in 181 patients after esophagectomy and reconstruction. Of these, anastmotic stricture accounted for 34%, reflux esophagitis/esophageal ulcer 17%, gastric tube ulcer 13%, metachronous cancer 7% (5 patients in gastric tube, 6 in the pharynx or larynx), and recurrence 3%. Postoperatative endoscopic follow-up revealed reflux esophagitis in patients with reconstruction by the posterior mediastinal route, (especialy, serious disease in young patients), and gastric tube ulcers and erosion in patients with reconstruction by the mediastinal route, especialy in patients who underwent post-operative radiotherapy. It was possible to perform minimal invasive surgery for patients with metachronous cancer diagnosed by follow-up endoscopy. From 1985 to 1994, 24 patients underwent re-operation a long time after esophagectomy and reconstruction. Of these, 8 patients had cervical esophageal cancer, 4 had gastric tube cancer, 4 had stagnation of food in the gastric tube, 4 had anastomotic stricture, 2 had perforation of the gastric tube by an ulcer, and 2 had marginal recurrence. The anastomotic route had an advantage in treating gastric tube diseases, such as gastric cancer.View full abstractDownload PDF (9972K) -
Minoru Muraoka, Teruo Kouzu, Akio Sakamoto, Yoshio Koide, Shinnichi Mi ...1995 Volume 28 Issue 10 Pages 2062-2066
Published: 1995
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSThe relationship between swallowing function and mis-swallowing after an operation for esophageal reconstruction was studied by measuring the esophageal inner pressure. Fifty-three outpatients with resected esophageal cancer in our department were studied. Esophageal inner pressure on swallowing was measured by the stationary pull-through method using a transducer with 4-channel microchips and pressure at rest of the cervical esophagus was measured by the rapid pull-through method. The ratio of the preceding negative wave to the following positive wave in swallowing pressure was 10.20±1.30 (M±SE) in the mis-swallowing group and 3.59±0.29 in the group without mis-swallowing, with a statistically significant difference. The ratio of inner pressure at rest around the upper esophageal sphincter and around the anastomosis in the cervical esophagus was 1.73±0.34 in the mis-swallowing group and 0.79±0.17 in the group without mis-swallowing. This difference was also statistically significant. The distance between the upper esophageal sphincter and the anastomosis was 2.2±0.3 cm in the mis-swallowing group and 3.7±0.6 cm in the group without mis-swallowing, with statistically significant differece.View full abstractDownload PDF (9357K) -
Michihiko Kitamura, Shichisaburo Abo, Masaji Hashimoto, Keiichi Izumi, ...1995 Volume 28 Issue 10 Pages 2067-2071
Published: 1995
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSThe purpose of this study was to assess the long-term nutritional condition of patients after esophagectomy and evaluate the significance of the home enteral nutritional support (HENS) that we started in 1989. From April 1989 to October 1992, 79 patients with no preoperative therapy underwent resection for esophageal cancer. Mean oral intake at discharge was 861 kcal/day. Enteral nutritional support was performed in 68 cases (86%) with a mean energy level of 671 kcal/day. As a result, mean total intake of energy increased to 1439 kcal/day, which corresponded to 124% of the basal energy expenditure calculated by the Harris-Benedict formula. Fifty-one of these patients were followed, and HENS was performed in 42 cases (82%) with a mean energy intake of 486 kcal/day. The mean period of HENS was 5.4 months. Mean body weight of patients up to 36 months after discharge stayed at the same level as that at discharge. Mean values of serum total protein and albumin rose 1 month after discharge and remained within the normal ranges. The mean values of serum total cholesterol gradually increased after discharge.Mean values of total lymphocyte count in peripheral blood remained within the normal ranges. Mean values of % tricuspid skinfold thickness (%TSF) ranged from 62 to 80%, and about 70% of patients experienced severe or moderate loss of body fatty tissue. Mean values of % arm muscle circumference (%AMC) ranged from 80 to 90%. Conclusions: HENS is considered to be useful for the maintenance of body weight and improvement of laboratory tests. Based on the results of % TSF, more aggressive nutritional support should be performed for improving the loss of body fatty tissue.View full abstractDownload PDF (10070K) -
Tatsuyuki Kawano, Kunihide Yoshino, Kagami Nagai, Haruhiro Inoue, Take ...1995 Volume 28 Issue 10 Pages 2072-2076
Published: 1995
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSThe problems of oral intake that occur after esophagectomy and its reconstruction for esophageal cancer and the clinical examinations for evaluation of them were discussed. Out of 483 patients who had esophagectomy and reconstruction in our department in the recent 10 years, we evaluated the data from a qestionnaire about oral intake of 134 patiens who were doing well without cancer recurrence and in whom the esophagus was reconstruted with the gastric tube. The patients were consisted with 119 men and 15 women, the mean postoperative period was 42 months, and the reconstruction routes were categorized as three types, retrosternal in 95 cases, posterior mediastinal in 9, and other resonstructive methods in 10. Although 128 patients (96%) complained of some discomforts about the oral intake such as the limitation of the amount of food, 62 patients (46%) had continuous complaints, and the main symptoms were caused by the decrease in the stomach volume as a reservoir and the so-called dumping syndrome. The evaluation of these symptoms was not easy. Some symptoms caused by esophageal resection and reconstruction may be unavoidable. However, some methods of evaluation of the esophagogastric motility function were useful for understanding the pathophysiology of postoperative disorders. The double marker absorption method in the gastric emptying test and electrogastrography (EGG) are expected as new objective examination methods for gastric tube motility function. According to the results of the examination, modification of the life style and medication such as prokinetics were effective in some patients.View full abstractDownload PDF (9848K) -
Carcinogenic Factors and Treatment for Patients with Cancers in the Esophagus and Stomach or in the Esophagus and Oral Cavity or NeckShunji Ikeuchi, Shingo Shima, Tetsuhiko Okamoto, Masaki Arimori1995 Volume 28 Issue 10 Pages 2077-2082
Published: 1995
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSWe performed esophagectomy with reconstruction using the subtotal stomach in 252 of 382 esophageal cancer patients-There were 27 patients who underwent surgery on cancers in both the esophagus and other organs. After esophageal reconstruction, multiprimary cancers occurred in 9 male patients (3.6%) aged 59 on average, who were younger than patients not-operated on average 65. The cancer occurred in the gastric tube in 5 patients, oral cavity in 3, hypopharynx in 1, and colon in 1. Concerning carcinogenic factors, frequency of cigarettes and drinking alcohol was markedly higher in patients with multiprimary cancer than in those with esophageal cancer alone. Familial cancer accumulation was prevalent in patients with multiprimary cancers in the esophagus and stomach. Well-diferentiated adenocarcinoma was found in 60% of their resected stomach. The severity of atrophic gastritis in the resected stomach ranged moderate to severe. Thus, it was considered a possible precursor of gastric cancer. Some esophageal cancer patients showed the extremely low levels of serum pepsinogen PG I and a low PG I/II ratio preoperatively and postoperatively. This suggested that the esophageal cancer diathesis and esophagectomy induced chronic gastritis. Many patients with gastric tube cancer died of gastric cance. Endoscopy was useful in early diagnosis and treatment in one patient. Microsurgery was effective as a treatment of multiprimary cancers in the oral cavity and neck.View full abstractDownload PDF (11555K) -
Kikuo Koufuji, Teruo Kakegawa, Tetsu Suematsu, Keishirou Aoyagi, Issei ...1995 Volume 28 Issue 10 Pages 2083-2086
Published: 1995
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSA total of 148 cases of multiple primary gastric cancers have been reviewed using Moertel's principles. From 1974 to 1983, there were 39 cases, while in the same length of time from 1984 to 1993, there were 109 cases. We excluded 3 cases of advanced multiple lesions, and reviewed the remaining 106 recent cases. The incidence of type IIa, of differentiated type, and of early (m) cancer were significantly (p<0.01) higher than those in cases of a solitary gastric lesion. Our diagnostic accuracy either using a barium study or endoscopy was only 71.7%. This was due to the fact that the most common type of accompanying lesion in multiple early cancers was superficial type of less than 10mm in diameter. The diagnostic accuracy for the 15 lesions of minute cancerous foci of less than 5 mm in diameter was only 13.3%, while that of the 13 lesions of adenoma was 33.3%. Almost all of these were found in the A-region. In the same period, we experienced 21 cases of remnant stomach cancer after resection of an initial malignancy. Most of these had occurred more than 10 years after the initial operation. More regular follow-up examinations are recommended for early detection of remnant stomach cancer.View full abstractDownload PDF (8641K) -
Koichiro Kumai, Yoshihiko Sakurai, Yasunori Hoshiya, Masashi Yoshida, ...1995 Volume 28 Issue 10 Pages 2087-2091
Published: 1995
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSForty-three patients with synchronous multiple early gastric cancer were compared histopathologically with 807 patients with a single lesion. Multiple early gastric cancer was more common in elderly patients and in males. The incidence of a macroscopically elevated lesion and histologically differentiated type of adenocarcinoma in multiple early gastric cancer was higher than in cancer with a single lesion. Tumor invasion of the submucosa was observed in 67.4% of the main lesions of multiple early gastric cancer, but 86.9% of the accessory lesions were mucosal cancers. The incidence of lymph node metastasis was not higher in multiple early gastric cancer. Many lesions were located in the middle or lower part of the stomach. The modified surgery with lymph node dissection D1 was used for 60% of the patients with multiple early gastric cancer according to the selection criteria of surgery for a single lesion. Their postsurgical survival rate revealed a good Qutocome compared to that of the patients with a single lesion. Nine synchronous and 3 metachronous multiple early gastric cancers were observed in 119 patients who underwent endoscopic treatment for early gastric cancer. Intensive examination for synchronous and metachronous cancer or adenoma should be conducted. Endoscopic mucoal resection, laparoscopic surgery, modified open surgery (D1) or standard surgery (D2) could be selected for multiple early gastric cancer using our selection criteria for surgery for early gastric cancer.View full abstractDownload PDF (8966K) -
Yasuhiro Kodera, Yoshitaka Yamamura, Akihito Torii, Katsuhiko Uesaka, ...1995 Volume 28 Issue 10 Pages 2092-2096
Published: 1995
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSMultiple gastric cancer presents a great problem, due to the prevalence of various types of limited operations that leave patients with greater gastric remnants. Overlooking multiple lesions would lead to the emergence of remnant cancer. To obtain further information on this problem, we studied the clinicopathological features of multiple gastric cancer and remnant cancer diagnosed over the past 16 years. Multiple cancer was found in 6.4% of all the gastric cancer patients who underwent curative resection and gastric remnant cancer in 1.8 to 2.8% of the same population over the same period. These percentages do not add up to the unexpectedly high frequency of multiple cancer recently reported from histopathological studies of serially cut specimens. The other cancerous lesions are expected to have been resected unnoticed in the gastrectomies performed. This means that limited operations by wedge resection or endoscopy could leave the missed lesions untreated, leading to the increase in remnant cancer. The prognosis of remnant cancer has improved due to efforts to achieve early diagnosis. Such efforts would be mandatory if limited operations are to be justified.View full abstractDownload PDF (9204K) -
Tsutomu Suzuki, Katsuyoshi Hatakeyama, Tadashi Nishimaki, Kikuo Aizawa ...1995 Volume 28 Issue 10 Pages 2097-2101
Published: 1995
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSA clinicopathologic analysis of 155 patients (369 lesions) with primary multiple gastric cancers was carried out to investigate the prevalence of multiple gastric cancers in recent years and their current clinical problems. The 155 patients underwent gastrectomy and/or local resection of their lesions between 1961 and 1993 and accounted for 6.8% of 2, 284 patients with primary gastric cancer in that period. The incidence of patients with multiple gastric cancers in the recent 13 years (1981-1993) increased about 5.7-fold over that in the earlier 20 years (1961-1989): 13.7% (121/884) vs 2.4% (34/1, 400) (p<0.01). The prevalence of multiple gastric cancers was especially marked in patients over the 7th and 8th decades with an incidence of 15.0% and 19.4% respectively. The lesions were often dispersed in the stomach. A great majority of them were differentiated adenocarcinomas: 66.5& (103/155) for the main lesions and 86.4% (185/214) for the minor lesions. Of the minor lesions, 154 (72.0%) were intramucosal and 80 (37.4%) were as small as less than 10 mm in their maximal diameter. Sixty-eight patients (56.2%) in the recent 13 years had multiple superificial carcinomas and 26 (21.5%) among them had multiple intramucosal lesions. The overall diagnostic accuracy for the minor lesions was as low as 46.6% by barium swallow and 63.0% by endoscopy, and was still quite unsatisfactory even in the recent 13 years. Gastrectomy with D2-lymphadenectomy had been conventionally performed and achieved a favorable outcome with a 67.2% cumulative 5-year survival rate. Limited surgery and/or endoscopic surgery should be considered hereafter as treatment modalities, especially for elderly patients with multiple small intramucosal carcinomas. However improvement in diagnostic accuracy for multiple lesions, especially minor ones, in the stomach is mandatory.View full abstractDownload PDF (10209K) -
Zenro Nihei, Yoshio Mishima1995 Volume 28 Issue 10 Pages 2102-2106
Published: 1995
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSSynchronous multiple gastric cancer was observed in 53 (8.1%) of 654 specimens resected at our department during a 15 year-period. Elderly and male patients had a relatively high incidence of multiple gastric cancer. The main lesions of multiple cancer were found in the early stage as compared with solitary ones. In cases in which the main lesion was located at the lower or middle third of the stomach, over 80% of the accessory lesions were found within 5 cm of the main lesion. Accessory lesions were found diffusely in cases in which the main lesion was located at the upper third. Accessory lesions were found to be early cancer in 69% of cases and their size was within 2 cm in maximum diameter. Careful preoperative examination should be carried out, especially in cases in which the main lesion will be resected with limited margins, so as not to miss accessory lesions, which are frequently located at within 5cm of the main lesion.View full abstractDownload PDF (8331K) -
Osamu Hosokawa, Jouji Tsuda, Kunishige Watanabe, Yutaka Tanigawa, Shin ...1995 Volume 28 Issue 10 Pages 2107-2110
Published: 1995
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSFrom 1969 to 1993, 375 cases of synchronous multiple gastric cancer and 34 cases of metachronous gastric cancer were treated in our hospital. The incidence of synchronous multiplecancer was 12.1% in cases of early cancer, 6.2% in cases of advanced cancer and 8.9% in total. The assessory lesions of synchronous multiple cancer were dtected in 38.1% of cases preoperatively, in 33.8% macroscopically and in 28.1% microscopically. There was no significant difference in macroscopic type, depth or size between the lesions which were detected preoperatively and those which were detected macroscopically. However, the lesions which were detected microscopically differed significantly from the others. In 41.4% of multiple cancers, the lesions missed preoperatively were located nearer to the cut wedge of stomach than the main lesion. It is important to observe carefully the lesser curvature ofthe gastric body in order to prevent residual accessory lesions. The incidence of metachronous gastric cancer was high in the cases of cardiac resection. The rate of early cancer in metachronous cancer was related to the interval from the first operation to the diagnosis. It is suggested that examination for Ebstein-Barr virus in carcinoma tissues was useful to select the high risk group with metachronous cancer.View full abstractDownload PDF (9169K) -
Hiroshi Furukawa, Masahiro Hiratsuka, Takeshi Iwanaga, Shingi Imaoka, ...1995 Volume 28 Issue 10 Pages 2111-2114
Published: 1995
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSThe pathological characteristics, location of the lesions, lymph node metastasis and metachronous multiple lesions in 323 patietns with multifocal cancer were studied. In macroscopic findings, the protruded type and flat type were observed more frequently in multifocal cancer than in single cancer. Lesions were close to each other in 77% of patients younger than 49 years, and they were apart from each other in 70% of patients older than 50 years. The incidence of lymph node metastasis for multifocal cancer (33.3%) was lower than that for single cancer (43.8%) (p<0.05). Within 10 years after partial gastrectomy for cancer, 80% of remnant stomach cancers were detected in regions apart from the anastomosis, and more than 15 years after the first operation, 50% of them were detected in the region of anastomosis. Before a partial gastrectomy the stomach should be examined carefully to avoid leaving cancer. After gastrectomy, endoscopy should be performed to detect any metachronous multiple lesions.View full abstractDownload PDF (6752K) -
Based on the Cell Proliferation Analysis by DNA-cytofluorometryHirosumi Itoi, Hisakazu Yamagishi, Masashi Nakata, Yuji Ueda, Teruhisa ...1995 Volume 28 Issue 10 Pages 2115-2119
Published: 1995
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSSimultaneous multiple gastric cancers were seen in 58 (5.6%) of 1039 stomach cancer patients. Recently the incidence of multiple early gastric carcinomas has been increasing and its incidence is 8.6% of early gastric cancers. The characteristic features of multiple early gastric cancers (MEGC) are the elevated type (35.2%) morphologically and differentiated type (68.6%) microscopically. Most (81.8%) of the multiple early gastric carcinomas were treated by distal gastrectomy. Lymphatic metastasis was found in 9.1% and its rate was roughly similar to that for single early gastric cancers (SEGC; 11.1%). The incidence of gastric cancers found at the remnant mucosa within 5 years of distal gastrectomy was 3.6% for MEGC, comparable to that for SEGC (2.2%). Cytofluorometry, DNA ploidy analysis for the patients without recurrence for more than 10 years showed that 93.8% of the lesions were of the diploid pattern, without a significant difference in the malignant potential based on cell proliferative activity among both the lesions and the cases. On the other hand, the lesions in the patient who died of recurrence showed a variety of polyploid patterns with increased S-G2 cells. These ploidy patterns were very similar to those of advanced gastric cancers. These results clearly indicated that the malignant potential based on cell population kinetics was increasing during cancer growth. The present study suggests that the growth characteristics in relation to the prognosis of SEGC can also be applied to MEGC.View full abstractDownload PDF (9576K) -
Hiroyuki Konno, Keiji Maruyama, Yuji Maruo, Toshikazu Kanai, Iwao Mats ...1995 Volume 28 Issue 10 Pages 2120-2124
Published: 1995
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSWe experienced 25 synchronous multiple gastric cancer cases in 12 years in our department. Twenty-two of the patients had double cancers and 3 had triple cancers, which accounted for 6.2% of the resected cases. Among them, 11 were early multiple gastric cancers. The sex ratio and median age of the 25 patietns were 2.57/1 male/female and 63.9 years, respectively, which were higher and older than those of patients with a single gastric cancer. Macroscopically, depressed and combined types in the main lesions and depressed and flat types in accessory lesions were common. Histologically, differentiated adenocarcinoma was common (64%) and intermediate or severe intestinal dysplasia was observed in 21 cases (84%). Immunohistochemical examination 17 patients (37 lesions) revealed that p53 was expressed in 14 patients (82.4%), and in 22 of the 37 cancer lesions (59.5%). No correlation of p53 expression with any histological type or with depth of cancer invasion was found. Because heterogeneity of p53 expression among multiple cancer lesions in the same patient was observed in 8 cases (47.1%), it is suggested that the cancer lesions in the same multiple cancer patient are produced independently.View full abstractDownload PDF (10648K) -
Michio Maeta, Kuniyuki Katano, Atsuo Oka, Hiroshi Yamashiro, [in Japan ...1995 Volume 28 Issue 10 Pages 2125-2129
Published: 1995
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSThe clinicopathologic findings were investigated in 164 patients with simultaneous multiple gastric cancers (MGC). In terms of the combination of gastric cancers, patients with MGC were divided into group A [advanced plus advanced cancers (n=14)], group B [advanced plus early cancers (n=69)] and group C [early plus early cancers (n=81)]. The number of patients in group C has tended to increase recently. With respect to the direction and distance along the long axis in the stomach between the main and associated lesions, 50 had both lesions in parallel, 63 had their associated lesions at the distal side of the main lesion (mean 3.2 cm) and 51 had the associated lesions at the proximal side (2.2 cm) and 51 had the associated lesions at the proximal side (2.2 cm). The rate of postoperative diagnosis of the associated lesions was low; it was only 22% (11/49) in patients whose lesions were less than 1.0 cm in diameter. Patients with MGC were associated with a significantly higher rate (12.2%) of double cancers that developed in organs other than the stomach than that (6.8%) in patients with single gastric cancer (SGC). Preoperative immunocompetence in patients with MGC showed a decreased level compared with that in patients with SGC. It was suggested that there might be a possible association between imparied immunosuppression and the development of both MGC and double cancers. The postoperative survival rate in patients with MGC was lower than that in patients with SGC; there was a significant difference between stages I and III. Based on these analyses, careful observation of patients with MGC should be carried out before and after surgery.View full abstractDownload PDF (9852K)
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