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Volume 31, Issue 8
Displaying 1-23 of 23 articles from this issue
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Akira Kanamoto, Hajime Yamaguchi, Hitoshi Kondo, Takuji Gotoda, Hiroyu ...1998 Volume 31 Issue 8 Pages 1833-1837
Published: 1998
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSA retrospective evaluation of 334 patients with superficial squamous cell carcinoma of the esophagus, who underwent esophagectomy or endoscopic mucosal resection without pre-operativetreatment from 1962 to June 1997, revealed 94 cases (28.1%) of multiple superficial carcinoma ofthe esophagus. The male-to-female ratio within this group was 93: 1, versus 5: 1 for single superficial carcinoma of the esophagus (p<0.0001). The Brinkman index was significantly higher in patients with multiple carcinoma than in those with single carcinoma (p<0.05). The incidence of pharyngeal malignancy was also significantly higher in the patients with multiple carcinomas (p<0.001). There was no significant difference between those groups with regard to extent of lymph node metastasis orprognosis. We evaluated the characteristics of 140 secondary lesions in 94 patients with multiple carcinoma, with the following results: 1) 74.5% of the patients with multiple primary tumors had onlyone second lesion. 2) Endoscopic type 0-IIc or 0-IIb lesions were found in 90%. 3) Mucosal cancer was found in 90%. 4) The maximum length of a lesion was less than 1 cm in 65%. 5) The distance between themain tumor and the second lesion was less than 3 cm in 67%. It is important to keep multiple tumors and multifocal tumors in mind for diagnosis, treatment and follow-up of superficial carcinoma of the esophagus.View full abstractDownload PDF (10725K) -
Masamichi Ohtani, Sumio Takayama1998 Volume 31 Issue 8 Pages 1838-1842
Published: 1998
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSWe performed cisplatin plus tegafur and uracil therapy as pre-operative chemotherapy in 24 among 90 patients with stage IVb advanced gastric cancer in our department from 1991 to 1996 and report our results in this paper. We obtained an efficacy rate of 46%(CR, 0; PR, 11; NC, 11; PD, 2). In the neoadjuvant chemotherapy (NAC) group, a significant difference in survival time was found between the PR group and the NC/PD group. However the difference in survival time between the group first treated by surgery (66 patients) and the whole NAC group was not significant. Nor was the difference in survival time significant when the PR group in the NAC group was compared with the preceding surgery group. NAC might be effective and enable the lesion to be resected for patients in whom the primary lesion was considered to be unresectable at the pre-operative diagnosis.View full abstractDownload PDF (9907K) -
Ryoko Sasaki, Masahiko Murakami, Nobuhiro Sato, Osamu Funato, Hiroyuki ...1998 Volume 31 Issue 8 Pages 1843-1849
Published: 1998
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSIn order to reveal the usefulness of monitoring hepatic venous hemoglobin oxygen saturation (Shvo 2) during hetatopancreatoduodenectomy (HPD) and hepatectomy, intraoperative Shvo2 was measured and its relation to postoperative hepatic functions was investigated in 9 HPD patients and 13 hepatectomy patients. Shvo2 dropped during removal of the liver, Pringle's procedure and dissection of the lymph nodes especially around the hepatoduodenal ligament and superior mesenteric artery. The duration of Shvo2≤60% was 38.5±37.9 minutes in patients who underwent hepatectomy, and 60.0±52.7 minutes in those who underwent HPD. When the relationship between the duration of Shvo2≤60% and the postoperative peak serum bilirubin level was investigated, there were significant correlations in HPD+hepatectomy patients and HPD patients (p<0.01 and p<0.05, respectively). There were no significant correlations between duration of Shvo2≤60% and the postoperative arterial ketone body ratio. It is considered that Shvo2 reflects intraoperative hypoxic stress against the liver and is useful to predict postoperative hepatic failure.View full abstractDownload PDF (12585K) -
Identification of a High Risk Group for Cholangitis and its ManagementHidefumi Ishida, Masahiro Yamamoto, Osamu Ohashi, Hidetoshi Fujiwara, ...1998 Volume 31 Issue 8 Pages 1850-1856
Published: 1998
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSLong term outcome in 35 patients after pancreaticoduodenectomy (PD) was studied from the viewpoints of cholangitis and social rehabilitation, by means of serum markers, image findings and clinical symptoms. Cholangitis was observed postoperatively in 5 patients (14.3%), all of whom had undergone the PD-II procedure; the causes of postoperative cholangitis appeared to be bile stasis at the hepatohilar region or in the manipulated jejunal loop. In the patients who developed cholangitis, serum alkaline phosphatase (ALP) levels were elevated and unstable and bile stasis detected by biliary scintigraphy; clinical signs of cholangitis did not occur. To improve long term outcome after PD, it is important to identify patients with a high risk of cholangitis using these findings and to counsel them to modify their lifestyle. Four of 5 patients with cholangitis were able to achieve social rehabilitation to some extent and maintain an excellent quality of life (QOL) by avoiding recurrence of cholangitis.View full abstractDownload PDF (12212K) -
Harutsugu Sodeyama, Kazuhiro Hanazaki, Masao Wakabayashi, Jun Igarashi ...1998 Volume 31 Issue 8 Pages 1857-1861
Published: 1998
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSLaparoscopic splenectomy was performed on 10 patients with idiopathic thrombocytopenic purpura. Laparoscopic splenectomy using a Harmonic Scalpel and an endocutter for resection of a splenic hilus was carried out in the last fivepatients. These patients were placed in a right Iateral and head-up position during the operation.In one patient during splenectomy the operation was converted into laparotomy because of anomalous bleeding from a short gastric artery. In the other four patients, successful surgery was possible and the average operation time was I hour 37 minutes, which was significantly shorter than the 3hours 10 minutes for the five patients operated on by the former surgical technique. All patients had uneventful postoperative courses without any complications. This new surgical technique of laparoscopic splenectomy is recommended for patients with idiopathic thrombocytopenic purpura.View full abstractDownload PDF (9324K) -
Hajime Nakase, Koji Kono, Takayoshi Sekikawa, Hidehiko Iizuka, Yoshiro ...1998 Volume 31 Issue 8 Pages 1862-1868
Published: 1998
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSWe studied the immunosuppressive state of patients with cancer of the digestive organs in the perioperative period by determining expression of surface antigen HLA-DR and CD11b on monocytes and serum cytokine IL-6 and IL-8 levels. Peripheral blood samples of 48 patients who received gastrectomy for gastric cancer (n=23), esophagectomy (transthoracic and abdominal approach) for esophageal cancer (n=8), pancreatoduodenectomy for pancreatic cancer (n=7) and colectomy for colon cancer, were examined on the preoperative day and the 1st, 3rd, 5th, 7th and 14th postoperative day. The mean fluorescence intensity of surface antigen HLA-DR and CD11b expressed on monocytes was determined by flowcytometry and serum cytokines were assayed by ELISA. In patients with esophageal cancer, the expression of CD11b on monocytes was at lower levels in the postoperative course compared to that of the other groups, and the levels of serum IL-8 remained higher than those of the other groups in the perioperative course. In pancreatic cancer patients, the level of expression of CD11b was elevated on the 1st day after surgery, but on the 14th day it dropped to a level lower as well as that of patients with esophageal cancer. Major surgical stress for esophageal or pancreatic cancer induced decreased expressionof CD11b on monocytes, which is thought to be related to monocyte adhesion. This phenotypic change of monocyte was suggested to be associated with hypercytokinemia caused by surgical stress.View full abstractDownload PDF (12709K) -
Shintaro Komukai, Norimasa Sandoh, Satoshi Yamamoto, Takayuki Okada, H ...1998 Volume 31 Issue 8 Pages 1869-1873
Published: 1998
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSA 79-year-old woman was admitted to our hospital with a complaint of poor appetite. Upper GI endoscopy revealed a tumor protruding into the anterior wall of the esophagus, 32 cm below the incisor, with mucosal lesions on the tumor which did not stain with iodine. Histological examination of biopsy specimens showed squamous cell carcinoma. A subtotal esophagectomy was performed. On histological examination of the resected specimen, the protruding tumor was found to be basaloid-squamous carcinoma (BSC), and the mucosal lesions were squamous cell carcinoma. This patient died of pleural recurrence of BSC, 5 months after the operation. Preoperative diagnosis of BSC of the esophagus is difficult, because the tumor is usually covered with normal mucosa. The prognosis of patients with BSC of the esophagus is dismal. Establishment of effective treatment for BSC is mandatory to improve it.View full abstractDownload PDF (9629K) -
Daisuke Wada, Shigetoshi Morimoto, Masaru Tsuyuguchi, Naoomi Tanaka, Y ...1998 Volume 31 Issue 8 Pages 1874-1878
Published: 1998
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSA 71-year-old man was admitted to our hospital for evaluation of fever and general fatigue. Abdominal ultrasonography and computed tomography revealed a tumor in the left lobe of the liver. Arteriography demonstrated a slightly hypervascular, tumor-staining mass in the left lobe of the liver. At surgery, a tumor arising in the left lobe of the liver and invading the left diaphragm was detected. Resection of the left lobe with partial resection of the left diaphragm were performed following diagnosis of malignant fibrous histiocytoma. The tumor was 20 cm × 10 cm × 13 cm in size, weighed 1300 gm, was yellowish-white in color, and contained necrosis and abscesses. Histological diagnosis of the resected tumor revealed the inflammatory type of malignant fibrous histiocytoma. The patient is alive 6 months after operation. Malignant fibrous histiocytoma of the liver is extremely rare, and only 22 cases have beenreported to date. Here, we report this rare case with a review of the literature.View full abstractDownload PDF (10920K) -
Atsushi Adachi, Toshiaki Toshimitsu, Toshihiro Saeki, Tetsuji Uchiyama ...1998 Volume 31 Issue 8 Pages 1879-1883
Published: 1998
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSWe report a case of resected adenosquamous carcinoma of the gallbladder with anomalous arrangement of the pancreaticobiliary ductal system. A 67-year-old woman was admitted to the hospital because of a tumor of the gallbladder, and liver dysfunction. Projecting of the tumor into the gallballer was observed by ultrasonography, and computed tomography, and an anomalous arrangement of the pancreaticobiliary ductal system with dilatation of the biliary tract was observed by ERCP. A cytologic diagnosis of adenosquamous carcinoma was obtained from the bile of the gallbladder and the biliary tract. So cholecystetomy with wedge resection of the liver, resection of the extrahepatic common bile duct, lymphadenectomy, and hepatico-jejunostomy were performed. The tumor presented macroscopically as a nodular infiltrating type. Microscopically it showed a mixed type of adenocarcinoma and squamous cell carcinoma with a transitional zone, suggesting that the adenosquamous carcinoma originated from adenocarcinoma. And metastatic lymphnode revealed mainly squamolus carcinoma, leading to a poor prognosis. The high level of amylase in the bile may be one of the factors leading to carcinoma in the gallbladder and the biliary tract.View full abstractDownload PDF (9627K) -
Kazuaki Uchimoto, Yoshiyuki Nakajima, Masayuki Sho, Hiromichi Kanehiro ...1998 Volume 31 Issue 8 Pages 1884-1888
Published: 1998
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSA 40-year-old woman was admitted to our hospital for detailed examination of a tumor in the body of the pancreas. The image findings showed that the tumor did not invade the splenic artery and vein and there was no lymph-node metastasis. Distal pancreatectomy was performed with preservation of the splenic artery and vein. The tumor size was 2.5 × 2.5 × 1.5 cm and showed chiefly cystic and partly solid element. The tumor was histologically diagnosed as a non-functioning islet cell tumor. In general, it is necessary to perform standard pancreatectomy with regional lymph-node dissection because nonfunctioning islet cell tumors of a high rate of malignancy. However it is rare for a tumor less than 3 cm in diameter to have lymph-node metastasis. We may follow up without re-exploration in case of the small tumor histologically diagnosed as non-functioning islet cell tumor.View full abstractDownload PDF (8995K) -
Kentaro Yamaguchi, Takao Katsube, Akira Tsuchiya, Syungo Endo, Takeshi ...1998 Volume 31 Issue 8 Pages 1889-1892
Published: 1998
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSThe case study is an 83-year-old male who had come to hospital complaining mainly of abdominal pain and fever. CT scans of the abdomen showed an increase in thedensity of the mesenterium, and a high density funicular image in the inner part. Although the patient was suspected of having mesenteric panniculitis, diagnosis was pan-peritonitis because of the strong rebound tenderness and muscular defence. Laparotomy was performed. Almost the whole area of the mesenterium of the small intestine showed thickening, and blood circulation was impaired in the small intestine. During surgery, the condition was confirmed as mesenteric panniculitis. Atonic incisions in the mesenterium of the small intestine, biopsy, and abdominal drainage were performed. Mesenteric panniculitis was also diagnosed in the histopathological examination. Steroids were administed from the first post operative day, improved the abdominal symptoms and decreased the blood level of C-reactive protein (CRP). In this case, we observed CT scans of the abdomen taken at different stages in time, this case showed both a normalization in the density and volume which accompanies recovery from the symptoms. These findings characteristic of mesenteric panniculitis are also reported in the present study.View full abstractDownload PDF (8119K) -
Michihiro Orihata, Hideo Sasaki, Makoto Hata, Hiroyuki Nakagawa, Teruo ...1998 Volume 31 Issue 8 Pages 1893-1896
Published: 1998
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSAppendicitis in pregnancy and appendiceal diverticulum are rare diseases and appendicitis in pregnancy requires to attention its diagnosis and treatment. We experienced a case of appendiceal diverticulitis at 15 weeks' gestation. A 28-year-old woman at 15 weeks' gestation was transported to our hospital because of right lower quadrant pain. Her WBC was 17100/μl and her CRP was 2.9mg/dl. She was admitted and underwent appendectomy. There was a no fetal problem on ultrasonography. Her appendix formed a tumor at the retro-peritoneum, and showed two distal ends and small diverticula around the distal 2/3 of the appendix. One and the small diverticula were pseudo-diverticula histologically. She experienced a preterm labor at 30 weeks' gestation. In the 113 domestically-reported cases of appendiceal diverticulum in Japan with the surgical treatment, our case was a first case report of appendiceal diverticulum in pregnancy.View full abstractDownload PDF (8473K) -
Naoyuki Kobayashi, Masahiko Watanabe, Nobutaka Yasui, Masami Ishihara, ...1998 Volume 31 Issue 8 Pages 1897-1901
Published: 1998
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSWe experienced a case of adenocarcinoma arising in jejunum polyps with lymph node metastasis in a patient with Peutz-Jeghers syndrome. A 27-year-old man was admitted to our hospital with appetite loss and lower abdominal pain. He had a previous history of surgical resection of colon and jejunal polyps under the diagnosis of Peutz-Jehers syndrome at the ages of 3 and 14, and adhesiotomy for adhesional ileus at the age of 15. Small intestinal X-ray examination revealed a stenosis in the jejunum and polyps on the oral and anal side of that. An operation was performed. An irregular elevated lesion 5×6 cm in diameter was seen on the oral side of Treitz's ligament, and the small intestine was partially resected. Pathological findings showed the coexistence of well-differentiated adenocarcinoma confined to the subserosa and Peutz-Jeghers polyps. In this case paraintestinal lymph node metastasis was observed. He was discharged from the hospital without postoperative complications.View full abstractDownload PDF (10814K) -
Shizuhiro Hirata, Hideki Kishikawa, Kazumitsu Nagafuchi, Toru Yamasaki ...1998 Volume 31 Issue 8 Pages 1902-1906
Published: 1998
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSWe report a case of multiple T-cell malignant lymphoma of the colon, and discussthis case in relation to the literature. An 89-year-old male was hospitalized with complaint of diarrhea. Barium enema and colonoscopy showed multiple ulcers ofthe rectum and sigmoid colon. Immunohistochemical stainings of biopsy specimens revealed T-cell malignant lymphoma. Emergency operation was performed because ofperforation of the sigmoid tumor. Resected specimen contained multiple ulcers ofthe colon and ileum. After the operation, the patient suffered from intractable, bloody and watery diarrhea. Anemia and hypoproteinemia could not be controlled and he died 71 days later. We speculate that remnant tumor might have existed. T-cell lymphoma of the colon is very rare, and only 16 cases have been reported inJapan. Its prognosis is much worse than that of of B-cell origin.View full abstractDownload PDF (10201K) -
Hidefumi Baba, Katsunori Tanaka, Shigenao Kan, Fumio Suzuki, Hitoshi O ...1998 Volume 31 Issue 8 Pages 1907-1911
Published: 1998
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSWe herein report a six-year survival case who had advanced sigmoid colon cancer with metastasis to Virchow's lymph-node. A 48-year-old woman presented with chief complaint of a tumor in the supra-clavicular fossa. An excisional biopsy of the tumor revealed cancer metastasis based on a histological examination of the specimen. The barium-enema and abdominal computed tomographic findings demonstrated advanced sigmoid colon cancer with para-aortic lymph-node swelling. Under a diagnosis of advanced sigmoid colon cancer with metastasis to Virchow's lymph-node and para-aortic lymph-node swelling, Hartmann's operation was performed along with a D4 lymphadenectomy. Histological examination of the resected specimens showed moderately to poorly differentiated adenocarcinoma with invasion to the subserosal layer and lymph vessel invasion in the subserosa. Many areas of lymph-node metastasis were diagnosed histologically, and the positive rate of the para-aortic lymph-nodes was 9/30 (30%). Tegafur and uracil (UFT) were thereafter admininstered orally for five years as postoperative adjuvant chemotherapy. The patient remains alive and well, without recurrence of the colon cancer, at 6 years after surgery. As far as we could ascertain, there have been no previous reports of6-year survival with advanced colon cancer with metastases to the Virchow's and Para-aortic lymph-nodes. Although the prognosis of patients with advanced cancer of the colon and metastasis to the para-aortic lymph-node has been reported to be poor, some patients may, nonetheless, show a good response to aggressive resection accompanied by D4 lymphadenectomy and followed by postoperative adjuvant chemotherapy.View full abstractDownload PDF (11487K) -
Masahiro Nakahara, Masazumi Okajima, Michinori Arita, Riichiro Kobayas ...1998 Volume 31 Issue 8 Pages 1912-1915
Published: 1998
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSA 29-year-old female who had an abdominal mass of abdomen was seen at the hospital. Barium enema radiography and colonoscopy showed a carcinoma (ulcerative lesion, advanced) of transverse colon and multiple polyps. Right hemicolectomy (D3 lymph node dissection) was carried out. Histopathologically, the ulcerative lesion proved to be well differenciated adenocarcinoma with invasion to the serosa and paracolonic lymph node metastasis was found. Multiple sessile and pedunculated polyps were shown to be hyperplastic polyps and serrated adenomas. Genetic instability was investigated at 5 microsatellite loci, however replication error was not detected in neoplastic site, including serrated adenoma.View full abstractDownload PDF (8001K) -
Yoshiki Nakamura, Yutaka Hamabe, Hajime Ikuta, Koichi Narita, Tsutomu ...1998 Volume 31 Issue 8 Pages 1916-1920
Published: 1998
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSFirst Department of Surgery, Kobe University School of Medicine A 62-year-old man was admitted to the hospital because of increasing dyspnea. In April 1990, he had undergone intra-thoracic esophagectomy using a gastric tube via the retrosternal route by right thoracotomy for intra-thoracic esophageal cancer. In July 1995 he suffered from worsenig dyspnea and was taken to the hospital. A hypopharyngeal tumor was found at the right piriform recess and a biopsy specimen of the laryngoscopic examination revealed well differentiated squamous cell carcinoma. He underwent a laryngo-pharyngoesophagectomy and radical neck dissection with reconstruction using a free jejunal graft. On the 11th postoperative day, an anastomotic leakage of the jejunogastrostomy occurred. resulting in no improvement in spite of conservertive treatment for two months. Therefore, on December 11, 1995 we repaired the portion of leakage placing a deltopectoral flap between the gastric tube and the jejunal graft. The postoperative course went well and radiography with water soluble contrast material performed two months after operation showed no anastomotic leakage or stenosis of the skin tube. After that, sequestration and curratage was performed three times for the chronic osteomyelitis and the repair of the skin tube-cutaneous fistula was performed twice. In March 1997 the steosis between the skin tube and the gastric tube occurred and reanastosis was performed in April. He discharged from the hospital in May in eood condition.View full abstractDownload PDF (10123K) -
Yasuhiro Yunoki, Hitoshi Takeuchi, Yu Ohshima, Yoshimasa Yasui, Kohji ...1998 Volume 31 Issue 8 Pages 1921-1924
Published: 1998
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSA shunt was placed between the peritoneal cavity and the subclavian vein with a Denver® Ascites Shunt System (Percutaneous Access Kit), for the surgical management of ascites in a patient who underwent gastrectomy for gastric carcinoma complicated by liver cirrhosis. The operation was successful to decrease the level of ascites, and the patient was discharged ambulatory on the 25th postoperative day. This operative technique is superior to the usual peritoneo-jugular shunt in two respects. First, the catheter is designed to run straight in order to prevent obstruction. Secondly, percutaneous placement of the catheter is easier and quicker than a surgical cutdown technique.View full abstractDownload PDF (7154K) -
Yutaka Ozeki, Kenichiro Tateyama, Naoki Imai, Yasuhiro Sumi, Michiya B ...1998 Volume 31 Issue 8 Pages 1925-1929
Published: 1998
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSTumor emboli of hepatocellular carcinoma (HCC) in the portal trunk that broke away during surgery were successfully removed by a Fogarty catheter. A 48-year-old man was admitted to our hospital because of a 12cm HCC in the right lobe of the liver. The mass had advanced into the right portal vein and inferior vena cava. Therefore, under total hepatic vascular exclusion, right hepatic trisegmentectomy was performed by the anterior approach. Although hepatic procedures were initially done, discoloration of the lateral segment of the liver was noticed during surgery. Intraoperative ultrasonography disclosed tumor emboli in the portal branch. Venotomy was performed on the transverse portion of the portal vein and a Fogarty catheter was inserted. The tumor emboli were successfully removed and the discoloration was immediately disappeared.View full abstractDownload PDF (8715K) -
Hideaki Yamana1998 Volume 31 Issue 8 Pages 1930-1935
Published: 1998
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSTo compare the adjuvant effect of radiation therapy and chemotherapy after curative resction for patients with esophageal squamous cell carcinoma, a prospective randomized study was performed by Japan Esophageal Oncology Group (JEOG) between 1984 and 1987. In this study, postoperative survival curves showed no significant difference between the two groups. Therefore, JEOG also performed a randomized trial between surgery alone and postoperative chemotherapy between 1988 and 1991. There was no significant difference in survivals between the two groups. In cases with lymph node metastasis positive, however, postoperative chemotherapy group showed a tendency of good survival (p=0.134) in comparison with surgery alone group. Adversely, a better survival was found in surgey alone group in patients with no jymph node metastasis, but it had no statistical significant difference (p=0.215). This result suggest that postoperative chemotherapy with more effective anti-cancer drugs may improve patients' prognosis and impresses that radically resected cases with no lymph node metastasis may not require adjuvant chemotherapy. On the other hand, co-operative study of anti-cancer drug sensitivity test was done by using adhesive tumor cell culture system. Although no correlation was found between the drug sensitivity and clinical effects, further studies on useful drug sensitivity tests are needed.View full abstractDownload PDF (10885K) -
Tetsuro Kubota1998 Volume 31 Issue 8 Pages 1936-1940
Published: 1998
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSThe response rate of gastric cancer to chemotherapy is limited. While European meta-analysis indicated that the adjuvant chemotherapy offers no additional benefit for patients with curatively resected gastric cancer, some positive results were obtained in Japanese experience. When we have applied the chemosensitivity test (MTT assay) to evaluate the adjuvant chemotherapy, it was elucidated that the sensitive group showed a better prognosis than the insensitive group and the group without chemotherapy with significant differences at p<0.01. This result was also confirmed by the collaborative and blind study in which all the patients were treated with a single arm chemotherapy and their chemosensitivity was evaluated by histoculture drug response assay. In this study, the overall survival rate of the sensitive group was better than that of the resistant group (p<0.0006 by log rank test). From these results, the chemosensitivity test was thought to be adequate in evaluating an appropriate cancer chemotherapy after the surgery of gastric cancer.View full abstractDownload PDF (9931K) -
Katsuyoshi Hatakeyama1998 Volume 31 Issue 8 Pages 1941-1946
Published: 1998
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSRandomized controlled study (RCS) compared with surgery alone is necessary to evaluate the significance of post-operative adjuvant chemotherapy for colorectal carcinoma. In this paper, I introduced a part of the results of our department by historical study, and mainly described the results of the national RCSs for adjuvant chemotherapy. The results of a study groups have been reported up to now. In adjuvant chemotherapy for colonic carcinoma, all of 6 study groups showed no significantly better survival rates. In adjuvant chemotherapy for rectal carcinoma, only 2 groups of them showed significantly better survival rates. Further RCSs which change the variety and combination of anti-cancer agents, or use the biochemical modulation together are required.View full abstractDownload PDF (10088K) -
Tadahiro Takada1998 Volume 31 Issue 8 Pages 1947-1952
Published: 1998
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSChemo-radiotherapy has been a common modality of postoperative adjuvant therapy in pancreatic carcinoma in Europe and the United States. In many opinions, chemo-radiotherapy seems to be effective in controlling the local recurrence, but a remarkable improvement of survival has not been proven. Loco-regional chemotherapy to prevent hepatic metastasis after surgical resection is recognized as one of the promising postoperative adjuvant therapies. Recently several clinical trials to evaluate pre- and intraoperative adjuvant therapy are ongoing in Europe and the United States, while there are only a few reports showing effectiveness of postoperative radiotherapy in biliary tract carcinoma. In the results of our randomized controlled trial (Japanese Study Group of Surgical Adjuvant Therapy for Carcinoma of the Pancreas and Biliary Tract) in resected patients, a significant improvement of survival by postoperative systemic chemotherapy was observed in non-curatively resected gallbladder carcinoma, but not in pancreatic and bile duct carcinoma. We think that this result consists with our previous 2 trials in nonresected patients showing that FAM combination chemotherapy suppressed disease progression in only gallbladder carcinoma. In the CD-DST, primary culture was successful in all 16 patients with pancreatic and biliary tract carcinoma. They were most sensitive to 5-FU, MMC and ADR among the 6 tested drugs, and positive rate in these drugs tended to be higher in biliary tract carcinoma than in pancreatic carcinoma. At present we are evaluating the correlation between clinical outcome and sensitivity in CD-DST in additional patients.View full abstractDownload PDF (11045K)
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