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Volume 32, Issue 10
Displaying 1-34 of 34 articles from this issue
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Naoto Senmaru, Takayuki Morita, Yuji Miyasaka, Miyoshi Fujita, Hiroyuk ...1999 Volume 32 Issue 10 Pages 2309-2313
Published: 1999
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSTo determine the optimum reconstruction procedure after proximal gastrectomy, the results of two different methods were compared retrospectively. 12 patients received jejunal pouch interposition (JPI) and 12 patients received single single jejunal interposition (JI). The operation time, postoperative stay, postoperative complications, postprandial symptoms, food intake in a single meal and body weight were evaluated. There were no significant differences in the operation time, postoperative stay and postoperative complications. Concerning postprandial symptoms, three patients had slight heartburn in the JPI group, one in the JI group. Three patients had dumping in the JPI group, five in the JI group. The JPI group showed a significantly lower incidence of epigastric pain, nausea, vomiting and dysphagia than the JI group. The JPI group showed greater food intake in a single meal than the JI group and significantly greater weight recovery than the JI group. Jejunal pouch interposition reconstruction after proximal gastrectomy is thus more useful for improving the postoperative quality of life than single jejunal interposition.View full abstractDownload PDF (51K) -
Shou Ishihara, Akio Yanagisawa, Takashi Takahashi1999 Volume 32 Issue 10 Pages 2314-2319
Published: 1999
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSThe reccurrence of early gastric cancer is rare, with liver metastasis showing the highest incidence of reccurrence. The relationship between liver metastasis and α-fetoprotein producing early gastric cancer has often been reported, however what this relationship actually implies is not clear due to the small number of patients. We studied 14 early gastric cancer patients with liver metastasis (0.8%) among a series of 1, 744 early gastric cancer patients who underwent surgery in our department between 1980 and 1995 to evaluate this relationship using clinicopathologic, findings serum AFP, and immunohistochemical (AFP) procedures. Clinicopathologic features were as follows:(1) submucosal carcinoma: 14/14, (2) differentiated adenocarcinoma: 13/14 (so-called hepatoid adenocarcinoma: 6/14), and (3) a high incidence of lymph node involvement: 10/14. We selected patients having these features who had lived over 5 years without liver metastasis, and compared them. Hepatoid carcinoma was not found in controls (p=0.0004). Abnormal serum AFP in patients with liver metastasis was seen in 9/14 (64%). No controls had abnormal serum AFP (p<0.0001). Five patients with liver metastasis were positive for immunostaining (AFP) for tumors, compared to only one among the controls (p=0.0089), indicating that differentiation to AFP producing tumors would begin at the stage of submucosal cancer. Of these patients, 9 (64%) were considered to have AFP producing early gastric cancer, so the 64%relationship between liver metastasis and AFP producing tumors in early gastric cancer patients with liver metastasis appears meaningful. It is important to detect patients with early gastric cancer who will develop liver metastasis as indicated by AFP producing tumors.View full abstractDownload PDF (91K) -
Kentaro Inoue, Yasushi Nakane, Hitoshi Iiyama, Mutsuya Sato, Syunitiro ...1999 Volume 32 Issue 10 Pages 2320-2324
Published: 1999
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSRecently, as the range of gastric resection has been reduced, the problem of multiple gastric cancers has received a great deal of attention. The incidence of multiple gastric cancers has been reported to be around 20% in some facilities, and in our department as well, multiple gastric cancers were found in 17.3% of patients with early gastric cancer and 8.1% of those with advanced gastric cancer. The mean age of patients with multiple gastric cancers was 64.5 years, and the ratio of men to women was 7 to 1, showing a significantly higher incidence in elderly men compared with that of solitary gastric cancer. Histology showed a well differentiated tubular adenocarcinoma in many cases. The accuracy of preoperatively diagnosing the presence of accessory lesions was as low as 53.4%. The accessory lesions missed preoperatively were examined by multivariate analysis. As a result, accessory lesions were frequently missed when the depth of the accessory lesion was shallow, there was no elevated lesion, the accessory lesion was near the main lesion or the depth of the main lesion was deep. The accessory lesions were frequently located in the M or A areas, suggesting that surgical techniques preserving more areas in the M or A areas can lead to a higher frequency of residual gastric cancer due to missing multiple gastric cancer sites.View full abstractDownload PDF (73K) -
Hiroshi Yabusaki, Atsushi Nashimoto, Yoshiaki Tsuchiya, Mitsuhiro Tsut ...1999 Volume 32 Issue 10 Pages 2325-2332
Published: 1999
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSTo investigate the expression of thymidine phosphorylase/platelet-derived endothelial cell growth factor (dThdPase/PD-ECGF) in gastric cancer, we measured its activity in normal tissues, cancer tissues and metastatic lymph nodes of 75 patients with resected advanced gastric cancer, and compared the results with histopathological features. We also evaluated cancer tissues immunohistochemically using anti-dThdPase antibody. The dThdPase activity was significantly higher in metastatic lymph nodes than in normal tissues (p<0.0001) and in cancer tissues (p=0.0002). There exists a definite correlation between cancer tissues and metastatic lymph nodes. Furthermore, dThdPase activity in cancer tissues was significantly higher in expansive type in growth pattern (p=0.0176), medullary type in stroma (p=0.0057), they are thought to have a close relationship with hematogenous metastasis, and INFα type in mode of infiltrative growth (p=0.0289), and also significantly lower in negative of lymph node metastasis (p=0.0383). Immunohistochemical study clarified that dThdPase activity of cancer tissue was significantly higher in the positive staining group than in the negative staining group of expansive type. Relapsed cases of peritoneal dissemination had significantly lower dThdPase activity in cancer tissue compared to non relapsed cases and other relapsing forms. In conclusion, dThdPase expression in advanced gastric cancer is higher in metastatic lymph nodes, and the relation between its expression in cancer tissues and hematogenous metastasis is speculated. Also, dThdPase expression has negative correlation with lymph nodes metastasis and a relapsed form of peritoneal disemination. Immunohistochemical study of expansive type is considered to be a very useful method.View full abstractDownload PDF (67K) -
Yuji Inoue, Mamoru Suzuki, Ken Takasaki1999 Volume 32 Issue 10 Pages 2333-2338
Published: 1999
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSOf 104 patients who underwent curative resection for submucosal invasive colorectal cancer in our institution from 1988 to 1997, 6 patients (5.8%) had tumor recurrence, and 4 patients (3.9%) had local and lymph node recurrence. Of the four patients, the tumors were located in the rectum in 3, and in the descending colon in 1. Histopathological study revealed that 3 patients had moderately differentiated tubular adenocarcinoma and one had well differentiated tubular adenocarcinoma. Three had lymph node metastasis. All 4 patients who had local and lymph node recurrence had lymph vessel invasion. The Depth of cancer invasion was sm3 in these 4 patients. In addition, local and lymph node recurrence occurred higher in the patients who had moderately differentiated tubular adenocarcinoma, lymph node metastasis and lymph vessel invasion. Among the 106 patients, 2 (1.9%) had solitary liver metastasis, and partial hepatic resection was performed with no evidence of recurrence. Liver metastasis was not observed to be a risk factor in this histopathological study of submocasal invasive colorectal cancers.View full abstractDownload PDF (101K) -
EPOGIN autologous blood transfusion study group, Takahiro Okabayashi, ...1999 Volume 32 Issue 10 Pages 2339-2349
Published: 1999
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSTo clarify the efficacy and safety of predeposit autologous blood transfusion (ABT) with concomitant use of recombinant human erythropoietin (rHuEPO) in surgical patients with gastroenterological malignancies, the efficacy was evaluated in terms of observed changes in hemoglobin (Hb) concentration after storage of self-donated autologous blood for elective surgery and the percentage of cases avoiding homologous blood transfusion (HBT). Postoperative changes in values for cellular immunity parameters were compared between the ABT group, HBT group and no transfusion (NT) group.
1. The effectiveness rate, as assessed in terms of the decrease in Hb concentration and the preoperative Hb increase, was 67.2%(43/64 cases) for rHuEPO-treated patients of the ABT group after predeposit of 800 ml of autologous blood and 85.7%(6/7 cases) for those of the ABT group after 1, 200ml predeposit. HBT could be avoided in 94.2% of cases (65/69) receiving rHuEPO.
2. Of the cellular immune function parameters assessed for postoperative changes, there was a depression of NK activity at weeks 1-2 postoperatively in all three groups. The depression tended to be reversed by week 3 in the ABT and NT groups, whereas the depression was significantly greater and no such recovery was noted in the HBT group. All other parameters showed similar trends of change in the three groups.
The results suggest a noticeable usefulness of rHuEPO and that autologous blood transfusion is also useful not only for the prevention of adverse reactions to homologous blood transfusion but also for inhibiting postoperative depression of cellular immune function.View full abstractDownload PDF (138K) -
Takafumi Oshiro, Hiroshi Yahata, Naoki Haruta, Hidehiro Tanji, Katsuno ...1999 Volume 32 Issue 10 Pages 2350-2354
Published: 1999
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSA 56-year-old mas who complained of dysphagia was admitted to our hospital. The patient was diagnosed as having an esophageal carcinoma with leukocytosis (19, 400/mm3). A subtotal esophagectomy was done on June 9, 1998. Histopathological examination revealed a so-called carcinosarcoma of mp, n (-), Pl0, M0 and stage I. Postoperatively, the leukocyte count decreased rapidly. Preoperative serum granulocyte-colony stimulating factor (G-CSF) level was 109 pg/ml, and postoperative serum G-CSF levels on 72POD and 195POD were 21pg/ml and 11 pg/ml. An immunohistochemical study showed positive staining for G-CSF in the tumor cell. GCSF producing esophageal so-called carcinosarcoma is very rare and only one case has been reported in Japan. Although the reports indicate poor prognosis for G-CSF producing tumors, postoperative recurrence has not been detected in this case for 8 months.View full abstractDownload PDF (103K) -
Eiji Nakamura, Tatsuo Hattori, Yoichiro Kobayashi, Kanji Miyata, Shinj ...1999 Volume 32 Issue 10 Pages 2355-2359
Published: 1999
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSA 46-year-old man, who had been ingesting only diet food for five years because of a sense of abdominal fullness after meals, was admitted for hematemesis in July 1994. Under the diagnosis of gastric ulcer and pyloric stenosis due to duodenal ulcer, distal partial gastrectomy was performed. The resected specimen revealed gastric ulcer at the angle of stomach and hypertrophy of the pyloric muscle. Histopathological examination showed neither infiltration of inflammatory cells, fibrosis nor degeneration of Auerbach's nerve plexus in the pylorus. Thus, this case was diagnosed as primary hypertrophic pyloric stenosis, which is rare in adults. If close attention is paid to the characteristic X-ray and endoscopic findings, a precise preoperative diagnosis could be possible.View full abstractDownload PDF (94K) -
Yongxin Chen, Seiji Sato, Daisuke Mori, Genichiro Edakuni, Kenji Kitah ...1999 Volume 32 Issue 10 Pages 2360-2364
Published: 1999
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSGastric magilnant lymphoma is rare especially when complicated with gastro-bronchial fistula. An 80- year-old woman was referred to our hospital with chief complaints of nausea and anorexia. After careful examinations, gastric malignant lymphoma and advanced colon cancer were diagnosed. On abdominal CT, tumors of the stomach were suspected of invading the spleen, pancreas and the diaphragm. According to the Classification of Gastric Carcinoma, the gastric tumors were judged beyond stage IIIa. Right-hemi colectomy for the colon cancer followed by preoperative chemotherapy for the gastric malignant lymphoma were proposed as the therapeutic strategy. During chemotherapy, perforation of the stomach was suspected, but conservative therapy was selected since the inflammation had been localized. At the end of 4 cycles of THP-COP chemotherapy, gastro-bronchial fistula was noticed. Total gastrectomy, splenectomy and closure of the fistula were ferformed. Although complications occurred, preoperative chemotherapy for the gastric malignant lymphoma was successful.View full abstractDownload PDF (97K) -
Yasushi Suzuki, Masashi Watanabe, Hiroko Nonaka, Hajime Kase, Natsuki ...1999 Volume 32 Issue 10 Pages 2365-2369
Published: 1999
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSA case of AFP (α-fetoprotein) producing gastric carcinoma successfully treated with post-operative intrahepatic chemotherapy in reported with a review of the literature. A 73 year old male was admitted complaining of epigastralgia. He was diagnosed as having advanced gastric cancer with multiple liver metastases by endscopy and computed tomography. Serum AFP level was 296.8ng/ml and serum CEA level was 3.2ng/ml. Distal gastrectomy (D2) and hepatic artery cannulation was performed. Histopathological study showed moderately differentiated adenocarcinoma surrounding a hepatoid adenocarcinoma. Immunohistochemical study showed a few AFP-positive tumor cells in the hepatoid structure. Post-operative intrahepatic chemotherapy with 5FU 500mg/body/day was performed 10 times and the therapeutic effect by CT showed a complete response in the liver. He has been well without any evidence of recurrence for 4 years and 2 months after thesurgery and this treatment.View full abstractDownload PDF (141K) -
Kazuhiro Iwai, Toru Takahashi, Yasuhumi Mito, Kousaku Satou1999 Volume 32 Issue 10 Pages 2370-2374
Published: 1999
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSWe experienced a case of superior mesenteric, portal and splenic vein thrombosis with massive intestinal necrosis. The patient was a 38-year-old man. Emergency laparotomy was performed with a diagnosis of acute abdomen due to intestinal infarction 2 days after the onset of upper abdominal pain. Massive resection of necrotic intentine, which included a section that began 20cm on tha anal side of the Treitz ligament to 40cm on the oral side of the ileocecal juncture, was performed and jejunostomy and ileostomy were performed without anastmosis. Necrosis of the cut end of intestine was not observed, but marked edema of the intestine continued and noted. Eight days after operation we noticed a portal vein thrombus on the preoperative CT scan and suspected superior mesenteric and portal vein thrombosis. Subsequently patency of the superior mesenteric artery and obstruction of the superior mesenteric portal and splenic vein with thrombus were revealed by angiography. On the same day, we performed thrombectomy and anastomosis of intestine. The postoperative course was uneventful. Complete recanalization of the superior mesenteric, portal and splenic veins was demonstrated by angiography on 75 days after the first operation. In spite of the shortened bowel (50 cm in length), he is being followed-up without special nutritional support 2 years of after the first operation.View full abstractDownload PDF (76K) -
Katsunori Matsuzawa, Kouichi Itabashi, Shingo Matsuzawa, Osamu Tsutsum ...1999 Volume 32 Issue 10 Pages 2375-2379
Published: 1999
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSThe patient was 68-year-old woman. The abdominal echograms and CT scans revealed a large cyst in the left lobe of the liver. The CA19-9 showed a high level of 356U/ml in the serum. Three weeks later, the level increased 565U/ml. We believe that the high serum level of CA19-9 was due to the large liver cyst since we could not find any other foci such as pancreatic or gastrointentinal disease. Percutaneous cystic needle aspiration showed serous fluid with extremely high levels of CA19-9 of 2400, 000U/ml and CEA of 2, 438ng/ml. The result of cytological examination proved benign. The serum showed a normal level of 18.3U/ml two weeks after the left hepatic lobectomy. The result of histological examination of the cyst proved benign. Localization of the CA19-9 and CEA was positive in immunohistochemical staining of the epithelium of the cyst wall. We conclude that high levels of tumor markers in the serum do not necessarily indicate malignant change. This case showed quite a rare large liver cyst with abnormally high levels of CA19-9 in the serum and CEA in the fluid.View full abstractDownload PDF (128K) -
Gaku Matsumoto, Hideo Ise, Haruyuki Inoue, Noritaka Yabuki, Gen Tomina ...1999 Volume 32 Issue 10 Pages 2380-2384
Published: 1999
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSWe report case of metachronous liver metastasis from rectal carcinoma presenting as an extrahepatic growing tumor with macroscopic portal tumor thrombosis. A 74-year-old man, who had undergone amputatio recti for advanced rectal carcinoma 9 years ago, was admitted complaining of epigastralgia and fever. By ultrasonographic examination, an extrahepatic growing tumor about 6cm in size was revealed in segment 6 of the liver. CT scan and pharmacoangiographic portography examination demonstrated a portal tumor thrombosis at the right anterior branch of the portal vein. MR images disclosed that the tumor contained much hematoma and necrotic tissue at the center and viable carcinoma at the right marginal lesion. Right hepatic lobectomy was performed, and histologically, the tumor was diagnosed as moderately differentiated adenocarcinoma. Metachronous liver metastasis from rectal carcinoma sometimes occurs in an unusual form with portal invasion after a long postoperative period.View full abstractDownload PDF (124K) -
Yutaka Ozeki, Naomasa Yoshida, Michiya Bando, Kimi Yamauchi, Takuya Ya ...1999 Volume 32 Issue 10 Pages 2385-2389
Published: 1999
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSA 74-year-old woman was admitted to our hospital because of chest pain. Ultrasonography revealed a 16 cm hepatocellular carcinoma (HCC) in the lateral segment of the liver. Lateral segmentectomy, partial resection of the stomach and left diaphragm, and splenectomy were performed. Histologically, a poorly differentiated HCC was proven and HCC was also demonstrated in the ascitic fluid removed during operation. Although her postoperative course was uneventful, a 2 cm mass of the umbilicus emerged on the 23rd postoperative day (POD). On the 36th POD, the umbilicus was resected and peritoneal dissemination was disclosed during operation. The resected umbilicus consisted of a poorly differentiated HCC and vascular invasion was detected. Therefore, hematogeneous metastasis was indicated. She died of respiratory failure due to left pleural dissemination 2 months after the hepatectomy. To our knowledge, there are no other reported cases of HCC which are metastatic to the umbilicus.View full abstractDownload PDF (164K) -
Eriko Umeda, Shunichi Shiozawa, Kenichi Kumazawa, Toshio Masuda, Arihi ...1999 Volume 32 Issue 10 Pages 2390-2393
Published: 1999
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSA 72-year-old woman was referred to our department with a complaint of repetitive upper abdominal pain. Abdominal ultrasonography and contrast-enhanced computed tomography (CT) revealed a lobulated elevated lesion of about 2 cm in size with an irregular border in the neck of the gallbladder. On endoscopic retrograde cholangiopancreatography (ERCP), a moving hypertranslucent image was depicted in the common bile duct in the shape of a cord. An aberrant parasite of the bile duct and gallbladder cancer were diagnosed, and extraction of the parasite, cholecystectomy, and resection of the biliary tract and the hepatic floor were performed. The tumor was histopathologically diagnosed as papillary adenocarcinoma with a depth of invasion of ss, hinf0, binf0, n0, stage II, and a curability of A. The parasite was found to be a female ascarid of about 15 cm long. Since the patient did not have any biliary calculus, the initial symptom of the upper abdominal pain was believed to be attributable to the ascarid which had migrated into the bile duct. This is a unique case in which a concomitant gallbladder cancer was detected at a relatively early stage because of the presence of ascarids.View full abstractDownload PDF (96K) -
Tetsuya Abe, Kaoru Azekura, Kiyoshi Hiramatsu, Masashi Ueno, Hirotoshi ...1999 Volume 32 Issue 10 Pages 2394-2398
Published: 1999
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSA 68-year-old man was admitted to our hospital complaining of a large abdominal mass. A firm irregular mass measuring 200×120 mm was palpated around the opening of a fecal fistula. Barium enema revealed stenosis of the sigmoid colon due to extramural compression. Abdominal computed tomography showed a heterogeneous mass containing air. Abdominal magnetic resonance imaging revealed that the rectum and the bilateral common iliac artery and vein were not involved by the tumor. A biopsy specimen revealed welldifferentiated adenocarcinoma. Finally the tumor was diagnosed as a large fistula cancer associated with a fecal fistula. Hartmann's operation with wide concomitant resection of the abdominal wall and pubic bone was performed. The large defect of the abdominal wall was repaired with bilateral tensor fascia lata myocutaneous flaps. Macroscopically the huge resected specimen had grown around the fistula which communicated with the sigmoid colon. Histological diagnosis was adenocarcinoma arising in the fecal fistula, because no primary lesion was found in the sigmoid colon. Cancer originating from a fecal fistula is rare; only three cases including this case have been reported in the literature. The chief complaint was a large abdominal mass in the three patients and curative resection was performed only in our case.View full abstractDownload PDF (131K) -
Masanori Kobayashi, Norihiro Kokudo, Makoto Seki, Takashi Takahashi, A ...1999 Volume 32 Issue 10 Pages 2399-2403
Published: 1999
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSWe report a case of alpha-feto-protein (AFP)-producing metastatic carcinoma of the sigmoid colon. A 65-year-old woman underwent sigmoidectomy for sigmoid colon cancer at another hospital. Eight months later abdominal CT showed a metastatic liver tumor in the left lobe. The serum AFP level was 1, 036.8 ng/ml at the time of diagnosis. Left bisegmentectomy and partial resection of the posterior segment was performed with curative intent. Twenty-six days after liver resection, a golf ball sized recurrent tumor was recognized in the subcutaneus tissue near the operation wound. Abdominal CT demonstrated tumor recurrence in the remnant liver. The patient died of hepatic failure ninety-four days after liver resection (1 year 4 month after the first operation). Histological findings of the primary lesion and liver tumor were moderatery differentiated adenocarcinoma including neoplastic cells with clear cytoplasm arranged in solid sheet or trabecular pattern (hepatoid differentiated areas). Immunohistochemical AFP staining showed AFP-positive cells. Both in the primary tumor and liver metastasis, AFP-positive cells were detected mainly in hepatoid differentiated areas. AFP-producing colorectal carcinomas tend to metastasize to the liver, and have a poor prognosis.View full abstractDownload PDF (129K) -
Kenji Yasuda, Akiko Umezawa, Hiromi Tokumura, Youichi Imaoka, Akio Ouc ...1999 Volume 32 Issue 10 Pages 2404-2408
Published: 1999
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSWe reported techniques and clinical outcomes of the 9 cases of laparoscopic surgery for gastric submucosal tumor (SMT). Of the 9 patients, 4 were male and 5 were female, and their ages ranged from 46 to 79 years old. The growth pattern and location were as follows: five endogastric type, three exogastric type and one endo-and exogastric type. The size of the tumors ranged from 22 to 40 mm in diameter. Seven patients underwent laparoscopic wedge resection of the stomach and the remaining 2 underwent laparoscopic intragastric surgery. The mean operating time was about 103 minutes. Mean postoperative hospitalization was 10 days. There was no complications. Final diagnosis of these tumors was leiomyosarcoma in 8 cases and schwannoma in 1 case, respectively. Generally, leiomyosarcoma is the most common malignant gastric SMT, and negligible incidence of lymphnode metastasis makes local resection of the stomach acceptable and feasible. We conclude that the laparoscopic surgery for gastric SMT is beneficial because of low grade operative insult and cosmetic merit when it is carried out according to certain criteria, such as the size, the location, and growing pattern of tumors.View full abstractDownload PDF (58K) -
Masato Kayahara, Takukazu Nagakawa, Toshiaki Yasui, Hirohisa Kitagawa, ...1999 Volume 32 Issue 10 Pages 2409-2413
Published: 1999
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSTo evaluate the results of extended pancreatectomy for pancreatic cancer, a total of 78 patients with carcinoma of the head of the pancreas were analyzed on the basis of a clinicopathologic study and quality of life. The incidence of nodal involvement was 77%. Rates of metastases to Group 14 and 16 were 31% and 18%, respectively. Perigastric lymph nodes were involved in three patients. Patients with lymph node involvement fared significantly worse than those without lymph node involvement (43%vs. 6% at 5 years). The category of tumor at the surgical margin (ew) was also an important prognostic factor. Although the 5-year survival rate for patients with a negative surgical margin was 36%, all patients with a positive surgical margin died within 3 years. Postoperative quality of life was evaluated by changes in body weight serum albumin levels, total cholesterol, and so on. Although diarrhea was one of the most important postoperative problems, the nutritional status was almost satisfactory. These results indicate that extended radical pancreatectomy is needed in the majority of patients with pancreatic carcinoma.View full abstractDownload PDF (60K) -
Ryo Hosotani, Ryuichiro Doi, Masayuki Imamura1999 Volume 32 Issue 10 Pages 2414-2418
Published: 1999
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSDuring the past seventeen years, 84 patients underwent standard Whipple procedures and 16 patients received a pylorus-preserving procedure for invasive adenocarcinoma of the head of the pancreas. A retrospective review of the clinical records was carried out, and the short- and long-term surgical outcomes were compared between the two patient groups. Successful surgery with no pathological residual tumor was obtained in 75.0% of the patients who underwent the pylorus-preserving procedure and 70.2% of those who underwent the standard Whipple procedure. Pathology revealed lymph node metastasis of the infra-pyloric node in eight patients who were operated on with the standard Whipple procedure but none occurred in patients who underwent the pylorus-preserving procedure. Operative morbidity and mortality were not significantly different between the two groups. Multivariate and univariate analyses for the two procedures showed no differences on the survival of the patients. However, the pylorus-preserving procedure patients showed better postoperative nutritional necovery; the increase of body weight and nutritional parameters, such as total cholesterol levels, hemoglobin levels and albumin levels in the pylorus-preserving procedure patients were significantly greater than the standard procedure patients. The results indicate that the pylorus-preserving Whipple procedure is performed without losing operative curability and is in favor of the patients' quality of life, therefore, it might be a procedure of choice for invasive adenocarcinoma of the pancreas.View full abstractDownload PDF (86K) -
Takashi Hatori, Toshihide Imaizumi, Nobuhiko Harada, Akira Fukuda, Ken ...1999 Volume 32 Issue 10 Pages 2419-2422
Published: 1999
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSThis study was undertaken to evaluate the indications and results of pylorus-preserving pancreatoduodenectomy (PpPD) for invasive ductal adenocarcinoma of the head of the pancreas. A total of 154 patients underwent radical resection from 1989 when we performed PpPD for invasive ductal adenocarcinoma of the head of the pancreas under the following indications; no tumor invasion in the first portion of the duodenum or stomach and no lymph node metastasis around the stomach (No.(3), (4), (5), (6), (7)), were analyzed in this study and divided into two groups, those who had PpPD (n=66), and those who had pancreatoduodenectomy with partial gastrectomy (PD, n=88). The extended radical operation was performed in about 80% of patients in both groups, safely. There were no statistically significant difference between PpPD and PD in tumor staging and curability. The 5-year survival rate and mean survival time in PpPD patients was 35% and 15.0 months, respectively. Retroperitoneal tumor recurrence or liver metastasis was seen in patients of both groups, but lymph node recurrence surrounding stomach was not seen in PpPD patients. Postoperative quality of life (QOL) in patients who survived more than one year was good in both groups. It was concluded that in accordance with our criteria of indications, PpPD could be performed as a standard operation for ductal adenocarcinoma of the head of the pancreas.View full abstractDownload PDF (47K) -
Tomoo Kosuge, Kazuaki Shimada, Junji Yamamoto, Susumu Yamasaki1999 Volume 32 Issue 10 Pages 2423-2426
Published: 1999
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSPylorus-preserving pancreatoduodenectomy (PpPD) was applied to selected patients with ductal pancreatic cancer. Criteria for indication included distant location of thelesion from the pyloric region, no or minimal involvement of regional lymph nodes, and high age and or poor general condition of the patient. Results of PpPD (N=9) was compared with those of classical PD perfermed in the period between 1980 and 1989 (early PD: N=16) and of extended PD performed between 1990 and 1997 (late PD: N=54). The proportion of advanced disease was larger in late PD than the others. Stage distribution was similar in PpPD and early PD. Lower mortality and higher survival rate were observed in PpPD, late PD, and early PD in that order. Although the background of each patient group was different, the application of PpPD to less advanced pancreatic cancer was justified.View full abstractDownload PDF (56K) -
Shin Takahashi, Kouichi Aiura, Junichi Saitou, Sigeo Hayatsu, Soujun H ...1999 Volume 32 Issue 10 Pages 2427-2431
Published: 1999
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSIn recent years pylorus-preserving pancreatoduodenectomy (PpPD) has come to be widely used in Japan to treat cancer in the pancreatic head region, but the indications for advanced cancer of the pancreatic head remain a matter of controversy. In this study we conducted a comparative assessment of the results of treating advanced pancreatic head cancer (stage III, IVa, and IVb) by PpPD and by pancreatoduodenectomy (PD). The subjects of this study were 76 patients with stage III, IVa, or IVb advanced pancreatic head cancer resected between September 1983 and December 1997. PpPD was performed in 22 of the patients (PpPD group), and PD was performed in the other 54 patients (PD group). Postoperative complications, pathohistological findings, postoperative QOL, mode of recurrence, and survival time were compared in the two groups. No significant differences were observed in the incidence of postoperative complications, especially the incidence of delayed gastric emptying. There were no differences between the groups in lymph node metastasis status, plx-positive rate, or mode of recurrence. PS was well maintained in both groups, and the rate of postoperative recovery of body weight was more favorable in the PpPD group until 1.5 years postoperatively. There were no significant differences in the survival rates, but the results from 2 years onward were more favorable in the PpPD group. If the indications are present, PpPD can be performed without reducing curability even in advanced pancreatic head cancer, and because of the excellent gastrointestinal absorptive function in the early postoperative period, it is a surgical procedure that will replace PD.View full abstractDownload PDF (62K) -
Hiroaki Ohigashi, Osamu Ishikawa, Terumasa Yamada, Yo Sasaki, Takushi ...1999 Volume 32 Issue 10 Pages 2432-2436
Published: 1999
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSIn resecting pancreatic cancer, the 5-year survival rate was improved from 11 to 29% in stage III andfrom 0 to 3% in stage IV, by extending the range of lymphatic and connective tissue clearance (D2α). Longterm survivors were obtained from the patients in the t2-subgroup regardless of the nodal involvement, however there was no 5-year survivor who had received D2α in the t3-subgroup. Liver perfusion chemotherapy via both portal vein and hepatic artery (2-channel treatment) significantly decreased the incidence of liver metastasis, resulting in a 25% 5-year survival rate for the t3-subgroup patients. Micrometastasis was examined in the peripyloric lymph node and surrounding connective tissues by histologic, cytologic and genetic (kras point mutation by MASA method) examinations. As a result, microinvasion was positive in two out of 15 patients by histologic examination alone, and in other three cases by cytologic or genetic examination. In order to erradicate the possible cancer cells aroud the pylorus and improve the patient's QOL, we performed pylorus resecting PD (PrPD) which preserved nearly entire stomach. In comparison with conventional PD, PrPD showed a smaller loss of body weight and earlier recovery. This result seemed to be supported by our isotopic analysis where the PrPD showed a longer gastric emptying speed than conventional PD. From these results, it is concluded that we need some adjuvanttherapies, like 2-channel treatment, in addition to an extended pancreatectomy if weintend to resect advanced pancreatic cancer (t3). Likewise, the PrPD would be helpful in improving the patient's QOL after pancreatoduodenectomy without escalating the chance of local recurrence.View full abstractDownload PDF (53K) -
Sonshin Takao, Hiroyuki Shinchi, Takashi Aikou1999 Volume 32 Issue 10 Pages 2437-2442
Published: 1999
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSThe indication of pylorus-preserving pancreaticoduodenectomy (PpPD) for stage IVa cancer was investigated using an analysis of 83 patients with invasive ductal adenocarcinoma of the head of the pancreas who underwent surgery between 1980 and 1997. In the cumulative survival curves of overall or stage IVa cancer, there was no significant difference among pancreaticoduodenectomy (PD), PpPD, and total pancreatectomy (TP). In patients with stage IVa cancer, the cumulative 5-year survival rate was only3%, although the conclusive curabilities of PD, PpPD, and TP, were 58%, 75%, and 55%, respectively. In patients with retroperitoneal or neural plexus invasion, the cumulative survival curves showed no significant difference among PD, PpPD, and TP. The important point to notice is that PpPD was not performed for the patients with invasion of the serosa of the pancreas. The recurrent rates and the modes of recurrence after PD and PpPD were almost similar. Although the extended operation was effective inprevently locoregional recurrence, it had no impact on the survival rate because of liver metastases. These results indicate that PpPD with extended lymphadenectomy and dissection of the retroperitoneal tissues and neural plexus can provide the conclusive curability, quality of life, and an effective strategy for liver metastases for the patients with stage IVa cancer. Therefore, the PpPD is an appropriate operation for the patients with stage IVa cancer of the head of the pancreas except for these cases involving invasion of the serosa of the pancreas.View full abstractDownload PDF (74K) -
Tadashi Nishimaki, Tsutomu Suzuki, Tatsuo Kanda, Tatsuhiko Hayashi, Sh ...1999 Volume 32 Issue 10 Pages 2443-2447
Published: 1999
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSTo determine the adequate extent of lymphadenectomy in radical esophagectomy for esophageal cancer, anatomic characteristics of lymph node metastasis patterns were studied according to the primary sites in 86 patients with esophageal cancer who had favorable grade nodal status, i.e. one to four positive nodes, after extended three-field lymphadenectomy. All of 5 patients with upper esophageal tumors had metastases tothe cervical paraesophageal lymph nodes. Metastases to the cervical, mediastinal, and abdominal lymph nodes were found in 6.5%, 64.5%, and 58.1% of 31 patients with lower esophageal tumors, respectively. Metastases were confined to the lower mediastinal lymph nodes in 85% of 20 patients with mediastinal lymph node metastases from lower esophageal tumors. Furthermore, metastases were confined to either lower mediastinal or perigastric lymph nodes in 92% of 12 patients with a single metastatic node from these tumors. However, in cases of mid-esophageal tumors, metastases to the cervical, mediastinal, and abdominal lymph nodes were found in 24%, 66%, and 54% of 50 patients with mid-esophageal tumors, respectively. Therefore, cervical lymphadenectomyand lower mediastinal and perigastric lymphadenectomies are essential in patients with upper and lower esophageal cancer, respectively. However, all of cervical, mediastinal, and abdominal lymphadenectomies are needed for cure in patients with mid-esophageal cancer.View full abstractDownload PDF (36K) -
Harushi Osugi, Masayuki Higashino, Taigou Tokuhara, Nobuyasu Takada, Y ...1999 Volume 32 Issue 10 Pages 2448-2452
Published: 1999
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSThe effect of extended lymphadenectomy was studied in 225 patients with thoracic esophageal cancer by depth of invasion and state of lymphatic metastasis. In the patients with the lesion of T1b or deeper, metastasis was found in the neck, mediastinum and abdomen, except celiac nodes or nodes required cervical approach to be dissected in patients with the lesion in Ut or Lt, respectively. Outcome was more closely related with lymphatic metastasis than depth of invasion. Curative surgery for the patients with T4 lesion should be indicated when lymphatic metastasis is minor. Because of high incidence of metastasis to the recurrent laryngeal nerve nodes, complete dissection of nodes at cervico-thoracic border, regardless to location of the esophageallesion, is essential to obtain good outcome. Many of the patients with metastasis tothe nodes required cervical approach to be dissected or celiac nodes still have beenat a stage of lymphatic dissemination and have little benefit for the lymphadenectomy. However the dissection including these nodes is recommended to obtain free surgical margin in dissection for these nodes with high incidence of metastasis and properstaging for indicating combined treatment except for the patients with an apparent metastasis to these nodes, because the precise diagnosis of lymphatic metastasis is still difficult.View full abstractDownload PDF (56K) -
Is Cervical Dissection Unnecessary for Carcinoma of the Lower Thoracic Esophagus?Mamoru Ueda, Toshiki Matsubara, Toyokazu Akimori, Tetsuya Abe, Takashi ...1999 Volume 32 Issue 10 Pages 2453-2456
Published: 1999
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSTo assess the role of cervical dissection for lower esophageal cancer, we investigated 31 patients with intrathoracic tumor which did not invade the middle or upper third of the esophagus. The cervical node group was defined as lower deep cervical nodes and recurrent nerve nodes that were accessible through a cervical approach. The cervical group was involved in six (19%), and most of cervical involvement was found in the recurrent nerve nodes. Of six patients with cervical involvement, four had noinvolved nodes in other regions. Such involvement limited to the cervical region wasfound in two of 11 patients with superficial cancer. Recurrent neurve palsy developedpostoperatively in four patients (13%), but hoarseness resolved within 6 months in all cases. Patients with involvement limited to the neck presented a favourable outcome. Cancer recurrence in the cervical region was found only in a patient who developed recurrence in the deep cervical nodes which were excluded from dissection at the cervical procedure. Even in the cancer of the lower third of the thoracic esophagus, cervical dissection is strongly recommended.View full abstractDownload PDF (31K) -
Reiki Eguchi, Hiroko Ide, Tutomu Nakamura, Kazuhiko Hayashi, Ken Takas ...1999 Volume 32 Issue 10 Pages 2457-2462
Published: 1999
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSTo define the rational extent of dissection for esophageal cancer clinicopathological study was carried out on 734 patients who underwent esophagectomy. The survival curve of patients who received cervical lymphadenectomy was better than that of patients who didn't, on conditions that the tumor locating in middle third of the thoracic esophagus (Im), with lymph node metastasis and without upper mediastinal lymph node metastasis. So cervical lymphadenectomy must be not available for patients with many lymph node metastasis in upper mediastinal. The extended upper mediastinal lymphadenectomy improved survival of the patients. The cervical lymphadenectomy should be performed in patients with carcinoma of upper third of the thoracic esophagus (Iu). Lymphadenectomy around common hepatic artery and celiac axis is not necessary for patients with carcinoma infiltrating within muscularis propria or reaching the adventitia (a1) of Iu. The cervical lymphadenectomy is recommended in patients with carcinoma invading to adventitia (a2) or adjacent structures (a3) of Im. But the dissection is not necessary for patients with carcinoma invading limited to the middle strata of the submucosal layer (sm2) of Im. And only inner side cervical lymphadenectomy should be performed for patients with carcinoma invading to the lower strata of the submucosal layer (sm3) of Im. Lymphadenectomy around common hepatic artery is not necessary in patients with superficial carcinoma of Im. The cervical lymphadenectomy must be required in patients with carcinoma infiltrating between sm3 and a1 of lower third of the thoracic esophagus (Ei), and the upper mediastinal lymphadenectomy isn't necessary for patients with carcinoma of lower part of Ei or with carcinoma infiltrating limited within sm2 of Ei.View full abstractDownload PDF (53K) -
Yutaka Shimada, Fumiaki Sato, Go Watanabe, Seiji Yamasaki, Masayuki Ka ...1999 Volume 32 Issue 10 Pages 2463-2468
Published: 1999
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSFor determination of the indication of cervical lymph node (LN) and abdominal para-aortic LN dissection in esophageal cancer patients, we examined micromatastasis in LNwith immunohistochemical (IHC) staining of cytokeratin (AE1/AE3) and RT-nested PCR for SCC antigen mRNA. Among 109 (3977 LNs) esophageal cancer patients, 80 cases received 2 fields (including left cervical LN dissection) and 29 cases received 3 fields dissection. Eighteen micrometastasis and 75 micrometastasis were newly detected in 1145 LNs (pN 0, 48 cases) and in 2832 LNs (pN1, 61 cases) with IHC respectively. As aresult, 11 cases were newly diagnosed as positive of lymph node metastasis. With RT-nested PCR detected more large number of LN metastases (10.6%, 59/557) were detectedthan with IHC (8.6%, 48/557) and HE (6.5%, 36/557). Among 12 cases of cervical LN metastasis, 6 cases (50%) had positive LN in upper mediastinal LN (#106), whereas among 89 cases of negative cervical LN metastasis, 23 cases (25.8%, 23/89) had positive LN in upper mediastinal LN. With regard to para-aortic LN metastasis (#lt-16a1 and #lt-16a2), all 10 recurret cases had metastasis (including micrometastasis) in perigastiric lymph node (#1, 2, 3, or 7). Furthermore, two recent cases of lower thoracic esophageal carcinoma with para-aortic LN dissection showed that both cases have micrometastasis in dissected para-aortic LN and one has survived 3 years after esophagectomy and the other has survived 5 months. These results indicated that the cases of upper mediastinal LN metastasis in thoracic esophageal cancer patients should receive cervical LN dissection and the cases of perigastric LN metastasis in lower thoracic esophageal cancer patients should receive para-aortic LN dissection. Further examination is required due to the small number of cases and short periods of follow-up.View full abstractDownload PDF (59K) -
Hideo Shimada, Osamu Chino, Hikaru Tanaka, Gen Oshiba, Takayoshi Kise, ...1999 Volume 32 Issue 10 Pages 2469-2473
Published: 1999
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSWe evaluated the significance of lymph node dissection of neck and upper mudiastinumand prognosis according to the number of metastatic lymph node. Two hundred twenty-five cases of thoracic esophageal cancer patients underwent three-field dissection from 1986 to 1997. The rate of lymph node metastasis was 66.7%, while the rate of necklymph node metastasis was 17.3%. The mode of lymph node metastasis depend on the region occupied by the tumor, but the metastasis is found throughout in these three field, and was noted to the upper mediastinum, around recurrent nerve and further to the neck as the first lymph node metastasis. The prognosis was not correlated with theexistence of neck lymph, but the number of lymph node more than four produced poor prognosis. The superficial esophageal cancer extending beyond sm2, regarded as havingfrequent lymph node metastasis, and the advanced cancer had the possibility to have neck lymph node measasis. Thereby the systemic three lymph node dissection was found necessary for these cases at this moment, when the preoperative diagnosis of lymph node metastasis is still uneasy.View full abstractDownload PDF (94K) -
Tomoko Hanashi, Misao Yoshida1999 Volume 32 Issue 10 Pages 2474-2478
Published: 1999
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSThe optimal lymph node dissection for thoracic esophageal carcinoma according to stage of the disease was studied. Thirty-four cases of m3 & sm1 cancer, treated by endscopic mucosal resection followed by radiotherapy or chemoradiotherapy in 67% of all cases, achieved good 5-years survival rates equal to surgical treatment. One hundred cases with sm2-a2 esophageal cancer underwent a curative operation with 3-field lymph node dissection (3FD) without neoadjuvant therapy. 68 cases with positive lymph nodes of less than 3, achieved good 5-year survival rate, and no lymph node recurrence. They should undergo a curative operation with 3FD. In 28 cases with 4-9 positive lymph nodes, or with severe microvascular invasion, distant organ metastasis was not decreased. These patients need multimodal therapy including a curative operation. In 29 cases with tumor at the lower half of Lt, and without lymph node metastasis in the neck and the upper mediastinum, the patients underwent lower esophageal and gastric resection through left-thoracothomy with lymph node dissection of the upper abdomen, and no lymph node recurrence was seen. So, in these cases, operations through left-thoracothomy and laparotomy are curative resections in superficial cancers, and are effective as a part of multimodal therapy for advanced cancers.View full abstractDownload PDF (52K) -
Tatsuyuki Kawano, Kagami Nagai, Haruhiro Inoue, Yohsuke Izumi, Masanor ...1999 Volume 32 Issue 10 Pages 2479-2483
Published: 1999
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSThoracic esophageal cancer has the potential risk of lymph node metastasis to any ofthe three fields of the neck, mediastinum, and/or abdomen. Therefore, an esophagectomy with three-field lymphadenectomy has been recommended in patients with cancer invading deeper than the deep mucosal (M3) layer. In this study 732 patients with thoracic esophageal cancer, between 1985 and 1997, were included. The rate of 5-year survival was compared between the groups of three-field and two-field (mediastinum and abdomen) nodal dissection. Patients who underwent partial neck dissection were included into the group of two-field dissection. In addition, 243 cases of superficial esophageal cancer were examined regarding recurrence in the neck region. The overall 5-year survival rate in the groups of three-field and two-field dissection were 28.8% and 47.9%, respectively. However, the background of the two groups was essentially different. In the superficial cancer cases, out of 50 patients after 3-field dissection a recurrence occurred in 8 (16.0%), and in 21 cases (10.9%) out of 193 patients after 2-field dissection. The neck recurrence contributed as a fatal factor in only one patient after 2-field dissection. Although neck dissection was valuable the local control of cancer, the recurrence in the mediastinum, abdomen, and distant organs was more influential on the mortality than the recurrence in cervical region becausethe metastatic cervical node (s) were usually resectable. Nowadays, we can predict the possibility of cervical node metastasis by applying many modalities and clinicopathological information. We think that the value of prophylactic neck dissection is not high in patients with clinically negative nodes in the neck region, and we can decide on the indication of prophylactic neck dissection individually in each patientwith thoracic esophageal cancer.View full abstractDownload PDF (49K) -
Miwako Arima, Yoshio Koide, Shinichi Okazumi, Hideaki Shimada, Hisahir ...1999 Volume 32 Issue 10 Pages 2484-2488
Published: 1999
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSThis study investigated indications and limitations of 3-field lymph node dissectionin thoracic esophageal carcinoma. The subjects were 446 patients who underwent resection including EMR. There were 61 cases of Ut, 268 cases of Mt and 117 cases of Lt. Fifty-five patients showing pEP or pLPM as the depth of the lesion did not develop any lymph node metastasis or recurrence, and were considered indications for EMR or blunt dissection. Lymph node metastasis and recurrence were extremely rare in the abdomen in cases of Ut/pMM to SM, and in the neck in cases of Lt/pMM to SM, and therefore, it seemed that dissecion could be omitted. In patients showing Adj, curability C, 3-field lymph node metastasis of 5 or more metastatic lesions showed a very poor prognosis, and were classified as the poor-prognosis group (F group). Other patientswere categorized as the A group. In the F group, the recurrece rate was 90% or more, and 3-year survival without recurrence was noted in 2 patients undergoing 3-field dissection, but not in any in patients undergoing 2-field dissection. In the A group, the recurrence rate was approximately 30%, and the 3-year survival rate without recurrence ranged from 40 to 50%. Three-field dissecion achieved significant improvementin prognosis compaired with 2-field dissection in cases showing pMP to Ad and Ut, Mt/SM to Ad in the A group. In the F group, 3-year survival without recurrence was notobserved in any patients undergoing 3-field dissection alone, but the prognosis was prolonged in patients receiving additional postoperative treatment. It is considerednecessary to aggressively administer chemo-radiotherapy to patients in the F group.View full abstractDownload PDF (65K)
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