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Volume 41, Issue 6
Displaying 1-21 of 21 articles from this issue
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Masayuki Ohta, Seigo Kitano, Seiichiro Kai, Yuichi Endo, Hidetoshi Egu ...2008 Volume 41 Issue 6 Pages 599-604
Published: 2008
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSBackground: We introduced laparoscopic adjustable gastric banding (LAGB) to Japan. Methods: Between August 2005 and August 2007, 21 morbidly obese patients with 44±10kg/m2 (mean±S. D.) BMI underwent LAGB. LAGB using the pars flaccida technique with 3-5 gastric-to-gastric sutures did to prevent band slippage. Results: No conversion to open surgery or post-LAGB complications were seen. Weight loss 12 months after surgery was 25±11kg and the percentage of excess weight loss was 41±7%. After 18 months, there were 29±13kg and 49±11%. Weight loss led to lower hypertension in 91% of patients, lower dyslipidemia in 94%, and improved type 2 diabetes in 100%. Conclusions: LAGB is safe and effective, and is expected to play an important role in the treatment of morbid obesity in Japan.View full abstractDownload PDF (595K) -
Ken-ichiro Fukuda, Osamu Kinoshita, Hiroaki Nagata, Akinobu Furutani, ...2008 Volume 41 Issue 6 Pages 605-611
Published: 2008
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSBackground: Unless recognized and treated promptly, colorectal perforation easily causes septic shock and life-threatening complications. We studied prognostic factors in patients with colorectal perforation. From April 1995 to March 2007, 38 patients with colorectal perforation underwent emergency surgery documented in Surgery Department files at our institution. Methods: Subjects were retrospectively divided into survivors (n=29) and nonsurvivors (n=9). We studied their clinical factors, and compared mortality for each factor. Results: Overall mortality was 23.7%(9/38). The underlying disease included colorectal cancer in 10 cases, diverticulitis in 9 cases, idiopathic disease in 8 cases, iatrogenic disease in 7 cases, abdominal trauma in 2 cases, and others in 2 cases. Mortality was high in cancer at 30%(3/10) and idiopathic disease at 50%(4/8). Most surgery involved Hartmann's technique (n=19). Mortality in patients with base excess≤-5 was 53.8%(P=0.023), with APACHE II score≥20 was 80%(P=0.007), and with renal complications was 100%(P=0.001), making these factors statistically significant, respectively. Mortality in 16 patients undergoing postoperative endotoxin absorption therapy (PMX-DHP) was 43.8%(7/16). In PMX-DHP, urinary output significantly increased from 61.0±61.0ml/h to 127.6±98.1ml/h (P=0.038). This is more likely to occur strongly among survivors (P=0.06). Discussion: Base excess, APACHE II score and renal complications are prognostic factors in patients with colorectal perforation. The usefulness of PMX-DHP is still controversial.View full abstractDownload PDF (483K) -
Yoshiko Yano, Wataru Takayama, Makoto Sugaya, Shinsuke Kakuta, Tetsumo ...2008 Volume 41 Issue 6 Pages 612-617
Published: 2008
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSA 60-year-old woman referred for abnormal duodenal findings in a mass screening X-ray examination was found in upper gastrointestinal endoscopy to have an ulcer at the duodenal bulb. Biopsy was negative for malignancy and the patient was treated with antacids. Ultrasonography and computed tomography at the outpatient clinic showed multiple masses at hepatic segments 4, 5, and 8. Ultrasound-guided needle biopsy of the liver mass showed adenocarcinoma. The patient was admitted and underwent left hepatic lobectomy. Because the duodenal ulcer remained unchanged despite drug administration, partial duodenectomy and gastrectomy with lymph node dissection were conducted on suspicion of malignancy. Pathological findings showed that the duodenal and liver tumors shared glandular and neuroendocrine differentiation. Immunohistochemical staining of liver and duodenal tumors was positive for synaptophisin and chromogranin A. The definitive diagnosis was adenocarcinoid of the duodenum with liver metastasis. The patient has been free from disease recurrence in the 18 months since surgery. Adenocarcinoid of the duodenum is very rare and this is, to our knowledge, the first report of surgery to treat duodenal adenocarcinoid with liver metastasis.View full abstractDownload PDF (791K) -
Dairou Tanabe, Keiichirou Kondou, Kenji Noda, Hirohisa Yano2008 Volume 41 Issue 6 Pages 618-623
Published: 2008
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSA 55-year-old woman admitted for high fever and hypotension was found in US, CT, and MRI to have a giant cystic mass at the left hepatic lobe and ascites. An ascites puncture suggested hepatic rupture, necessitating abdominal drainage. After she recovered, we conducted left hepatic lobectomy due to suspected cystadenocarcinama. The resected specimen showed a multilocular cyst without mural nodules containing pus, mucus, and coagulation fluid. Based on the results of histopathological and immunohistochemical studies, the tumor was definitively diagnosed as hepatic cystadenocarcinoma with mesenchymal stroma. The rupture was complicated by cystadenocarcinoma infection. Hepatic ruptured cystadenocarcinoma is rare.View full abstractDownload PDF (876K) -
Masaaki Iwatsuki, Keiichiro Kanemitsu, Akira Chikamoto, Yoshifumi Baba ...2008 Volume 41 Issue 6 Pages 624-628
Published: 2008
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSA 67-year-old man diagnosed ten years earlier with systemic amyloidosis and suffering epigastric pain with fever was referred for evaluation of intrahepatic bile duct dilation. Percutaneous transhepatic cholangiography showd dilated bile duct in the left lateral segment. Cytology of the bile juice was class III. Although no definitive tumor-like lesion was detected in abdominal ultrasonography, computed tomography or magnetic resonance imaging, portgraphy showed a stricture of the left branch of the portal vain, necessitating left hepatectomy based on a diagnosis of intrahepatic cholangiocarcinoma. Histological examination showed no malignant cells in the epithelium of the bile ducts, but amorphous eosinophilic material stained with Congo red was found in the expanded Glisson.s capsule. No amyloid deposit was seen along the sinusoidal wall. The definitive diagnosis was nonspecific cholangitis due to amiloid deposit in Glisson.s capsule.View full abstractDownload PDF (1067K) -
Takuya Nojiri, Yoshiaki Tanabe, Satoru Yanagisawa, Yohichi Tohyama, Su ...2008 Volume 41 Issue 6 Pages 629-633
Published: 2008
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSA 61-year-old man with a history of total gastrectomy treated for gallbladder hemorrhage due to a ruptured cystic artery pseudoaneurysm was admitted for pyrexia, right hypocondralgia, and hematemesis. Ultrasongraphy and abdominal plain computed tomography (CT) on admission showed a distended thick gallbladder wall with hematoma, but no gallstones. Abdominal enhanced CT after admission showed decreased distention and wall thickening of the gallbladder without obvious tumors. Angiography showed no extravasations of contrast medium in any artery. Panendoscopy showed no source of hemorrhage. The man was diagnosed with hemobillia due to gallbladder hemorrhage. After angiography, no active bleeding was recognized and elective surgery was planned. However the man developed shock on hospital day 7 due to recurrent hemorrhage, he underwent emergency cholecystectomy. Histopathologically, the gallbladder was diagnosed as having gangrenous cholecystitis. After surgery, a review of the angiogram confirmed the diagnosis of cystic artery pseudoaneurysm. Gallbladder hemorrhage should therefore be considered in the differential diagnosis of gastrointestinal hemorrhage.View full abstractDownload PDF (687K) -
Eiji Ako, Mami Yoshii, Yuhiko Fuyuhiro, Akiko Tachimori, Isao Kanehara ...2008 Volume 41 Issue 6 Pages 634-639
Published: 2008
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSA-72-year-old man admitted for examination of a liver cyst seen in a physical health screening was found in abdominal computed tomography (CT) to have a cystic tumor 5cm in diameter having a contrast-enhanced papillary projection 2cm in diameter arising from the cystic wall in the S4 segment of the liver. Abdominal T1-weighted magnetic resonance imaging (MRI) showed a low-intensity lesion and T2-weighted MRI a highintensity lesion. Drip infusion cholangiography (DIC)-CT suggested that the tumor might not be connected to the intrahepatic bile duct. Abdominal angiography showed tumor staining in the S4 segment of the liver, indicative of the solid portion in the cystic tumor. Based on a diagnosis of biliary cystadenocarcinoma, we conducted left hepatectomy and cholecystectomy. The resected specimen showed a unilocular cystic tumor with a papillary projection inside. The cystic tumor was diagnosed as biliary cystadenocarcinoma on histological examination, and the entire cystic wall showed the presence of cancer cells. Segmental hepatectomy including the cystic tumor provides the most favorable prognosis for biliary cystadenocarcinoma.View full abstractDownload PDF (1118K) -
Toshifumi Wakai, Yoshio Shirai, Jun Sakata, Makoto Inoue, Masahiro Min ...2008 Volume 41 Issue 6 Pages 640-645
Published: 2008
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSWe herein report the case of a patient with cholangiocellular carcinoma presenting as Budd-Chiari syndrome. A 63-year-old man with shortness of breath and abdominal distension. Thoracoabdominal CT and inferior vena cavography showed inferior vena cava obstruction diagnosed as Budd-Chiari syndrome. Soft tissue density around the obstruction on CT indicating a malignant tumor necessitated exploratory laparotomy, which revealed a 5cm tumor arising in hepatic segment VIII involving the inferior vena cava. Histologic examination of excisional biopsy specimens showed moderately to poorly differentiated adenocarcinoma. Extrahepatic stromal invasion involved the inferior vena cava and led to Budd-Chiari syndrome. Radical resection was contraindicated due to distant nodal disease and peritoneal metastases. Immunohistochemical study confirmed a diagnosis of cholangiocellular carcinoma, because tumor cells were diffusely positive for cytokeratin 7, a marker for biliary epithelium. He underwent systemic chemotherapy with gemcitabine (250mg/m2/day) and irinotecan (25mg/m2/day). No adverse effects were noted. Eight months after chemotherapy was started, the man died of disease. In the literature, we found only 6 cases, including ours, of cholangiocellular carcinoma presenting as Budd-Chiari syndrome. This case and a review of the literature suggest that patients with cholangiocellular carcinoma arising in the liver adjacent to the inferior vena cava may present as Budd-Chiari syndrome and clinicians should consider this in differential diagnosis of Budd-Chiari syndrome.View full abstractDownload PDF (1152K) -
Seiichi Shinji, Noritake Tanaka, Kiyonori Furukawa, Kimiyoshi Yokoi, T ...2008 Volume 41 Issue 6 Pages 646-652
Published: 2008
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSWe report the case of a patient with multiple endocrine neoplasia type 1 (MEN-1), with an gastrin-producing hepatic tumor and pancreatic glucagonoma. A 55-year-old woman admitted for abdominal pain and nausea was found to have a severe duodenal ulcer and elevated gastrin, glucagon, parathyroid hormone, and calcium. Abdominal computed tomography (CT) showed a high-density area suggesting a 4cm neuroendocrine neoplasm in the pancreatic tail and a high-density area suggesting a 2cm metastatic lesion in the left lateral hepatic segment. Neck CT showed a parathyroid tumor. Based on a preoperative diagnosis of MEN-1 with Zollinger-Ellison syndrome and pancreatic gastrinoma with liver metastasis, she underwent distal pancreatectomy and left lateral segment hepatectomy with splenectomy and cholecystectomy. The pathological diagnosis was gastrin-producing hepatic tumor and pancreatic glucagonoma. Both tumors showed different hormone production profiles and there were many microadenoma-like lesions in the pancreas. Genetic examination showed a point mutation in MEN-1.View full abstractDownload PDF (1906K) -
Takeshi Nishi, Seiji Yano, Touko Inao, Yoshihide Simojo, Yasuhiko Yoko ...2008 Volume 41 Issue 6 Pages 653-657
Published: 2008
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSIntraductal papillary mucinous neoplasm (IPMN) is reported to complicate malignancies disease in 30% of cases and complicate invasive ductal carcinoma of the pancreas too, but is rare in multiple cancers. We report a patient with IPMN accompanied by triple cancers. The 60-year-old woman had been followed for IPMN for 7 years, during which time she underwent a hysterectomy due to uterine corpus cancer at age 56 and bilateral breast-preserving surgery due to bilateral breast cancer at age 60. During radiation therapy after breast cancer surgery, a tumor was found in the pancreas body in abdominal computed tomography. Magnetic resonance cholangiopancreatography and endoscopic retrograde cholangiopancreatography showed the main pancreas duct to be occluded at the body and at the tail to be delated. Cytology of the pancreatic juice was class IV. We diagnosed pancreatic cancer with IPMN and conducted subtotal distal pancreatectomy, without resecting the IPMN, which was considered benign.
Physicians should look for malignant disease in patients with IPMN because cancer complications may adversely affect their prognosis.View full abstractDownload PDF (1033K) -
Yoshiaki Shindo, Kazuo Tenma, Hiroshi Imano, Masanori Hibino, Kei Yosh ...2008 Volume 41 Issue 6 Pages 658-663
Published: 2008
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSA 37-year-old man reporting abdominal pain and distension and diagnosed with ileus based on abdominal plain X-ray findings was admitted, but failed to respond to conservative therapy, necessitating surgery on hospital day 6. A 50cm length of jejunum 15cm anally from Treitz's ligament showed wall thickening and ischemic change suggesting impaired circulation and mesenteric lymphadenopathy. We partially resected the jejunum. Histopathological examination showed marked eosinophilic infiltration and fibrinoidal necrosis of the jejunal. The definitive diagnosis was allergic granulomatous angitis (AGA) based on allergic rhinitis, fever caused by angitis, weight loss, muscle pain, and main pathological findings. He has since suffered no AGA recurrence. We review the five cases reported in the Japanese literature of ileus caused by AGA and report this to broaden the knowledge available on this topic.View full abstractDownload PDF (750K) -
Seiichi Kitahama, Makio Mike, Satoshi Endo, Satoshi Matsuda, Seiko Uwa ...2008 Volume 41 Issue 6 Pages 664-669
Published: 2008
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSWe report a case of adult intussusception due to inverted Meckel's diverticulum with lipoma, accompanied by idiopathic intussusception. A 34-year-old man with intermittent abdominal pain was found in enhanced abdominal CT to have multiple concentric ring signs of the intestines, diagnosed as ileoileal intussusception, necessitatingemergency surgery. After confirming the presence of two separate intussusceptions laparoscopically, we made a minimal 5cm incision at an appropriate site. The anal one shrank completely. The oral one, includingthe tumor, was resected after it had been shrunk as much as possible. Subserosal lipoma was located at the base of the inverted Meckel's diverticulum. Two such simultaneous intussusceptions are extremely rare.View full abstractDownload PDF (1016K) -
Satoshi Inose, Shuji Suzuki, Nobuhiko Harada, Seiichi Tanaka, Tsuneo H ...2008 Volume 41 Issue 6 Pages 670-675
Published: 2008
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSAn 81-year-old women with abdominal pain and vomiting was suspected in abdominal CT to have small bowel obstruction associated with intussusception. Insertion of an ileus tube did not alleviate symptoms. Five days later, the patient was admitted to our hospital. An ileus tube contrast study showed a tapering occlusion of the jejunum, diagnosed as intussusception associated with a jejunal tumor, necessitating surgery. Laparotomy showed a 60-cm intussusception of the jejunum, 80cm distal from the ligament of Treitz with the jejunal tumor as its front edge. We palpated 5 tumors in the jejunum and 3 more in the terminal ileum, necessitating partial jejunal and ileal resection including tumors. Histopathologically, the diagnosis was malignant T-cell lymphoma. The patient's postoperative course was favorable, and she was discharged on postoperative day 20, but died 5 months after surgery due to an aggravated general condition associated with recurrence in the intraabdominal lymph nodes.View full abstractDownload PDF (989K) -
Kenji Yamaguchi, Takaaki Yamane, Toshihiko Hirata, Seiji Fukuda2008 Volume 41 Issue 6 Pages 676-681
Published: 2008
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSA 66-year-old man treated by hemodialysis for about 30 years repeatedly suffered from ileus in the last three years. Because endoscopic biopsy of the rectal mucosa could not detect amyloid deposition, it was unable to identify gastrointestinal amyloidosis. Admitted with a diagnosis of colonic ileus, he under went conservative treatment, but, a sigmoid colostomy did not improve the ileus. Severe amyloid deposition in the proper muscle caused the large-intestin wall to become paralyzed. In dialysis amyloidosis, such a gastrointestinal complication is believed to be caused by massive amyloid deposition in the proper muscle, making it is very difficult to locate amyloid deposition endoscopically. Dialysis amyloidosis thus becomes serious in long-term dialysis patients and may paralyze the gastrointestinal tract beyond recovery.View full abstractDownload PDF (735K) -
Akira Toyoshima, Takeshi Endo, Sakae Nagaoka, Yoshikazu Maruyama, Keis ...2008 Volume 41 Issue 6 Pages 682-687
Published: 2008
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSA 22-year-old man admitted for difficulty in defecating, bloody stool, and diarrhea and diagnosed with mechanical ileus due to circulatory disorder underwent surgery 5 days later due to left abdominal pain and a hard abdomen. Operative findings showed inferior mesenteric vein thrombosis with congestion, edema, anddegenerative sclerosis from the descending colon to the rectosigmoid colon. Because the colon was not necrotic, we conducted only transverse colostomy, relieving the man's symptoms. Postoperative laboratory examination showed a coagulation disorder due to protein C deficiency. IMA arteriography showed a defect in the IMV and collateral vein. Mesenteric vein thrombosis was attributed to protein C deficiency. We conducted resection from the transverse colon to the rectosigmoid with end-to-end anastomosis 2 years later, due to the lack of improvement in colon stenosis. The stenoeic region of the resected colon showed a defect of the mucosa and muscularis mucosae and marked luminal obliteration of subserosal veins. Anticoagulation therapy administered after the procedure, enabled the man to progress well, and no signs of recurrence have been seen since surgery. To our knowledge, only 2 cases, including ours, have been reported in the Japanese literature.View full abstractDownload PDF (898K) -
Takehiro Sakai, Koichi Sato, Toru Tamura, Masanori Tanaka, Yasuhiro Su ...2008 Volume 41 Issue 6 Pages 688-694
Published: 2008
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSA 60-year-old man admitted for abdominal pain was found in chest and abdominal imaging to have free air under the diaphragm and marked dilation of the transverse colon. Based on a diagnosis of perforation peritonitis, we undertook emergency laparotomy. The colon was markedly dilated and the intestinal wall was thin and dark red. We found a colonic perforation at the hepetic flexure, and conducted right hemicolectomy with primary end-to-end anastomosis. Histologically, amyloid was seen throughout the entire colon layer. Congo red staining was positive both before and after treatment with potassium permanganate, and the protein compo- nent of the amyloid fibers corresponded to type AL fibers. Although the patients suffered postoperatively respiratory failure, retoperitoneal abscess formation, and wound infection, he recovered and was discharged ambulatory on postoperative day 55. Colonic perforation is one of the severest complications of gastrointestinal amyloidosis, which must be considered in patients with idiopathic digestive tract perforation. Although our patient was successfully treated without anastomotic failure, evaluation and appropriate digestive tract and organ follow-up is essential.View full abstractDownload PDF (1014K) -
Naoya Yoshida, Nobutaka Sato, Kenichiro Yamamoto, Takeharu Maeda, Sini ...2008 Volume 41 Issue 6 Pages 695-699
Published: 2008
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSWe present a case of an 86-year-old man diagnosed with invagination by advanced rectal cancer. He was admitted elsewhere due to sudden melena and diagnosed with local advanced lower rectal cancer. We conducted Mile's operation. Legional invagination was found intraoperatively, so we conducted anal function-preserving surgery. Invagination by rectal cancer is infrequent, being reported, to our knowledge, in only 5 cases. We discuss our case in light of a review of the literature.View full abstractDownload PDF (635K) -
Takashi Nonaka, Yoshihito Shibata, Kazuo Tou, Seiji Honjyou, Tadayuki ...2008 Volume 41 Issue 6 Pages 700-704
Published: 2008
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSWe report a very rare case of an incarcerated internal hernia in a paracolic gutter of the descending colon. A 78-year-old man seen elsewhere for sudden abdominal pain onset and he sent to our hospital for internal her-niadiagnosis was found in abdominal contrast Comupted tomography to have a small-intestine loop in the paracolic gutter of the outside descending colon, and contrast effect was poor. Suspecting a strangulated intes-tinalobstruction caused by an internal hernia, we conducted emergency surgery, finding that part of the small intestine had protruted through a defect of the paracolic gutter on the left side of the descending colon for 50cm, becoming strangulated. We removed the strangulated intestine and closed the orfice.View full abstractDownload PDF (580K) -
Yoshihiko Tsukamoto, Masahiro Samizo, Tetsuya Takahashi, Takayo Maekaw ...2008 Volume 41 Issue 6 Pages 705-710
Published: 2008
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSA 31-year-old woman seen for a genital bleeding was found in palpation and digital examination to have an elastic soft, smooth unmovable tumor on the right behind the lower rectum. Barium enema and colonoscopy showed extrarectal compression of the right posterior lower rectum. CT and MRI showed a presacral cystic tumor, 63×47×80mm, which we resected in using a sacral approach in the jack knife position. Macroscopically, the smooth surfaced cyst cotained white mucous material, with no tumorous lesion seen in the wall. Microscopically, the inner cyst wall consisted of keratinized squamous epithelium. No sebaceous glands or hair was found. The cyst was diagnosed as epidermoid. We review 57 cases of presacral epidermoid cyst including our case, reported in Japan. We believe presacral cysts must be completely excised because of possible complications including squamous cell carcinoma and infection. Presacral epidemoid cyst should be treated by appropriate operative procedures, based on, the tumor location, direction of the growth and tumor size.View full abstractDownload PDF (853K) -
Yasuyuki Miyakura, Hidenori Haruta, Toru Zuiki, Yoshinori Hosoya, Yosh ...2008 Volume 41 Issue 6 Pages 711-716
Published: 2008
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSMalignant fibrous histiocytoma (MFH), the most frequently occurring soft tissue sarcoma, originates in fibroblast cells, figures a high rate of metastasis or recurrence, and commonly metastasizes to the lung. We report a case of huge, rapidly growing metastatic intraabdominal MFH. A 45-year-old man with anorexia and epigastric discomfort admitted elsewhere was found in abdominal CT to have a huge solid tumor in the abdominal cavity, and was referred to Jichi Medical University Hospital for surgery. He had undergone radical resection of MFH of the left buttock 2 years earlier and a metastatic MFH of the right pleura 7 months earlier. Abdominal enhanced CT showed a low-density area (LDA) forming ‘beak’ image in the pancreas body. CT 5 months earlier had shown no such LDA. Gastroscopy showed a huge submucosal tumor with ulceration from the upper gastric body to the pyloric region, indicating a huge, rapidly growing tumor suspected of being pancreatic MFH metastasis, and necessitating by total gastrectomy and distal pancreatectomy with a negative surgical margin. Histopathological findings indicated a stromal tumor consisting of storiform spindle cells with invasion to both pancreas and stomach not decided the origin of recurrence, and similar to pathological findings in the MFH of the left buttock, and a definitive diagnosis of metastatic MFH.View full abstractDownload PDF (1268K) -
Jiro Ohuchida, Kazuo Chijiiwa, Naoya Imamura, Motoaki Nagano, Masahide ...2008 Volume 41 Issue 6 Pages 717-722
Published: 2008
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSChemotherapy with gemcitabine (GEM) has improved the survival of patients with pancreatic cancer. We studied the efficacy of adjuvant chemotherapy or chemoradiotherapy, mainly with GEM, in those with resected and unresected pancreatic cancer. Of 140 patients with pancreatic cancer from January 1992 to December 2006, 41 underwent surgical resection and 99 did not. Of the 41 undergoing resection, 8 with distant organ metastasis or macroscopic residual tumor and one with carcinoma in situ were excluded, giving us 32 resected and 99 non resected subjects for this study. These two groups were subdivided based on adjuvant therapy and overall and disease-free survival were compared between groups. In the resected group, the overall and disease-free survival rates 3 years after surgical resection were significantly better in patients undergoing postoperative adjuvant therapy than in these who did not (47% vs. 19% and 48% vs. 20%). Overall survival at one year in unresected cases with adjuvant therapy was significantly better than without adjuvant therapy (26% vs. 6%). No significant difference in survival was observed between chemotherapy alone and chemoradiotherapy in the non resected group. These results suggest that adjuvant therapy after complete resection for pancreatic cancer and for unresected advanced pancreatic cancer is useful in improving the outcome.View full abstractDownload PDF (388K)
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