To provide data prospecting future surgical problems in the aged people, we has analyzed current status of surgeries for aged patients in Awaji Island, where the population is made up of more numbers of aged people with the percentage of 17.7%, which makes us suppose a coming Japanese aging society in the eraly 21st century.
Results revealed that the aging of population would increase an occurrence of colorectal cancer among the malignancies, cholelithiasis among benign diseases, and trauma as well. Furthermore, postoperative complications of delirium (senile dementia) and cerebrovascular diseases were also suggested as possible problems for the aged.

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Thyroid scintigraphy, ultrasonography and soft rentgenography have been used conventionally for the evaluation of thyroid nodules. These diagnostic procedures, however, are often inaccurate for a small portion of malignant tumors. Therefore the diagnostic accuracy of fine-needle aspiration biopsy for cytology (FNABC) was assessed in 204 patients with nodular thyroid disease.
Seventy-two out of the 204 patients were confirmed histologically as malignant thyroid nodules. In this group the true positive rate was 66.7% with only one folse-positive case. In papillary carcinoma it was 74.1% and 33.3% in follicular carcinoma. There was a correration between the tumor size and true positive rate in FNABC. The larger the tumors were, the higher the true positive rate became.
In papillary carcinoma 15 out of 58 cases were false-negative. Main reason was bad sampling of the smear. In follicular carcinoma 8 out of 12 cases were false-negative. It might be difficult for FNABC to make a precise diagnosis of follicular carcinoma, being a future theme to improve it.
FNABC was a easy, safe and reliable method in treating the patients with thyroid nodules.

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The clinical significance of breast cancer-related antigen CA15-3 and its relationship with CEA are examined. Subjects are 328 cases comprising of 90 of primary breast cancer, 28 of relapsed breast cancer, 66 of postoperative and non-relapsed breast cancer, 46 of benign mammary glandular diseases, 59 of other organic cancers, 16 of puerperae and 23 of healthy females.
When CA15-3 levels more than 25U/ml were regarded as positive, the positive rate was as low as 13.7% or 33.3% for stage I or stage II cancer respectively, so that CA15-3 might not be a possible candidate for screening marker. However, significant high levels of serum CA15-3 and the positive rate in cases above n1β indicated the usefulness of CA15-3 as an index of biological malignancy.
CA15-3-positive was rated as igh as 79.3% for relapsed breast cancer, indicating a favorable feature of CA15-3 as monitoring marker for postoperative relapse. Moreover, well-coincided variation of serum CA15-3 with therapeutic effects in advanced or relapsed cancers revealed that CA15-3 was a valuable index in judging therapeutic efficacy.
In terms of relationship between CA15-3 and CEA, correlation coefficient between the both was as low as r=0.287 for relapsed breast cancer, suggesting a greater effectiveness of combination assay with CA15-3 and CEA as postoperative monitoring.
CA15-3 appears to be as the same substance as antigen DF3, and immunohistochemical assay revealed that antigen DF3 localized in the cytoplasm of breast cancer cells.

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For the past 20 years, we experienced 6 cases of ruptured abdominal visceral aneurysms. These included 3 cases of middle colic, 1 of splenic, 1 of right hepatic and 1 of submucosal gastric aneurysm. The 3 cases of middle colic aneurysms had abdominal pain with shock caused by intra-abdominal bleeding, and underwent emergency operation. The other 3 cases had gastrointestinal bleeding. Of the 3 cases, splenic aneurysm ruptured into the pancreatic duct, right hepatic aneurysm ruptured into the bile duct and submucosal gastric aneurysm ruptured into the stomach, their bleeding points being detected by arteriography preoperatively. All 6 cases were treated surgically without significant postoperatie complications.
In our country, there were 117 caes of ruptured abdominal visceral aneurysms for past 20 years. They included 37 cases of splenic, 29 of hepatic, 15 of submucosal small intestinal, 10 of pancreaticoduodenal, 8 of superior mesenteric, 7 of gastric, 7 of colic, 2 of celiac and 2 of interior mesenteric aneurysms. Of the 117 cases, 50 cases had intra-abdominal bleeding and 63 cases had gastrointestinal bleeding. Mortality rate of them was 28.3%.

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1538 cases of resectable primary gastric cancer for past 15 years are reviewed especially to clarify characteristics of aged patients.
For recent 5 years, an increase in occurrence of gastric cancer was remarkable in aged patients over 70 years. A tumor occupying M-area are common generally, however, a tumor occupying A-area was more common among aged cases ever 70 than among younger ones under 39 years; gastric cancer type II was also more common among the aged cases of both sexes (p<0.005). When compared with younger and middle cases, differenciated or undifferenciated cancer was significantly more common among male or female aged cases respectively (p<0.005). Stage III or IV tumor was more often found among patients over 70 than among those under 69 years, accompanying by more n-positive cases (p<0.005). H·P factor-positive tumor was more common among patients over 70 than any other age groups except younger group (p<0.05-0.005). Moreover, v·ly factor-positive tumor was significantly more common especially among patients over 80. Examination of nuclear DNA ploidy pattern of cancer cells revealed a more common non-diploid pattern among patients over 70 than among others (p<0.05-0.025).
These findings indicate that gastric cancer among aged people are characterized by more frequent occurrence in advanced stages and a strong tendency to be invasive regionally, which could be confirmed by studying nuclear DNA of cancer cells.

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Twenty patietns who were admitted for sigmoid volvulus between 1964 and 1987 were analysed. Four of six patients who were treated with non-operative reduction or operative detorision as an initial treatment subsequently underwent resection of the sigmoid colon. Of thirteen patients who underwent sigmoid resection and primary anastomosis, two patients complicated by anastomotic dehiscence, one did by intra-abdominal abscess, and one died. Recent four cases undergone intraoperative irrigation of the colon developed no postoperative complications. All three death cases after operation had gangrenous bowel and arrived the hospital with shock state. One underwent sigmoid resection and anastomosis and two did Hartmenn's operation. Because of the high recurrence rate after reduction and of the low postoperative mortality rate in non-gangrenous cases, sigmoid resection and primary anastomosis is thought to be the treatment of choice in such cases.

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210 cases of metastatic liver cancer for recent 5 years were subjected to ultrasonographic review. When compared to ultrasonographic fundings obtained from primary liver cancers, the findings from metastatic liver cancers were characterized by more frequent occurrence (79%) with smooth boundary, and also more frequent occurrence of thickened marginal low echo band if the band was involed. Sixty nine percent of the metastatic subjects revealed high internal echo level, or the two percent did an enhanced posterior echo of the tumor, which was lesser than that for primary cancer. The outside shadow was noted in as low as 8% of the subjects, while that figure was 29% in primary liver cancer cases. The above findings were observed with higher rate especially in tumors with sizes of more than 2cm to less than 5cm in diameter. An understanding of characteristics of ultrasonographic images, accordingly, appears to lead to improvement in correctly diagnosing of metastatic liver cancer.

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Percutaneous transluminal angioplasty (PTA) has been widely adopted to dilate the atheroscleroitc vessels becaue this procedure is safe and facilitates with good patient's adaptation. We analyzed the results of PTA for atherosclerotic stenosis of the iliac and superficial femoral arteries in 36 patients with intermittent claudication. In these 61 vessels, thg initial success rate was 87% (32 cases, 53 vessels) with immediate remission of claudication. 26 were followed up in care of initial PTA alone. Most patients treatd with PTA alone had only a single lesion of arterial stenosis. Repeated dilation was required for 3 patients. Synthetic graft bypass had to be done for 3 patients. Those cases had multiple sclerotic changes in the proximal and distal sites of stenotic lesion. Cumulative patency rates for iliac angioplasty were 88%, 73%, and 66% after one, two, and three years, respectivley. There were 5 complications (14%) and only 2 of them required surgical repair.
Our findings suggest that PTA provides an immediate symptomatic remission and good long-term results for the majority of patients with a single and short area of stenosis in the peripheral arteries.

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An unusual case of local recurrence that developed on the chest wall irradiated after mastectomy for cancer is described. A 53-year-old female was admitted to our hospital with a complaint of a mass in the anterior chest wall. She had had a right radical mastectomy followed by radiotherapy in another hospital fifteen years previously for early breast cancer. The tumor contained cystic fluid, the cytology of which showed cells strongly suspicious for epithelial malignancy, and it was diagnosed as recurrence on the chest wall. Thus, wide local resection of the chest wall was done. The patient is alive with no further recurrence three years later. Therefore, surgical intervention is considered to be appropriate to a solitary local recurrence after a long latent period.

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We experienced fifteen cases of breast reconstruction to the early stage of breast cancer. This report detalis our operative technique of breast reconstruction utilizing the transverse rectus abdominis myocutaneous flap and the latissimus dorsi myocutaneous flap, and refers to the necessity as well as problems.
The rectus abdominis myocutaneous flap has enough volume to reconstruct a breast completely without a mammary implant. And there is a convinience of operating on a patient lying spine on the operation table. Donor site scar is inconspicuous and the procedure offers an additional benifit of abdominoplasty to the middle aged women. But some problems include a lower abdominal weakness and an insufficiency of vascular supply at the cantralateral flap tip. abdominal wall hernia will be prevented using MARLEX MESHR. And we tried to excise distal portion of the flap.
The silicon prosthesis is applied to the reconstruction using the latissimus dorsi myocutaneous flap, becaue the flap has not enough volume to reconstruct a breast by itself. It is necessary to take care of postoperative capsulation.

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A case of mediastinal abscess formed from deep neck infection is reported. A 59-year-old woman was first seen with chief complaints of right ear-ache and sore throat, and diagnosed as right otitis externa and pharyngitis. After that, the patient uregently admitted to the hospital, because hoarse voice, swelling in the right anterior cervix, and dyspnea appeared. The cervical swelling and dyspnea were further developed, and trachectomy was done on the first hospital day. Since her chest X-ray film revealed a clear and enlarged mediastinal shadow, CT exhibiting a possible shadow of mediastinal abscess, she was treated for drainage. The patient, however, was complicated by postoperative DIC and dead due to massive hematemesis and melena. An appearence of antibiotics with superior qualities is said to extremely decrease the development of deep neck infection, however, it can provide a delayed diagnosis and insufficient therapy which lead to severe complications. Mediastinal abscess in this case might be originated from parenchymatous tonsillitis through formation of lateral pharyngial abscess and postpharyngial abscess. We keenly realize a necessity of drainage with sufficient depth.

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Adeno-squamous cell carcinoma of the thymus is a very rare tumor. In Japan only a case has been reported.
Recently, the authors experienced a 65-year-old female with adeno-squamous cell carcinoma of the thymus admitted because of anterior chest pain.
Plain chest X-ray films and chest CT revealed that she had an anterior mediastinal tumor.
At operation no metastasis was found, and the tumor was totally removed. The tumor was 4.0×4.5×1.5cm in size. Histologically it was diagnosed as adeno-squamous cell carcinoma of the thymus.
Post operative adjuvant rediotherapy was applied to the mediastinum, and systemic chemotherapy with Cis-Diaminedichloroplatinum was added.
During the follow-up period of 8 months, she has done well.

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We reported a 43-year-old male case of abnormality of mitral valve, that was found by echocardiogram 2 months after the start of antibiotic therapy for infectious endocarditis (IE). Congestive heart failure was also getting worse, and double valve replacement was performed. Resected anterior mitral leaflet showed a saccular formation 1.5×1.0×1.0cm in size with perforation of 0.5cm in diameter at the center. In microscopic study, true aneurysm of mitral valve was diagnosed.
Aneurysm of mitral valve occurs most commonly in association with IE. Among domestic 16 cases, nine were associated with IE. In this point of view, a possible relationship has been suggested between healing process from IE using antibiotics and the pathogenesis of aneurysm. And our case also appears to develop aneurysm during antibiotic therapy. We could not confirm the diagnosis because of atypical view in echocardiogram, but repetitious echocardiogram during antibiotics therapy is necessary to detect aneurysm.

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We have experienced five complete repair cases of aortic dissections, four of which classified as DeBakey type III-b and one done as the type III-b like abdominal dissection were treated with entry and re-entry at the same time or in two-step procedure.
Case 1 and 3 with major viseral branch from true lumen underwent graft replacement of decending aorta and clossure of re-entry.
Case 2 with visceral branch from false lumen underwent graft replacement of decending aorta and abdominal aorta.
Case 4 with abdominal dissection underwent clossure of entry and re-entry. Case 5 with aneurysmal change of the aortic dissected lesion underwent all replacement of dissecting aorta and reconstraction of visceral branch.
Their postoperative courses are uneventful without complications such as paralysis and visceral ischemia, and DSA have demonstrated favarable results. We believe these methods are currently radical operations for type III-b dissection.

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A 41-year-old male patient visited our hospital because of persistent cough and sputum. Chest roentogenogram showed calcification in the right hilum and an infiltrative shadow consistent with so-called "middle lobe syndrome" in the right lung field. Bronchoscopy and CT scanning revealed a stone obstructing the right middle bronchus. The stone was removed by surgical intervention since it was difficult to do so endoscopically. Right middle and lower lobectomy was performed because adhesion around the right middle lobe artery was so severe that the ligation and division of the artery was impossible. The patient enjoys good health at the present time although intrathoracic infection developed early in the postoperative course.
Broncholithiasis should be cured by surgery when endoscopical method is hard to hold and remove the stone, or when an irreversible change is formed in the lung tissues distal to the obstruction.

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Three cases of hernia of the foramen Morgagni that is often refered as a rare type among diaphragmatic hernias are reported and examined from preoperaitve diagnostic aspect. The patients were all females aged 12, 73, and 77 years who were detected from abnormal shadow in the chest radiogram. The hernia involved the greater omentum alone in 2 cases and a part of right lobe of the liver in one case. Morgagni's foramen hernia of which content includes the greater omentum or liver is difficult to be diagnosed before surgery, successful preoperative diagnosing rate being as low as 20%. In the three patients, preoperative CT scanning could successfully detected Morgani's foramen hernia. The CT scan is extremely valuable as preoperative diagnostic method, however, consecutive through scanning from the lower part of the thoracic cavity to the upper part of the abdorminal cavity is important.

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We obtained information about case of peptic ulcer through a questionnaire on symptoms, location of the lesion, indication for surgical treatment and operations performed to study the recent treatment modality.
We analyzed 14 cases of surgically treated peptic esophageal ulcer reported on the questionnaire of which three were from our experience. Of our three patients, two required resection of a severely stenotic segment of the esophagus, and in the other who had Barrett's ulcer a total thoracic esophagectomy was performed because of difficulty in distinguishing that lesion from esophageal cancer.
Analysis of replication of the questionnaire responses showed that dysphagea was the most common symtpom and that all ulcers except Barrett's ulcer were located in the lower portion of the esophagus. Ten ulcers were associated with an esophageal hiatal hernia.
According to the responses, lower esophagectomy and cardiectomy were performed on 11 patients and total or subtotal thoracic esophagectomy on three. Various methods of reconstruciton were reported from each institution, but esophago-gastrostomy was the common procedure for the disease.
On the basis of this investigation, we discussed the surgical management of peptic esophageal ulcer.

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Recently, case reports of triple primary carcinomas have been increasing. But curatively resected simultaneous triple primary cacinomas are still rare. Here, a case of 58-year-old woman with simultaneous triple primary carcinomas with severe valvular disease is reported. The patient who complained of epigastralgia and melena was diagnosed by further examinations as having simultaneous triple primary carcinomas (adenocarcinoma of stomach, descending colon and uterine corpus). She was complicated with severe valvular disease as stage III according to the New York Heart Association. Radical operation for triple primary carcinoma was simultaneously performed. The postoperative course was uneventful. Cases of triple primary carcinomas in Japan were reviewed and analyzed as to age, symptoms, gross findings and treatment. Careful pre-and per-operative evaluation for cancer is necessary, bearing in mind the possibility of multiple lesions.

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A case of superior mesenteric artery syndrome operated for the acute abdomen was presented.
A 28-year-old female patient hospitalized as emergency case with complaints of severe pain and vomiting, and With severe emaciation suspected anorexia nervosa. Preoperative plain X-ray of the abdomen showed severe gastric and duodenal dilatation. Mobilization of the duodenum and ascending colon without enterostomy was performed. After this operation, there was no signs of recurrence, and the postoperative course was satisfactory, although a transident left pleural effusion was appeared. We discussed particulary the imication and problems of this method with references to other reports.

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It is very rare to encounter the malignancy of the small bowel. Especially leiomyosarcoma is characteristic of both an exoenteric growth and a cavernous formation in the tumor. And that, occasionally fistura may be formed between the cavity in the tumor and the mucosal ulceration. Through this fistura an abscess would be formed in the cavity.
A rare case of leiomyosarcoma is reported, who was complicated by abscess formation in the cavity which brought about septic shock.

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For past 11 years, we experienced 7 cases of villous adenoma of the large bowel. These masses topically located at the rectum in 4 cases, at the sigmoid colon in 2, and at the ascending colon in one. Various preoperative tests revealed that the masses with sizes of 1.0-12.0cm in diameter were all benign. Thus the masses smaller than 2cm were subjected to endoscopical polypectomy, and the masses larger than 2cm, local or intestinal resection. Resected specimens were histologically determined during surgery and serial sections of the whole lesion were made to detect cancer cells and their staging if the malignancies were developed. All cases were clarified to be villous adenoma with no cancerous cells. Accordingly, no additional operation corresponding to that for colorectal cancer was done. A high possibility of canceration in this disease offers a problem what type of operation is selected, and we employ the above-mentioned surgical treatment in principle. The radical operation, however, might be better to select first; when digital examination of the rectum could detect a palpable hard mass lacking in movability; when barium enema and rectoscopical examinations revealed a dimpling lesion on the surface of mass; or when a mass located to oral side of the sigmoid colon.

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Although colon cancer in adults under 19 years old is very rare, it is of major interest because its prognosis is poor.
A 15-year-old boy was admitted with the chief complaint of epigastric pain and vomiting. Under the diagnosis of appendicitis and ileus, and operation was performed.
During the operation, a mass like a French Nut was palpated on the transverse colon 3cm anal to the right flexure, and the colon oral to the mass lesion was clearly dilated.
Carcinoma of the colon may have caused the ileus.
Among 66 cases of carcinoma of the colon in adults under 19 years old reported in Japan, in only 29 cases was the correct diagnosis made preoperatively.
Early diagnosis and surgery are the cue to obtaining good results and careful preoperative and intraoperative examinaiton is required for cases of the colon disease even in young adults.

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By means of surgical proceudre alone, it is difficult to treat intrahepatic stone inboth the lobes accompanied by stricture of hepatic bile duct. A successful such case is reported, for whom the electrohydraulic lithotriptic instrument made in USSR (URAT-1M) was applied to break and remove the residual stones after surgery.
A 46-year-old male patient with intrahepatic lithiasis underwent subsegmental resection of outside of the left hepatic lobe, however, a lot of stones were left in both the lobes. Postoperative electrohydraulic lithotripsy was succeeded in treating the residual stones, which was applied after expansion of the ductal stricutre induced by Griintzig catheter for the esophagus through external fistula. No recurrence of stricutre of the bile duct nor stone was observed till now of 7 months after the treatment.
This prosedure is valuable in treating residual intrahepatic stones with stricture of the bile duct, because it can be applied for poor risk cases of for patients who deney operation; it causes lesser complications with high safety; and no recurrence of the ductal stricutre is observed during long period.

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A 71-year-old man visited our hosptial with the chief complaint of a mass in the left epigastric region. MDL revealed a compresed area ranging from the fundus ventriculi to the corpus ventriculi, and CT revealed a giant mass with an uneven interior. Angiography revealed dilatation of the celiac, splenic and hepatic arteries and indicated that the tumor mass was nourished mainly by the splenic artery. Because gastric sarcoma was suspected, surgery was performed on the patient. The mass, which was found to have developed extramurally, was connected with the diaphragm and the left lobe of liver. The left lobe and part of the diaphragm were resected, together with total gastrectomy. Histopathologicaly examination revealed that the tumor originating from the left lobe of the liver had developed extensively and extended extrahepatically. It was evaluated as Ed-grade II to III hepatocellular carcinoma with infiltration into the anterior wall of the stomach. Three months after surgery the patient was discharged from the hospital, but the metastatic lesions to the liver gradually enlarged. In spite of the injection of mitomycin C or lipiodol into the hepatic artery, the patient died of liver failure seven months after surgery.
The present case of liver cancer with extrahepatic development, a relatively rare condition, is discussed with a review of 62 cases reported in the Japanese literature and with reference to other literature.

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A 66-year-old female visited our hospital with chief complaint of left abdominal mass. Abdominal plain X-ray revealed left abdominal calcification and CT revealed a tumor located ventral to the left kidney. Dynamic CT showed that the tumor vessel was derived from the abdominal wall. Angiography revealed that the left inferior epigastric artery and the left deep iliac circumflexa artery feeded the tumor. On operation, the tumor was hanging from the anterior abdominal wall and resected with wide surgical margin. Histologically it was hemangiopericytoma.
Hemangiopericytoma is derived from the capillary pericytes. It has no specific clinical symptoms that makes preoperative diagnosis difficult. The tumor must be resected with wide surgical margin because of its histological dfficulty in differenciating benign hemangiopericytoma from malignant one.

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Two cases of the gigantic retroperitoneal liposarcomas resected with the adjacent organs are reported. Case 1 (56-year-old woman): A gigantic tumor (60×52×34 cm, 10.2 kg) was extirpated with left adrenal gland and the psoas muscle. Case 2 (72-year-old man): A tumor occupying the left hypochondrium (28×21×18 cm, 5.2 kg) was extirpated with the stomach and the spleen. In both cases, the histological feature revealed well-defferentiated type-dominant liposarcoma. By applying the adjuvant postoperative chemotherpy and irradiation, no recurrence has been found by the present time, for postoperative 17 months in case 1 and for 9 months in case 2.
Based on our experience and a reivew of the literatures from 1968 to 1987 in Japan, 130 cases in the Japanese adults were analyzed in terms of their clinical features and surgical treatments. Surgical resection was performed in 114 cases (87.7%) and adjacent organ resection was required in 44 cases including the kidney (24 cases), colon (10 cases), spleen (8 cases) and others.
Since the recurrence rate is still high (34.1%), aggressive and radical surgical extirpation followd by adjuvant postoperative irradiation and chemotherapy should be achieved.

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A case of venous gangrene (=VG) accompanied with pancreatic carcinoma was recently treated. A 16 year old boy, whom cystduodenostomy was performed for congenital choledocal cyst at the age of 1, was admitted to our hosptial, complaining of rt-upper abdominal pain. The amylase levels on serum and urin were high, and swelling of pancreas was recognized on CT scan. Excision of the cyst and construction of a hepaticojejunostomy were performed. Duodenal stenosis occurred postoperatively, and a jejunostomy was made. Respiratory dysfunction, which was recognized before the operation, proceeded postoperatively, and renal function got worse, too. Swelling of rt-lower limb and peripheral cyanosis appeared on the 3rdpostoperative day. From the findings of dynamic venography and clinical features, he was diagnosed as VG and was performed thrombectomy, but died on the 4th postoperative day. At an autopsy advanced pancreatic carcinoma accompanied by multiple venous thrombosis and pulmonary embolism was found.

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We has experienced a case who had normal preoperative ECG findings, however, developed a left bundle branch block (LBBB) in preinduction period of anesthesia.
A 73-year-old male, with chief complaint of melena, was diagnosed as cancer of the sigmoid colon. He had no remarkable medical history nor abnormalities in preoperative laboratory findings.
After entering the operating room to undergo elective resection of the sigmoid colon, lead II ECG tracing prior to mesthesia induction revealed a LBBB. However, it changed to normal sinus rhythm snddenly during our investigation of the cause.
Following preoxygenation, anesthesia was induced with thiopental, intubated with succinylcholine, and maintained with nitrous oxide 66 percent in oxygen and halothane. During operation, a LBBB pattern occurred whenever heart rate increased to over 110 per minutes (rate dependent LBBB). No change in blood pressure was accompanied by these episodes.Recovery from anesthesia was uneventful.
Post operative holter ECG showed intermittent LBBB with no change in GOT, GPT, CPK etc.
Though LBBB itself is a relatively benign dysrhythmia, it is significant during anesthesia, because it may indicate a possible development of myocardial infarction. It is difficult to diagnose myocardial infarction on the ECG in the presence of a LBBB.

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Pilonidal sinus is not a rare disease for Japanese, though it more oftenly occurred in European people. We had experienced 4 cases of the disease one after another, and successfully treated the 2 cases of them with excision and W-plasty closure. The patients included 3 males and one female aged from 23 to 39 years. A 26-year-old male underwent simple excision and suture, however, 2 times of operations were needed for healing of the wound. Thus, the rest 3 patients were treated with Z- or W-plasty closure. These surgical procedures prevent an entering of fistula due to rotating movement of crena ani which causes pilonidal sinus, namely, these methods fundamentally remove the cause of the disease. Especially, W-plasty closure, when compared to Z-plasty, appears to be more rational in easy suture after excision.

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It is entirely an exception that the surgical resection can yield a long survival in malignant peritoneal metastasis. We have experienced a long survival patient with peritoneal metastasis spread from pelvic chondrosarcoma, who survives 10 years after the onset or 7 years after the first resection, with no other distant metastasis.
A 35-year-old male suffered from chondrosarcoma at the ischium received a total of 7 times of resections, including recent 2 times for peritoneal metastasis which developed during the course of the original disease. He could successfully return to his normal life.
No case of peritoneal metastasis from chondrosarcoma nor its resection has been reported. But a possible survival from the metastasis has been demonstrated in this case. We also discussed the significance of the resection of metastasis in peritoneal metastasis.

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