Atsushi Takenaka

Eradication of microscopic metastases with intratumoral injection of Bacillus Calmette-Guerin

The studies reported here were designed to examine the effects of intratumoral preoperative administration of Bacillus Calmette-Guerin (BCG) on the cure rates of C3H mice transplanted with MH134 tumor cells and on the metastatic rates in the regional lymph nodes. Furthermore, the morphological findings occurring in the regional lymph nodes were monitored during tumor growth using H-E stain and non-specific esterase staining. The cure rate of the Group treated with BCG intratumoral injection and surgery was significantly higher than that of the Group treated with surgery alone, and in the BCG+ surgery group metastatic rates of regional lymph nodes decreased consistently after operation. Moreover, in this group, extensive sinus histiocytosis and marked swelling of the regional nodes were frequently observed. Quantitative studies of the cell kinds using the esterase staining indicated that intratumoral injection of BCG has an effect on the influx of lymphoid cells into the regional nodes, but does not aid specific cell lineage to flow into the regional nodes. In cytostatic assays, it was shown that the regional lymph node cells and spleen cells in the BCG + surgery group always have a greater per cent of inhibition than those in the surgery alone group.

Extent of D2 Surgery for Colon Cancer According to Tumor Location with Respect to Vascular Anatomy and Lymph Node Metastasis.

術前血管造影を行い, D2以上の根治術を行った結腸癌344例を対象に, 主幹動脈の走行変異とn2症例 (63例) の転移状況から, 深達度sm-mpの結腸癌に対してD2郭清を行う場合の切除範囲を, 占居部位別に検討して以下の結論を得た.回盲部癌は, 回結腸動脈の分岐変異は認めず, n2転移はNo.202のみであり, 回盲部切除でD2郭清可能である. 上行結腸癌は, 主幹動脈の分岐走行変異が豊富で, n2の転移部位も多様であり, D2郭清といえども右半結腸切除を要する. 横行結腸癌は, 横行結腸切除にてD2郭清可能なものが多いが, 右側では右・中結腸動脈が共通幹を有する場合, 右半結腸切除を行うべきであり, 左側では副中結腸動脈に注意が必要である. 左結腸動脈とS状結腸動脈第1枝が共通幹を形成している場合, 下行結腸癌ではNo.242-1を, S状結腸癌ではNo.232を含めて郭清すべきである. S状結腸癌はn2症例の39%にNo.252転移を認めたことよりD2郭清ではNo.252の郭清が必須である.