Hiroshi Akiyama

Prognostic factors in adenocarcinoma of the gastric cardia: pathologic stage analysis and multivariate regression analysis.

PURPOSEnTo clarify the pathologic stages of adenocarcinoma of the gastric cardia in which the prognosis is worse than in adenocarcinoma of the middle or distal part of the stomach, and to determine prognostic factors in these stages by multivariate analysis.nnnPATIENTS AND METHODSnWe analyzed 2,536 cases of surgically resected gastric adenocarcinoma of all pathologic stages. Four hundred seventy-two cases of gastric carcinoma, in which cumulative survival of gastric cardia was poor, were subjected to Cox regression analysis for prognostic factors, and to logistic regression analysis for factors influencing venous or lymphatic invasion.nnnRESULTSnThe prognosis of adenocarcinoma of the gastric cardia was inferior when compared with similarly staged carcinomas of the middle or lower part of the stomach when there was invasion of proper muscle layer or subserosal layer, with no lymph node metastasis or with only adjacent (group 1) lymph nodes metastases (T2N0 or T2N1, according to the Japanese classification). In these stages, the prognostic factors were age, histologic type, venous invasion, and location of the tumor in the upper part of the stomach. Tumor location in the upper stomach was also a predictor for the presence of venous invasion.nnnCONCLUSIONnThe prognosis of adenocarcinoma of the gastric cardia is poor in patients with T2 tumors with no or few lymph node metastases. Additional treatment after surgery may be necessary to improve the survival of this population.

Cologastric fistula and colonic perforation as a complication of percutaneous endoscopic gastrostomy.

Cologastric fistula has rarely been reported as a complication of percutaneous endoscopic gastrostomy (PEG). We encountered a patient in whom this problem went unrecognized for 2 years. After the initial PEG tube was changed, the second PEG tube was advanced into the colon, causing severe diarrhea. When a third PEG tube was inserted, acute peritonitis occurred because of colonic perforation. We discuss the mechanism of this complication and technical points related to its prevention.

Background of Lymph Node Dissection for Squamous Cell Carcinoma of the Esophagus

Resection of the cancer and reconstruction of a functional organ are the two major components of the surgical treatment of esophageal carcinoma. Although both are equally important, adequate tumor resection is definitely more relevant as far as survival and the operative objectives are concerned, since incomplete resection will make cure impossible. The presence of lymphatic metastases implies the systemic spread of tumor. However, patients with lymph node involvement can still be cured by radical lymph node dissection, as long as the tumor spread remains within certain limits. We have shown [1–4] that radical lymph node dissection in appropriate cases offers a chance of cure in an otherwise uniformly fatal disease.

Evaluation of Adjuvant Therapy for Esophagectomy with Collo-Thoraco­ Abdominal Lymph Node Dissection

With the introduction of cisplatin (CDDP) and new types of combination chemotherapy for the treatment of esophageal carcinoma, the use of adjuvant therapy for this disease has attracted increasing attention [1]. In this study, the effects of adjuvant chemotherapy and adjuvant radiotherapy on patients who underwent esophagectomy with collo-thoraco-abdominal lymph node dissection were investigated retrospectively.

Problems Related to Radical Esophagectomy and Reconstruction. Study of Postoperative Patients without Tumor Recurrence.

食道癌切除再建術後長期経過における問題点を探るため非再発症例の検討を行った. 術後他因死症例の検討から食道癌術後の患者には肺炎, 全身衰弱に代表される特徴的リスクが明らかとなった. 再建術式別には明らかな差はなかった. 術後心不全死は術前または術後に放射線治療を受けた患者に有意に高頻度であった. 術後5年以上無再発生存例の5年経過後の平均生存期間は8.35年で同一性年齢構成の一般集団の平均余命16.75年より明らかに短かった. 術後5年以上経過した無再発生存症例のアンケート調査から胆汁逆流を中心とする術後の生活上の問題が明らかとなったが, 胸骨後, 後縦隔の2つの再建経路の間に明らかな優劣は見出せなかった. 多くの長期生存者は術後の生活状況を受け入れてはいるが現在の術式が問題なしとはできない. 食道癌切除再建術においては術後患者の注意深い追跡とともに今後のさらなる術式の工夫が必要である.

Surgical Treatment of Intrathoracic Esophageal Carcinoma: Analysis of 481 Cases of Resected Squamous Cell Carcinoma

Conventional surgical treatment of esophageal carcinoma does not yield a satisfactory outcome. Recurrence is frequently observed in upper mediastinal and/or cervical lymph nodes. Blood-borne metastasis is another factor contributing to the poor prognosis. Considerable effort, including extensive lymph node dissection and chemotherapy, has been directed to improving the long-term survival rate. In our department, the routine surgical treatment for thoracic esophageal carcinoma including adjuvant therapy was changed in 1984, particularly in terms of the extent of lymph node dissection. The aim of this investigation was to analyze the difference in long-term survival achieved with the surgical approaches applied before and after 1984.