Hiroshi Habu

The use of endoscopic ultrasound in determining the depth of cancer invasion in patients with gastric cancer

SummaryEndoscopic ultrasonography (EUS) was performed in 110 patients with gastric cancer to examine the depth of cancer invasion. The normal gastric wall has a five-layer structure on EUS. In 19 lesions, changes on EUS were limited to the first and/or second layers, suggesting that invasion was limited within the mucosa. In 91 lesions, changes were evident in the third or deeper layers. Alterations in the EUS appearance could be divided into two types: type A, with destruction of the layered structure and type B with thickening of the layers. The amount of interstitial tissue in cancer was classified as medullary or intermediate in 90% of type A, and as scirrhous in 82% of type B tumor. The EUS diagnosis of invasion was 95% accurate for stage M cancers, 75% for SM, 64% for PM, 100% for SS, 79% for SE, and 100% for SI lesions. The overall accuracy was 81%. Accompanying fibrosis and metastatic perigastric nodes were the main reasons for overestimating the extent of disease.

Prognostic factors of early gastric cancer —Results of long-term follow-up and analysis of recurrent cases—

The prognosis of early gastric cancer (EGC) is generally excellent, however, EGC is not an exception to recurrence. In order to know what type of EGC is liable to recur, long-term results were studied in 304 cases of resection. The cumulative 10-year survival rate was poorer in patients with positive lymph nodes than in those with negative nodes (52.8±15.8 per centvs 94.1±2.4 per cent; p<0.05). It was also less favorable when the EGC was greater than 5 cm in diameter (61.5±13.2 per centvs 92.9±2.4 per cent;p<0.05). Among 50 cases which died postoperatively, six deaths were due to recurrence. A predominant mode of recurrence was hematogenous metastasis (4/6). The characteristics of EGC which recurred later included large cancer (≧5 cm) (6/6), macroscopically combined-type cancer (5/6), cancer of depth invasion to the submucosa (4/6) and histologically differentiated cancer (6/6). Lymph node dissection was not carried out in two of these patients at their primary operation. Adjuvant therapy should be added in the EGC bearing risk factors depicted above. Primary cancer in other organs, either metachronous or synchronous, was found in 13 cases (4.3 per cent). Colonic cancer, in particular, was seen in three, and it was 4.8 times as frequent as the expected number of the general population, calculated using the person-year method.

Effect of lentinan on lymphocyte subsets of peripheral blood, lymph nodes, and tumor tissues in patients with gastric cancer.

The effect of lentinan on lymphocyte subsets of peripheral blood, lymph nodes, and tumor tissues in gastric cancer patients was investigated. A 2-mg dose of lentinan was administered to 12 patients intravenously twice, the first at 3–9 days before and the second the day before surgery. The results were then compared with a control group without lentinan administration comprising 12 patients. Regarding peripheral blood and lymph nodes without metastasis, lymphocyte subsets defined with anti-CD3, anti-CD4, anti-CD8, anti-Leu7, and anti-Leu11 were analyzed by flowcytometry. As for tumor tissues, lymphocyte subsets defined with anti-CD3, anti-CD4, anti-CD8, anti-Leu11, and anti-M3 were analyzed after immunohistochemical staining. There were no significant changes in the lymphocyte subsets of peripheral blood between the two groups. In the lymph nodes, the CD4 cell ratios increased; otherwise in regard to tumor-infiltrating lymphocytes (TILs), the number of CD4, Leu11 and LeuM3 cells showed a prominent increase. Therefore, lentinan was observed to produce different effects in accordance with the subjective organs.

Endoscopic evaluation of gastric cancer infiltrating the lower esophagus

SummaryEndoscopic and histopathological findings were compared in 74 patients with gastric cancer infiltrating the lower esophagus who had undergone gastrectomy to evaluate mode of esophageal infiltration. There were no early cancers. Cancer infiltration modes were histopathologically broken down into three types: superficial, whole layer, and deep layer. Endoscopic findings were broken down into five types for proximal infiltration. Endoseopy used for histological evaluation frequently revealed the protruded type to be whole layer and had a highly accurate diagnosis rate (94%); it revealed the histology of the other four types to be primarily superficial. Extent of cancer invasion was underestimated in giant-rugae tumors (40%), as endoseopy could barely detect the small nest of esophageal infiltrations. Lugol staining was useful in preventing underestimation. For flat cancer, which is poorly demarcated and is often accompanied by vascular invasion, preoperative evaluation is very difficult, requiring preoperative examination of a frozen section taken from the proximal edge of resected specimen.

Recurrent Gastric Cancer after Absolute Curative Resection

Among 428 patients who had undergone absolute curative resection of gastric cancer, 57 died of cancer recurrence. One hundred and seventeen patients who had survived longer than 5 years were used as c

Sequential changes in nuclear dna content by chemotherapy observed in experimental canine gastric cancer

SummaryIt is known that the nuclear DNA contents correlate with the grade of malignancy. In this study, nuclear DNA contents of biopsy specimens taken from N-ethyl-N′-nitro-N-nitrosoguanidine (ENNG)-induced canine gastric cancer were measured by Feulgen-DNA-cytofluorometry. The DNA content and histological findings were sequentially observed after weekly administration of 7-N-(p-hydroxyphenyl)-mitomycin C (0.8 mg/kg), a kind of mitomycin C derivative. The appearance rate of cells over 4C decreased remarkably from 18.8% to 9.86% on average (p< 0.02) and the maximum value of distribution also went down from 9.18C to 7.33C (p< 0.01) at the early stage of administration of the oncostatic agent when no histological change was yet observable. It might be expected that this procedure will enable the future evaluation of oncostatic effects at the cellular level more objectively.

Pathophysiology of motility disordors in esophagogastric junction and indication of surgical treatment.

胃切除後例を含むびらん潰瘍型逆流性食道炎29例とachalasia 14例を対象として, 主に内圧面から病態を検討し, その手術適応につき考察した.逆流性食道炎では食道の縦軸に沿って変化の広がるL型に比べ, 食道胃粘膜接合部近傍に限局するM型で保存的治療効果が悪く, 運動機能異常は食道炎の広がりに一致する傾向を示した.AchalasiaにおいてはX線や内圧検査成績が機能異常の程度を表し, 術中内圧測定は各手術操作の意義を明らかにしていた.それぞれ8例および14例において外科的治療を行った.前者においては主にNissen法に, 後者では主にJekler-Lhotka法に基づいて手術を施行したが, ともに内圧面からも機能の改善が認められ, 外科的治療の有用性が示された.手術の安全性と治療効果の確実性および持続性からみて, またquality of lifeの観点からも, 難治例においては積極的に手術を考慮すべきと考えられた.

Basic studies of photodynamic therapy in experimentally induced canine gastric cancer

Photodynamic therapy (PDT) was used in two cases of experimental canine gastric cancer produced by the oral administration ofN-ethyl-N′-nitro-N-nitrosoguanidine (ENNG). Endoscopic examination and biospy showed the development of cancer in the gastric antrum. The cancerous lesions, a polypoid lesion and the normal epithelium were photoradiated superficially by an argon dye laser with a power of 300 to 400 mW for five to ten 30-s periods, 48 h after the intravenous injection of 3.0 mg/kg body weight of haematoporphyrin derivative (HPD). Dog 1 was killed three days after PDT, and was examined histologically. The tumour cells showed vacuolar degenerative changes in the mucosa, and the irradiated normal epithelium was less damaged. Dog 2 was followed up periodically by means of gastrofibrescope and biopsy. A wider and deeper ulcerative lesion was observed three days after PDT and it was healed by day 40. But the recurrence of a cancerous lesion was shown on day 80. The remnant of a small cancer nest was revealed histologically by means of biopsy and autopsy. The results show that PDT is suitable for superficial gastric cancer and that long-term follow-up observation is necessary for the evaluation of PDT.

Indication of surgery for the gastric cancer in elderly patients.

70歳以上の高齢者胃癌に対する手術適応を再検討するために, 高齢者胃癌切除例139例の手術成績を69歳以下の709例と比較し, 以下の結論を得た. 1) 高齢者の合併症発生率 (29%), 直死率 (4%) や5生率 (47%) は69歳以下の症例と比べて遜色なく, 高齢を理由に手術適応を狭める必要はない. 2) 高齢者の非治癒切除例では合併症発生率 (41%) や直死率 (8%) は高く, 予後は不良であった. 根治性のない症例に過大な侵襲を加えることは避けるべきである. 3) 患者の暦年齢や術前の検査データは, 手術の危険性を予測する上であまり参考にならなかった. 4) 術後のQuality of lifeには問題が多く, きめ細かいアフター・ケアーが必要である.

Study on the cases of gastric cancer with hematoemesis and melena.

胃癌切除例のうち吐血, 下血を主訴とする43例を出血群と呼び, 臨床病理学的所見と治療成績について非出血群314例との比較検討を試みた. 出血群では早期癌の頻度は16%で, 非出血群の31%に比べて低いが (p<0.05), 癌巣の大きさ, リンパ節転移, stage, 脈管侵襲については差を認めなかった.出血群では胃上, 中部の癌が合計82%を占め, 非出血群の58%に比べて多く (p<0.01), 出血群の49%に胃全摘もしくは噴切が行われている. 出血のため緊急手術が行われた7例のすべてに何らかの合併症を認め, 手術死亡は2例 (29%) ときわめて高く, 遠隔成績も不良であった.緊急手術の際は患者のリスクと癌の進行度を考慮し, 慎重に術式を選ぶべきである.