Hiroyoshi Ayabe

A long-term survival case of thymic squamous cell carcinoma, performed complete extirpation with vascular reconstruction of the superior vena cava.

A 59-year-old woman who complained of anterior chest pain exhibited an abnormal shadow on chest X ray and was admitted to our hospital. The chest X ray showed a demarcated tumor at the anterosuperior mediastinum and she was diagnosed as having a mediastinal tumor. After the midsternotomy was performed, the mediastinal tumor derived from the thymic tissues was discovered to have invaded the right upper lung, pericardium and superior vena cava. After excising the tumor, anastomosis between the right brachiocephalic vein and superior vena cava, followed by that between the left brachiocephalic vein and right cardiac auricle was performed using expanded polytetrafluoroethylene-ringed vascular grafts (phi 10 mm) for reconstruction. The tumor was diagnosed as a thymic carcinoma (squamous cell carcinoma) pathologically. After surgery, she was treated by cobalt irradiation. One month and again 3 months after the operation, venography showed patency. The patient has not demonstrated recurrence for 9 years and 6 months.

Transhiatal Esophagectomy for Intrathoracic Esophageal Cancer

Surgical treatment is the best management for the patients with dysphagia and resection should be performed unless there are any contraindications. It is generally accepted that the standard radical operation for thoracic esophageal cancer is a subtotal or total thoracic esophagectomy with intrathoracic and intra-abdominal lymph node dissection through right thoracotomy and laparotomy [1]. However, transthoracic esophagectomy has high morbidity and mortality rates [2, 3]. Therefore, for the patients with poor nutritional condition and low cardiopulmonary reserve, transhiatal esophagectomy without thoracotomy for esophageal cancer may have lower morbidity and mortality [4, 5].

A Clinical Study of Esophageal Cancer with Invasion of Contiguous Structures

Esophageal cancer invading contiguous structures is associated with a poor prognosis. Lymph node metastases are present in the majority of cases. When the lesion extends to the diaphragm, lung, or pericardium, combined resection is relatively easy. However, when the lesion invades the aorta or tracheobronchial tree, combined resection may be technically demanding. Herein, we evaluate the indications for surgery, patient selection, and outcome after surgery in a group of patients with esophageal cancer invading contiguous intrathoracic structures.

A Retrospective Clinicopathological Study on Adenocarcinoma of the Upper Part of the Stomach with Special Reference to Lymph Node Metastases

上部胃癌切除294例について, 占居部位・漿膜面浸潤・組織学的壁深達度別に所属リンパ節の転移を検索し, 術式の選択・適応について検討した.切除全胃癌中21.3%を占め, 男女比は2.7: 1, 平均年齢は60.0歳であった.胃癌取扱い規約によれば, Cに限局するものは129例で, 早期癌は15.0%であった.術式は胃全摘214例, 噴切52例, その他28例であった.リンパ節転移は, 早期癌ではn (-) であったが, pmで#2・3に7.7, 30%, ssβで#1・3に40%, #7・9に20%, #6・10・11・13・14に10%, ssγでは#4s・4d・16に37.5, 12.5, 12.5%の転移をみた.Cの漿膜面浸潤と#4d・5・6の転移は, S0S1はn (-) であったが, S2ではそれぞれ2.8, 11.1, 5.6%の転移をきたし, S3では21, 4, 14.2, 7.1%であった.5年および10年生存率は全摘で43.1%, 40.9%, 噴切で32, 5%, 27.5%で, 全摘が優れていたが有意差はなかった.以上より上部胃癌の噴切の適応はS1までのもの, 組織学的にはssγまでにとどまるものである.