Hiroyoshi Suzuki

Multiple depressed‐type colonic cancer (IIC)‐like configurations: metastases from gastric cancer

We present a rare case of multiple colonic metastases from advanced gastric cancer presenting colon depressed‐type multiple early cancer (IIc)‐like configuration. The case was a 74‐year‐old man who presented with a symptom of abdominal fullness. Colonoscopy and barium enema study revealed multiple IIc‐like lesions, which were shown histologically to be metastatic deposits of signet ring cell carcinoma. He had synchronous gastric cancer, which histologically demonstrated moderate to poorly differentiated adenocarcinoma with signet ring cell differentiation. In addition, he had concomitant multiple small bowel metastatic lesions. This appears to be the first published report of multiple IIc‐like colonic metastatic lesions from a gastric cancer.

Laparoscopic Wedge Resection of the Stomach for Submucosal Tumor

We performed laparoscopic wedge resection of the stomach in two patients with submucosal gastric tumor. Three trocars were inserted in addition to a laparoscope. After the blood vessels surrounding the tumors had been ligated with ENDO CUPs, we used ENDO GIA (a linear endoscopic stapling device) four times and then wedge resection was performed. The operative time was 3h33m in Case 1 and 2.5h in Case 2, and bleeding was minimal in both cases. The postoperative courses were uneventful, and intestinal peristalsis recovered rapidly with minimal wound pain. These results suggest that laparoscopic wedge resection of the stomach, a radical procedure, is indicated for submucosal tumor of the stomach.

The Effect of Extended Lymph Node Dissection in Patients with Gastric Cancer from Two Aspects, Quality of Life and Postoperative Survival Rate.

胃癌におけるリンパ節拡大郭清の効果について, 過去10年間の2,592例を検討した. 検討は, 4群郭清 (D4) と2群郭清 (D2) の2群間で, 胃癌取扱い規約12版の進行程度に沿って層別化し, 生存率を対比した. また3年間経過を追えた再発のない胃全摘膵脾合切例で, 全身状態, quality of life (QOL) などについて対比した.(結果) D4郭清がD2郭清より, 各進行程度で良好であり, sen0, m, sm, n2 (+), mp, ss, n2 (+), se, n2 (+) の各群で, 有意の差を認めた.また, D4, D2の2群間で直死率, 術後縫合不全, 入院日数などに差を認めなかった. また各種QOLに関するアンケート調査の結果差を認めなかった.(まとめ) D4郭清はD2郭清と対比して, 安全で, QOLを損なうことがなく, また, stage II, IIIで良好な成績を示すことから, 積極的に選択すべき術式と考えた.

Diagnosis of Lymph Nodes with Metastasis from Stomach Cancer Using Ultrasonography

Diagnosis of Lymph nodes metastasis has not been studied thoroughly. Thus, the diagnosis of lymph nodes metastasis using ultrasonography were examined. The following 3 items are defined as the criteria of metastasis (1)the major axis is more than 5mm, (2) the shape is spherical, (3)uniformly low internal echo is observed. Cases for which the extent of occupation by cancer was small were, how ever, not consistent with the above criteria. This is a future problem.

PRESENT STATUS AND EVALUATION OF CLINICAL DIAGNOSIS FOR EARLY GASTRIC CANCER

胃癌の予後が悪いことは周知のことであるが, これを早期胃癌の段階で治療すればその五生率は90%以上である.そこで早期胃癌688病巣を細かく分析し, より多くの早期胃癌発見のためには現在何が必要であるかを探ってみた.X線, 内視鏡の併用はもちろんであるがまず内視鏡器種は1本にこだわらずそれぞれの欠点を補うような組合せで使用し, 胃体上部から噴門部の病変を見落さぬこと, 生検は胃体部からとくに慎重に行うこと, IIbの発見には色調の変化を重視し, 確実な生検を行うこと, III型の診断には潰瘍全周からの的確な生検が必要であること, 微小癌はわずかな変化の発見と第1個目の生検組織採取を確実に行うこと, などが重要であることが判明した.これにさらに最近の色素法等の補助診断の活用も望まれる.

THE TREATMENT AND PROGNOSIS OF DOUBLE CARCINOMAS IN DIGESTIVE ORGANS

検索対象 は昭和42年12月 か ら昭和52年7月 までにわれわれが経験 した消化器に関す る同 時性重複癌45例,異 時性重複癌18例,計63例 である.こ れ らにつ いて原発臓 器お よび治療 法 と予後 との関係 を検討 した. 同時性食道 胃重複癌 では 両癌腫 とも切除 で きた ものはその 他の もの よ り予 後が良かつ た.し か し切除率 は42.9%に す ぎなかつた. 同時性 胃結腸 重複癌で も両癌腫 とも切除 された場合 の予後が良 く,ま た切除 率は71.4% と比較 的良好 であつた. その他 の同時性 重複癌 では実質臓器癌 あるいは食道癌を伴つた ものの予後は きわめ て不 良であつた. 異時性食道 胃重複癌についてみ ると,食 道癌先行例では二次癌 であ る胃癌を部分切除 し た症例 の予後 が比較 的良好であつた.胃 癌先行例では二次癌 であ る食道癌 に対 して手術的 治療 を施行 した症 例は化学療法あ るい は放射線治療 を施行 した症例 よりわずか ながら予後 が良かつた. その他の異時性重複癌で はや は り食道癌 あるいは実質臓器癌を伴 つた場合 の予後 はきわ めて不 良で,こ れ らの早期発見 の必要性 が痛感 され る.

Some investigations about the early esophageal cancer (about some problems about preoperative irradiation)

T h e mos t appropr ia te the rap ies for t he e sophagea l cance r a re the rad ia t ion t h e r a p y and the opera t ion . T h e c o m b i n a t i o n of t hese two t he r ap i e s ( the preopera t ive i r radia t ion) is now rou t ine m e t h o d a t our Ins t i tu te . T h e s t u d y of the preopera t ive i r rad ia t ion to the advanced cance r was pe r fo rmed w h e t h e r the a d v a n c e d c a n c e r showed the ear ly c a n c e r like change or not . Seven ea r ly e sophagea l cance r s of wh i ch lesions were res t r ic ted ins ide of s u b m u c o s a l layer were exper i enced in ou r Ins t i tu te . T h e s t u d y was pe r fo rmed u s i ng t h e s e ea r ly cancers . T h r e e ca se s w i thou t preopera t ive i r rad ia t ion showed no inc rease of connect ive t i s sue w h e n the his tological e x a m i n a t i o n was done to the opera ted spec imen . T h e resu l t of the p reopera t ive i r rad ia t ion to t he 4 cases were as fo l lows; 1 case showed a lmos t no inf luence, 1 case showed t he degene ra t i on of the whole c ance r ne s t and 2 cases showed no infi l t rat ion of the c a n c e r to t he musc le l ayer bu t some par t showed the degenera t ion and the o the r par t showed t he r a t h e r h igh g rade of inc rease of connec t ive t i ssue . T h i s inc rease of the connect ive t i s sue m e a n t the r e p l a c e m e n t of the cancer , wh ich invaded to the m u s c l e layer , by the f ibr inizat ion a f te r i ts necrosis . T h e s e la te r two cases were t h o u g h t to be c h a n g e d into the ear ly cance r f r o m the advanced cance r by t he rad ia t ion t he r apy . T h e fo rmer two ca se s were or iginal ly ea r ly cance r despi te of t he i r radia t ion . Cons ide r ing t he se facts , t he def ini t ion of the ear ly e sophagea l cance r should be decided not d e p e n d i n g on t he pe r fo rmance of r ad ia t ion t he r apy or not bu t t he p re sen t pa thologica l f e a tu r e as it is.