Kazuhiko Soejima

Evaluation of extensive lymph node dissection for carcinoma of the stomach.

We compared the results of curative resection for carcinoma of the stomach in 254 patients who underwent simple resection (SR) and 454 patients who underwent extensive regional lymph node dissection (ELD). The 5-year survival rates of the 2 procedures were significantly different in carcinoma involving the serosa of the stomach; it was 45% in the ELD group and 18% in the SR group (p<0.001). In patients with regional lymph node metastasis we obtained a 5-year survival rates of 39% and 18% by ELD and SR, respectively (p<0.001). The incidence of metastasis to the secondary lymph nodes, removable only by ELD, was higher in cases with carcinomatous invasion of the deeper layers of the gastric wall, and this may have been the reason why ELD proved to be more effective than SR. ELD is discussed in relation to the site of the primary carcinoma and the extent of lymph node metastasis.

Preliminary report of tumor metastasis during liver regeneration after hepatic resection in rats

In an attempt to ascertain possible facilitation of tumor metastasis during liver regeneration after hepatectomy, a series of experiments in rats was carried out using the RBT-1 carcinoma. WKA rats were separated into three groups: Group A received a sham operation; Group B underwent one-third hepatectomy; and Group C underwent two-thirds hepatectomy. Three groups had viable tumor cells injected into the tail vein after treatment. Survival period and lung metastases were analysed 14 days after initial injection of tumor. When comparisons were made between all groups, survival was shown to be significantly shorter in Group C than Group A (P < 0.05). The number of metastatic nodules in the lungs was significantly increased in Group B (P < 0.05) and C (P < 0.01), compared to Group A and in Group C, compared with Group B (P < 0.05). These results suggest that facilitation of tumor metastasis during liver regeneration may be proportional to the extent of liver resection.

Stromal reaction around tumor and metastasis and prognosis after curative gastrectomy for carcinoma of the stomach

The prognosis of 270 cases with carcinoma of the stomach after curative gastrectomy was studied by histologic examination of the resected specimen. In cases without metastases, when there were both fibrous and cellular stromal reaction in the main tumor, the 5‐year survival rate was 100% and, when the reaction was negative, the prognosis was 30%. If, however, there was no stromal reaction in the metastases, the prognosis was as miserable as 7.0%, with or without reaction in the main tumor. The authors conclude that stromal reaction around the carcinoma dominates the prognosis and that the prognosis can be estimated with further accuracy after analysis of the reaction in metastatic nodes.

Carcinomas of the stomach in the young adults

The clinical and pathologic characteristics of the gastric carcinomas in the young adults were described in special comparison with the carcinomas in the old men. They were found to be similar in many respects, but had some different features like the histologic findings with particular references to the histogenetic background.

Postoperative long term chemotherapy for advanced gastric cancer

A postoperative long term chemotherapy was carried out against stage IV gastric cancer with Mitomycin-C, Futraful and a plant polysaccharide, PS-K. The 2-year survival rate was 15 per cent in patients who received an intraoperative Mitomycin-C alone, while it increased to 34 per cent in those receiving the anticancer agents for a prolonged period. The postoperative long term chemotherapy is assumed to be an effective means of improving the therapeutical results of gastric cancer.

Reactive hyperplasia of paracortex and germinal centers of the regional lymph nodes in gastric carcinoma cases as a favorable prognostic indicator

The prognosis of 141 patients subjected to curative resection for gastric carcinoma was analyzed with special reference to the paracortex, germinal centers and sinus histiocytes in the regional lymph nodes. Five year survival rates of the patients with paracortical and/or germinal center hyperplasia (PH and/or GH) was definitely superior to those without such hyperplasia. This difference was most pronouced in those with moderately advanced stage. The incidence of lymph node metastasis was lower in the patients with PH or GH. The presence of sinus histiocytosis (SH) seemed to be correlated neither with a longer survival nor with lower incidence of lymph node metastasis. No close correlation was found between Ph, GH and SH on one hand and histological types of the primary gastric carcinomas on the other. These results suggest that cell mediated and/or humoral immune response may play an important role in host resistance against gastric carcinoma.

Clinical characteristics of the carcinoma of the stomach and its localization.

The result of follow-up study and the localization of gastric carcinoma subjected to the operation at the Second Department of Surgery, Faculty of Medicine, Kyushu University during 7 year period from 1963 to 1969 form the basis of the present communication. The curative resectability was 70.3 per cent in the carcinoma of the distal third of the stomach (A), 82.9 per cent in that of the middle third (M) and 55.3 per cent in that of the proximal third (C); the 5-year survival rate was 48.6 per cent in the cancer of A, 81.1 per cent in that of M and 49.1 per cent in that of C respectively. In the carcinoma of A incidence of high grade penetrative invasion into the gastric wall as well as metastatic involvment was high. It is noteworthy that the tendency of the metastasis was found even in those with low grade penetration. In the carcinoma of M the incidence of high grade penetration as well as lymphatic metastasis was relatively low. The hepatic metastasis and peritoneal dissemination were also not frequent. In the carcinoma of C the incidence of high grade penetration was very high and the lymphatic metastasis was frequently observed in those with high grade penetration. Biological characteristics of the carcinoma of the stomach in each location and their therapeutic significance are discussed.

Surgical managiment of gastric polyps

Fibergastroscopic partial recision is the most recommendable for a begnin polyp in the stomach. The authors thought that, even in the presence of cancer, if its existence was limited at the top of polyp, fibergastroscopic partial recision of the polyp would be sufficient. The fibergastroscopic polypectomy with snare method I and II were investigated. In the polypectomy I, a double folded stainless steel wire was passed through a fibergastroscope had been inserted, and formed a loop in the stomach. The loop was hooked around the polyp and pulled to make the circle smaller to resect the polyp. The cut polyp was taken out of the stomach by forceps. In the II polypectomy, scissors were set at the top of the outer guide tube and a loop of the doublefolded stainless steel wire could be formed by one action. In this method recision and removal of a polyp could be performed at a time. According to these methods, 38 polyps were removed from 34 patients. Hemorrhage was very slight, and the artificial ulcer healed for 2 weeks in the average. The removed polyps were whole examined histologically. Among 38 polyps, 37 were adenoma polyps, 4 of which were accompanied with atypie. The other one was aberration pancreas: Conclusion: In these methods the polyp can be wholy examined histologically, instead of the partical biopsy usually performed. Unnecessary laparotomy can be avoided. They are easy and safe methods for healing polyps without laparotomy.