Ken Yanagibashi

Usefulness of preoperative low dose cisplatin treatment for advanced esophageal cancer.

In order to decrease the perioperative complications by preoperative cisplatin chemotherapy, the preoperative single administration of cisplatin (30 mg/m2) was performed weekly from one to six times in 36 consecutive patients with esophageal cancer classified as higher than Stage II. The survival curve of 17 patients in Stage III was significantly better (P<0.05) than that of patients who had been treated without preoperative cisplatin treatment. In 3 of the 12 patients who had locally invasive cancer, either the main tumors or the metastatic lymph nodes, which had invaded the trachea or the left main bronchus, sufficiently receded, so that a curative esophagectomy became possible; 2 of them have survived over 33 months while 1 died of pneumonia 33 months after surgery. The number of perioperative complications was minimal, and thus, we consider that the postoperative use of cisplatin and fluorouracil is indicated in patients in whom a histological response is noted in the resected specimens.

Transthoracic resection of esophageal cancer in patients with pulmonary dysfunction. Usefulness of high frequency ventilation during thoracotomy.

Although curative resection of esophageal cancer has become a safe procedure, in patients with pulmonary dysfunction, postoperative complications remain a serious problem. Of 122 patients who had transthoracic resection of esophageal cancer, 27 had pulmonary dysfunction; in six, the forced vital capacity was less than 70% (minimum of 42.8%, mean ± SD of 56.6 ± 8.9%); in 18, forced expiratory volume for one second (FEV1%) was less than 70% (minimum of 34.6%, mean ± SD of 60 ± 10%); and in three, both forced vital capacity and forced expiratory volume was less than 70%. Two patients had undergone hemipneumo-nectomy before receiving resection of the esophagus. During the intrathoracic operative procedure, high frequency ventilation was used, providing good surgical exposure and contributing to a decrease of postoperative pulmonary complications. There were no deaths during the month after surgery. The survival curve of these patients was not significantly different from that of other patients who had had esophagectomy for cancer of the esophagus. These patients survived for an average of 24 months. The patient who survived the longest has been alive for more than 11 years.

Retrosternal Esophagogastrostomy with the EEA Stapler after Subtotal Resection of the Esophagus: Application and Results

We previously reported a new technique for handling the EEA stapler for anastomosis of the cervical esophagus and the retrosternally shifted gastric tube after subtotal esophagectomy for cancer of the esophagus. This report describes the results of the application of the technique in 15 patients.

A Case of Congenital Esophagobronchial Fistula with Esophageal Cancer

症例は63歳の男性. 幼少時より頻回の咳嗽を, 特に成人後はビール摂取時の咳嗽を自覚していた. また, 肺炎を繰り返していた. 約3年半前に食道気管支瘻と診断されていたが, 今回当科にて食道造影, 食道内視鏡, 気管支鏡の各検査を行い, 胸部中部食道前壁と左主気管支との間に瘻孔を確認した. また瘻孔対側となる食道後壁には径約2cmの隆起性病変 (扁平上皮癌) を認めた. 同病変を内視鏡的に切除したところ深達度sm2であったため, 右開胸開腹にて食道切除を行い, 瘻管は結紮・切離した. 病理組織学的には瘻管内腔は重層扁平上皮で覆われており, 粘膜筋板を伴っていた. 病歴, 術中所見, 病理組織学的所見よりBraimbridge II型先天性食道気管支瘻と診断した. 本疾患と食道癌との合併例は極めてまれである. 当症例では瘻孔と食道癌病変の位置関係から, 瘻孔の存在が癌発生の一因になった可能性も考えられた.