Kenichi Sumi

Does extensive dissection of lymph nodes improve the results of surgical treatment of gastric cancer

The results of surgical treatment of patients with advanced gastric cancer were analyzed retrospectively in terms of the extent of dissection of lymph nodes. The postoperative 5-year survival rate was 50.3% for 160 patients who had undergone potentially curative surgery with dissection of group 1, 2, and 3 lymph nodes (R3), compared with 48.8% for 185 patients with dissection of group 1 and 2 lymph nodes (R2). There was no difference in terms of survival between the two groups of patients. Of 160 patients receiving R3, 19 (11.9%) were found to be positive for metastasis to group 3 lymph nodes, and only 5 survived for more than 5 years after surgery (postoperative 5-year survival rate of 26.3%). In four of these five patients, metastases in the group 3 lymph nodes were confined to nodes in the hepatoduodenal ligament. Thus, it appears that in dissection of the deepest nodes, lymph nodes in the hepatoduodenal ligament are the most important to remove in the surgical treatment of advanced gastric cancer.

Analysis of Results of Surgical Treatment of Gastric Cancer

Patients with gastric cancer treated by curative resection had an overall 5-year survival rate of 73.4%. Of these patients, those with early gastric cancer had a 5-year survival rate of 91.6%, while t

A prospective cohort study on the development of colorectal cancer after gastrectomy

A prospective cohort study was conducted to examine whether an association exists between gastric surgery and the subsequent development of colorectal carcinoma. One thousand nine hundred twenty-seven patients (1316 men and 611 women) who had undergone curative gastrectomy for gastroduodenal diseases in the First Department of Surgery, Tottori University Hospital, during the 18-year period from 1964 to 1981, were followed to determine the incidence of the development of large-bowel carcinoma after gastric surgery. The age-, sex-, and calendar-specific population at risk was calculated by the person-years method. The observed number of colorectal cancers after gastrectomy was 19 (15 men, 4 women) compared with 9.69 expected carcinomas. The difference between the observed and expected numbers was statistically significant. The authors believe that patients with previous gastrectomy are at high risk for colorectal carcinoma.

Multiple malignant lymphoma within an ileal blind loop--report of a case.

A 55 year old woman presented to our hospital with abdominal fullness and edema of both legs. She had undergone a bypass operation by an ileotransversostomy for adhesive ileus following a drainage operation for acute appendicitis 35 years previously. We diagnosed the patient as having blind loop syndrome as a consequence of the side-to-side ileotransversostomy, and performed a right hemicolectomy and intestinal resection. The resected specimen of dilated ileal blind loop contained 15 crater-like lesions, proven histologically to be nodular proliferation of atypical lymphocytes. Lymph follicles had also proliferated in the mucosa of the blind loop and the histologically confirmed diagnosis of non-Hodgkins lymphoma of the diffuse medium-sized cell type was thus made. The etiology of such tumors is probably related to the alteration in intestinal environment caused by conditions such as fecal stasis, bacterial overgrowth, and bacterial toxins in the blind loop.

Chronological trends in the pathological characteristics of gastric cancer

1,780 patients have undergone gastrectomy for gastric cancer in our clinic, and the chronological trends in the pathological findings of this cancer have been evaluated. Recently, the proportion of pa

A comparison of pelvic retroperitoneal pneumography and computed tomography in the assessment of extramural invasion of rectal carcinoma

Pelvic retroperitoneal pneumography (PRP) and pelvic computed tomography (CT) were performed on 33 patients with rectal carcinoma in order to compare the usefulness of the two diagnostic procedures in the preoperative assessment of local malignant extramural invasion. Six PRP-negative patients in whom no free air was visualized in the retroperitoneal space surrounding the mass, were all assessed as having extramural invasion by CT scan and all had histologic evidence of invasion. Of 27 PRP-positive patients in whom free air was seen surrounding the mass, 18 were diagnosed as having extramural invasion on CT, 15 of whom had histologic proof of invasion. In the remaining 9 PRP-positive patients, there was no evidence of extramural invasion on the CT scans, but 5 patients showed evidence of invasion histologically. PRP, when positive, had an unacceptably high rate of being false positive and was therefore unreliable in assessing extramural invasion, whereas CT was able to detect, to some extent, extramural invasion which PRP failed to demonstrate. Based on these findings, we conclude that CT is more useful than PRP in the preoperative assessment of extramural invasion of rectal carcinoma, but is of limited diagnostic value when negative.

Relationship between the size of lesions and intramural spread of gastric cancer. With particular reference to the features of carcinoma of the upper portion of the stomach.

下部胃癌123例, 中部胃癌101例, 上部胃癌50例につき粘膜面からみた肉眼的癌巣の広がり (肉眼的癌巣面積) と組織学的にみた癌巣の広がり (組織学的癌巣面積) を比較し, 壁深達度との関係を検討した. 肉眼的癌巣面積と組織学的癌巣面積はよく相関しており, 組織学的癌巣面積が16cm2以下の場合, 進行癌の占める割合は下部胃癌15/102 (14.7%), 中部胃癌19/73 (26.0%), 上部胃癌18/33 (54.5%) と上部胃癌で有意に高く, 同じ大きさの胃癌であっても胃上部の癌はより進行した癌が多かった. さらに, 全摘胃を用いて粘膜筋板の厚さを胃の各部位ごとに測定したところ, 胃上部ほど粘膜筋板は薄く, 粘膜筋板が癌の壁深達に何らかの関わりをもっている可能性が示唆された.