Kohei Sumiyoshi

Relationship between preoperative assessment of organ function and postoperative morbidity in patients with oesophageal cancer

OBJECTIVE To find out if strict assessment of organ function preoperatively predicted morbidity and mortality in patients being operated on for oesophageal carcinoma. DESIGN Retrospective study. SETTING Teaching hospital, Japan. SUBJECTS 178 patients operated on for oesophageal cancer 1989-1993. INTERVENTIONS Oesophagectomy and reconstruction (using either stomach or colon) in one stage by a right thoracoabdominal approach in 173, and transhiatal resection in 5 with either poor pulmonary reserve or early lesions. MAIN OUTCOME MEASURES Correlation between preoperative assessment of organ function and postoperative development of complications. RESULT 79 patients (44%) developed complications and 6 died (3%). Pulmonary dysfunction preoperatively was significantly associated with the development of all complications (p=0.001) and of postoperative pulmonary complications (p=0.04). No other preoperative assessment correlated significantly with the development of postoperative complications. CONCLUSION Accurate preoperative assessment of pulmonary function is a valuable indicator of postoperative morbidity.

Carcinogenesis and histogenesis of esophageal carcinoma.

Dysplasia is one of the most important subjects regarding carcinogenesis of the esophagus, because there is continuing controversy as to whether esophageal dysplasia is a cancerous lesion or a noncancerous lesion.

What is the earliest malignant lesion in the esophagus

The incidence of early esophageal cancer is definitely increasing due to recent advances in diagnostics. When we discuss early carcinoma of the esophagus, however, there is still controversy as to whether dysplasia is either benign or the earliest malignant lesion.

Preoperative hyperthermia combined with chemotherapy and irradiation for the treatment of patients with esophageal carcinoma.

Aims and Background The purpose of this study was to investigate the combined effects of hyperthermia, chemotherapy and irradiation on esophageal cancer. Methods and material Since 1978, we have clinically applied hyperthermia combined with chemotherapy and irradiation (HCR therapy), to patients with carcinoma of the esophagus. The clinical results of 136 patients receiving preoperative HCR therapy were then compared with those of 107 cases undergoing preoperative chemo-radiotherapy (CR). Results A histological examination of the resected esophagus after preoperative treatment revealed that 65.4% and 50.5% of the patients responded markedly (no viable cancer cells) and moderately (more than two thirds of all cancer cells destroyed) to HCR and CR therapies, respectively (p <0.05). The five-year survival rates were 22.3% and 13.7% in the HCR and CR groups, respectively, and the difference was statistically significant (p <0.01). In particular, for the patients classified as TNM Stages III and IV, a significantly longer survival period was obtained with HCR therapy (p <0.05). In addition, no severe side effects were encountered in the patients given just hyperthermia. Conclusion Our clinical results suggest that preoperative hyperthermo-chemo-radiotherapy shows great promise for treatment of patients with advanced carcinoma of the esophagus.

The prognostic significance of the cytophotometric DNA content and its relationship with the argyrophilic nucleolar organizer regions (AgNOR) and proliferating cell nuclear antigen (PCNA) in oesophageal cancer

We examined the DNA pattern, AgNOR number and PCNA-positive ratio (PCNA ratio) from biopsy specimens of oesophageal carcinoma, and attempted to identify any prognostic factors for oesophageal carcinoma. DNA analysis: the cell nuclear DNA content was measured and the distribution pattern of the DNA content was grouped into four types according to the ploidy pattern (n = 182). The survival rate of patients with high-ploidy tumours (type III and IV) was shorter than that for low-ploidy tumours (type II), (P < 0.05). AgNOR number (n = 99) and PCNA ratio (n = 41): the AgNOR number and PCNA ratio were measured from 100 cancer cells in each specimen. Both the high-AgNOR-number patients (> or = 5) and the high-PCNA-ratio patients (> or = 35) demonstrated poorer prognoses than the low-rate patients (P < 0.05). These results suggest that the DNA pattern, AgNOR number and PCNA ratio may thus reflect the proliferative activity of tumours and therefore also offer the possibility of interdependence among these three factors.

Tumor invasion and angiogenesis in early esophageal squamous cell carcinoma.

Although the relationship between angiogenesis and tumor proliferation or malignant potential has been previously demonstrated in several studies, early stage of cancer invasion and angiogenesis has seldom been investigated.

Surgical Treatment of Patients with Esophageal Achalasia

Beetween 1979 and 1992, 18 patients with esophageal achalasia underwent surgical treatment in our Department of Surgery II. The operative procedure was mainly selected according to the X-ray type whil