Kouki Masuo

Peritoneal metastasis in gastric cancer with particular reference to lymphatic advancement; Extranodal invasion is a significant risk factor for peritoneal metastasis

We investigated the relationship between peritoneal metastasis and lymphatic involvement in gastric cancer by examining resected specimens.

The usefulness of postoperative continuous epidural morphine in abdominal surgery.

The influence of continuous epidural morphine on the recovery course of intestinal activity, urinary function, and ambulation after surgery was studied in 40 patients who underwent either gastrectomy for gastric cancer or cholecystectomy for cholelithiasis. Compared with a control group of patients whose postoperative pain was managed by pentazocine or hydroxyzine as before, the length of time before passing flatus or faeces was significantly shortened in the morphine groups (P<0.05). Following gastrectomy, the urinary catheter was able to be removed significantly earlier in the morphine group (P<0.05) although there was no statistical difference between both cholecystectomy groups. The morphine group experienced no difficulty with postoperative ambulation and exercise, although the difference in time before ambulation between the two groups was not considered significant. The results of this study led us to conclude that the postoperative continuous epidural infusion of morphine would be more beneficial following major abdominal surgery than the conventionally used methods of administering postoperative analgesia.

Physiological Age as an Outcome Predictor for Abdominal Surgery in Elderly Patients

It would seem that a large discrepancy exists between the “chronological” age and “apparent” age of elderly patients, and we often observe that the latter reflects the results of surgical procedures very well. In the present study, we reviewed 258 patients aged 70 years or older who underwent elective abdominal operations under general anesthesia, to evaluate an outcome predictor representing their “physiological” age. A total of 24 preoperative variables were compared between patients who left the hospital in a satisfactory condition, being survivors, and those who died in hospital despite the operative procedure performed, being nonsurvivors. In the group of patients aged between 70 and 79 years, there was no significant difference between the survivor and nonsurvivor groups for any of the variables examined; however, in the group of patients aged over 80 years old, the oldest of whom was 93 years, there were significant differences in the total lymphocyte count (TLC) and the performance status (PS), as well as in age, between the survivor and nonsurvivor groups. Utilizing the three variables of age, PS, and TLC, a computer-generated discriminant function analysis yielded an equation which discriminated survival with 97% accuracy, and mortality with 83% accuracy. These findings indicate that the PS and TLC scores added to the chronological age should be considered when deciding whether a surgical procedure is appropriate for an elderly patient.

A case of Crohn's disease limited to the appendix, showing a portentous ultrasonographic finding

A case of Crohns disease limited to the appendix is reported. A preoperative ultrasonic study of the lower right abdomen revealed an interesting appearance that we named the “milky way sign.” Microscopic findings in the resected specimen confirmed that the sign represented adipose tissue of the mesoappendix that had become involved by transmural inflammation. This seems to be highly suggestive of Crohns disease.

Anticancer Effects ofPreoperative Chemotherapy onColorectal Carcinoma

This study was designed to evaluate the efficacy of preoperative chemotherapy and to investigate the relationship between the histopathologic response and prognosis in patients with colorectal carcinoma. Thirty-six previously untreated patients with advanced colorectal carcinoma were consecutively enrolled in this study and received preoperative N-(2-tetrahydrofuryl-5-fluorouracil (FT-207) by suppository. The histopathologic response was investigated. Histopathologically, 14 patients had no response, 19 responded slightly, 2 moderately and 1 had a complete response to the chemotherapy. The extent of the histopathologic response to chemotherapy was greater in the deeper layers of the invaded tissue. There was no relation between the location of the tumor and the extent of the histopathologic response. Based on clinical cancer staging, the overall 5-year survival rate was 100% in patients with Duke’s A and Duke’s B cancer and 45% in patients with Duke’s C cancer; the 3-year survival rate was 25% in patients with Duke’s D cancer. The 5-year survival rate for those with a positive histopathologic response to chemotherapy was 71%, whereas that for the nonresponders was 79%. Mild chemotherapy in the form of FT-207 suppositories was found to be effective histopathologically. However, no relationship was seen between the histopathologic response and survival rate.