Masaaki Urade

Continuous hyperthermic peritoneal perfusion for the treatment of peritoneal dissemination in gastric cancers and subsequent second-look operation

A total of 31 patients with gastric cancer showing peritoneal dissemination received continuous hyperthermic peritoneal perfusion (CHPP) in combination with the administration of cisplatin (CDDP) and mitomycin C (MMC). The authors developed a new special device named the peritoneal cavity expander (PCE) for sufficient perfusion and direct temperature measurement in the peritoneal cavity. As complications of CHPP three patients presented with bone marrow suppressions (leukocytes ⩽ 3000/mm3 and/or platelets ⩽ 30,000/mm3): one, leakage of intestinal anastomosis; one, intestinal perforation; and one, acute renal failure. But none of them was lethal. Twelve of 31 patients who had received CHPP during the initial operation underwent second‐look operation (SLO) for the assessing the effects of CHPP and for resecting residual or recurrent tumors. Among 12 patients who received SLO complete response (CR) was observed in four patients, partial response (PR) in one, no change (NC) in three, and progressive disease (PD) in four, with the overall response rates (%CR + %PR) standing at 41%. Two‐year survival rate of the complete and partial responders was 50%, which was significantly higher than 0% of the other responders (NC + PD). The survival curves of the two groups were significantly different (P < 0.05, generalized Wilcoxon test). These results supported that CHPP was well tolerated and effective for the treatment of patients with peritoneal dissemination in gastric cancer when combined with anti‐cancer drugs having synergism with hyperthermia. Since the outcome of SLO was one of prognostic factors it was important to follow up these patients by SLO.

A clinicopathologic study on multiple gastric cancers with special reference to distal gastrectomy

Simultaneous multiple gastric cancer was seen in 49 (5.8%) of 852 resected stomachs. Patients with multiple cancers were older than those with single gastric cancers (P < 0.01) and the incidence of multiple gastric cancer was significantly higher in male patients than in female patients (P < 0.05). The incidence rates of multiple carcinomas were 9.6% of early gastric carcinomas and 4.0% of advanced gastric carcinomas. With regard to histologic type, the incidence rate of the differentiated type was 71% and the incidence rate of the undifferentiated type was 29%. In 68 serially resected stomachs, 5 (7.4%) new multiple cancers were detected microscopically, whereas 4 (5.9%) had already been diagnosed grossly. The incidence rate of multiple carcinoma increased to 13.2% by this procedure. The cases that were cut serially showed that most of the multiple cancers were located distally from the F‐line presenting the line along which intestinal metaplasia appeared. This study suggests that the surgeon is required to resect the area including the F‐line at the time of distal gastrectomy so as not to leave another cancer in the gastric remnant.

Criteria of curability in the hepatectomy for hepatocellular carcinoma.

肝細胞癌切除例79例を対象に,肝癌取扱い規約に基づいた切除術式別及び腫瘍進展度の各因子別に予後を検討した.絶対的治癒切除術の生存曲線は相対的非治癒切除術及び絶対的非治癒切除術に比べ,また相対的治癒切除術の生存曲線は相対的非治癒切除術よりも有意に良好であった.腫瘍進展度では,予後に最も影響を及ぼす因子は門脈侵襲であった.相対的治癒切除術の中でも,腫瘍径によってT2となり相対的治癒切除術となった相対的治癒切除A群と,主として門脈侵襲による血管侵襲が陽性であるためにT2となり相対的治癒切除術となった相対的治癒切除B群,及び絶対的治癒切除術とでの予後の検討では,血管侵襲をみない絶対的治癒切除術及び相対的治癒切除A群の予後は血管侵襲を認めるB群よりも良好であった.血管侵襲を認める症例に対する肝切除術では,肝切除単独では治癒治療法にはなり難く,術後の綿密なfollow upとadjuvant chemotherapyの必要性が示唆された.