Masahiko Ozaki

Surgery versus radiochemotherapy for resectable locally invasive pancreatic cancer: final results of a randomized multi-institutional trial.

PurposeAlthough the outcome of surgery for locally advanced pancreatic cancer remains poor, it is improving, with 5-year survival up to about 10% in Japan. The preliminary results of our multi-institutional randomized controlled trial revealed better survival after surgery than after radiochemotherapy. We report the final results of this study after 5 years of follow-up.MethodsPatients with preoperative findings of pancreatic cancer invading the pancreatic capsule without involvement of the superior mesenteric or common hepatic arteries, or distant metastasis, were included in this randomized controlled trial, with their consent. If the laparotomy findings were consistent with these criteria, the patient was randomized to a surgery group or a radiochemotherapy group (5-fluorouracil 200 mg/m2/day and 5040 Gy radiotherapy). We compared the mean survival time, 3-and 5-year survival rates, and hazard ratio.ResultsThe surgery and radiochemotherapy groups comprised 20 and 22 patients, respectively. Patients were followed up for 5 years or longer, or until an event occurred to preclude this. The surgery group had significantly better survival than the radiochemotherapy group (P < 0.03). Surgery increased the survival time and 3-year survival rate by an average of 11.8 months and 20%, respectively, and it halved the instantaneous mortality (hazard) rate.ConclusionLocally invasive pancreatic cancer without distant metastases or major arterial invasion is treated most effectively by surgical resection.

A case of extragastric leiomyoblastoma with peduncle.

症例は65歳, 女性. 1988年7月, 胃粘膜下腫瘍の診断のもと開腹し, 胃体上部前壁に胃外有茎性腫瘤を認め, 術中迅速組織検査にて胃平滑筋芽細胞腫と診断され, 胃部分切除を施行した. 腫瘍の切除標本の大きさは, 3.5×2.5cmで一部に出血を伴っていた. 組織学的には, ヘマトキシリンーエオジン染色では, 核は異型性に乏しく, 核周囲に透明帯を有し, 胞体は好酸性であり, 鍍銀染色では, 一部にalveolar patternが認められた. 電子顕微鏡像ではdense patchを認め, 本腫瘍が平滑筋由来であることが示唆された. 今回集計しえた本邦における胃平滑筋芽細胞腫228例について検討したところ, 最大腫瘍径が5cm未満では手術時に転移, 直接浸潤を認めず, また予後の明らかな69例の10年生存率は88.8%であり, この内手術時に転移, 他臓器直接浸潤を示した13例の予後は5年生存率が71.3%, 10年生存率が47.5%であった.

The clinical significance of ultrasonicaliy guided puncture of the gallbladder for the cases of non-visualized gallbladder by oral cholecystography and intravenous cholangiography.

胆嚢疾患に対して施行した排泄性胆道造影法の成績を検討し, さらに高率に認められる胆嚢像陰性例に対して, 超音波誘導下の胆嚢穿刺術の有効性について報告する.(1) 胆嚢疾患148例に対して排泄性胆道造影法を施行するに胆嚢像陰性例は102例 (68.9%) と高率に認められた.(2) 胆嚢像陰性例を中心に胆嚢穿刺術を行い145例中138例 (95.2%) に明瞭な胆嚢像を得た.(3) 胆嚢癌34例に対する吸引細胞診の成績は34例中28例 (82.4%) の診断率であった.(4) 胆嚢胆汁CEA濃度は良悪性鑑別の補助診断に成り得る.胆嚢穿刺術は胆嚢癌の早期発見および良悪性の鑑別診断に有効であり, とくに胆嚢像陰性例に対して不可欠の検査法である.