Masazumi Takahashi

Surgical outcome of para-aortic lymph node dissection preserving neural tissue based on anatomical evaluations

The anatomical distribution of the para-aortic lymph nodes was studied to establish an effective operative procedure that preserves neural tissue for patients with advanced gastric cancer. Para-aortic lesions were anatomically examined in 31 cadavers, and histologic preparations of 14 cadavers were used to evaluate the relationship between para-aortic lymph nodes and surrounding neural tissue. Surgical results were analyzed in patients with D3 gastrectomy based on anatomical findings (n = 33). Anatomically, the splanchnic nerves merged into the celiac ganglion, which consisted of either one ganglion (type I) or several ganglia (type II). The average number of lymph nodes were 17.4 in the area superior to the superior mesenteric artery (SMA) and 13.3 in the area inferior to the SMA. According to the number of metastatic lymph nodes (⪯3, ≥4), the median survival time was 14.7 and 9.7 months, respectively (P < 0.02). Patients either with or without metastatic lymph nodes behind the neural tissue had a median survival time of 14.7 and 9.7 months, respectively (P <0.02). We conclude that para-aortic lymph node dissection preserving neural tissue is useful in patients with three or fewer para-aortic metastatic lymph nodes that are in front of the neural tissue.

A Case of Common Bile Duct Carcinoma Associated with Primary Biliary Cirrhosis.

原発性胆汁性肝硬変経過観察中に胆管癌を併発した1例を報告する. 症例は50歳の女性で, 7年前より無症候性PBCと診断されていたが, 外来治療中, 黄疸・皮膚掻痒感が出現した. 画像診断上, 膵頭部領域癌と診断し, 閉塞性黄疸のため経皮経肝胆道ドレナージ術を施行した. 手術所見では十二指腸へ浸潤する膵頭部腫瘤を認め, 膵頭十二指腸切除術を施行した. 病理組織学的所見上, 下部胆管を中心とした高分化型腺癌であった.PBCは悪性腫瘍併発率が高いといわれているが, 胆管癌併発例については, 本邦・欧文とも論文報告はなく, 日本病理剖検輯報第33輯に記載された肝門部胆管癌併発例の1剖検例のみと非常にまれであった.