Michiyasu Nonaka

Features of second primary cancer in patients with gastric cancer.

Background: In order to improve the prognosis of gastric cancer patients, the timely identification of second primary cancers is considered to be a crucial clinical problem. Methods: We analyzed the clinicopathological data of 2,250 patients with gastric cancer with regard to both synchronous and metachronous second primary cancers. Results: Of 2,250 patients, 95 (4.2%) had a second primary cancer. Both colorectal and lung cancer were frequently detected, followed by cancer in the liver, esophagus and breast. Regarding the time of detection for such second cancers, 65% of colorectal cancers were detected synchronously, while more than 80% of lung cancers were detected metachronously. The prognosis of gastric cancer patients with a second primary cancer was more negatively influenced by a second primary cancer than by a primary gastric cancer. Conclusion: Since gastric cancer patients may develop synchronous and metachronous second cancers in other organs, effective preoperative and postoperative diagnostic modalities both for second primary cancers, as well as for the recurrence of gastric cancer, need to be developed.

Intraoperative localization of right-sided small colonic lesions: a novel use of the cholangioscope.

Background/Aim: We describe a novel use of the cholangioscope to help in the intraoperative localization of small colonic malignancies on the right side of the colon. Methods: A small incision was made at the base of the appendix and a cholangioscope was inserted into the ascending colon through the incised hole of the appendix. Results: The site of the lesion was precisely determined by palpating the distal end of the cholangioscope while observing the area right under it. Conclusion: Our procedure therefore appears to be worthy of consideration in patients with small colonic lesions on the right side of the colon in whom preoperative endoscopic marking techniques might otherwise be required.

Clinical evaluation of the gallbladder cancer with special reference to the mural invasion.

年間に経験した癌深達度漿膜下組織以内の胆嚢癌は粘膜1例, 固有筋層5例, 漿膜下組織5例の11例である, 術前診断は7例 (64%) に診断できFた. 主な術前検査法と腫瘍描出率は超音波では11例中5例 (45%), computed tomographyおよび直接胆道造影では8例中6例 (75%), 血管造影では7例中3例 (43%), 細胞診陽性例は術前5例中2例 (40%) だが, 術中は捺印塗抹細胞診の併用により4例中3例 (75%) と高率であった. 術中超音波では4例中3例 (75%) に組織学的癌深達度とほぼ一致し, 術式決定に非常に有用であった. 手術術式は肝床切除と第2群リンパ節郭清が主な術式である. 遠隔成績は11例中7例 (64%) が3年以上生存中で良好な成績である.