Ryosuke Okada

Clinical significance of interleukin-6 (IL-6) in the spread of gastric cancer: role of IL-6 as a prognostic factor.

BackgroundIt is becoming clear that various cytokines are associated with the spread of cancer cells. The purpose of this study was to compare interleukin (IL)-6 levels in patients with gastric cancer to elucidate the role of IL-6 in predicting the spread of tumors.MethodsIn 60 patients, we assessed the correlation of serum IL-6 (pg/ml) with stage, histological findings, hepatic metastasis, and related factors (hepatocyte growth factor [HGF], IL-1β, tumor necrosis factor [TNF]-α, and transforming growth factor [TGF]-β1). We also investigated the diagnostic significance of the IL-6 level for advanced gastric cancer and lymph node metastasis, as well as the association between IL-6 elevation and outcome. Finally, we examined the expression of IL-6 in tumor tissue.ResultsSignificant relationships were seen between serum IL-6 and stage, depth of tumor invasion (pT), lymphatic invasion (ly), venons invasion (v)*, lymph node metastasis (pN), hepatic metastasis (cH), and HGF (P < 0.01; *P < 0.05). With regard to the diagnostic significance of the IL-6 level for advanced gastric cancer and lymph node metastasis, when the cutoff value of IL-6 was set at 1.97 pg/ml, the sensitivity was 81.8% and 87.5%; specificity was 66.7% and 58.3%; and accuracy was 77.1% and 72.9%, respectively. The 1- and 3-year cumulative survival rates for patients with an IL-6 value of more than 1.97 pg/ml (69.0% and 43.4%, respectively) were significantly lower than those for patients with an IL-6 value of 1.97 pg/ml or less (94.4% and 87.2%, respectively; P < 0.05). Immunohistochemical staining was positive for IL-6 in the cytoplasm of cancer cells.ConclusionWe suspect that IL-6 is involved in cancer invasion and lymph node and/or hepatic metastasis. Our results indicate that IL-6 could be used as a prognostic factor for survival.

Comparison of plastic prostheses and self-expandable metallic stents in the treatment of malignant esophageal stenosis

OBJECTIVE We compared the efficacy of plastic prostheses and self-expandable metallic stents in the treatment of malignant esophageal stenosis and/or fistula. SUBJECTS AND METHODS Subjects were 31 patients with esophageal cancer, 4 with esophagotracheal fistula, and 1 with esophageal stenosis. A plastic prosthesis was inserted in 15 patients (group A) and a self-expandable metallic stent in 21 patients (group B). We evaluated food ingestion improvement, effectiveness, complications, mean survival, food ingestion duration, the percentage of food ingestion capability in total survival time, and inhospital mortality. RESULTS No differences were seen in food intake improvement or in the effectiveness between groups, whereas fatal complications were higher in Group A. No significant differences were seen in mean survival, food ingestion duration, percentage of food ingestion capability, or inhospital mortality between groups. CONCLUSION We concluded that a self-expandable metallic stent was safer than a plastic prosthesis because of fewer serious complications such as bleeding, and recommended the use of metallic stents in the treatment of malignant esophageal stenosis and/or fistula.

Surgeon at Work: Hand-Assisted Laparoscopic Construction of Gastric Conduit for Thoracic Esophageal Cancer

A method for hand-assisted laparoscopic construction of gastric conduit for thoracic esophageal cancer was developed. Since this endoscopic surgical procedure is less invasive than open surgery, it contributes to improvement of post-operative respiratory functions and reduces respiratory complications. What distinguishes our surgical procedure is that unlike methods described in previous reports, it begins with treatment of the left gastroepiploic vessels at the height of the inferior edge of the spleen, followed by dissection from the esophageal hiatus to the lesser curvature and then dissection and excision of left gastric arteries and veins. Finally, the exposed esophagus and stomach are drawn outside the body and the right gastroepiploic blood vessels are preserved, followed by dissection of the greater omentum. This approach to gastric conduit construction was undertaken in 6 patients and the mean operating time was 123 minutes. Although in the first 3 of these patients the operating time was 150 minutes or more, the time required shortened to around 90 minutes for each of the last 3 cases, as the procedure was mastered. In each case, the volume of intraoperative hemorrhage did not exceed 50 ml.

Strategy for the Treatment of Carcinomata in the Advanced Aged Patients. Therapeutic Strategies for Esophageal Carcinoma in Elderly People.

We encountered 588 patients with esophageal carcinoma between 1986 and 1998. For 96 (16.4%) of the patients 75-year-old or older, we examined the features and issues of esophageal carcinoma in elderly people based on preoperative conditions and treatment results. 1) Cardiac dysfunction was observed in 39 patients (40.6%). Concerning respiratory function, there was a significant difference in forced expiratory volume in 1 second (FEV1.0%) and % vital capacity (%VC) compared to patients under 75 years of ages (t-test). Furthermore, disorders of several organs were observed in 31 patients (32.2%). 2) Eleven patients underwent right thoracotomy and laparotomy. Three (25%) of these patients died in hospital postoperatively. The 3-year survival rate was 27.3%. 3) Fourteen patients underwent esophagectomy. Four (28.6%) of these patients died in hospital. The 3-year survival rate was 7.7%. 4) In 66 patients who did not undergo resection, the 3-year survival rate was 11.7%. 5) With respect to postoperative complications, the incidences of pulmonary complications and postoperative delirium were high. Some patients died during surgery or during hospitalization. Careful perioperative management is important. 6) There was no significant difference in long-term results between treatment methods. However, none of the patients who underwent C0 surgery survived more than 2 years. Therefore, this procedure should be avoided if possible.