Shichisaburo Abo

Analysis of results of surgery performed over a 20-year period on 500 patients with cancer of the thoracic esophagus

This study was conducted to examine the long-term outcome of 500 patients who underwent surgery for cancer of the thoracic esophagus during the past 20 years. Favorable results were obtained with postoperative adjuvant radiation and chemotherapy and there were no surgical deaths in the last 5 years. The mortality rate decreased from 17% prior to 1980 to 5% between 1981 and 1993, this being most probably attributable to the decreased incidence of suture leakage. With respect to changes in surgical techniques, during the initial years we performed intrathoracic anastomosis, after which sternal manubrium resection with anterior mediastinal esophagogastrostomy was carried out. Subsequently, we invented a technique for performing esophagogastrostomy via the posterior mediastinum. The posterior mediastinum was selected as the most physiologic route, based on measurement of tissue oxygen tension. Using blood flow determinations obtained by laser-Doppler velocimetry, we concluded that the effectiveness of thicker gastric tubes was superior to that of thin tubes. Esophagogastrostomy was performed in a shallow field in the cervical region, with the anastomosis ultimately positioned in the superior mediastinum and covered with mediastinal pleura.

Mediastinal extraadrenal myelolipoma: Report of a case

We herein report a case of surgically resected mediastinal extraadrenal myelolipoma. Myelolipoma is an uncommon tumor composed of adipose tissue and normal hematopoietic elements, and is most often found in the adrenal glands. We could find only five such cases of mediastinal myelolipoma in the English literature.

The intrapleural administration of recombinant interleukin-2 (rIL-2) to patients with malignant pleural effusion: Clinical trials

Recombinant IL-2 (rIL-2) was administered intra-pleurally according to an original protocol to 11 patients with malignant pleural effusion, 7 of whom suffered from breast cancer and 4 from esophageal cancer. The pleural effusions either disappeared or decreased roentgenographically, and malignant cells disappeared from all 13 pleural cavities in the 11 patients, confirming the validity of this therapy to be 100%. The mean survival time from the initial administration of rIL-2 was 15.9 months. We ensured that the concentration of IL-2 in the effusion was maintained at a high level for a sufficient period of time, and that the lymphokine-activated killer (LAK) activity of lymphocytes in the effusion was augmented. Fever, eosinophilia, and a transient increase in the pleural effusion were the main side effects, but the symptoms were temporary and not serious. The results of this study therefore suggest the efficacy of intrapleural rIL-2 for patients with malignant pleural effusion.

Gene Amplification of int-2 and erbB in Human Esophageal Cancer: Relationship to Clinicopathological Variables

Gene amplification is a relatively frequent event in human malignant tumors and is believed to play an important role in tumor progression. The int-2 and erbB genes are amplified more frequently than any other genes in human esophageal cancer. In order to investigate the correlation between these two proto-oncogenes and the clinical behavior of esophageal cancer, we examined DNA amplification of int-2 and erbB and analyzed their relationship to clinicopathological variables. Genomic DNA was extracted from 21 esophageal squamous carcinomas and normal esophageal mucosa, as well as from 4 metastatic tumors. We used Southern blot analysis for detection of gene amplification. Amplification of int-2 was observed in 13 of 21 cases (62%) and in all the metastatic tumors (4/4; 100%). We found a significant correlation between amplification of int-2 and the length of the primary lesion. Amplification of erbB was detected in 3 of 18 patients (17%). All patients who showed amplification of erbB also demonstrated amplification of int-2. These results suggest that amplification of int-2 or neighboring genes on 11q may participate in tumor progression and metastasis in patients with esophageal squamous cancer.

Peripheral edema after esophagectomy

Patients who have undergone major surgery such as esophagectomy may develop peripheral edema in the immediate postoperative period, the cause of which is not fully understood. The purpose of this study was therefore to determine the mechanism of this phenomenon. Finger edema was measured as a marker for peripheral edema before and after esophagectomy in eight patients. Plasma interleukin-6 (IL-6) was also measured by an enzyme-linked immunosorbent assay. Finger edema markedly increased in the immediate postoperative period and remained significantly elevated until after postoperative day (POD) 3 compared to the preoperative value (P<0.05). Plasma IL-6 also markedly increased in the immediate postoperative period and repreoperative value (P<0.05). The degree of finger edema highly correlated with the level of plasma IL-6 (r=0.71,P=0.0001). These findings indicate that peripheral edema after esophagectomy might be caused by a proinflammatory cytokine response.

Analysis of Gene Amplification in Human Esophageal Cancer

The “multistep” of genetic alterations is necessary for cancer formation [1], but there are few reports dealing with both oncogenes and tumor suppressor genes in human esophageal cancer. To investigate the correlation between oncogenes and esophageal cancer, we examined gene amplification of the int-2 and erbB genes, and the p53 and DCC tumor suppressor genes by Southern blot analysis.

Postoperative Respiratory Function in Esophageal Cancer Patients with Special Reference to Respiratory Muscle Strength.

食道癌術後早期には呼吸機能低下を認めるが, その原因については十分検討されていない. 今回, 我々は食道癌術後早期の呼吸機能低下を呼吸筋力の面から検討した. 1995年2月から9月の間に右開胸, 胸腹部食道全摘, 後縦隔経路頸部食道胃管吻合術を施行した食道癌患者13例を対象とした. 呼吸筋力の指標として最大吸気口腔内圧 (MIP) と最大呼気口腔内圧 (MEP), 骨格筋力の指標に握力を, 術前日, 第3, 4, 5, 6, 7, 14, 21病日に測定した. MIP, MEPは, それぞれ第3病日で術前の42-2%, 34.7%と有意な低下を認め, 21病日には87.2%, 86l4%に回復し, FVC, FEV1.0との間にそれぞれ有意な相関を認めた. 一方, 握力はMIP, MEPとの問に強い相関を認めなかった. 以上の結果から術後呼吸機能評価の指標としてMIP, MEPは有用と考えられ, 食道癌術後早期の呼吸機能低下には骨格筋力など全身的因子よりも呼吸筋障害, 肺・胸郭complianceの低下など局所的要因が強く影響していると推測された.

Significance of Home Enteral Nutritional Support in Patients after Surgery for Esophageal Cancer.

食道癌患者の退院後の栄養状態の改善を目的として1989年より導入した在宅経腸栄養補助 (home enteral nutritional support: HENS) の意義について, 根治術を受けた51例を対象とし検討した. HENSは42例 (82%) に平均486kca1で5.4か月間投与されていた. 結果: 体重は退院時のレベルで推移した. 理想体重比 (%IBW, 入院時90%, 退院時87%), 健常時体重比 (%UBW, 入院時97%, 退院時93%) も退院時のレベルを維持できた. 血清総蛋白 (TP), アルブミン値 (Alb), 総コレステロール値の回復も良好であった. 一方, 上腕三頭筋部皮下脂肪厚 (%TSF) は約70%の例が中-高度の低下を呈した. 上腕筋囲 (%AMC) の低下は軽度であった. 結論: 退院後の体重減少が防止でき, 血液検査成績も良好であったことからHENSは有用であった. TP, Alb, %AMCに比較して%TSFの低下は著しく, 体脂肪を消費し体蛋白や内臓蛋白を維持するのが, 食道癌患者の退院後の栄養状態の本態と考えられる. %TSFの低下を防止すべく, %IBWや%UBWを目安とする入院直後からのより積極的な栄養管理が今後の課題である.

Treatment for Recurrence of Carcinoma of the Thoracic Esophagus

Despite developments in diagnostic methods, many cases of esophageal cancer are not diagnosed until an advanced stage. Of the cases occurring during a recent period, about 70% were diagnosed at stage III or IV. Many cases of esophageal cancer have recurred after curative resection, and treatment for the recurrence is important. In order to define the important points for improving the prognosis after recurrence, we retrospectively analyzed the cases of recurrence after curative resection for thoracic esophageal cancer.