Shigemasa Koga

Does extensive dissection of lymph nodes improve the results of surgical treatment of gastric cancer

The results of surgical treatment of patients with advanced gastric cancer were analyzed retrospectively in terms of the extent of dissection of lymph nodes. The postoperative 5-year survival rate was 50.3% for 160 patients who had undergone potentially curative surgery with dissection of group 1, 2, and 3 lymph nodes (R3), compared with 48.8% for 185 patients with dissection of group 1 and 2 lymph nodes (R2). There was no difference in terms of survival between the two groups of patients. Of 160 patients receiving R3, 19 (11.9%) were found to be positive for metastasis to group 3 lymph nodes, and only 5 survived for more than 5 years after surgery (postoperative 5-year survival rate of 26.3%). In four of these five patients, metastases in the group 3 lymph nodes were confined to nodes in the hepatoduodenal ligament. Thus, it appears that in dissection of the deepest nodes, lymph nodes in the hepatoduodenal ligament are the most important to remove in the surgical treatment of advanced gastric cancer.

Correlation between subserosal venous invasion by gastric cancer and the occurrence of liver metastasis.

We have examined the correlation between the depth of venous invasion of the gastric wall and the occurrence of liver metastasis in cases of gastric cancer. In 244 patients examined, the incidence of venous invasion, and in particular of sub- serosal venous invasion, was appreciably high in cases of poorly differentiated adenocarcinoma of the medullary type. Synchronous and metachronous liver metastases were found in 13 and 18 patients, respectively. In these cases, poorly differentiated adenocarcinoma with a medullary growth pattern was the most frequent, and papillary adenocarcinoma was the next most frequent type of cancer. The incidence of liver metastases was appreciably higher in patients with sub- serosal venous invasion than in those with only submucosal venous invasion. Considering the above observations, we posit that subserosal venous invasion by cancer, especially by poorly differentiated adenocarcinoma of the medullary type, is indicative of the risk for development of liver metastasis in patients with gastric cancer.

Continuous hyperthermic peritoneal perfusion as a prophylaxis of peritoneal metastasis from gastric carcinoma.

治癒切除がなされたse胃癌の術後5年生存率はR248.4% (n=182), R350.9% (n=159) であり, これをリンパ節転移程度別に検討してもR2とR3とでほとんど差はみられなかった. ダブラス窩洗浄細胞診にて, se胃癌治癒切除例の21% (30/142) に腹腔内遊離癌細胞が検出され, これらの術後生存率はきわめて低く, 大部分は腹膜転移にて死亡した. 術中肉眼的に漿膜浸潤陽性で治癒切除と判定された例を無作為に2群にわけ, 持続温熱腹膜灌流療法の効果を検討した. その結果, 対照群の5生率58.3% (n=53) に対して本法施行群では76.2% (n=55) という成績が示された. 漿膜浸潤胃癌では積極的な腹膜再発防止対策が必要である.

Morphological changes in intraperitoneal free cancer cells of gastric cancer patients treated with continuous hyperthermic peritoneal perfusion.

腹膜播種を有する胃癌患者10名を対象とし, 温熱と抗癌剤を併用した持続温熱腹膜灌流療法continuous hyperthermic peritoneal perfusion (CHPP) を行った. その前後にわたり経時的に腹腔内遊離癌細胞を採取し, 主としてこれらの形態的変化につき検討し, 以下の成績を得た.1. CHPP施行後には, 遊離癌細胞の胞体内空胞形成および核の腫大, 凝縮などの変性所見が認められ, さらに特徴的な多核巨細胞化した癌細胞の出現が認められた.2. CHPPの回数を重ねるに従い, 癌細胞の変性程度, 変性癌細胞の出現頻度が増加した.

Relationship between the size of lesions and intramural spread of gastric cancer. With particular reference to the features of carcinoma of the upper portion of the stomach.

下部胃癌123例, 中部胃癌101例, 上部胃癌50例につき粘膜面からみた肉眼的癌巣の広がり (肉眼的癌巣面積) と組織学的にみた癌巣の広がり (組織学的癌巣面積) を比較し, 壁深達度との関係を検討した. 肉眼的癌巣面積と組織学的癌巣面積はよく相関しており, 組織学的癌巣面積が16cm2以下の場合, 進行癌の占める割合は下部胃癌15/102 (14.7%), 中部胃癌19/73 (26.0%), 上部胃癌18/33 (54.5%) と上部胃癌で有意に高く, 同じ大きさの胃癌であっても胃上部の癌はより進行した癌が多かった. さらに, 全摘胃を用いて粘膜筋板の厚さを胃の各部位ごとに測定したところ, 胃上部ほど粘膜筋板は薄く, 粘膜筋板が癌の壁深達に何らかの関わりをもっている可能性が示唆された.

Circulatory hemodynamic changes in the early dumping syndrome

ConclusionsIt seemed that the early dumping syndrome might occur in patients with unstable vegetative nerves and psychoneurotic characters, who sensitively responsed to altered blood flow in various parts of the body and a reduction in circulating blood volume, which was thought to arise from the rapid influx of the hypertonic foodstuff into the jejunum. As the surgical treatment, we emphasized the excellent effect of Tomoda’s gastrectomy for the prevention of the early dumping syndrom.