Shigeo Sawai

Total colectomy, mucosal proctectomy, and ileoanal anastomosis

A safe and practical procedure for total colectomy and mucosal proctectomy with ileonal anastomosis has been developed and performed by us on 11 patients with adenomatosis coli and two patients with ulcerative colitis. The major features of the operative procedure are 1) total removal of the rectal mucosa to just above the dentate line; 2) preservation of anorectal function by a long rectal cuff procedure achieved by rectal mucosal excision from a level just below the sacral promontory, using a rectal internal stent and gauze packing techniques for rectal mucosal stripping, with, in some patients, an ileal reservoir added; and 3) prevention of pelvic sepsis by intraoperative rectal irrigation, rectal cuff drainage, and a temporary defunctioning loop ileostomy. Of six patients with at least three months of follow-up after reconstruction, each has returned to normal life, averaging two to seven semiformed stools each day. A side-to-end ileoanal anastomosis with a lowlying, loop-type ileal reservoir provided the best functional results.

Omental bleeding with spontaneously derotated torsion--a case report.

A case of omental torsion seen in a 16 year old male is reported herein. Abdominal pain in the right lower quadrant suddenly developed just after the patient twisted his waist and an emergency laparotomy revealed a hemorrhagic mass at the edge of the right omentum, which was excised. Histological examination of the resected specimen showed hemorrhage without any venous thrombosis or infarction, possibly suggestive of omental torsion with early spontaneous derotation. The patient was successfully treated as a case of omental torsion.

Clinical trials of long-term RF local hyperthermia for advanced gastric cancer

The effect of local hyperthermotherapy (HT) using 13.56-MHz radiofrequency (RF) capacitive heating was evaluated in 25 patients with unresectable or recurrent gastric cancer. HT was carried out once to 3 times a week for a duration of one hour at each session. Patients who underwent RF-HT frequently showed maintenance of performance status, symptomatic improvement and a reduction in tumor size. Moreover, the survival time of 9 patients who had numerous metastases to the distant perioneum was significantly high (p<0.01), compared with 42 historical control patients who also had massive peritoneal dissemination, but had not received HT. The results of this study therefore indicate RF-HT to be a favorable modality in the palliative treatment of patients with far-advanced gastric cancer.

Histology of the healing process after total colectomy, mucosal proctectomy and ileo-anostomy

Total colectomy, mucosal proctectomy and ileo-anostomy were performed on 10 dogs to observe the healing process of the space between the rectal muscle cuff and the pulled through ileum. Adhesion was complete in six cases. The ileal and rectal muscle layers were well preserved, but two weeks after the surgery the healing was not completed. One month after the operation, there was little scar formation between the rectal muscle cuff and the ileum, in the absence of infection. If there was infection between the ileum and the rectal muscle cuff, abscess and scar formation was seen even one month after the operation. This operation is thought to be rational from a histological viewpoint and the most important factor is the prevention of infection in the space between the ileum and rectal muscle cuff.

Comparison by carcinoembryonic antigen doubling time of hepatic injection and infusion for unresectable hepatic metastasis from colorectal cancer

This study explored the efficacy of hepatic arterial therapy, comparing both injection and infusion of 5-fluorouracil (5-FU) in prolonging the survival of 92 patients with recurrent unresectable hepatic metastasis from colorectal cancer. With respect to pretreatment carcinoembryonic antigen doubling time (CEA-DT), 56 patients were treated with intra-arterial injection, and 36 with intra-arterial infusion. In 21 patients with a CEA-DT of less than 40 days, the cumulative survival of patients treated with arterial injection was significantly longer than that of patients treated with arterial infusion. In 45 patients with a CEA-DT of 40-80 days, the survival curves of patients did not differ from each other. Of the remaining 26 patients with a CEA-DT of more than 80 days, those treated using arterial infusion had an excellent prognosis, in contrast to those treated using arterial injection, with statistical significance. CEA-DT may be useful when choosing a chemotherapy regimen, and may help to accurately establish the prognosis of patients with unresectable hepatic metastasis from colorectal cancer.

Effect of Intra-Arterial Injection of Mitoxantrone-Lipiodol Emulsion on Hepatocellular Carcinoma

The effect of intra-arterial injection of mitoxantrone emulsified with ethiodized oil was investigated in 24 patients with hepatocellular carcinoma. After treatment, 6 of the patients underwent hepatectomy. In 18 unresected cases, there were 8 (44%) partial responses, which had continued 2 to 10 months (mean, 7.4 months). In the remaining 6 resected cases, the necrotic areas in the main nodules accounted for 65% (mean, 85%) of the nodule, with complete necrosis in three cases. The results in this preliminary study are encouraging to further study.