Shoichi Onoda

Evaluation of treatment for gastric cancer with liver metastasis.

In 161 cases of gastric cancer with liver metastasis but without peritoneal dissemination, evaluations were executed to find effective treatment. The most favorable results with best prognosis were obtained in the group receiving gastrectomy + hepatectomy + chemotherapy, followed by gastrectomy + chemotherapy, and gastrectomy alone. The most unfavorable outcome was in nonresected cases. Chief chemotherapy to be used after gastrectomy was FML (5‐fluorouracil (5‐FU) + mitomycin C [MMC] + lentinan) continuous intra‐arterial infusion. Hepatectomy was found to be effective as an active measure for tumor reduction in cases of liver metastasis so far as the metastatic lesions are only a few scattered ones in both lobes.

Studies on the causes of deaths from esophageal carcinoma

Statistics on the causes for deaths of 638 patients operated on in our department for resection of cancer of the intrathoracic esophagus (squamous cell carcinoma) during the period from 1959–1979 showed that the major causes for direct operative deaths were pyothorax, pulmonary complications, failure of the sutures, and postoperative hemorrhage. Among operation survivors, recurrence was the most frequent cause of death, responsible for the deaths of as many as 80% of less‐than‐five‐year survivors; and recurrence in the cervical, supraclavicular fossa, and superior mediastinal lymph nodes and that in the other organs were the frequent causes for the deaths of two‐ to three‐year survivors. Pulmonary complications were the causes for the deaths of 50%, and recurrence for the deaths of 30% of five‐ to ten‐year survivors. Recurrence in the digestive organs other than the esophagus and cardiovascular diseases were the frequent causes for the deaths of more‐than ten‐year survivors, while none of these survivors died of recurrence.

The treatment of lymph node metastasis from esophageal cancer by extensive lymphadenectomy

During the period between 1965 and the end of 1988, 560 patients with esophageal cancer were surgically treated in our University hospital. In an attempt to improve patient survival, three-field lymphadenectomy of the bilateral neck, mediastinum and abdomen was performed in 117 patients treated since 1983. The present study was undertaken to reveal the substantial rate of lymph node metastasis in esophageal cancer and to decide if three-field lymphadenectomy is mandatory or not for surgery of esophageal cancer. Despite the increased radicality of the operation, the mortality and morbidity rates decreased in the 1980s compared to the earlier periods, the operative death being 12.5 per cent in the 1960s, vs. 2.0 per cent in the 1980s. Moreover, the mortality rate of the patients receiving the three-field lymphadenectomy was as low as 2.6 per cent. The metastatic rate of cervical nodes in the patients receiving three-field lymphadenectomy was 32.5 per cent, while that of mediastinal and abdominal nodes was 47.0 per cent and 46.0 per cent respectively. The metastatic rate in the mediastinum was high in the bilateral recurrent nerve lymph nodes, bifurcation nodes and paraesophageal nodes, while in the abdomen, it was high in the bilateral paracardial nodes. Recurrent nerve paralysis, which had been rarely seen was observed in 12.0 per cent of the patients. Metastasis from esophageal cancer is often seen in the cervical nodes, however, the clinical importance of three-field lymphadenectomy will be decided by the data of patient survival in the near future.

The prognostic significance of resection of primary tumor in gastric and colorectal cancer patients with synchronous liver metastasis.

The significance of primary tumor resection in gastric and colorectal cancer patients with liver metastasis (H(+)) was evaluated in terms of operative mortality and survival rate by dividing the materials [293 gastric cancer and 80 colorectal cancer patients (53 colon and 27 rectum) with synchronous liver metastasis] into the following groups: Firstly, with or without peritoneal dissemination (P), secondly, with or without resection of the primary tumor and thirdly, with or without postoperative adjuvant chemotherapy. The following results were obtained: (1) The direct operative death rate of primary tumor resection, excluding death from other causes, showed an absence of statistically significant differences between the P0H(+) and P(+)H(+) gastric and colorectal cancer patients. (2) There was no significance in the prognosis between the primary tumor resection + postoperative chemotherapy group and the non-resectable group in the P(+)H(+) gastric and colorectal cancer patients, revealing no prognostic value of the primary tumor. (3) In the P0H(+) gastric and colorectal cancer patients, the primary tumor resection + postoperative chemotherapy group was significantly more favorable in prognosis than was the primary tumor resection alone group or the non-resectable group, showing the value of primary tumor resection.

Granular cell tumor of the esophagus —report of a case and review of the literature—

We report herein a case of a 46 year old man presenting with a gastric ulcer in whom an endoscopy happened to detect an elevated lesion in the lower esophagus. Endoscopic biopsy proved sufficient for determining the diagnosis of a granular cell tumor (GCT). Electron and microscopic studies suggest that GCT are derived from Schwann cells. Although commonly found in the tongue and skin, GCT are rarely seen in the gastrointestinal tract, especially in the esophagus. However, advances in endoscopic techniques will increase the opportunity of detecting GCT of the esophagus.

CLINICAL AND EXPERIMENTAL STUDY OF BESTATIN FOR ESOPHAGEAL CANCER

Publisher Summary This chapter describes a clinical and experimental study of bestatin for esophageal cancer. The schedule of preoperative combined therapy for patients with esophageal cancer in department is shown. It was found that although irradiation and bleomycin were principally administered at the end of routine examination upon admission, the immunotherapeutic agent was given at the moment of admission and the dose of bestatin was 30 mg/day from admission to the day before surgery. The effectiveness was evaluated clinically according to radiographic features observed 7–10 days after the end of preoperative combined therapy in comparison with those observed upon admission. The total dose of bleomycin was 100 mg and that of bestatin was approximately 1000 mg though it was influenced by the duration from admission to surgery. After such preoperative treatment, the surgically resected specimens were investigated histopathologically for therapeutic effects and all revealed an effectiveness of Ef2, 3. It was found that the effective rate was 100% and more than 2/3 of cancer cells went into degeneration and necrosis.

A surgically recovered case of spontaneous rupture of the esophagus. —The significance of preoperative esophagoscopy for direct sture—

A 65-year-old man with spontaneous rupture of the esophagus survived with a direct suture of the esophagus 15 hours after the onset of symptoms. Endoscopic examination of the esophagus was especially of great help in determining the surgical procedure in this patient, and we want to stress the importance of prompt diagnosis and immediate surgery for this disease.

Protection against suture insufficiency in ante-thoracic esophagogastrostomy

In attempts to decrease suture insufficiency in case of antethoracic esophagogastrostomy, a gastric tube was so specially prepared that the short gastric vessels as well as the splenic vessels were severed very adjacent to the spleen. The anastomosis of the gastric tube thus prepared to the cervical esophagus was made using EEA-autosuture instruments. The suture insufficiency rate was thus markedly improved, with a value of aproximately 10 per cent. Even cases of suture insufficiency with minor leakage, control was complete with simple pressure with gauze.

Multidisciplinary Treatment for Intrathoracic Esophageal Cancer: CDDP Plus Irradiation

At the present time, in an attempt to improve the patient survival rate of esophageal cancer, our operative procedure for the disease consists of thoracic esophagectomy via right thoracotomy followed by esophagogastrostomy along with lymph node dissection of the three areas of the neck, thorax, and abdomen [1].

Evaluation of Preoperative Stage of Esophageal Cancer by Endoscopic Ultrasonography

Esophagography and endoscopy have long been used for evaluation of patients with esophageal carcinoma. Recently these have been supplemented by computer tomography, magnetic resonance imaging, and endoscopic ultrasonography (EUS). Our institution has shown great interest in EUS because of its high degree of sensitivity in small lesions and its accuracy in the preoperative staging of esophageal carcinoma.