T. Kawano

Analysis of 1.125 cases of early esophageal carcinoma in Japan

A total of 1.384 Tl and Tis cases of cancer of the esophagus resected between January, 1984 and December, 1989 at 208 institutions throughout Japan were analyzed. Of these, 1.123 (71%) were classified as stage 1 carcinoma (Tl N0 MQ) and stage 0 carcinoma (Tis N0 MQ), and studied according to various factors. The long-term results in Tl and Tis cancer were examined: the presence or absence of lymph node metastasis, m cancer and sm cancer and lymph vessel invasion, showed significant differences in respect of the five-year survival rate. The low incidence (4%) of lymph node metastasis in m cancer suggests that it can be considered as true early cancer, treatable for cure.

Intestinal metaplasia at the esophagogastric junction in Japanese patients without clinical Barrett's esophagus.

Objective:The significance of intestinal metaplasia found in biopsy specimens taken from healthy appearing squamocolumnar junction is unclear. The aim of the present study was to investigate the prevalence of intestinal metaplasia at the esophagogastric junction in Japanese patients with no clinical diagnosis of Barretts esophagus.Methods:A total of 103 specimens from consecutive surgeries were studied. All subjects underwent surgical resection for squamous carcinoma of the esophagus. Microscopic examination was performed from the squamocolumnar junction to 4 cm distal to the squamocolumnar junction. The extent of intestinal metaplasia was investigated in detail. Microscopic columnar-lined esophagus was defined as columnar epithelium with esophageal-type submucosal glands.Results:The extent of intestinal metaplasia varied and was usually identified at intervals. Intestinal metaplasia exactly at the squamocolumnar junction was identified in 29 of 103 specimens (28%). Microscopic columnar-lined esophagus was identified in five of the 103 (5%), four of which had intestinal metaplasia in the columnar-lined esophagus.Conclusion:Intestinal metaplasia occurs frequently in the region of the esophagogastric junction in Japanese patients with squamous cell cancer of the esophagus.

Local treatment of oesophageal cancer

The indications for curative endoscopic resection of oesophageal cancer are as follows: (1) mucosal cancer without gross invasion to the muscularis mucosae; (2) less than 2 cm × 2 cm in size or less than a third of the circumference of the oesophagus; (3) absence of recognizable nodal involvement. In our department, a small transparent cap is attached to the distal part of the forward-viewing endoscope. The snare forceps is passed through the working channel of the endoscope and is opened in the cap. The protruding mucosa is then snared into the cap by the suction mechanism of the endoscope. Endoscopic resection was performed in 40 cases. In all instances a complete response was obtained locally. There were a few post-operative complications. The 5 year survival rate was 95% and no recurrence has been observed.

3447 Ultra-high magnification endoscopy for early stage esophageal cancer.

For purpose of evaluating characteristic microstructure of the early-stage esophageal cancer, ultra-high magnification endoscopic examination was introduced as pretherapeutic in vivo study. Methods: Ultra-high magnification endoscopy (UHME, Q240Z, Olympus, Tokyo) can vary its magnifying rate from eight times to one hundred and fifty times. High-quality pictures can be constantly obtained by attaching a 2-mm depth soft distal attachment onto the tip of UHME. Results: Vascular architecture can be continuously visualized starting from submucosal vein through proper mucosal layer, configurating characteristic fine-vascular network pattern, to intrapapillary capillary loop (IPCL) in the epitherium, which can never be observed during traditional magnifying endoscopic examination with maximal thirty-five magnifications. 0-IIc lesion that was usually observed as a well demarcated red patch, are revealed to be a composite of scattered red dots and a pink homogenous background. Those red dots are disclosed to be changes of IPCL such as dilatation, weaving, irregularity of caliber, which are never observed in normal and esophagitis mucosa. Infiltration depth of the lesions was clearly demonstrated as elongation and destruction of IPCL. We observed one hundred and twelve cases, and overall accuracy was 75%. Conclusion: By utilizing UHME, authurs succeeded to disclose various novel knowledge of microstructure in early esophageal cancer. This information is essential to pre-therapeutic diagnosis.

Value of Postoperative Continuous Measurement of Tissue Oxygen Tension in Microvascular Free Jejunum Transfer for Reconstruction of Hypopharynx and Cervical Esophagus

Free jejunum transfer for reconstruction of hypopharynx and cervical esophagus is now widely used and its safety appears established. But microvascular anastomotic occlusion is still a serious early postoperative complication and if not detected earlier and managed properly, permanent graft loss is inevitable. Therefore, postoperative continuous measurement of tissue oxygen tension (PtO2) was made to assess the viability of the graft.