Tetsuji Sasaki

Treatment of esophageal cancer in patients over 80 years old

A total of 828 patients with esophageal cancer were treated at the Second Department of Surgery of Tokai University in the 20-year period from 1975 to June 1994, including 45 patients over 80 years old. We reviewed these elderly patients to assess the optimum therapeutic approach for such individuals. In recent years, the number of elderly patients with esophageal cancer has steadily been increasing. Advanced cancer is more common among this group, but early cancer has also been detected more frequently in recent years. Of the 45 elderly patients (80%) in our series, 36 were encountered in the last 10 years. As 28.9% of the patients had multiple cancers, a careful workup was necessary preoperatively. Since most patients (88.9%) had complications and were also in a poor general condition, limited surgery was recommended in consideration of the postoperative quality of life. The indications for endoscopic mucosal resection (EMR) may be able to be extended to submucosall (sml) cancer without lymph node swelling. Postoperative complications occurred in 60% of those undergoing surgical resection or esophageal bypass, although death only resulted in 1 case. The 5-year survival rate after surgical resection was 30.8%. These results therefore support the use of surgical treatment for selected elderly patients with esophageal cancer.

Treatment of So-Called Early Esophageal Carcinoma

Recently, in Japan, progress has been made in the diagnosis of esophageal carcinoma. Increasing numbers of superficial and early stage lesions are being detected. A preoperative diagnosis defines so-called early esophageal carcinoma as being a lesion having pT1, pNO, and pMO [1]. Based on our study of 32 cases in the past 10 years, we will discuss the different therapeutic modalities and their results. We will also provide an overview of the current status of the therapeutic approach for superficial esophageal carcinoma in Japan.

Diangosis of Strangulated Small Bowel Obstruction. Efficacy of Enhanced CT Scanning.

過去10年間に当教室では25例の絞扼性腸閉塞腸切除症例を経験した.この25例を壊死群 (20例), 非壊死群 (5例) の2群に分類し対比検討を行った.2群間の自他覚所見, 血液生化学所見, 臨床所見で比較検討したが, 両群間には有意な差を認めなかった.絞扼性腸閉塞7症例を含む計12例の腸閉塞のenhanced computed tomography (CT) 像の対比を行った.絞扼部壊死腸管のenhanced CT上の特徴的所見は,(1) 腸管壁の肥厚 (4mm以上),(2) ケルクリング皺壁の消失,(3) 腸管の口径が小さい (40mm未満),(4) 腸管内ガスの消失,(5) 腸間膜のdensityの上昇などの所見があげられ,(6) 腸管壁の不鮮明なenhancement (blurred enhancement),(7) 腸管内容のdensityの上昇 (出血, CT number+30HU以上) がより進行した所見と考えられた.以上より絞扼性腸閉塞の術前診断には腹部所見, 単純X線所見, 腹部超音波所見などに加え, enhanced CT所見がその補助診断として積極的に導入されるべきであると思われた.

Evaluation of Preoperative Irradiation Therapy for Carcinoma of the Esophagus

Prognosis of 43 patients with esophageal squamous cell carcinoma with pre-operative irradiation and that of 50 patients by surgical excision alone were compared by five year survival rate. The pre-operative radiation treatment comprised a daily doses of 2 Gy. given for consecutive days, up to total dosage of 40 Gy. (T.D.F.66). The operative excision was done two weeks after the the completion of the radio-therapy. In early cases (st. I, II), five year survival rate of the pre-operative irradiation group was 59.8% and 74.2% for surgical treatment alone group. In advanced cases (st. III, IV), the radiation group and surgical treatment alone group showed 21.8% and 15.1% respectively. Among advanced cases, the result in relation to the location of tumor in the esophagus was studied. In the cases which the tumor was located at the upper and middle intra-thoracic esophagus, five year survival rate in pre-operative radiation group was 21.4% versus no survivor in surgical excision alone. In contrast, five year survival rate was better by surgical treatment alone among these advanced cases located at the lower esophagus. The pre-operative irradiation treatment is indicated for esophageal cancer which is advanced and located in the upper and middle intra-thoracic esophagus.

A huge villous tumor of rectum: a case report.

SummaryVillous tumor of the large intestine was first identified and named by Holmes in 1858. It is said to account for 1.4 to 2.5 per cent of all tumors of the large intestine, but only sporadic cases have been reported in Japan. Although considerably large villous tumors are known to exist, reports refering to them, home and abroad, show that there are no more than 50 known cases which had diameters exceeding 10 cm1). This paper presents one of our recent experience of the tumor whose diameter reached 20 cm.