Tokio Okusa

Jejunal pouch reconstruction after total gastrectomy for cancer. A randomized controlled trial.

ObjectiveThe authors determined the optimum reconstruction procedure after total gastrectomy in terms of the quality of life of the patients. Summary Background DataGastric replacement with various enteric reservoirs has been used to improve the postprandial symptoms and nutrition of patients after total gastrectomy. However, the effect of each is uncertain because no prospective randomized studies have been conducted. MethodsA randomized controlled trial was conducted to compare the usefulness of the three reconstruction procedures of simple Roux-en-Y (RY; N = 10), pouch and Roux-en-Y (PR; N = 10), and pouch and interposition (PI; N = 10). In each subject, the postprandial symptoms, food intake in a single meal, body weight, serum nutritional parameters, and emptying time of the gastric substitute were evaluated. ResultsThe PR group showed significantly greater food intake in a single meal than the RY and PI groups, and greater weight recovery than the PI group. A gastric emptying test also revealed satisfactory retention capacity and emptying time of the gastric substitute in the PR group. ConclusionsPouch and Roux-en-Y reconstruction is the most useful of the three procedures for improving the postoperative quality of life. In patients with pouch and interposition reconstruction, the clinical assessment was quite poor, even though it is a physiologic route.

Correlation of preoperative carcinoembryonic antigen levels and prognosis of gastric cancer patients

Background. The prognostic significance of preoperative serum carcinoembryonic antigen (CEA) determination in patients with gastric cancer has been controversial.

Jejunal Pouch and Interposition Reconstruction After Total Gastrectomy for Cancer

The authors modified the operative procedures used in pouch and interposition (PI) reconstruction in an attempt to improve the surgical results after a total gastrectomy, because a randomized controlled trial had revealed that the clinical assessment of PI was quite poor, even though it is a physiological route. In most of the treated patients, the gastric emptying test revealed delayed emptying, and an X-ray video film showed folding and twisting of the jejunal conduit between the pouch and duodenum, which disturbed the transmission of the nutrition. Modified PI (m-PI) was performed by decreasing the length of the jejunal conduit and widening the jejunal pedicle to preserve the blood and nerve supply. The m-PI group showed a lower incidence of symptoms, a greater food intake, and a greater weight recovery than the PI group. The gastric emptying test also revealed an acceptable degree of emptying. We conclude that the m-PI reconstruction is more useful for improving the postoperative quality of life than the previously used method of PI reconstruction.The authors modified the operative procedures used in pouch and interposition (PI) reconstruction in an attempt to improve the surgical results after total gastrectomy, because a randomized controlled trial had revealed that the clinical assessment of PI was quite poor, even though it is a physiological route. In most of the treated patients, the gastric emptying test revealed delayed emptying, and an X-ray video film showed folding and twisting of the jejunal conduit between the pouch and duodenum, which disturbed the transmission of nutrition. Modified PI (m-PI) was performed by decreasing the length of the jejunal conduit and widening the mesenteric pedicle to preserve the blood and nerve supply. This procedure was retrospectively compared with the previously used PI reconstruction by evaluating the postprandial symptoms, food intake, body weight, serum nutritional parameters, and emptying time of the gastric substitute. The m-PI group (n=6) showed a lower incidence of symptoms, a greater food intake, and a greater weight recovery than the PI group (n=6). The gastric emptying test also revealed an acceptable degree of emptying. We thus conclude that the m-PI reconstruction is more useful for improving the postoperative quality of life than the previously used method of PI reconstruction.

HLA-DR Expression on Cancer Cells and T Cell Reaction in Colorectal Carcinoma

60 cases of colorectal adenocarcinoma were immunohistochemically examined to clarify the relationship between HLA - DR expression on tumor cells and T cell infiltration. The more HLA-DR+ cancer cells in the carcinoma tissue increased, the more T cells tended to aggregate in both the infiltrating front of cancer tissue and the intracarcinomatuos stroma. We speculate that HLA - DR antigen on cancer cells might be immunoreactive and seems to be closely related with the cellular immunity in colorectal carcinoma.

Clinicopathological Study of Lymph Node Metastasis for Early Gastric Cancer.

早期胃癌351例を対象としリンパ節転移から見た縮小手術の適応について検討を行った. リンパ節転移率はm癌5.4%, sm癌18.0%であり, 各臨床病理学的因子別にみてもsm癌で転移率は高い傾向があった. 多変量解析数量化II類を用いた検討では, リンパ節転移に関与する重みは腫瘍径, 組織型, 肉眼型で大であり, 深達度, 術前CEA値, 占居部位では小さかった. リンパ節転移の高い因子は腫瘍径4cm以上, 組織型por, 肉眼型は進行癌型, 隆起+陥凹型で, 低い因子は組織型tub1, 肉眼型は平坦型, 腫瘍径3cm以下であった. 各症例の転移の有無を判別点で決め, 組織学結果と比較検討すると, 正診率は71.7%であった. 判別点以下の症例を縮小手術の対象とするが, por, UI (+) 例は転移例があり注意が必要であった. 数量化II類を用いた判定は縮小手術を考慮する上でひとつの良い指標になると考えられた.

Comparison between the general rules for the gastric cancer study in japan and the new TNM classification of stomach cancer by the UICC.

1) 日本の胃癌取扱い規約と新TNM分類との比較検討を行った, 両規約の定義には微妙に相違があるものの実際上はほとんど差を認めず, 日本のデータを容易に新TNM分類に翻訳可能と考えられた.2) 両群とも胃癌の予後判定に有用な指標であると思われた. ただ新TNM分類では予後的漿膜面因子評価の概念が取り入れておらず将来何らかの形で考慮が必要と思われた.3) 新TNM分類は生存率の良いものから順に並ベグループ分けを行っているが, 生存率というものは治療の進歩によって変わりうるものであり, この点が問題と思われた.4) 胃癌取扱い規約のstage IV症例には大きく予後の異なる組合せが含まれている. これをさらに亜分類する必要があることは一般に認められているが, どういった亜分類を用いるかは結論がでていない. しかしこうした観点からはT4の症例の一部をstage III扱いとした新TNM分類は優れた分類と思われた.

Relationship between histologic type and metastatic patterns of lymph nodes in early gastric cancer.

リンパ節郭清の立場から早期胃癌193例 (m癌86例, sm癌107例) とpm癌81例み対象として, 深達度および組織型別に転移リンパ節の個数ならびに転移リンパ節の浸潤様式にどのような差があるかについて検討した. m, sm, pm癌のリンパ節転移率はそれぞれ7%, 19%, 44%であった. 平均転移リンパ節数は深達度に比例して増加し組織型別では早期胃癌に関しては分化型に多い傾向がみられた. また転移リンパ節の浸潤様式については深達度が増すにつれて1型 (辺縁洞型) が少なくなりII型 (髄内洞型), III型 (全域型) が増加した. 組織型別では分化型に1型は少なく, II, III型が高率であった. 以上の成績より早期胃癌のうち分化型癌は転移リンパ節数が多く, リンパ節転移程度も強いため術中操作の際には転移リンパ節からの2次的波及予防に注意を要する.