Toru Nagashima

Preoperative chemotherapy for advanced esophageal cancer and relation with histological effect

The results of surgical treatment for advanced esophageal cancer remain extremely poor. Irradiation and chemotherapy are not superior to surgery. Perioperative morbidity and the influence on long-term survival of a combination of surgery and preoperative chemotherapy were investigated in patients with advanced esophageal cancer. Forty-nine patients with advanced esophageal squamous cell carcinoma were subjected to preoperative chemotherapy of cisplatin-5-fluorouracil. Fifty-seven patients were chosen as a historical control group who had not undergone chemotherapy before surgery but had the same histological stages as the chemotherapy group. The response to chemotherapy was assessed by histological studies of surgical specimens. The survival rates noted no significant difference between preoperative chemotherapy plus surgery and a resection alone. However, subclassification according to the grading of chemotherapeutic effectiveness showed that, compared with control, preoperative chemotherapy was beneficial to high responders (P=0.01), ineffective in low responders (P=0.61), and detrimental to nonresponders (P=0.03). Postoperative morbidity was significantly higher in the chemotherapy group than in the control group (P=0.02). These findings suggest that preoperative chemotherapy is necessary only for high responders and we therefore need to reliably identify non-, low, and high responders before chemotherapy to improve the survival and quality of life of patients with advanced esophageal cancer.

Clinical problems of surgical treatment for biliary tract cancer with special reference to the mode of reccurence and the factor of non curative resection.

胆道癌228例について非治癒切除となった要因, 治癒切除後の再発様式について検討した. 切除率は胆管癌75%, 胆嚢癌55%, 乳頭部癌86%であるが, 治癒切除率はそれぞれ47%, 26%, 83%と乳頭部癌を除き低率である, 胆管癌では上部, 中部で非治癒切除となる例が多くその要因はhw (+), ew (+) で, 治癒切除後の再発死19例中14例が肝管断端再発である. 胆嚢癌の非治癒の要因はhw (+), bw (+), ew (+), N>R (+) が多く, 治癒切除後の再発死7例中4例が肝門部再発である. 乳頭部癌は治癒切除後再発死6例中3例が肝再発3例がリンパ節再発であった. 胆管癌, 胆嚢癌ではpn (+) が再発の大きな要因となっており十分な胆管切除が, 乳頭部癌では適切な郭清と化学療法が必要と思われた.

The clinical significance of ultrasonicaliy guided puncture of the gallbladder for the cases of non-visualized gallbladder by oral cholecystography and intravenous cholangiography.

胆嚢疾患に対して施行した排泄性胆道造影法の成績を検討し, さらに高率に認められる胆嚢像陰性例に対して, 超音波誘導下の胆嚢穿刺術の有効性について報告する.(1) 胆嚢疾患148例に対して排泄性胆道造影法を施行するに胆嚢像陰性例は102例 (68.9%) と高率に認められた.(2) 胆嚢像陰性例を中心に胆嚢穿刺術を行い145例中138例 (95.2%) に明瞭な胆嚢像を得た.(3) 胆嚢癌34例に対する吸引細胞診の成績は34例中28例 (82.4%) の診断率であった.(4) 胆嚢胆汁CEA濃度は良悪性鑑別の補助診断に成り得る.胆嚢穿刺術は胆嚢癌の早期発見および良悪性の鑑別診断に有効であり, とくに胆嚢像陰性例に対して不可欠の検査法である.