Toshiharu Tsuzuki

Predictive factors for long term prognosis after partial hepatectomy for patients with hepatocellular carcinoma in Japan. The liver cancer study group of japan

Background. Great progress in the diagnosis and surgical treatment of hepatocellular carcinoma (HCC) has led to an increased number of resectable cases. Much attention has been paid to the factors affecting long term survival of patients with HCC after partial hepatectomy.

A Prospective Randomized Trial of the Preventive Effect of Pre‐operative Transcatheter Arterial Embolization against Recurrence of Hepatocellular Carcinoma

To clarify whether pre‐operalive transcatheter arterial embolization (TAE) improves survival after hepatectomy, a prospective randomized comparative study was done. Of a total of 115 registered patients having solitary hepatocellular carcinoma (HCC) 2 to 5 cm in diameter, 18 (15.7%) were excluded after randomization. As a result, 97 patients were chosen as subjects and divided into two groups: hepatectomy with (group A: n = 50) and without (group B: n=47) pre‐operative TAE. The period of observation of the patients who survived the surgery was between 4.0 and 6.6 years. The randomization appeared to have provided well‐balanced groups of patients and the clinico‐pathological characteristics of the two groups were quite similar. The necrotic part of the cancerous lesions, as confirmed by operative specimens, amounted to 74.8 ±33.4% (mean±SD) in group A and 6.8 ±7.2% in group B (P<0.01). However, the cancer‐free survival rates after hepatectomy in both groups showed little difference (39.1±7.0 (%±SE) and 31.1±0.1, respectively). We speculate that TAE is not effective against such HCC accessory lesions as minute intrahepatic metastasis and tumor thrombus and that pre‐operative TAE does not improve post‐operative survival.

The long-term survival of patients with carcinoma of the main hepatic duct junction.

Carcinoma of the main hepatic duct junction tends to invade extensively the bile ducts and hepatic parenchyma, although dissemination is rarely seen. Therefore, extensive resection of the bile ducts combined with hepatic resection is the procedure of choice for treating this disease. From January 1973 to January 1987, 23 of 41 patients underwent resection, giving a resectability rate of 56%. One patient died postoperatively, yielding an operative mortality rate of 4.3%. The 5‐year actuarial survival rate is 29.8%. Three patients are now alive and well 6 years and 9 months, 5 years and 10 months, and 5 years and 5 months after the operation. One additional patient who underwent resection in an affiliated hospital has done well for 8 years and 8 months. The results from these four patients treated by curative resection support a strategy featuring curative resection with aggressive surgery.

Transcatheter hepatic arterial chemoembolization using epirubicin-lipiodol: experimental and pharmacological evaluation.

SummaryThe experimental and pharmacological characteristics of various formulations of an anticancer agent (epirubicin, EPI) and lipiodol were evaluated in vitro and in vivo. Three forms of EPI-lipiodol, i.e., an oil-in-water type of emulsion (O/W type), a water-in-oil type of emulsion (W/O type), and a suspension (S type), were prepared and investigated for their stability. An O/W-type emulsion using a stock solution of Iopamidol as the solvent for EPI was the most stable form in the stationary state in vitro. In 16 patients with malignant liver tumors (14 hepatocellular carcinomas and 2 liver metastases), the three forms of EPI-lipiodol were injected into the proper hepatic artery. The plasma EPI level was monitored periodically and analyzed pharmacokinetically. No significant difference in the pharmacokinetics of EPI was detected among the O/W, W/O, and S types.

Postresection autopsy findings in patients with cancer of the main hepatic duct junction.

Extensive resection of the bile ducts combined with hepatic resection is the procedure of choice for carcinoma of the main hepatic duct junction. Currently this procedure is done without great risk, and increasing long‐term survival is now the issue. For this purpose, it is necessary to elucidate the biologic properties of the cancer to take reasonable measures. Autopsy findings of patients who died of recurrence may offer a reliable guide. Autopsy findings were studied in 14 patients: eight who had undergone curative resection and six who had received noncurative resection. Cancer recurred at the liver hilum with invasion into adjacent organs. Peritoneal dissemination and lymph node metastases were infrequent. These were common findings in both curative and noncurative resection groups. Cancer cells in the connective tissue of the hepatoduodenal ligament may play a major role in recurrence.

Long-term survival of patients with hepatocellular carcinoma combined with liver cirrhosis. Report of two patients.

Two patients with hepatocellular carcinoma combined with liver cirrhosis lived more than 5 years after hepatic resection. One patient with liver cirrhosis combined with schistosomiasis japonica survived 5 years and 2.5 months after left lobectomy and died of liver failure. Two recurrent tumors, each 1 cm in diameter, were present in the remaining lobe but were not responsible for death. Another patient is well 9 years and 2 months after extended right lobectomy. The tumor was bulky, and the resected specimen was 2800 g in weight. These facts show that patients with hepatocellular carcinoma combined with liver cirrhosis can survive for a long period even if a large tumor is involved.

Recent trends in treatment of TS1 carcinoma of the pancreas

Between July 1974 and June 1994, we resected ductal cell carcinoma of the pancreas in 149 patients. From their formalin-fixed specimens, we selected those of 19 patients with tumor size (TS)1 pancreatic cancer of, at most, 2 cm in maximum diameter. All the patients had cancer in the head of the pancreas. The chief complaint on presentation at the hospital was jaundice, in 17 of 19, the majority of patients. According to the pTNM, 4 were stage I, 1 was stage II, 13 were stage III, and 1 was stage IV. Thus, the majority of the patients had progressive cancer. Pancreatoduodenectomy was employed in 10 patients, pancreatoduodenectomy with resection of the portal vein in 7, and total pancreatectomy with resection of the portal vein in 2. D2 dissection was performed in all of these patients. Since 1985, intraoperative irradiation has been performed in 5 patients, and since 1986, the continuous administration of 5-fluorouracil by portal catheterization through the ligamentum teres hepatis has been performed in 6 patients. We compared the pathern of recurrence in the patients treated before 1985 (1974–1984), was intraoperative irradiation was initiated, with that in patients treated in 1985 and later (1985–1994). There were no effects of intraoperative irradiation on local recurrence. The incidence of hepatic metastases was significantly lower in the patients treated by portal catheterization in the latter period. There were four 5-year survivors; the overall 5-year survival rate in the 19 patients was 33%, and the mean survival period was 39 months.

Clinical Implification of Molecular Biological Parameter for Prognostic Factor in Digestive Organ Cancer.

消化器癌における分子生物学的パラメーターの予後因子としての有用性を明らかにすることを目的として, 癌遺伝子増幅の有無と予後や再発など癌患者の臨床像との関連を解析した.その結果食道癌では, int-2およびc-erb B癌遺伝子増幅が, 胃癌ではint-2およびc-erb B-2癌遺伝子増幅が高率に認められたが, 大腸癌や肝細胞癌では, いずれの癌遺伝子も増幅頻度は10%以下であった.食道癌, 胃癌ではint-2増幅群で術後累積生存率が低下し, さらに食道癌では遠隔臓器転移が, 胃癌では腹膜転移と遠隔臓器転移が非増幅群に比較して有意に高率であった.c-erb B癌遺伝子増幅は食道癌で高率にみられたが, これらの症例ではいずれも手術時にリンパ節転移がみられ, しかも術後5年生存率は低下していた.以上, 分子生物学的手法により癌遺伝子増幅を検索することにより, 癌患者の治療上重要な情報を得ることが可能であり, 有用な腫瘍マーカーであることが明らかにされた.

Study of a method for esophagography and its clincial value

Subjects of the present investigation are 20 control cases free from upper gastrointestinal diseases and nine cases with achalasia. Intraluminal pressure of the esophagus was measured with the use of an open-tip method. In the control cases, presence of W-shape pattern with three high pressure zones and two low pressure zones were verified. On the basis of this W-shape pattern, analysis was made of the resting pressure of the esophagus in nine cases with aehalasia. The results led to classify into four types. These are; disappearance of the W-shape pattern with the lowest resting pressure above 5 emH20 (Type 1), same as the above exeept for the lowest pressure below 5 cmH20 (Type II), prcsence of W-shape pattern with the lowest resting pressure above 5 cmH20 (Type III) and same as the above except for the lowest resting pressure below 5 emH20 (Type IV). Analytical data of the achalasia cases relatively well correlated with clinical findings and clarified significance of the pressure study for diagnosis and judgment of symptomatic severity. In analysis of deglutition pressure waves, it seems convenient to locate a point of pressure measurement in view of three high pressure zones and two low pressure zones.