Toshikuni Nishikawa

Extensive En bloc resection of regionally recurrent carcinoma of the rectum

To remove regionally recurrent cancer of the rectum completely, more radical extensive resections were attempted than the conventional ones in 35 patients. Twenty‐two patients underwent total pelvic exentera‐tion. In 23, sacral resection was done, combined with other procedures including excision of the entire circumference of the lower pelvic ring. There were two hospital deaths. Delayed wound healing was seen in ten. Preoperative severe pain was alleviated in 18. Also, perineal ulcer, vaginal bleeding, bloody stools, and tenesmus disappeared. Of the four 5‐year survivors (estimated rate, 23%), only one was disease‐free. A second recurrence was seen in 27 patients, of whom 23 had regional failure. It was concluded that so‐called local recurrence is a lesion more widespread than indicated by imaging and biopsy. Therefore, even the most radical resection rarely can cure this disease. However, such a surgical procedure can afford more effective palliation than other treatments and may prolong life in selected patients significantly.

Histopathological prediction of liver metastasis after curative resection of colorectal cancer

To estimate the risk of liver metastasis after curative resection of colorectal cancer, resected specimens from 290 patients (45 with metachronous liver metastasis) were examined and the relationships between 10 histopathological variables and liver metastasis were analysed using our application of the Akaike information criterion (AIC). Of the 10 variables examined, the depth of venous invasion (Vd) had the greatest prognostic value for metastasis, followed by the number of venous invasions, the number of lymphovascular invasions, lymph node metastasis and type of infiltration. The prediction of liver metastasis was further improved by combining Vd with lymphocyte infiltration, mucinous production, interstitial fibrosis or depth of penetration, although these four variables per se were minimally informative for metastasis. We conclude that the prediction of liver metastasis is best achieved by combining Vd with other variables. Our risk group classification, and the estimated probability of liver metastasis for each group, are shown.

Parametric mean survival time analysis in gastric cancer patients

Background The mean survival time (MS) has acquired increasing importance as an outcome indicator for patient care and technology assessment. The authors use lifelong followup data from gastric cancer patients to study whether the MS is predictable from 5-year follow-up information based on 2 parametric models. Methods . The authors used 3597 gastric cancer patients operated on between 1950 and 1969 to create 50 groups. For each group, the disease-related survival curve (DRSC) was estimated from the 5-year follow-up data using the Boag model. The MS for the group was then estimated by combining the DRSC with the survival curve for the age and sex-matched contemporaries (control group) based on the competing risk model. Alternatively, it was estimated by using the DRSC and the MS for the control group (the survival limit model). These predicted MS values were compared with the full follow-up observations. Results . Although individual prediction errors varied depending on the group size (63 to 3597 patients) and the length of MS (0.3 to 20.2 years), the mean prediction errors were reasonably small; the survival limit model overestimated MS by 4.7% (95% confidence interval [CI], 1.6 to 7.8) and the competing risk model by 3.2% (95% CI, 0.1 to 6.5). Conclusions . MS for gastric cancer patients is parametrically predictable from 5-year follow-up data. This analysis should be applicable to other diseases showing log-normal failure time distributions.

A Case of Solitary Ulcer Syndrome Treated by Transsacral Proctomucosectomy.

直腸孤立性潰瘍症候群に対し, 経仙骨的に広範な直腸粘膜環状抜去術を施行した症例を報告する.症例は20歳男性で, 8年前から持続する血便, 粘液便, 裏急後重を訴え, 内科治療や排便時のいきみを控えても軽快しなかった.下部直腸に多発する隆起性病変を認め, 生検にて粘膜固有層のfibromuscular obliterationの所見を得, 直腸孤立性潰瘍症候群と診断した.術式は経仙骨的に直腸後壁を切開後, 粘膜のみを環状に剥離後切除し, 露出した直腸筋層を縦に縫縮後, 粘膜断端を再吻合した.術後の直腸肛門内圧測定でも異常は認められず, 患者は術後25か月現在無症状である.本症例はこの術式で治癒した第2例目である.

Diagnosis and Treatment of Recurrent Colorectal Cancer

In recurrent cancer of the large intestine, hepatectomy for localized liver metastasis and extensive total pelvic exenteration for pelvic local recurrence are often beneficial and prolongation of life can be achieved. Histological venous invasion of original tumor (v-factor) is an important parameter in the prediction of liver metastasis, and nuclear magnetic resonance (NMR) is useful for detecting liver metastases and determining the extent of local invasion. Early diagnosis and aggressive treatment of recurrent and metastatic cancer are as important as early and curative resection of initial malignant lesions. Oral administration of biological response modifier (BRM) and adjuvant adoptive immunotherapy after hepatectomy are considered to be promising approaches for the prevention of recurrence.