Toshiya Takeda

An evaluation of radical resection for pancreatic cancer based on the mode of recurrence as determined by autopsy and diagnostic imaging.

Background. To determine the extent of dissection in curative resection for cancer of the pancreatic head, the mode of recurrence was determined at autopsy and by radiographic examinations.

Lymphatic flow in carcinoma of the distal bile duct based on a clinicopathologic study

Background. Nodal status is one of the most important prognostic factors for distal bile duct cancer. The pattern of lymphatic spread of distal bile duct cancer was analyzed by determining the frequency of involvement of various lymph nodes.

Pancreatic resection for periampullary carcinoma in the elderly

The effect of pancreatic resection for periampullary carcinoma in the elderly was studied by comparing the pre-and perioperative factors affecting survival in 102 patients less than 70 years of age (group A) with those in 28 patients 70 years and older (group B). Concomitant cardiac and pulmonary diseases were significantly more frequent in group B (P < 0.05), but the difference in routine laboratory data was not significant. The overall operative mortality was 7% (7/102) in group A and 18% (5/28) in group B, while the actuarial 5-year survival rates were 31%o in group A and 23% in group B, these differences not being significant. A multivariate analysis using a logistic model showed that blood loss was the greatest risk factor for early postoperative death in the elderly patients, whereas anastomotic dehiscence and postoperative bleeding were significant factors in the younger patients. Thus, we conclude that age is not a contraindication to pancreaticoduodenectomy which offers the only hope for long-term survival in patients with periampullary carcinoma; however, meticulous dissection to minimize blood loss is especially important in elderly patients.

The pattern of lymph node involvement in carcinoma of the head of the pancreas. A histologic study of the surgical findings in patients undergoing extensive nodal dissections.

SummaryTo clarify the pattern of lymph node metastasis in carcinoma of the pancreas, lymph node involvement was examined in forty-two patients who underwent extensive nodal dissections, including the paraaortic lymph nodes. The correlation between the spread of the tumor and lymph node involvement was evaluated: The most common site of involved lymph nodes was the retropancreatic region. The prevalence of nodal metastases was 78.6%. Metastases to the paraaortic region were present in seven patients, among whom metastases in the paraaortic region were most common in the median region from the celiac artery to the inferior mesenteric artery and in the space between the aorta and the vena cava. The risk of lymph node metastases tended to increase with tumor size, except in the paraaortic region, where the correlation between the frequency of metastasis and tumor size was poor. The probability of lymph node metastases increased with the degree of lymphatic invasion (ly) and the growth pattern of the tumor (INF) and was high in patients with invasion into the retropancreatic tissue and in tumors with scirrhous histology. These results indicate that even in small cancers, lymph nodes of the paraaortic region frequently harbor metastases and should be dissected en block during radical resections of pancreatic cancer.

Randomized Phase II trial of paclitaxel plus valproic acid vs paclitaxel alone as second-line therapy for patients with advanced gastric cancer.

The standard regimen of second-line chemotherapy for patients with unresectable gastric cancer has not been established. However, weekly paclitaxel (wPTX) has become the preferable second-line chemotherapy in Japan. Histone deacetylase (HDAC) inhibitors have been shown to have antiproliferative activity through cell-cycle arrest, differentiation, and apoptosis in gastric cancer cells. One HDAC inhibitor, valproic acid (VPA), also inhibits tumor growth by inducing apoptosis, and enhances the efficacy of paclitaxel in a mouse xenograft model of gastric cancer. wPTX plus VPA as a second-line chemotherapy is expected to improve survival in gastric cancer patients. A multicenter randomized Phase II study was conducted to compare the effects of wPTX plus VPA and wPTX alone. A total of 66 patients participated in this study. The primary end point of the study was overall survival, and secondary end points were progression-free survival, response rate, and assessment of peripheral neuropathy.

Expression of argyrophilic nucleolar organizer regions in ductal adenocarcinoma of the pancreas and its relationship to prognosis

SummaryThe aim of the present study was to investigate the relationship between Ag-NOR count levels and survival in 33 patients undergoing resection for ductal adenocarcinoma of the pancreas at Kanazawa University Hospital from 1985 to 1991. To determine the biologic behavior of invasive ductal adenocarcinoma of the pancreas, 33 tumors were classified into two groups according to the median value of Ag-NOR counts: Group 1, Ag-NOR count ≥ 3.25 (higher Ag-NOR count group); Group 2, Ag-NOR count < 3.25 (lower Ag-NOR count group). As a result, we found that tumors with a higher Ag-NOR count were more likely to have liver or peritoneal metastasis than those with a lower Ag-NOR count, although the differences were not statistically significant. Tumors with lower Ag-NOR count levels were associated with favorable prognoses 2 and 3 yr after surgery, whereas those with higher Ag-NOR count levels were related to poor prognosis. Our results indicate that a Ag-NOR count level is a reliable prognostic parameter in resected pancreatic ductal adenocarcinoma.

Carcinoma of the pancreatic body with cavernous transformation of the portal vein

Cavernous transformation of the portal vein is a rare disease in the adult. We report a case of a 60-year-old woman with a large carcinoma of the body of the pancreas, who underwent a curative resecti

Clinicopathologic Study of Carcinoma of the Pancreas Head Based on its Recurrence.

膵頭部領域癌耐術肉眼的治癒切除例92例を対象に再発形式を検討し, 外科治療の問題点を考案した.膵頭部癌では組織学的治癒, 非治癒を問わず大動脈周囲リンパ節再発, 後腹膜局所再発が高頻度であり, 画像確認24例の検討では肝転移のみが2例, 後腹膜再発のみが12例, 両者が10例であった.また, Stage I, IIの膵頭部癌では拡大郭清の効果がみられたが, Stage III, IV症例に対してはいまだ十分とはいえなかった.下部胆管癌では膵浸潤が認められる場合には再発例がみられるようになり, リンパ節再発や肝十二指腸間膜内再発などの後腹膜再発が多かった.乳頭部癌では後腹膜局所に加え肝再発が重要であった.以上より, 膵頭部癌においては大動脈周囲リンパ節郭清, さらびに神経叢切除を伴う現行の拡大手術は不可欠であり, 下部胆管癌, 乳頭部癌では上腸間膜動脈周囲リンパ節を確実に郭清する手術が必要と考えられた.

Appraisal of Extended Radical Operations for Carcinomas of the Pancreatic Head Region. Curability and Postoperative Quality of Life.

膵頭部領域癌に対する拡大郭清膵切除術式のうち上腸間膜動脈周囲郭清の意義について, 術式の根治性と術後quality of life (QOL) の面から検討した.上腸間膜動脈周囲神経叢浸潤と腸間膜根部リンパ節転移の頻度は膵頭部癌 (61例) で68.9%, 36.1%, 下部胆管癌 (21例) で4.8%, 33.3%, 乳頭部癌 (34例) で0%, 14.7%であり, 根治性向上のうえで上腸間膜動脈周囲郭清の重要性が示唆された.同部位の郭清程度を拡大, 準拡大, 標準の3群に分類すると, 累積生存率では準拡大郭清群が最も良好であつたが, 膵頭部癌, 拡大群の3例を含む7例に5年生存を得た.一方術後QOLは術後入院期間, 在院死亡率, 再入院率, 術前後のperformance statusの変化, 術後糖尿病, 難治性下痢, 脂肪肝の発生率において拡大郭清群で不良であつた.治療成績の現状からみて根治性の向上が急務であり, 術後QOLについては再入院加療を含めた長期の栄養管理により対処している.