Tsuyoshi Sasagawa

Laparoscopic Wedge Resection of the Stomach for Submucosal Tumor

We performed laparoscopic wedge resection of the stomach in two patients with submucosal gastric tumor. Three trocars were inserted in addition to a laparoscope. After the blood vessels surrounding the tumors had been ligated with ENDO CUPs, we used ENDO GIA (a linear endoscopic stapling device) four times and then wedge resection was performed. The operative time was 3h33m in Case 1 and 2.5h in Case 2, and bleeding was minimal in both cases. The postoperative courses were uneventful, and intestinal peristalsis recovered rapidly with minimal wound pain. These results suggest that laparoscopic wedge resection of the stomach, a radical procedure, is indicated for submucosal tumor of the stomach.

The Effect of Extended Lymph Node Dissection in Patients with Gastric Cancer from Two Aspects, Quality of Life and Postoperative Survival Rate.

胃癌におけるリンパ節拡大郭清の効果について, 過去10年間の2,592例を検討した. 検討は, 4群郭清 (D4) と2群郭清 (D2) の2群間で, 胃癌取扱い規約12版の進行程度に沿って層別化し, 生存率を対比した. また3年間経過を追えた再発のない胃全摘膵脾合切例で, 全身状態, quality of life (QOL) などについて対比した.(結果) D4郭清がD2郭清より, 各進行程度で良好であり, sen0, m, sm, n2 (+), mp, ss, n2 (+), se, n2 (+) の各群で, 有意の差を認めた.また, D4, D2の2群間で直死率, 術後縫合不全, 入院日数などに差を認めなかった. また各種QOLに関するアンケート調査の結果差を認めなかった.(まとめ) D4郭清はD2郭清と対比して, 安全で, QOLを損なうことがなく, また, stage II, IIIで良好な成績を示すことから, 積極的に選択すべき術式と考えた.

Diagnosis of Lymph Nodes with Metastasis from Stomach Cancer Using Ultrasonography

Diagnosis of Lymph nodes metastasis has not been studied thoroughly. Thus, the diagnosis of lymph nodes metastasis using ultrasonography were examined. The following 3 items are defined as the criteria of metastasis (1)the major axis is more than 5mm, (2) the shape is spherical, (3)uniformly low internal echo is observed. Cases for which the extent of occupation by cancer was small were, how ever, not consistent with the above criteria. This is a future problem.