Yasuo Iitsuka

Intraperitoneal free cancer cells and their viability in gastric cancer

Free cancer cells in the peritoneal cavity of 100 patients with gastric cancer were examined by means of Douglas lavage, and their viability was estimated by 3H‐thymidine uptake with autoradiographical technic. Furthermore, the effect of mitomycin‐C on the viability of free cancer cells in the peritoneal cavity was studied. The appearance of intraperitoneal free cancer cells was dependent on the degree of invasion of cancer to the gastric serosa; that is, free cancer cells were not found in cases without serosal invasion, but were found in 48% with serosal invasion. The viability of free cancer cells in the peritoneal cavity was relatively high, but could be suppressed remarkably by intraperitoneal administration of 10 mg of mitomycin‐C.

Prognostic significance of intraperitoneal free cancer cells in gastric cancer patients

SummaryWe performed intraoperative peritoneal cytology in 171 gastric cancer patients undergoing curative surgery. Intraperitoneal free cancer cells were demonstrated in almost all patients in whom the area of serosal cancer invasion exceeded 15–20 cm2. In patients with both serosal cancer invasion and free cancer cells the 5-year survival rat was 13% as compared with 85% for patients who had neither, and 40% for patients who had serosal invasion but no free peritoneal cancer cells. Peritoneal metastasis was the most frequently observed recurrence pattern. There-fore, in gastric cancer patients with marked serosal invasion, intraoperative IP administration of cytocidal anticancer drugs should be considered.

Relaitonship between area of serosal invasion and prognosis in patient with gastric carcinoma

We examined the relationship between the spatial extent of invasion of the gastric serosa in patients with gastric carcinoma and their postoperative 5‐year survival rate. At the time of surgical resection of gastric patients with gross evidence of serosal invasion. Examination of the relaitonship between the presence of with an area of serosal invasion 10 cm2 or less were positive for free cancer cells, but such cells were found in 72% of cases with an area of serosal invasion greaer than 20 cm2. The 5‐year survival rate was 31% in patients iwht ana area of serosal invasion of less than 10 cm2, whereas the rate was only 8% in patients witha n area of serosal invasion greawter than 20 cm2. Not only the presence of serosal invaison by a tumor but also the spatial extent of the invasion are significant factors that ainfluence the prognosis of patients wiht gastric carcinoma.

Possible role of lymph node dissection in the surgical treatment of gastric cancer with disseminating peritoneal metastasis

Pathological background factors of patients with gastric cancer and peritoneal metastasis were studied. In palliatively gastrectomized patients, there was a close relationship between the extent of cancer invasion to the gastric serosa and postoperative survival; the less extensive the serosal invasion, the longer was the survival time. The relationship between the extent of lymph node dissection and postoperative survival showed that, in the presence of metastasis to Group 1 and 2 lymph nodes, many of the long-term survivors had undergone dissection of these lymph nodes. Although a sweeping conclusion should be avoided since retrospective analysis forms the basis of this report, it is assumed that in patients with gastric cancer and peritoneal metatasis, surgery should not be confined to resection of the primary focus, but should include regional lymph node dissection.

Diagnostic significance of bile cytology in obstructive jaundice

Cytological examination of exfoliated cells in the bile or irrigated fluid from a percutaneous transhepatic choledochal drainage (PTCD) tube and other jaundice-reducing fistula was performed in 59 patients with obstructive jaundice. Malignant cells were found in 22 of 27 patients with choledochal cancer, 5 of 17 patients with pancreatic cancer, 3 of 6 patients with gallbladder cancer, and one of 5 patients with other malignancies. Exfoliated malignant cells were found at a higher rate in the washed fluid of the PTCD tube than in the pure bile aspirated from the PTCD tube. Half of the positive cases were diagnosed as such upon the first cytological examination, and the remaining in second or subsequent cytological examinations. The cytological appearance of cells in the washed fluid or bile reflected the type of cancer cells found by touch-smear of the lesion and also the histological type. This method requires no special technique and facilitates accurate diagnosis in patients with malignant lesion of the choledochal duct.

The effects of hyperthermia on the cell cycle of Ehrlich ascites cancer cellsin vivo

The effects of hyperthermia on the cell cycle of Ehrlich ascites cancer cells were studied, and these effects simultaneously evaluated in terms of prolonging the survival of test mice inoculated with tumor cells from heat-treated mice. DDY mice bearing Ehrlich ascites cancer cells were placed in a water bath at 37°C, 39°C, 41°C, 32°C or 43°C. The heating of mice at 41°C, 42°C and 43°C induced the accumulation of cancer cells at the G2M phase of the cell cycle with many cells exhibiting polyploidy (16C). The extent of accumulation increased as the temperature of incubation was raised, however the interrupted cell cycle resumed 120 hours after heating. The retransplantation of cells from the heat-treated mice revealed that the mice which were inoculated with Ehrlich ascites cancer cells from mice heated at 43°C survived longer, while the mice which were inoculated with Ehrlich ascites cancer cells from mice heated at 39°C survived for only a slightly shorter time than those which were inoculated with cells from mice heated at 37°C.

Continuous hyperthermic peritoneal perfusion as a prophylaxis of peritoneal metastasis from gastric carcinoma.

治癒切除がなされたse胃癌の術後5年生存率はR248.4% (n=182), R350.9% (n=159) であり, これをリンパ節転移程度別に検討してもR2とR3とでほとんど差はみられなかった. ダブラス窩洗浄細胞診にて, se胃癌治癒切除例の21% (30/142) に腹腔内遊離癌細胞が検出され, これらの術後生存率はきわめて低く, 大部分は腹膜転移にて死亡した. 術中肉眼的に漿膜浸潤陽性で治癒切除と判定された例を無作為に2群にわけ, 持続温熱腹膜灌流療法の効果を検討した. その結果, 対照群の5生率58.3% (n=53) に対して本法施行群では76.2% (n=55) という成績が示された. 漿膜浸潤胃癌では積極的な腹膜再発防止対策が必要である.

Morphological changes in intraperitoneal free cancer cells of gastric cancer patients treated with continuous hyperthermic peritoneal perfusion.

腹膜播種を有する胃癌患者10名を対象とし, 温熱と抗癌剤を併用した持続温熱腹膜灌流療法continuous hyperthermic peritoneal perfusion (CHPP) を行った. その前後にわたり経時的に腹腔内遊離癌細胞を採取し, 主としてこれらの形態的変化につき検討し, 以下の成績を得た.1. CHPP施行後には, 遊離癌細胞の胞体内空胞形成および核の腫大, 凝縮などの変性所見が認められ, さらに特徴的な多核巨細胞化した癌細胞の出現が認められた.2. CHPPの回数を重ねるに従い, 癌細胞の変性程度, 変性癌細胞の出現頻度が増加した.

Two Cases of Retroperitoneal Liposarcoma of which the Peroperative Aspiration Cytology was Useful for Diagnosis

We have experienced two cases of the retroperitoneal liposarcoma, which are relatively rare and scarcely experienced at daily clinical practice.At its diagnosis, though a qualitative diagnosis was impossible preoperatively, the peroperative aspiration cytology was very useful.Histologically, one was predominantly pleomorphic (poorly differentiated) type and the other was pledominantly myxoid (well differentiated) type (by WHO classification).This paper emphasized that the peroperative aspiration cytology was a very useful procedure for diagnoses of tumorous lesions of which especially preoperative diagnoses were uncertain.