Yozo Aoki

Laparoscopic resection for gastrointestinal stromal tumors of the stomach.

BACKGROUND We reviewed our experience with primary gastrointestinal tumors (GISTs) after surgical treatment. METHODS Between 1998 and 2003, 56 patients who underwent surgical treatment for primary GIST of the stomach were enrolled in this study. Statistical analyses of the risk factors for recurrence were assessed. RESULTS The proportion of cases undergoing laparoscopic surgery was 25 of 56 (44%) in these retrospective data. The site of recurrence was only the liver in all cases. These recurrent cases were defined as high-risk category. Tumors measuring over 2 cm in size tended to recur earlier, namely within 32 months. A statistical analysis showed a statistically significant correlation between the disease progression and the pathological phenotype. CONCLUSIONS This retrospective study has shown that an initial laparoscopic resection of gastric GISTs is feasible even when the tumor size is relatively small (2-5 cm). The pathological phenotype (especially tumor mitosis) directly correlates to the patients survival even if the resected tumor size was relatively small.

Primary adenosquamous carcinoma of the stomach: Experience of 11 cases and its clinical analysis

Summary1)During the last 10 years, 11 cases of primary adenosquamous carcinoma of the stomach’were operated on.2)Histologically, the specimens from the stomach showed adenocarcinoma with squamous differentiation in all the cases.3)All the patients but 1 were males and their average age was 61.2 years.4)The duration of illness prior to treatment was relatively long period of time and the chief complaints in over half of the patients were abdominal pain.5)Eight cases showed metastases at the time of operation. Metastasis to the regional lymph nodes was observed in 8 cases and the squamous element was present in 5 of these cases.6)There was no operative death. Followup study was made in 9 cases. Only 2 are still alive and the remaining 7 died of recurrence. The length of survival averaged 10.7 months.

Palliative surgery for unresectable carcinoma of the head of the pancreas, ampulla, and distal end of the common bile duct in Japan. A statistical review.

To elucidate the approximate present status of palliative surgery for unresectable carcinoma of the head of the pancreas, ampulla, and distal end of the common bile duct in Japan, surgical methods in 151 institutions were collected and analyzed. Biliary drainage alone was performed in 144 institutions (95 percent) and in 80 of them, cholecystectomy and choledochojejunostomy with a Roux-Y procedure was adopted. Gastric bypass with biliary drainage was routinely performed in 13 institutions (8.7 percent), whereas in 62 institution (41.3 percent), combined biliary and gastric drainage operations were performed as the primary procedures in selected cases. In over half the institutions, neither gastrectomy nor vagotomy was provided. Some means to alleviate the pain caused by tumor invasion were performed in about a third of the institutions (49), and about 80 percent of them added some manipulations of the celiac plexus.

Papilloma of the gallbladder

A case of papilloma of the gallbladder is reported. The gallbladder was associated with cholesterosis but not with stones. The causes of colicky pain in this case are discussed. Papillomas of the gallbladder exhibit no characteristic clinical picture; the symptoms are similar to those of any type of gallbladder disease. Papillomas of the gallbladder may be associated with malignant degeneration. Cholecystectomy is the treatment of choice.

Effects of TPN or Enteral Nutrition on Gallbladder Motor Function in Postoperative Gastric Cancer Patients

In totally gastrectomized patients on enteral nutrition (EN) or total parenteral nutrition (TPN), we studied the gallbladder (GB) image ultrasonographically on the 14th postoperative day, and compared its contractibility with each other by nutritional supports. In EN group, the GB began to contract 20 min after the beginning of EN (P<0.01, vs before EN), and reached its peak 40 min later (P<0.001). In TPN group, significant contraction could not be observed compared with the initial GB size and intravesical sludge continued to exist throughout the experiment. Thus, EN seems to be a more physiological nutritional method from a viewpoint of GB motor function.

Evaluation of surgical treatment for advanced gastric cancer based on long term results.

進行胃癌のうち, R2以上のリンパ節郭清を施行しえたA領域癌150例, M領域癌178例およびC領域癌100例を対象に, 組織学的リンパ節転移率を検討し, 手術時のリンパ節郭清の差が遠隔成績に及ぼす影響を, R1と比較して検討した. リンパ節郭清の意義が5年生存率に最もよく反映されるのはA, M領域のstage IIとM領域のstage III症例であることが判明した. C, CMにMCを含めた進行癌に対する胃全摘時の脾摘または膵脾合併切除の是非については, 5生率からは差は得られなかったが, 膵脾合併切除例で10, 11番リンパ節転移率が高率なこと, stage IVの全摘の5年生存例4例全例が膵合併切除例であったことより, 積極的な合併切除によるリンパ節郭清が重要であるといえる.

[A study of hepato-biliary and alimentary scintigrams using a triple tracer method].

In order to evaluate the gastric emptying and postprandial mixing of bile with food, the scintigraphies of hepatobiliary and gastrointestinal tracts by using three different kinds of radioisotopes were performed simultaneously (99mTc-E.HIDA for hepatobiliary scintigraphy, 111In-DTPA containing orange juice and 131I-albumin containing scrambled egg for gastrointestinal scintigraphy). This method was available for observation of gastric emptying of liquid and solid foods and also examination of the mixing effect of bile and food quantitatively.

ELEMENTAL DIET FOR PRE-AND POSTOPERATIVE MANAGEMENTS IN COLONIC SURGERY

下部消化管手術時の縫合不全の発生を可及的に減少させるための対策の一環として, elemental dietを主体にした経口的術前術後栄養法を工夫し臨床的に応用した.術前食は固形とし術前4日間摂取させ, その間抗生剤の経口投与は行わず, 従来のmechanical preparationでは期待し得なかった優れた効果を得ることが出来た.術後食は流動態とし, 従来の経口水分を許可してから粥食を摂取しはじめるまでの間の一定の期間投与し, 腸管内の残渣を少なくして吻合部にかかる負担を出来るだけ軽くするよう心掛けた.現在までの約80例の我々の経験からすれば, 本法による術前術後管理は優れた方法の1つであると思われる.