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M Sasako

Publications and source records attributed to M Sasako.

At least 55 records · Page 3Linked to original sources
PubMed1998

Morbidity and mortality after D2 gastrectomy for gastric cancer: results of the Italian Gastric Cancer Study Group prospective multicenter surgical study.

PURPOSE: To investigate whether pancreas preservation together with a strict quality-control system could ameliorate the outcome of D2 resections for gastric cancer in Western patients. PATIENTS AND METHODS: Italian patients with potentially curable proven adenocarcinoma of the stomach were registered from nine general and/or university hospitals in the area of Turin, Northern Italy. The study was performed according to the guidelines of the Japanese Research Society for Gastric Cancer (JRSGC). A strict quality-control system was guaranteed by a supervising surgeon of the reference center, who had stayed at the National Cancer Center Hospital, Tokyo, to learn the standard D2 gastrectomy. The standard procedure entailed removal of the level 1 and 2 lymph nodes. During total gastrectomy, the pancreas was preserved according to the Maruyama technique. RESULTS: Between May 1994 and December 1996, 191 eligible patients were entered onto the study. The mean number of lymph nodes removed was 39. The overall morbidity rate was 20.9%. Surgical complications were observed in 16.7% of patients. Reoperation was necessary in six patients and was always successful. The overall hospital mortality rate was 3.1%; it was higher after total gastrectomy (7.46%) than after distal gastrectomy (0.8%). The average length of hospital stay was 17 days. CONCLUSION: Given that postoperative morbidity and mortality rates are favorably comparable with those reported after the Western standard gastrectomy, the more extensive Japanese procedure with pancreas preservation can be regarded as a safe radical treatment of gastric cancer for selected Western patients treated in experienced centers.

Adenocarcinoma↗
PubMed1998

[TNM classification: cancer of the stomach].

The 5th edition of TNM Classification was published by the UICC (International Union Against Cancer) in 1997. In the classification of gastric cancer, anatomical subsites and N category were newly published. The new classification and role of the Japanese TNM Joint Committee were described in this paper. The Japanese committee had strongly advocated to continue "the anatomical N classification", because the hazard ratios were more significant for prognosis of patients with gastric cancer, and had many reasonable and scientific advantages. However, the UICC introduced "a new N classification by number of metastatic lymph nodes" because of the difficulty in studying nodes by anatomical classification. The new TNM can not be considered an improved classification, and so we are looking for a more scientific, practical, and internationally acceptable classification.

Humans↗
PubMed1998

Surgical treatment for gastric leiomyosarcoma.

BACKGROUND: Gastric leiomyosarcoma is an uncommon disease, and the optimal treatment has not been established. In order to better define the optimal surgical treatment, we retrospectively analyzed our experience with these tumors. METHODS: Records of 103 patients, who underwent surgery between 1972 and 1997 were reviewed. RESULTS: The upper third of stomach was the most frequent site of disease (66 cases). Seventy one tumors were smaller than 50 mm. Forty patients had ulcerated tumors. Twenty nine of 33 tumors had an inhomogeneous pattern on endoscopic ultrasonography. Nodal involvement was not observed in our series. The most common surgery was wedge resection, performed in 68 patients. The 5-year disease-specific survival rate after curative resection was 93.0% overall, 87.5% after gastrectomy, and 95.0% after wedge resection. 5 year survival rate was worse in patients with ulcer than those without ulcer (87.1% vs. 96.3%, p < 0.01). No patient with a tumor smaller than 3 cm died from the disease. The dominant mode of recurrence was liver and peritoneal metastasis. No lymph node recurrence was observed. CONCLUSIONS: Surgery is indicated for tumors larger than 3 cm, with rapid growth, with inhomogeneous US pattern, or with ulceration. Wedge resection is the preferred treatment.

Disease-Free Survival↗
PubMed1997

Total gastrectomy for primary gastric lymphoma at stages IE and IIE: a prospective study of fifty cases.

BACKGROUND: Treatment of primary gastric lymphoma at Ann Arbor stage IE or IIE is controversial. Randomized trials to compare various modalities are not feasible because of the rarity of this disease. We have prospectively treated patients by means of primary surgery to achieve complete local control and accurate staging. METHODS: Between 1987 and 1995, 50 patients with stage IE or IIE gastric lymphoma were prospectively treated by total gastrectomy with systematic lymphadenectomy. When nodal metastases were histologically confirmed or the resection was noncurative, chemotherapy was added. Intragastric tumor spread, lymph node metastasis, and treatment results were examined. RESULTS: Resection was potentially curative in 48 cases. There were no operative deaths. Histologically, the middle third of the stomach was most frequently involved. Either the proximal two thirds or the entire stomach was involved in 62% of all patients. Lymph node metastasis was demonstrated in 25 patients. The deeper the tumor invasion in the gastric wall, the more frequent and distant the nodal involvement. The 5-year survival rate was 85.6%, excluding one death caused by heart disease. CONCLUSIONS: Primary surgery followed by chemotherapy in selected cases is an appropriate strategy for primary gastric lymphoma in patients in whom this regimen can be safely carried out.

Adult↗
PubMed1997

c-erbB2 and p53 expression are not associated with stage progression of gastric cancer in Britain or Japan.

The results of surgical treatment for gastric cancer are apparently better in Japan than in Western countries. It has been proposed that this is because of a biological difference between the tumours in Japan and in the West. We have previously reported very similar frequencies of positive immunohistochemical staining for the c-erbB2 oncogene and mutant p53 proteins in British and Japanese gastric cancers, findings which do not seem to support the 'biological difference' hypothesis. We realized that these studies did not rule out differences in the mechanism of cancer progression which might show themselves by a different association between p53 and c-erbB2 expression and stage in the two populations. We therefore re-analysed our data to look for differences in the frequency of p53 and c-erbB2 expression in the British and Japanese populations. Comparison of fixed tissue from 88 British and 89 Japanese tumours showed no significant association of c-erbB2 or p53 with stage progression in either population. Logistic regression showed no difference between the two populations in the relationship between stage and oncogene expression. These results do not support the idea of biologically different cancers in Japan and Britain. Other possible explanations for the difference in results such as the stage migration effect, better efficacy of Japanese-style surgery, or a difference in the host resistance to cancer in the two countries should be considered.

Humans↗
PubMed1997

Extended lymph node dissection for gastric cancer: results of a prospective, multi-centre analysis of morbidity and mortality in 118 consecutive cases.

This study reports interim data on post-operative morbidity, hospital mortality and duration of hospital stay of Italian patients undergoing extended lymph-node dissection combined with a pancreas-preserving technique for gastric cancer. Of the 218 patients admitted to one of eight general and/or university hospitals in North Italy, 118 were enrolled in the trial. Eligible patients presented with proven primary adenocarcinoma of the stomach without clinical evidence of distant, peritoneal and/or liver metastasis, or metastasis in para-aortic and retropancreatic nodes at intraoperative biopsy. Patients underwent the extended procedure as described by the Japanese Research Society for the Study of Gastric Cancer, following the Maruyama pancreas-preserving technique. A strict quality control system was used to ensure the performance of a standard surgical treatment. A surgeon of the reference centre (M.D.), who stayed at the National Cancer Center Hospital in Tokyo to learn the D2 technique from a specialist Japanese surgeon, became the trial supervisor and assisted each surgeon in all the Italian participating centres. The patients were staged according both to the TNM system and to the General Rules for the Gastric Cancer Study in Surgery and Pathology. Post-operative surgical complications developed in 21 patients (17.8%). The non-surgical complication rate was 2.5%. Reoperation was necessary in six patients (5%), all of whom survived. The 30-day mortality rate for the eligible group was 2.5%. The overall hospital mortality was the same. Total gastrectomy was associated with a slightly higher operative mortality (4.5% vs 1.3%). Only one patient died from an anastomotic leak. The rate of leakages was higher after total than after distal gastrectomy (15.9 vs 5.4%); the association of splenectomy and pancreatectomy worsened the morbidity rate. D2 lymphadenectomy with pancreas-preserving technique, when performed at experienced centres, seems a feasible and safe technique for the radical treatment of gastric cancer in selected Western patients.

Adenocarcinoma↗
PubMed1997

A prospective study of surgery and adjuvant chemotherapy for primary gastric lymphoma stage II.

The standard management of primary gastric lymphoma (PGL) (stage II) has not been established despite the use of various treatment modalities. The present prospective trial of combined surgery and chemotherapy for the treatment of PGL (stage II) included 25 consecutive patients treated between July 1978 and December 1993. Twenty-one patients were treated with total gastrectomy and four with partial gastrectomy; this was followed by post-operative chemotherapy with m-VEPA (vincristine, cyclophosphamide, prednisolone and doxorubicin), followed by consolidation chemotherapy with VEMP (vindesine, cyclophosphamide, methotrexate and prednisolone) or VQEP (vindesine, carbazilquinone, cyclophosphamide and prednisolone). Twenty-one of the 25 patients who completed post-operative chemotherapy were free of relapse 26-203 (median 94) months after the gastrectomy. Of the four patients who did not complete the projected chemotherapy, two relapsed and died of lymphoma. Another patient with recurrent lymphoma died in an accident, and the fourth patient was in remission at 54 months after surgery. The post-operative overall and disease-free survival rates at 10 years for the 25 evaluable patients were 81.6% and 92.0% respectively. Major surgical complications and treatment-related death after chemotherapy were not observed. PGL (stage II) appears to be curable when treated with gastrectomy and adjuvant chemotherapy.

Adult↗
PubMed1997

Risk factors for surgical treatment in the Dutch Gastric Cancer Trial.

BACKGROUND: A multicentre randomized study of surgical treatment of gastric cancer has shown increased mortality and morbidity rates in patients having D2 resection. The aim of this report is to analyse risk factors in these patients. METHODS: In a prospective randomized trial, comparing two types of lymphadenectomy for curable gastric cancer, risk factors for hospital death and morbidity in 711 patients treated with curative intent were evaluated by multivariate analysis using stepwise regression analysis. RESULTS: Age greater than 65 years and male sex were the most important risk factors for death (relative risk (RR) 4.35 (95 per cent confidence interval (c.i.) 2.07-9.15) and 2.51 (95 per cent c.i. 1.24-5.08) respectively). The extent of nodal dissection was also a significant risk factor for death (RR 2.13). For overall complications, splenectomy was the most important risk factor (RR 2.13 (95 per cent c.i. 1.44-3.16)), while pancreatectomy and type of gastrectomy were the only factors significantly influencing the occurrence of major surgical complications. CONCLUSION: The cumulative mortality risks of these factors should be considered carefully when planning surgery for individual patients.

Adult↗
PubMed1997

[A Meaning for incurable patients to know the truth of their disease].

Actually most of unresectable solid cancers are incurable, except some pediatric cancers and germ cell tumors etc. For these patients, what doctors can provide is basically prolongation of life with acceptable quality. Without knowing the fact and possible advantage and disadvantage or side effect of any treatment, these patients cannot choose the treatment, either anti-cancer therapy or best supportive therapy. In such situation, prognosis is almost mandatory information. No body feels comfortable to hear severe facts of their diseases especially when they are hopeless. However, this information is essential to choose the treatment which has strong influence on their lives themselves. The 38 incurable patients and 33 with poor prognosis (cure rate will be less than 10%) treated by the author between 1993 and 1995 were analyzed to see the attitude of patients in such situation. After getting all information including effect and side effect of possible treatment, mean survival, and natural course of their disease, 24 out of 70 selected supportive care. 11 of 70 requested consultation of a psychiatrist but all recovered soon with minimum treatment. In such critical or life threatening situation, decision is completely personal and cannot be done by their family. When doctors and patients can make a good relationship with confidence, patients can create their own style of remaining life and even death.

Hospice Care↗
PubMed1997

Amylase concentration of drainage fluid after total gastrectomy.

BACKGROUND: Pancreatic fistula is a serious complication of total gastrectomy with splenectomy. The amylase content of drainage fluid was examined and its usefulness for predicting pancreatic complications after gastrectomy was evaluated. METHODS: The amylase concentration of the fluid in the peripancreatic drain was determined prospectively in 102 patients who underwent total gastrectomy in 1995. RESULTS: Pancreatic fistula developed in 13 patients, whose drainage fluid amylase levels on the first postoperative morning were significantly higher than those of patients without fistula formation. Among 27 patients with amylase levels exceeding 4000 units, eight later developed pancreatic fistula, while only five (7 per cent) of 68 with amylase levels below 4000 units did so. All complications were successfully managed and there were no deaths. CONCLUSION: Determination of drainage fluid amylase levels is a simple and useful method for the prediction of pancreatic fistula formation and may help to plan appropriate management.

Adult↗
PubMed1997

Treatment of early gastric cancer.

Early or superficial gastric cancer identifies a lesion that is confined to the mucosa or submucosa layer and that even in the presence of lymph nodes metastasis can be successfully treated with resection and lymph node dissection. In presence of cancer that invades the submucosa the incidence of N2 metastasis raises to 3-5%, and even though a D2 procedure is indicated as the postoperative mortality is similar to D1 procedure. Early gastric cancer of the mid portion of the stomach can be treated with a distal D2 pylorus preserving gastrectomy that has the advantage to reduce the incidence of dumping syndrome; this result can be achieved with a complete dissection of the infrapyloric nodes preservng part of the suprapyloric nodes to spare the right gastric artery. Endoscopic mucosal resection is another therapeutic option available in presence of a mucosal gastric cancer less than 2 cm, well differentiated without ulceration; among 50 cases treated so far, 32 cases were completed resected and they are free of disease up to now. The main risks of this procedure are hemorrhage (5%) and perforation (6.4%).

Endoscopy↗
PubMed1996

Risk factors for lymph node metastasis from intramucosal gastric carcinoma.

BACKGROUND: Although regional lymph node metastasis from intramucosal early gastric carcinoma (EGC) is rare, it is very important to clarify the characteristics of patients having lymph nodal metastases in order to determine appropriate therapy. METHODS: The authors investigated 1196 patients with solitary intramucosal EGC who underwent resection at the National Cancer Center Hospital in Tokyo, with special reference to lymph node metastases. Eight clinicopathologic factors (age, sex, tumor: size, location, macroscopic type, histologic type, histologic ulceration of the tumor, and lymphatic vessel invasion) were investigated by univariate and multivariate analyses for their possible relationship to lymph node metastasis. RESULTS: Lymph node metastases were found in 43 patients (3.5%). Univariate analysis revealed that younger age (< 57 years), macroscopic depressed type, larger tumor size (> or= 30 mm), undifferentiated histologic type, histologic ulceration of the carcinoma, and lymphatic vessel invasion had a significant association with regional lymph node metastasis. Multivariate analysis revealed that lymphatic vessel invasion, histologic ulceration of the tumor, and larger size (> or = 30 mm) were independent risk factors for regional lymph node metastasis. The incidence of lymph node metastasis from intramucosal EGC negative for these 3 risk factors was only 0.36% (1 in 277 patients). CONCLUSIONS: Lymphadenectomy is unnecessary for patients with small intramucosal EGC with neither histologic ulceration of the tumor nor lymphatic vessel invasion because the incidence of regional lymph node metastasis is extremely low in those patients. The therapeutic options for such patients would be local resection or endoscopic resection.

Age Factors↗
PubMed1996

Difference between carcinoma of the lower esophagus and the cardia.

We analyzed the records of patients with carcinoma of the lower esophagus and cardia. Mediastinal node involvement was found in 43% of the patients with squamous cell carcinoma of the lower esophagus, and the 5-year survival after mediastinal dissection for patients with mediastinal node involvement was 27%. Mediastinal node involvement was found in 19% of the patients with adenocarcinoma of the cardia involving the esophagus, and no patients with mediastinal node involvement survived more than 2 years. When the patients had mediastinal node involvement, survival curves were significantly different. There were large differences between these tumors in terms of the extent of lymph node involvement and the survival of patients with mediastinal lymph node involvement. It is incorrect to consider the behavior of these tumors identical and to treat the conditions similarly.

Adenocarcinoma↗
PubMed1996

Gastric carcinoma in young adults.

Among 4608 patients with gastric carcinoma treated during a 20-year period from 1971 to 1990, 328 (7.1%) were less than 40 years of age. The clinicopathologic features and treatment results in this young group were compared with those for older gastric carcinoma patients (40-79 years of age, control group). In the young group, the male/female ratio and the prevalence of tumors in the lower third of the stomach were both lower than in the control group, and undifferentiated-type adenocarcinomas with diffusely infiltrative growth predominated. The TNM stage distribution and the proportion of curative resections were similar in the two groups. The overall cumulative 5-year survival rates were also similar, although that of patients who underwent curative resection was higher in the young group, due probably to the low rate of death from other causes. There was no difference in the recurrence rates after curative resection between the two groups. Contrary to widely held belief, the prognosis of young patients with gastric carcinoma is not poorer than that of older patients if the disease is diagnosed at a reasonably early stage.

Adult↗