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M Sasako

Publications and source records attributed to M Sasako.

At least 91 records · Page 5Linked to original sources
PubMed1992

Wert der systematischen erweiterten Lymphknotendissektion--Ergebnisse in Japan. [Value of systematic extended lymph node dissection--results in Japan].

In the National Cancer Center, 6112 patients with primary gastric cancer have undergone gastric resection since 1962, and the 5-year survival rate (5YSR) was 57.5%. In the 25-year period, 5YSR rose from 57% to 83% in stage II disease, and from 33% to 50% in stage III disease. Systematic lymph node dissection (R2 dissection) played major role in this improvement. It gave significantly better prognosis (5YSR, 48%) than incomplete dissection (31%), particularly reducing local recurrence. The proportion of local recurrence was 38% in 1967-1971, however it decreased to 16% in 1982-1986 by introduction of this treatment. Disadvantages of the dissection were minimal. Surgical death rate was 3.0% in the 1960s but it was only 0.6% in the 1980s.

Cause of Death↗
PubMed1992

[Lymph node dissection around the splenic artery for gastric cancer--a comparative study of pancreatectomy and pancreas-preserving operation].

From 1977 to 1988, four hundred and sixty-five patients received total or proximal gastrectomy for advanced gastric cancer without leaving a tumor mass at National Cancer Center Hospital. Of these, 182 patients received distal pancreatectomy (PS) and 123 received pancreas-preserving operation with removal of the splenic artery (PP). The 5-year survival rate for the PS group (32.0%) was significantly lower than 61.0% for the PP group. Concerning grades of cancer stage, the 5-year survival rates for the PP group were better than those for the PS group in stages 1, 2 and 3. Seventy-four of the 465 patients were found to have histologically proven metastatic nodes around the splenic artery. Their 5-year survival rates were 9.2% for the PS group (n = 46) and 32.7% for the PP group (n = 13) respectively. Considering the difference in the background factors, these data suggest the effectiveness of the pancreas-preserving operation for advanced gastric cancer even with microscopic lymph node metastasis around the splenic artery. The pancreas-preserving operation with removal of the splenic artery might be indicated for the patient without definite macroscopically metastatic lymph node around the splenic artery.

Gastrectomy↗
PubMed1992

Quality control of surgical technique in a multicenter, prospective, randomized, controlled study on the surgical treatment of gastric cancer.

To evaluate the effect of lymph node dissection on gastric cancer patients operated upon with curative intent, we are carrying out a multicenter, prospective, randomized, controlled study in the Netherlands. The trial compares conventional gastrectomy to gastrectomy with extended lymph node dissection. In the first four months, a Japanese supervisor attended all the extended surgery and instructed many Dutch surgeons, including the eight consulting surgeons; since then, all extended gastrectomies have been attended by one of the consulting surgeons. The study coordinator attended all conventional cases. This assured that the quality of the extended surgery was as good as the Japanese standard, of which excellent results have been reported. To achieve this quality control, randomization before surgery was obligatory for practical reasons. Curability assessment at laparotomy, however, is done quite objectively with histological proof, except for the judgement of irresectability. Although this has resulted in many non-curative cases being randomized but subsequently not given the allocated surgery, the sample size should be sufficient to allow analysis according to randomization or the initial "intention to treat." This is the first protocol for a multicenter trial in surgical oncology to have such excellent surgical quality control and to assure a quality as high as that in the original report with uniformity in the level of technique. In studies comparing surgical techniques, it is vital that attention should be given to surgical quality control, otherwise survival rates may show little improvement and fail to make any impact on surgical practice.

Adenocarcinoma↗
PubMed1991

Non-ominous micrometastases of gastric cancer.

So-called R2 or wider meticulous node dissection was performed in 1368 patients with resected gastric cancer invading beyond the submucosa but without distant metastases. Survival rates were similar in subsets of patients with or without microscopic node metastases and macroscopically normal lymph nodes. The extent of node metastases has previously been shown to be one of the two most important prognostic factors in gastric cancer without distant metastases, and its lack of impact in these patient groups was not explained by the imbalance of other prognostic factors. The findings indicate that micrometastases of gastric cancer are curable by a wide node dissection made in the absence of palpable abnormality. They also offer the possibility that an extensive node dissection may yield good stage-specific survival rates, in part because of upstaging of patients. The findings should influence the recording of node metastases for evaluation of stage-specific treatment results and for research purposes.

Female↗
PubMed1991

Surgical treatment of carcinoma of the gastric stump.

To evaluate retrospectively the surgical treatment of patients with gastric stump cancer following gastrectomy for benign disease, we reviewed 52 patients operated on at the National Cancer Centre, Tokyo, between 1962 and 1988. Resection was carried out in 47 patients (90 per cent) and with curative intent in 36 (69 per cent). Stage distribution was: stage 1, 15 patients; stage 2, 5; stage 3, 9; stage 4, 23. In 36 cases curatively resected, 32 had completion total gastrectomy and four had subtotal resection. An R1 resection was performed in 11 patients and an R2 in 25. We had two hospital deaths and a 5-year survival rate excluding hospital deaths of 39 per cent. The 5-year survival rates of resected cases, curative cases and those having metastatic nodes were 43 per cent, 57 per cent and 29 per cent respectively. Radical resection is a reasonable treatment for gastric stump cancer as it is for primary cancer of the stomach.

Duodenal Ulcer↗
PubMed1989

Computer analysis in making preoperative decisions: a rational approach to lymph node dissection in gastric cancer patients.

In Japan, R2 lymph node dissection is standard practice for all curatively resected gastric cancer patients. From 1969 to 1984, data were collected prospectively to evaluate this procedure and to provide information for a more rational approach to node dissection for each individual case. A total of 3843 cases was included in this study and an evaluation was made of the prognostic variables and lymph node involvement at various locations. Using a computer program, it is possible to compile a group of treated patients, with prognostic variables exactly matching those of an individual patient. Analysis of this group can then give an indication of the extent of lymph node dissection required for an individual patient. This paper gives a demonstration of the structure of such a system by means of an example.

Decision Making, Computer-Assisted↗
PubMed1989

Lymph node metastases of gastric cancer. General pattern in 1931 patients.

The incidence of metastases from gastric adenocarcinoma to various regional lymph node stations was studied after meticulous node dissection and correlated to survival in 1931 resected patients. The incidence of metastases increased with deeper tumor invasion into the stomach wall. Deposits were most common in some perigastric node stations, and their distribution was clearly related to the location of the tumor. Some nonperigastric node stations also were frequently involved, e.g., those around the left gastric artery or in the splenic hilum, and may be considered primary draining nodes. Skip metastases to distant nodes were found in a few per cent of perigastric node-negative patients. Deposits in nodes around the middle colic artery, but not in any other upper abdominal node stations, were incompatible with 5-year survival rates. The analysis favors a so-called R2 or more extensive resection for cancers invading beyond the submucosa.

Female↗
PubMed1989

[Reasonable lymph node dissection in radical gastrectomy for gastric cancer: introduction of computer information system and lymphography technique by India-ink].

A computer information system was developed and clinically used in National Cancer Center Tokyo in 1983. Seven data of an individual patient are preoperatively input in the system: sex, age, location, macroscopic type, maximal diameter, depth of invasion, and histological type of biopsy. After the data-analysis of 3,785 patients, the computer outputs three data; expected five year survival rate, each metastatic rate of 16 regional lymph nodes, and types of recurrence. Plan of lymph node dissection can reasonably be decided by this report. 0.5ml of India-ink (CH-40) is injected in the perigastric lymph nodes, and it stains all lymphatic channels from the injection points in black. Using the technique, systematic dissection can be performed easily and completely. After the introduction of these systems, five year survival rate was improved from 90.0% to 95.5% in Stage I, from 76.0% to 81.6% in Stage II, from 51.1% to 56.8% in Stage III, and from 12.9% to 16.6% in Stage IV.

Carbon↗
PubMed1989

[Surgical treatment of perforated diverticular sigmoiditis. A retrospective study apropos of 45 cases].

The authors report their experience with 45 cases of perforated diverticular sigmoiditis (10 cases of mesocolic abscesses, 13 cases of localised peritonitis and 22 cases of generalised peritonitis). The mean age of the patients was 69 years and a previous history of diverticulosis was found in 26.6% of patients. 18% were taking steroids or anti-inflammatories. The often atypical symptomatology only suggested sigmoid perforation in 50% of cases. Surgical procedures consisted of 33 immediate resections (group 1) and 12 conservative procedures (group 2). Overall mortality was 17.8%, and was 13% at the abscess and localised peritonitis stage, and 22.7% at the generalised peritonitis stage (difference not significant). 12% of patients died after resection in comparison with 33.3% after conservative surgery (difference not significant). Mortality was significantly higher when there was evidence of shock, pre-operative leucopenia and pyostercoral peritonitis. In group 1, the surgical morbidity was 24% with 9% reinterventions, while in group 2, there was a 50% complication rate and 25% reintervention rate. Intestinal continuity was reestablished in 67.5% of surviving patients with zero mortality. In view of the results obtained and after review of the literature, immediate resection would appear to give better results than conservative treatment.

Adult↗
PubMed1987

[Preoperative skin preparation. A prospective study comparing a depilatory agent in shaving].

Two types of pre-operative skin preparation were compared in a prospective randomized study conducted on 100 patients undergoing elective surgery: 51 patients were shaven (group I) and 49 were prepared with a depilatory agent. In all cases skin preparation was performed on the eve of the operation. Bacterial density, measured immediately before surgery by application of a contact agar preparation was 493 +/- 928 CFU in group I and 386 +/- 670 CFU in group II (NS). Bacterial density was less than 25 CFU in a significantly greater number of group II patients (P less than 0.01). On the second postoperative day, the number of scars without any sign of sepsis was significantly greater in group II patients (P less than 0.05). In addition, the depilatory agent proved bactericidal against 3 pathogenic strains (S. aureus, Pseudomonas aeruginosa and E. coli). Depilation with a chemical agent seems to be a satisfactory method of pre-operative skin preparation. It is more rapid than shaving, it can be applied to areas not easily accessible to razors, and it can often be carried out by the patient himself.

Adult↗
PubMed1985

Nd-YAG laser for general surgery.

We report here our clinical experiences with Nd-YAG laser on general surgery, and evaluate the results of this procedure. From December 1979 to December 1981, we applied Nd-YAG laser to various operations as a hemostatic and cutting tool. For hemostasis, we used conventional quartz fiber which was covered with sterile tube, and hemostatic efficacy was examined especially in the subcutaneous bleeding and the bleeding from solid organs. For cutting, we used special devices, ie, Medilas YAG surgical probe (noncontact-type probe), and a laser blade (contact-type probe), and performed four liver resections. It is concluded that the hemostatic efficacy of Nd-YAG laser to various bleeders was proved in general surgical procedures, and furthermore this laser can cut tissue if we utilize these devices. When comparing these two devices, we would prefer the contact-type probe.

Carcinoma, Hepatocellular↗
PubMed1985

[The effect of Nd:YAG laser irradiation on gastric cancer in rats induced by N-methyl-N'-nitro-N-nitrosoguanidine as a model of endoscopic laser treatment for early gastric cancers].

The aim of this report is to prove that cancer tissue is to be eradicated by Nd:YAG laser irradiation and to show the process of its eradication using MNNG induced gastric cancers in rats as a material. Material and Method; in male rats of Wister strain, gastric cancers were induced by 30 weeks administration of 80 mg/1 MNNG solution. Then tumor bearing rats underwent laparotomy and gastrotomy, and tumors were irradiated by the Nd:YAG laser with 30W at the distance of 1cm, total energy ranging 120-1800 joules. These 20 stomachs were examined histologically; 10 of them within 14 days, the rest more than 4 weeks after the irradiation.

Adenocarcinoma↗
PubMed1982

Clinical application of the Nd:YAG laser endoscopy.

We report here our clinical experiences with Nd:YAG laser therapy, and evaluate the results of this treatment. From July 1980 to December 1981, we carried out endoscopic laser treatment for 31 patients with 33 lesions. Bleeding gastric ulcers except stomal ulcers were treated successfully. For mucosal lesions of the stomach, Nd:YAG laser irradiation was effective in extirpating them. In advanced gastric cancers, symptoms of cardiac stenosis could be relieved in 80% of the cases. Endoscopic laser therapy was also effective in 80% of postoperative stenosis in the gastrointestinal tract. It is concluded that endoscopic irradiation with the Nd:YAG laser is useful for hemostasis and also for the treatment of malignant tumors and stenosis of the gastrointestinal tract.

Adenoma↗
PubMedDate not supplied

Pancreas-preserving total gastrectomy for proximal gastric cancer.

Lymph node (LN) dissection along the upper border of the pancreas is one of the essential parts of curative surgery for gastric cancer, and the distal portion of the pancreas was frequently resected for complete removal of LNs along the splenic artery. However, pancreatic juice leakage, subphrenic abscess, and postoperative diabetes were common complications in patients treated by pancreatic resection. To avoid these problems a new surgical procedure, the pancreas-preserving operation, was developed by Maruyama in 1979. We found that lymphatic channels from the stomach did not flow into the pancreas parenchyma, and that the spleen, splenic artery, and fatty connective tissue including nodes could be removed completely without dissection of the pancreas parenchyma and splenic vein. The preserved pancreas receives its arterial blood supply through the transverse pancreatic artery, and its preservation prevents postoperative diabetes. A total of 299 patients were treated by this procedure. The operative mortality rate was 0.3%, the hospital death rate 1.6%, and the surgical complications rate 19.6%. The cumulative 5-year survival rate for those with stage II was 70.5% and for those with stage III 54.1%. These results were superior to those of the pancreas resection group.

Gastrectomy↗
PubMedDate not supplied

Lymphadenectomy for gastric cancer in clinical trials: update.

The controversy over the value of extended lymph node dissection for treatment of gastric cancer is fiercely debated. Whereas Japanese surgeons claim that the superior survival rates in their series are due to extensive resection (D2 resection), many Western authorities believe that their results only reflect differences in the prevalence of prognostic factors, inconsistencies between Japanese and Western staging systems, and the phenomenon of "stage migration," which occurs with extensive resection. Two small randomized prospective trials from Hong Kong and Cape Town showed a tendency toward high morbidity with extensive lymph node dissection but no survival benefit. In contrast, the recently completed prospective German Gastric Carcinoma Study demonstrated a clear survival advantage with D2 resection for tumor stages II and IIIa with no increase in perioperative morbidity or mortality. The long-term results of the still ongoing randomized MRC and Dutch trials are therefore eagerly awaited.

Clinical Trials as Topic↗
PubMedDate not supplied

Comparison of factors influencing the prognosis of Japanese, German, and Dutch gastric cancer patients.

As a result of Japanese reports of improved survival of gastric cancer patients after extended lymph node dissection, a study was undertaken to evaluate factors that might influence these results. The influence of staging was evaluated by stratifying 1085 patients of the National Cancer Center of Japan and grouping them according to the three commonly used systems; UICC's old and new TNM systems (fourth edition) and the system of the Japanese Research Society for the study of Gastric Cancer (JRSGC). No survival difference was found between the stages of the three systems, except for stage II, where the new TNM and the JRSGC differed (p < 0.05). In a second analysis, the incidence of the most important prognostic factors for advanced gastric cancer was compared among three institutions: the National Cancer Center Tokyo, Japan (NCC), the University Hospital Erlangen, Germany (UHE) and the University Hospital Maastricht in The Netherlands (UHM). Japanese patients were on average 3 years younger than the German patients and 8 years younger than the Dutch patients, and had a higher proportion of advanced (T4) carcinomas. Male-female distribution, histology, and lymph node invasion were comparable in the three groups. From these data a rather worse prognosis for Japanese advanced gastric cancer patients could be expected. However, the observed 5-year survival rates show a marked advantage for the Japanese patients: 57% (NCC) versus 34% (UHE) and 31% (UHM). The survival difference for stage II patients between the new TNM and the JRSGC staging systems is not sufficient to explain this advantage. This result underlines the importance of the Japanese therapeutic approach.(ABSTRACT TRUNCATED AT 250 WORDS)

Age Factors↗
PubMedDate not supplied

The effects of blood transfusion on the prognosis of patients with gastric cancer.

The effect of perioperative blood transfusion on the survival rate of patients with gastric cancer was studied. One thousand patients with primary gastric cancer, who had curative surgery performed at the National Cancer Center Hospital in Japan from 1976 to 1981, were studied retrospectively. Overall comparison of transfused (n = 371) versus nontransfused (n = 629) patients by log rank analysis revealed a statistically significant adverse influence of blood transfusion on survival (p = 0.0001). Fifty-seven percent of transfused as compared to 80.8% of nontransfused patients survived for 5 years or more; however, after stratifying patients into stages and applying proportional regression analyses, blood transfusion did not appear to have any effect on prognosis: relative risk ratio, 1.16; p = 0.28. Similarly, comparison of patients transfused with more than 600 cc of blood and those transfused with 600 cc of blood or less revealed no statistical difference in survival time. It is postulated that the possible adverse influence of blood transfusion on the survival of patients with gastric cancer is linked to other prognostic features rather than to the immunologic sequelae of the transfusion itself.

Blood Transfusion↗