A total of 143 patients who underwent hepatic resection for hepatocellular carcinoma in our department were reviewed. The review was conducted for two periods: 1970-1982 (early period) and 1983-1990 (late period), that is, the periods before and after introduction of the hepatic surgical technique involving the use of a microwave tissue coagulator and ultrasonic dissector. One patient underwent extended lobectomy, 12 lobectomy, 9 segmentectomy, and 26 partial hepatectomy during the early period. Two patients underwent extended lobectomy, 7 lobectomy, 9 segmentectomy, 36 subsegmentectomy, and 41 partial hepatectomy during the late period. Operative mortality and hospital mortality were 16.7% and 22.9% during the early period and 1.1% and 8.4% during the late period, respectively. The overall mortality rate was significantly lower during the late period than during the early period. Postoperative complications developed in 62.5% of the patients with hepatic resection during the early period and in 48.4% of the patients during the late period. The size of tumors during the early period was significantly greater than that during the late period. Intraoperative blood loss during the late period was significantly lower than that during the early period. The survival curve was better among patients who underwent hepatic resection during the late period than among those during the early period. The satisfactory results during the late period are due to the introduction of intraoperative ultrasonography, microwave tissue coagulation, and ultrasonic dissection for hepatic surgery.

Adolescent↗

PubMedDate not supplied

Tumor size as a predictive factor.

Is tumor size a predictive factor in carcinoma of the pancreas? In order to answer this question, the data of the Japan Pancreatic Cancer Registry from 1981 to 1987 were retrospectively analyzed. Of the 7687 cases that were registered, 5826 cases (75.7%) were laparotomized. Out of the 5826, 2311 (39.7%) underwent resection. Postoperative deaths within 1 mo among resected cases numbered 104, and the operative mortality rate was 4.5%. The postoperative survival rates were calculated by Kaplan-Meier's method. They clearly showed that the rates for small carcinomas (greater than 2 cm [T1]) were significantly higher than those for the tumors larger than 2 cm (T2, T3, T4) according to the Greenwood formula. Although the survival-rate calculation excluded operative deaths and deaths of causes other than pancreatic cancer, and included islet cell carcinoma, cystadenocarcinoma, and acinar cell carcinoma, it seems that tumor size may be a predictive factor for postoperative prognosis. However, our previous study on long-term survivors (more than 5 yr) after resection on the exocrine pancreatic cancer) revealed that there was no relation between the size of tumor and the postoperative prognosis. In those long-term survivors, there was no definite or severe cancerous invasion of either the retroperitoneal tissue or the portal venous system. It is concluded that a tumor 2 cm or smaller has a significantly better prognosis after resection than does a tumor larger than 2 cm, and it seems, in general, that tumor size may be a predictive factor. However, if the tumor does not invade the retroperitoneal tissue or the portal venous system, tumor size per se is not always a predictive factor.

Adult↗

PubMedDate not supplied

Long-term survivors after hepatectomy for hepatocellular carcinoma.

Sixteen long-term (more than 5 years) survivors after hepatic resection performed for hepatocellular carcinoma (HCC) from 1970 to 1988, were reviewed. The mean age of the patients was 51 years. There were 11 males and 5 females. HBs antigen was positive in 9 patients. Liver cirrhosis was associated with 11 patients but its severity was designated as Child's A in all patients except one. The mean tumour diameter was 2.8 cm and was relatively small. At the first operation, limited procedures (i.e. partial hepatectomy and subsegmentectomy) were employed in 87.5% of patients. A large percentage of tumours were located in S5 and S6 segments. A recurrence of HCC occurred in 9 patients after the first resection. A second resection was carried out in 7 patients, in 2 of which a third resection was done. Transcatheter arterial embolization (TAE) was performed on 4 patients. These results show that, in addition to detection of small tumours and early resection, repeated operation or TAE for treatment of recurrent HCC was important in achieving long-term survival after HCC resection.

Carcinoma, Hepatocellular↗

PubMedDate not supplied

The complete hilar-mediastinal lymph node dissection.

Starting from Cahan's "radical pneumonectomy" and "radical lobectomy", mediastinal lymph node dissection was introduced in Japan by Ishikawa and survival results analyzed by Naruke. Japanese Lung Cancer Society (JLCS) introduced Naruke's lymph node map to standardizing dissection. Upper mediastinum, subcarinal, interlobar and upper lobar lymph nodes are to be dissected for tumors located in the right upper lobe, and the same areas in the case of middle lobe. In tumors of the lower right lobe, also nodes of the lower mediastinum should be dissected. When the tumor is in the left upper lobe, upper mediastinum (except pre and paratracheal lymph nodes), subcarinal, interlobar and lobar nodes should be dissected. Finally, in left lower tumors, lower mediastinum is to be dissected. Super-radical dissection is performed through a median sternotomy to reach pre and paratracheal nodes in tumors affecting the left upper lobe.

Humans↗

PubMedDate not supplied

The Japanese database for the staging of lung cancer.

From the beginning of the 60s, Japanese Lung Cancer Society (JLCS) proposed an original TNM classification of lung cancer based on a database of resected cases. The final step was the UICC classification edited in 1973. Complete hilar-mediastinal lymph node dissection was started in the same era and the concept of station number of lymph nodes was introduced. The proposal of definition of "early lung cancer" came from Japan with the subgroups of hilar and peripheral type. A new national database is now collected for the next revision of UICC TNM classification to be edited in 2007.

Databases, Factual↗

PubMedDate not supplied

Cytologic detection of small pancreaticoduodenal and biliary cancers in the early developmental stage.

Employing pancreozymin-secretin stimulation and percutaneous transhepatic cholangiographic aspiration, cytologic examination for pancreaticoduodenal and biliary tract cancers was carried out in 763 patients, with 47 of 61 cancers cytologically detected (79%). The cancers detected included seven minute or small cancers less than 1.0 cm in maximum diameter, all of which were successfully surgically extirpated. The results indicate that diagnostic cytology contributed to the detection of cancers in these anatomic sites at an early developmental stage.

Adult↗