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PubMed2002

[Prognostic value of CLIP score system for patients with resection of hepatocellular carcinoma].

OBJECTIVE: To evaluate the prognostic value of CLIP score system for patients with resection of HCC. METHODS: A retrospective survey was carried out in 174 patients undergoing resection of HCC from January 1986 to June 1998. 153 of 174 patients with curative resection were followed up for at least three years. Disease-free survival rate was defined as the time relapsed from the date of image diagnosis and either the date of death or the date of the latest follow-up visit, with final evaluation at June 30, 2001. Recurrences were classified into early (</= 3 year) and late (> 3 year) recurrence. Risk factors for recurrences and prognostic factors for survival in each group were analyzed by the chi-square test, the Kalain-Meier estimation and the COX proportional hazards model respectively. RESULTS: The 1-, 3-, 5-, 7-, and 10-year cumulative disease free survival rates were 57.2%, 28.3%, 23.5%, 18.8% and 17.8%, respectively. The associated factors with early recurrence were as fellows: tumor size > 5 cm, microsatellite, venous invasion, tumor morphology, tumor extension, advanced TNM stages, CLIP scores, radical resection, and resection margin, respectively. But both CLIP scores and Child stage were associated with late recurrence. Univariate survival curves analysis expressed that Child grades, radical resection, resection margin, tumor size, microsatellite, venous invasion, tumor morphology, tumor extension, TNM stages, and CLIP scores were associated with prognosis. The multivariate analysis by COX proportional hazards model, the independent prognostic factors for survival were radical resection, resection margin, and TNM stages. CONCLUSIONS: CLIP score, which takes into account both liver function and tumor extension, has displayed a unique superiority in predicting the tumor early and late recurrence and prognosis. It could be an useful tool in predicting the patient recurrence and prognosis with resection of HCC. Meanwhile, it may help physicians to decide the more appropriate management in advance for patients with HCC.

Adolescent↗
PubMed2002

[Evaluation of hepatic resection for metachronous liver metastases from gastric cancer].

To evaluate the effect of hepatic resection for metachronous liver metastases after resection of gastric cancer, the clinicopathological factors of gastric cancer, state of liver metastasis, surgical procedures for liver metastasis, and remote survival were studied. Between 1989 and 2001, 30 consecutive patients underwent hepatic resections (36 resections) for metachronous liver metastases. The patients included 25 men and 5 women, and the median age was 60 years old (range 46-86 years old). As for curability, curative A/curative B was 10/20, and H0/H1/H2 was 25/3/2. The mean period from initial surgery to the liver resection was 19.3 months (range 6.3-65.2 months), and the liver metastatic conditions were H1 for 27 patients and H2 for 9 patients. By number of liver metastases, 27 patients had 1 lesion, 24 patients had 2, and 5 patients had more than 3 lesions. Twenty-nine patients were negative and 7 were positive for lymph node metastasis. A partial resection was performed for 13 patients, a subsegmentectomy for 3 patients, a segmentectomy for 7 patients, a lobectomy for 8 patients, and an extended lobectomy for 5 patients. For all patients except those who had other causes of death, the overall mean survival time was 702 days and the 5-year survival rate was 26.4%. There were four 5-year survivors after hepatic resection. In conclusion, the main prognostic factor after resection of metachronous liver metastases was the existence of lymph node metastasis, and the remote survival of patients with abdominal para-aortic lymph node recurrence was poor. The type of liver resection was not a predictor of survival. The resection of liver recurrence was evaluated clinically, but we should maintain strict criteria and select adequate surgical procedures.

Aged↗
PubMed2003

Hepatic resection for bilobar hepatocellular carcinoma: is it justified?

HYPOTHESIS: Patients with bilobar stage IVa hepatocellular carcinoma (HCC) are generally considered unsuitable for hepatic resection. Recent data suggest that palliative hepatic resection in selected patients with advanced HCC may result in a favorable survival outcome. The aim of the present study was to evaluate the operative outcome and survival benefits of hepatic resection for patients with bilobar HCC. DESIGN: Retrospective study. SETTING: Tertiary referral center. PATIENTS: The study comprised 78 patients who were diagnosed as having unilobar HCC and considered initially suitable candidates for curative hepatic resection on preoperative investigations from 1989 to 2000. Bilobar disease with discrete tumor nodules in the contralateral lobe was diagnosed in these patients on laparoscopy (44 patients) or laparotomy (34 patients) with the help of intraoperative ultrasonography. Fifteen patients (19%) underwent palliative hepatic resection (group A), and hepatic resection was not performed in the remaining 63 patients (81%) (group B). MAIN OUTCOME MEASURES: The clinicopathologic data and operative and survival outcomes of both groups of patients were compared. RESULTS: The clinicopathologic parameters were comparable in both groups of patients. In group A, 12 patients (80%) underwent major hepatic resection, and the mean +/- SEM size of the resected tumors was 8.3 +/- 0.9 cm. The operative morbidity and mortality were 20% and 0%, respectively. Treatment for tumors in the contralateral lobe included wedge excision (5 patients), alcohol injection (5 patients), cryotherapy (2 patients), and transarterial oily chemoembolization (3 patients). In group B, treatment for HCC included transarterial oily chemoembolization (42 patients), systemic chemotherapy (3 patients), transarterial oily chemoembolization and systemic chemotherapy (5 patients), cryotherapy (2 patients), tamoxifen (3 patients), and no treatment (8 patients). The median survival of patients in group A was 19.5 months, with 4 patients surviving for more than 3 years. The survival in group A was significantly better than in group B (median = 7.1 months; P =.008). On multivariate analysis, hepatic resection and preoperative serum alpha-fetoprotein level were the 2 independent factors that significantly affected patient survival. CONCLUSIONS: Hepatic resection for HCC in patients with stage IVa bilobar disease results in a better survival outcome than nonresectional therapies. It should be considered in selected patients with low operative risks and satisfactory liver function.

Adolescent↗
PubMedDate not supplied

[The learning curve in laparoscopic resections of the colon and rectum: results and considerations].

A well-designed learning curve is essential for the success of laparoscopic colorectal surgery for cancer. The aim of this study was to evaluate the results and characteristics of the learning curve in laparoscopic colorectal surgery beginning with benign diseases and eventually going on to include colonic resections for cancer. A total of 60 laparoscopic resections were performed. In the first 33 cases only benign diseases (diverticular disease and polyps) were treated. The next 27 cases included resections for cancer, initially with the following exclusion criteria: obesity, previous abdominal surgery, emergency surgery for occlusion, voluminous tumours or infiltration of surrounding organs. Since January 2002 the only applicable exclusion criteria for laparoscopic resection have been emergency surgery for occlusion and invasion of adjacent organs. The following procedures were performed: 29 left hemicolectomies, 19 sigmoid resections, 7 segmentary resections, 3 abdomino-perineal resections and 2 right hemicolectomies. The conversion rate was 11.6%. The mean length of the segment removed was 21.5 cm. The mean number of lymph nodes harvested (for cancer) was 22.3. Major complications were observed in 3.3% and minor complications in 13.3%. The operative time decreased from a mean of 207 minutes to a mean of 170 minutes in the last group of 20 patients. Laparoscopic resections are safe and give the patient the opportunity to make a rapid recovery with less pain and a better outcome. We suggest performing laparoscopic colorectal resections initially for benign diseases (diverticular disease and polyps). This is needed in order to hone the technique. Resections for cancer can be undertaken only when the surgical team can guarantee an oncologically correct procedure in terms of lymphadenectomy, intraabdominal manipulation and extraction of the diseased segment from the abdomen.

Adult↗
PubMed2003

[Anatomy of the head of the pancreas and various limited resection procedures for intraductal papillary-mucinous tumors of the pancreas].

The surgical anatomy, as well as the results of anatomic investigation of the pancreas, are reviewed. Anatomic descriptions, which are useful not only for ordinary pancreaticoduodenectomy or distal pancreatectomy, but also for limited resection of the pancreas for low-grade malignancy such as mucin-producing tumors or cystic lesions of the pancreas, are also provided. The fusion fascia of the head of the pancreas is called the "fusion fascia of Treitz" and that of the body and tail of the pancreas is termed the "fusion fascia of Toldt." The fusion fascia is histologically composed of a loose connective tissue membrane. All of the important pancreaticoduodenal arcades of arteries and veins are situated on this membrane, i.e. between this membrane and the pancreatic parenchyma. The topography of the head of the pancreas shows that, after branching from the gastroduodenal artery, the anterior superior pancreaticoduodenal artery runs toward a point 1.5 cm below the papilla of Vater, then turns to the posterior aspect of the pancreas to join the anterior inferior pancreaticoduodenal artery. For preserving the duodenum, the artery toward the papilla is very important. The artery toward the papilla of Vater runs along the right side of the common bile duct after branching from the posterior superior pancreaticoduodenal artery. The gastrocolic trunk of Henle has been reported to be found in about 60% of individuals. It is possible that the gastroepiploic vein and anterior superior pancreaticoduodenal vein (ASPDV) can be divided at pancreaticoduodenectomy with preservation of the superior right colic vein if this area is free of carcinoma. The ASPDV and anterior inferior pancreaticoduodenal vein (AIPDV) form an arcade on the anterior surface of the pancreas. However, arcade formation was not found between the posterior superior pancreaticoduodenal vein (PSPDV) and posterior inferior pancreaticoduodenal vein (PIPDV) in many of the cases examined. The vein joined by the inferior mesenteric vein was also investigated. We termed the artery originating from the gastroduodenal (GD) or dorsal pancreatic (DP) arteries, located on the cranial side of the head of the pancreas, the supra-transverse pancreatic (supra-TP) artery. Surgeons should be aware of the presence of the supra-TP artery during pancreatic surgery. The type of procedure used for intraductal papillary-mucinous tumor (IPMT) of the pancreas is various. The standard operations, such as pancreaticoduodenectomy, pylorus-preserving pancreaticoduodenectomy, and distal pancreatectomy with splenectomy, are performed. In some cases, limited resection such as uncal resection, pancreatic head resection with segmental duodenectomy, duodenum-preserving subtotal resection of the head of the pancreas, and spleenpreserving distal pancreatectomy with conservation of the splenic artery and vein are also performed. However, the type of procedure to use for IPMT is unclear, since there are still many unanswered questions regarding IPMT. Those unanswered questions include how a differential diagnosis of benign or malignant can be made clinically, how the extent of tumorous spread can be determined clinically, and whether patients with this disease can be cured after the tumor apparently infiltrates. IPMT may show multicentric development, while ordinary duct cell carcinoma may easily develop in the pancreas with IPMT. The reasons why duodenum-preserving resection of the pancreatic head is not popular involve the above problems and other technical problems. With preservation of the residual pancreas to maintain the duodenum and/or bile duct, the cut end of the pancreas may more frequently be positive for tumor cells, and IPMT and/or duct cell carcinoma may develop more often in the residual pancreas. We face the problem of whether several types of limited resection of the pancreas are suitable for IPMT with surgical indications due to possible malignancy and/or considerable ductal spread of neoplastic epithelia. When the pancreas head is completely resected, the bile duct, the papilla of Vater, and/or part of the duodenum should also be resected, and the significance of function-preservation declines. Important points for the future development of duodenum-preserving resection of the pancreatic head include clarifying the unanswered questions about IPMT, solving technical problems through the accumulation of anatomic and basic studies, and reporting objective results obtained in successful duodenum-preserving procedures. On the other hand, distal pancreatectomy that preserves both the splenic artery and vein and the spleen is steadily gaining popularity. Although this procedure is somewhat complicated, it is not technically difficult and can be safely performed by any surgeon. This procedure is indicated for some cases with chronic pancreatitis and IPMT.

Adenocarcinoma, Mucinous↗
PubMed2003

[Evaluation of lung function as a prognostic index before and after surgical resection due to NSCLC].

BACKGROUND: Although there were several studies on survival, death and morbidity rates after lung resection, considering both limited and extended resections, lung exercise capacity has been quite seldom taken into account as an index for prognosis. The aim of this study compare the consequences of three kinds of lung resections (pneumonectomy, lobectomy and wedge resection), to test pre- and post-surgery exercise capacity for patients affected by NSCLC in order to obtain more detailed prognostic indices. METHODS: All the patients were studied by means of thorough lung static function and hemogas analytical tests before and after surgical resection, from 15 days to 12 twelve months' time past surgery. RESULTS: In fact, in relation to lung resection due to neoplasms, several studies pointed out that zone-limited resections show an obvious anatomical benefit in terms of parenchyma spair compared to lobectomy; however, it is underlined that the functional benefits of small resections don't really prevail over post-lobectomy anatomical advantages. Furthermore local relapses are more common after small resections rather than after lobectomy. CONCLUSIONS: Neither limited lung resection nor lobectomy alone, therefore, in accordance with nearly all the recent and still ongoing studies in this huge research field, has a significant effect on exercise capacity. Only pneumonectomy is associated with impaired exercise performance, and, nevertheless, quite below our expectations.

Carbon Dioxide↗
PubMed2004

[Efficiency of combined multiple organs resection in advanced gastric carcinoma].

BACKGROUND & OBJECTIVE: Presently, 26.05% of cases with gastric carcinoma hospitalized in Cancer Center of Sun Yat-sen University were revealed adjacent organs involvement in varying degrees in exploration. There have been many arguments about the issue of surgery therapy on these advanced gastric carcinomas for a long time. This study was designed to demonstrate the feasibility of combined multiple organs resection in such cases. METHODS: Clinical data of 44 advanced gastric cancer patients received combined multiple organs resections from 1985 to 1995 in Cancer Center of Sun Yat-sen University were enrolled retrospectively. Among them, 34 cases received curative resection and 10 cases received palliative resection. The effects of two kinds of operations were analyzed. RESULTS: Median survival time was 588 days (average is 1 676 days) in radical combined multiple organs resection group and 344 days (average is 1 045 days) in palliative resection group respectively (P >0.05). In addition, no serious complication occurred and no patients died of extended resection. CONCLUSION: Combined multiple organs resection is practicable in curative therapy for gastric carcinoma; even palliative resection may have better treatment effect. So, if permission, radical combined multiple organs resection should be top-priority.

Adult↗
PubMedDate not supplied

Does the surgical stress associated with palliative resection for patients with incurable gastric cancer with distant metastasis shorten their survival?

BACKGROUND/AIMS: In cases of incurable stage IV gastric cancer with distant metastases, surgical treatment has usually consisted merely of palliation. The effect of palliative resection in these highly advanced cases remains controversial. Palliative resection may be prohibited by the potential disadvantages of surgical stress. METHODOLOGY: Over the past 23 years, 382 stage IV incurable gastric cancer patients with distant metastases were classified into a resection group (group R) whose subjects underwent a palliative resection of the primary tumor and the non-resection group (group N) who were treated without resection of primary tumor. In order to exclude patients with very poor prognosis due to irresectability even if trying to resect, we restricted the subjects to patients who survived more than 30 and 60 days and some months and estimated the mean survival. Cumulative survival rates were calculated by using the Kaplan-Meier method, and the mean survivals of groups R and N were compared. RESULTS: A significantly longer mean survival was observed in group R than in group N (381 vs. 181 days, P<0.0001). Restricting the subjects to patients who survived more than 30 and 60 days, there is also a significant difference between the mean survival of group R and that of group N. However, restricting the subjects to patients who survived more than 300 days, no significant difference was seen between the two groups. The rate of hospital death was higher in group N than in group R (15.9% vs. 3.4%) CONCLUSIONS: Palliative resection of the primary tumor in stage IV gastric cancer is meaningful in view of hospital stay, long-term survival, and satisfaction with the treatment. We should resect the primary tumor in cases in which it is resectable.

Female↗
PubMed2004

Downstaging followed by resection plays a role in improving prognosis of unresectable hepatocellular carcinoma.

BACKGROUND: Curable outcome of unresectable hepatocellular carcinoma (HCC) was seldom encountered in the past. This study was designed to assess the role of downstaging followed by resection (downstaging-resection) in the improvement of prognosis of unresectable HCC. METHODS: During the period of 1958-2003, a total of 1085 patients were verified surgically to be unresectable. Of these patients, 139 received downstaging-resection, with a rate of 84.2% for coexisting cirrhosis and a median tumor diameter of 11.1 cm. Resection of the right lobe, hepatic hilum and bilateral cancer accounted for 97.8% of the patients. Downstaging including hepatic artery ligation (HAL)+hepatic artery chemo-infusion (HAI) was performed in 65.5% of the patients, HAL+HAI+radiotherapy/radioimmunotherapy in 29.5%, and HAL or HAI alone in 5.0%. Retrospective analysis was made of the survival of patients with unresectable HCC, downstaging-resection rate and treatment pattern. RESULTS: In the 139 patients with downstaging-resection, the median interval between the first and second operation was 7.2 months and the 5-year survival rate calculated from the first operation was 48.7%. In the 1085 patients with unresectable HCC, their 5-year survival was 0% in the period of 1958-1973, 11.5% in the period of 1974-1988 and 19.3% in the period of 1989-2003. These figures were correlated with the increasing downstaging-resection rate from 0%, 9.0% to 15.6%, and the increasing percentage of triple or double combination treatment from 32.2%, 60.4% to 69.7%. The 5-year survival in triple treatment group was 24.9%, double treatment 15.2%, and single treatment only 10.9%, which was also correlated with the downstaging-resection rate of 34.6%, 16.2% and 1.8% respectively. CONCLUSIONS: Downstaging-resection plays a role in improving prognosis of unresectable HCC. Triple and double treatments provide a higher downstaging-resection rate and may result in better prognosis.

Adult↗
PubMed2005

[Anesthesia and operative approach of resection of the trachea].

OBJECTIVE: Review and discuss anesthesia and operative approach of resection of the trachea for different tracheal diseases, especially for the resection of long-segment of trachea. At the same time to introduce the method of reconstruction of long-segment of trachea with Zhao's (two-stage procedure with memory-alloy mesh) artificial trachea. METHODS: Retrospective study of 18 cases of tracheal resection, analysis of the relation between the choice of anesthetic and operative approach. RESULTS: General anesthesia through cut open the trachea with local anesthesia in 2 cases, general anesthesia through previous tracheotomy in 2 cases, extracorporeal circulation in 2 cases, general anesthesia through endotracheal tube in 12 cases. There were no anesthetic or operative death. Local resection in 3 cases, segmental resection in 15 cases. The longest segmental resection was 8.0 cm. Primary anastomosis after segmental resection in 8 cases, Reconstruction with Zhao's artificial trachea in 7 cases. Postoperative follow-up was 5 months to 8 years. Four cases died from systemic metastasis or other reasons at 4, 11 and 12 months, respectively. CONCLUSIONS: Different methods of anesthetic and operative procedures should be used for different patients. Extracorporeal circulation used for patient with highest dangerous condition, or, for which could be inserted endotracheal tube by tracheotomy with local anesthesia. Conservative local resection performed only for patients with very bad general condition. Segmental resection less than 5 cm long could be reconstructed with primary reanastomosis. Resection longer than 5.5 cm could be reconstructed with Zhao's artificial trachea.

Adolescent↗
PubMed2005

[Resection hip arthroplasty--mid- and long-term results].

PURPOSE OF THE STUDY: The study deals with resection hip arthroplasty, which is currently one of the principal orthopedic surgery procedures.The aim of the study was to evaluate the mid- and long-term results of resection arthroplasty carried out for different indications and to ascertain effects of the extent of proximal femur resection on the functional outcome. MATERIAL: In the period from 1979 to 2000, we carried out 159 resection hip arthroplasties for septic and aseptic loosening of total hip arthroplasty (THA), septic arthritis or osteomyelitis. Of these only the patients who underwent no THA implantation or reimplantation within 2 years of the operation were evaluated. We assessed 102 patients (71 women and 31 men) with 105 resection arthroplasties for the following indications: 14 cases of aseptic loosening of the THA, 72 cases of septic loosening and 19 cases of hip inflammation. The average follow-up was 70.8 months (range, 26 months to 20 years). The average age of the patients at the time of surgery was 62.5 years (29 to 86 years). METHODS: We recorded the patient's subjective evaluation of the surgery outcome, shortening of the extremity, and the range of hip motion. Harris hip scores were used to assess the functional outcome. We also evaluated, and statistically analysed, the extent of resection of the proximal femur on X-ray images and its effect on the eventual shortening of the extremity; this was done on the basis of the Grauer classification system. RESULTS: The average Harris hip score was 63.2 points (range, 47 to 88). None of the joints achieved excellent outcomes; 8.5 % were good, 22 % were satisfactory and 73 % were poor. On pain evaluation, 35 % of the patients were completely free from pain, 18 % reported mild pain not interfering with daily activities, 27 % experienced moderate pain responding to common analgetics and 11 % had severe pain necessary to be treated with strong analgetics. Persistent rest pain not responding to analgetics was in 9 % of the patients. The average shortening of the extremity for the whole group was 4.1 cm (range, 3.5- 7 cm): the average values for shortening in type I, type II and type II resections were 3.25 cm (3-5 cm), 4.1 cm (3-6 cm) and 5.3 cm (4.5/7 cm), respectively. The range of passive flexion was on average 81 degrees (range, 45-105 degrees ). Limping and a positive Trendelenburg's test were recorded in all patients and all also had to use walking aids. The outcome of surgery was evaluated as satisfactory by 35 % and as partially satisfactory by 43 % of the patients. DISCUSSION: Resection arthroplasty is a reliable technique for pain reduction, but it results in a considerable alteration of hip function. Pain in the hip after surgery is bearable, as 80 % of our patients reported only mild or moderate pain alleviated by common analgetics, or complete absence of pain. This is in agreement with the results of Stoklasa (84 %) and Stedrý (79 %). However, the subjective evaluation of surgery by patients is different; Petty has reported 14 % of satisfied patients, while Ahlgren and Böhler described 100 % of satisfied patients. Hip stability and less shortening of the extremity are more important for patients' satisfaction than a certain mild degree of pain. The best subjective evaluation was reported by the patients who had resection at the femoral neck level and who also had the lowest average shortening of the extremity. But only 55 % of the satisfied or partially satisfied patients reported mild or no pain. CONCLUSIONS: Resection arthroplasty is, in indicated cases, a reliable method which, in spite of certain drawbacks, produces good functional outcomes and makes the patients satisfied. It is, without doubt, an integral part of the current orthopedic surgery repertoire. We recommend a cautious approach to repeated attempts at THA reimplantation or to reconstruction procedures.

Adult↗
PubMed2006

[Experience in resection of hilar cholangiocarcinoma: a report of 54 cases].

OBJECTIVE: To summarize the experience in ameliorating curative resection rate and major postoperative complication rate for treatment of hilar cholangiocarcinoma. METHODS: Respective analysis was made on the clinical data of 54 consecutive cases who underwent resection of hilar cholangiocarcinoma from Jan. 1998 to Dec. 2004. RESULTS: In this group 54 cases received tumor resection with a resection rate of 63.5%. Combined partial hepatectomy was performed in 14 patients, while combined pancreaticoduodenectomy (Whipple) in 3 patients, and combined resection of portal vein in 2 patients and combined resection of hepatic artery in 2 patients. Thirty patients had curative resection. The curative resection rate was greatly increased from 27.0% (before 2001) to 41.7% (after 2001) in this group with well controlled perioperative mortality and postoperative complications rate (e.g. hepatic failure and major infection). The gross 1-, 2-, and 3-year survival rates for the whole group were 67.4%, 28.1% and 13.5% respectively. The 1-, 2-, and 3-year survival rates for curative resection were 87%, 36% and 24% respectively. The 1-, 2-year survival rates for palliative resection were 42% and 18%. CONCLUSIONS: Enhanced surgical technique resulted in better clinical outcomes.

Adult↗
PubMed1991

[Influence of 50% proximal or distal small bowel resection on gut hormone release after test meal loading in dogs].

The effect of proximal and distal small bowel resection on gut hormone release after test meal loading in dogs was studied. Ten beagle dogs were subjected to 50% proximal or distal small bowel resection, and test meal loading was performed after one night fasting to examine gut hormone release. Fasting levels of plasma gastrin were not changed after both proximal and distal resection, but response to test meal was increased at 18 weeks of postoperative period in 50% proximal resection. Postprandial release of plasma GIP was significantly decreased in both proximal and distal resection compared with preoperative period. Postprandial release of enteroglucagon was increased at 4 and 8 weeks in proximal resection. In distal resection, it was increased at 4 weeks but returned to preoperative levels at 8 weeks. Villus height of middle part of the intestine was increased in both proximal and distal resection, and significant change was observed in the duodenal mucosa of proximal resection at 4 weeks. These findings suggest that part of the resection of small bowel influences gut hormone release, and these may play an important role in intestinal adaptation.

Adaptation, Physiological↗
PubMed1988

[Endoscopic resection with local injection of hypertonic saline epinephrine for the treatment of early gastric cancer].

We have developed a new method of endoscopic resection of early gastric carcinomas and other tumors. Characteristics of the new method are summarized as follows. 1. In order to prevent bleeding after endoscopic resection of the tumors, local injection of hypertonic saline epine phrine (HSE) solution was applied to the lesion. Even a depressed lesion like II c type early gastric carcinoma was artificially protruded by local injection of HSE solution. 2. Instead of a single fiberscope, double fiberscopes were employed simultaneously for endoscopic resection of the lesion. 3. Prior to resection of the lesion by high frequency current snare method, incision of the mucosa along the marking line around the lesion performed, enabling the area to be resected precisely. 4. Because tissue damage is mild, resected materials removed are suitable for pathological study. Endoscopic resection was performed on a total of 113 cases in early gastric carcinomas; 103 cases among them (91.2%) were curative resections. Ten cases of the rest underwent surgical gastrectomy for the endoscopic non-curative resections. Rate of five-year survival in 103 cases was 85.2%. Endoscopic resection by our method seems to be effective for the treatment of early gastric carcinomas in any lymph node metastasis and in patients at high surgical risk.

Epinephrine↗
PubMed1982

Influence of histologic type on survival after curative resection for undifferentiated lung cancer.

Undifferentiated carcinoma of the lung carries a worse prognosis overall than other cell type, but it is unclear whether these tumors represent a homogeneous group with uniformly poor survival. This study identifies certain histologic subtypes of large cell and small cell undifferentiated carcinoma which have a better prognosis after curative resection than other similarly treated undifferentiated carcinomas. From 1947 through 1975, a total of 2,352 patients with lung cancer were admitted to one hospital. Follow-up to death was available in 98%. Pathological material was reviewed from 1,979 cases by a team of three pathologists during a single 6 month period without knowledge of clinical outcome. Curative resection was carried out in 632, with 170 (27%) 5 year survivors. Small cell cancer occurred in 481 patients and nine (1.6%) survived 5 years. Curative resections were performed in 34 with polygonal small cell carcinoma, 20 with normal lymph nodes and 14 with diseased lymph nodes. Seven survived 5 years (21%), six of 20 with normal and one of 14 with diseases lymph nodes. Eleven with nonpolygonal small cell carcinoma (eight oat cell, three fusiform) (five normal, six diseases nodes) underwent curative resection, with no survivors. Large cell carcinoma occurred in 151 and 19 survived 5 years. Curative resection was performed in 24 having large cell carcinoma with stratification (16 normal, eight diseased nodes), and 12 (50%) survived 5 years. In 26 with nonstratified large cell carcinoma undergoing curative resection (18 normal, eight diseases nodes); six (23%) survived 5 years (chi 2 = 4.06 p less than 0.05). Thus patients with resectable polygonal small cell carcinoma appear to have a better prognosis than those with nonpolygonal small cell carcinoma, and their prognosis approaches that of all patients with resectable lung cancer. Patients having resectable large cell carcinoma with stratification have a significantly better prognosis than those with nonstratified large cell carcinoma. Patients with these subtypes should therefore not be denied an attempt at curative resection because of the diagnosis of undifferentiated lung cancer.

Carcinoma, Small Cell↗
PubMed1976

Role of fat maldigestion in pathogenesis of steatorrhea in ileal resection. Fat digestion after two sequential test meals with and without cholestyramine.

To clarify the role of fat maldigestion in the pathogenesis of steatorrhea in patients with ileal resection the total and aqueous phase concentrations of bile acid and fatty acid were characterized in 8 such patients (5 patients with small ileal resection, bile acid diarrhea, and steatorrhea less than 20 g per day; 3 patients with large ileal resection, fatty acid diarrhea, and steatorrhea greater than 20 g per day) as well as 4 healthy control subjects after a morning and an afternoon liquid test meal. The study was then repeated with cholestyramine, 4 g being administered before each meal to induce fat maldigestion. After a conventional test meal, patients with large resections and severe steatorrhea had significantly lower aqueous phase concentrations of bile acids (and fatty acids) than patients with smaller resections or control subjects, explained in part by intraluminal precipitation of about one-half of the bile acids during digestion. When cholestyramine was administered before the meal, aqueous phase bile acid concentrations decreased in all patients, including the normal control subjects; the degree of fat maldigestion induced in the patients with small resections (and the control subjects) became similar to that present after the conventional test meal in the patients with large resections. Because steatorrhea increased little in the patients with small resections when cholestyramine was administered continuously, the data suggest that fat maldigestion per se does not induce severe fat malabsorption in patients with sufficient anatomical reserve, because such patients can absorb fat efficiently by utilizing the distal small intestine. In patients with large ileal resections, severe steatorrhea is explained in part by the combination of fat maldigestion and decreased surface area. It is also speculated that the steatorrhea occurring in patients with small resections and relatively normal fat digestion during two test meals may be explained by impaired fat digestion which occurs during the final meal of the day, which is often the largest meal.

Adult↗
PubMed1984

Survival following resection for second and third primary lung cancers.

The performance of sequential resections and the consideration of new lesions as second or third primary lung cancers remain controversial issues. Criteria to define these as new primary lesions depend upon a difference in histologic types, a prolonged interval between initial and second or third resections, and location in the contralateral lung or a different ipsilateral lobe. Ninety patients have undergone multiple resections for bronchogenic carcinoma from 1960 to December, 1983. There were 10 examples of synchronous lesions and the remaining 80 were metachronous with the longest interval between resections being 17 years, 4 months. The initial surgical procedure was pneumonectomy in 11, lobectomy in 43, sleeve lobectomy in eight, segmentectomy in 27, and carinal resection in one. At the second operation, the procedures were segmentectomy in 55, lobectomy in 11, completion lobectomy in six, and completion pneumonectomy in 15. Two patients had sternotomy with bilateral resections and one patient had a tracheal resection. At the third operation, the procedures were segmentectomy in seven, completion lobectomy in two, and completion pneumonectomy in two. In 20 patients undergoing the second procedure and three undergoing a third resection, a different cell type was identified. The perioperative mortality following the second operation was seven of 90 patients (8%) and there were no deaths in those patients undergoing three resections. The cumulative survival rate following second resection in 80 patients with metachronous tumors was 33% at 5 years and 20% at 10 years. These data support continued aggressive surgical approach to second and third primary lung cancers.

Adenocarcinoma↗
PubMed1995

[Resection of the posterior mediastinal gastric tube used in reconstruction after radical surgery for esophageal cancer--case reports].

Two patients are presented who underwent resection of a gastric tube placed in the posterior mediastinum during reconstruction following radical esophageal resection for esophageal cancer. The indications for gastric tube resection were bleeding from a peptic ulcer in one and gastric cancer in the other. Case 1: A 72-year-old man, who had undergone a thoracic esophagectomy 3.5 years prior to admission, presented with a chief complaint of hematemesis. The gastric tube was resected and replaced with an antethoracic, pedicled segment of left colon. Pathologic examination of the resected gastric tube revealed a penetrating peptic ulcer. Case 2: A 65-year-old man with esophageal cancer and early gastric cancer underwent thoracic esophagectomy with combined resection of the fundus and lesser curvature of the stomach. One year later, he was found to have a new early gastric cancer in the antrum. The distal portion of the gastric tube was resected and replaced with a pedicled jejunal graft. Of the 526 patients with esophageal cancer treated in our department from 1972 to 1993, peptic ulcers were evident in the gastric tube used to reconstruct the esophagus in only seven cases. The stomach was resected in only one of these patients. Similar patients requiring gastric tube resection have been reported. All six of these cases are reviewed. Cancer of the gastric tube developed in 3 of the 526 patients. Although 74 cases of gastric tube cancer have been reported in the Japanese literature, the patient presented here (case 2) is the first to undergo successful resection of the stomach from the posterior mediastinal position.

Aged↗