Aggressive Node Dissection for Esophageal Cancer

Fifty-eight patients with esophageal cancer were compared by dividing into two groups, the two-field and the three-field lymphadenectomy groups. The modes of node involvement were estimated according to grading of the depth of cancer infiltration. When cancer infiltration extends beyond the submucosal layer, the nodes were extensively involved thoroughout the three fields. Therefore, an extensive lymphadenectomy is mandatory for curative operation and it is the only way to improve the surgical outcome with help of surgical techniques

Prognosis for recurrence of carcinoma of the esophagus

Surgical outcome for carcinoma of the esophagus is not yet satisfied. The reasons are based on the delay in diagnosis. As a matter of fact a complaint of dysphagia means advanced stage of cancer. In general, such a patient suffers from poor nutritional condition which relates to restriction of oral intake, and this disease frequently affects the aged people. Furthermore, anatomical specificity of the lack of the serosal layer is likely affected by carcinoma outside the wall of the esophagus. And rich lymphatic flow tends to constitute lymphatic metastasis anywhere in the longitudinal direction. In order to improve surgical results for carcinoma of the esophagus an important access to the treatment is to inhibit the growth of recurrent cancer cells effectively. In this series, experience with recurrent carcinoma of the esophagus was clinically analyzed to search for a better management

Carcinoid Tumor Arising from the Cystic Wall of the Lung

A 65-year-old male with carcinoid arising from the cystic wall was reported with some consideration to lung cancer associated with lung cyst. It is emphasized that an increasing mass adjacent lung cystic wall on chest xp should be taken into account as a malignant tumor arising from the cystic wall

Surgery for Recurrence of Lung Cancer

Fifteen patients with recurrence after surgery for lung cancer were clinically investigated in terms of the validity and the indication of reoperation. 1) In most of cases with reoperation for recurrence, the disease stage was stage I lung cancer at the time of the initial operation. 2) In five out of the eight patients who underwent node dissection, nodal involvement was positive (62.5%). 3) A longer survivor is predicted in patients with negative node metastasis at the initial and the second operations. 4) Reoperation for recurrence is required for obtaining a longer survivor, if possible. The surgical outcome for lung cancer has been more and more improved. However, a five year survival rate is not satisfactoried with as large as 25 to 35%. It is great concern about the treatment of postoperative recurrence. Recently advances in the adjuvant therapy of chemotherapy and radiation enabled us to make the survival rate longer. In rare cases with localized recurrence, it has become possible to perform a radical excision for recurrence. The purpose of this study is to clarity the feasibility and validity of reoperation on the basis of clinical experience with the 15 patients who underwent re-excision for recurrence

Results in Surgical Correction of Pectus Excavatum

The results in 37 patients who underwent surgical correction of pectus excavatum at the First Department of Surgery, Nagasaki University Hospital during a period from 1973 to 1984 were reported. A variety of surgical techniques were used, and satisfactory resuls were obtained in 29 patients (78%), including 24 excellent and 5 good appreciation. Topical postoperative complications occurred in 14 of the 37 patients (38%). Five patients had recurrence of the excavated deformity. Repair of the deformity using sternal turnover technique yielded satisfactory results in 24 of the 27 patients (88%). However, partial bone necrosis occurred in 2 patients, and recurrence of the deformity occurred in 2 patients, who underwent the classical type of turnover operation at their ages over 9 years old. Since 1982 subperichondrial dissection technique has been employed for free grafted sternal turnover operation, the results have been satisfactory without any major topical complication. The efficacy of total preservation of the perichondrium was emphasized

Differentiation between Metastasis and Synchronous Double Cancers of the Esophagus

Simultaneously two independent tumors were detected in the esophagus. Histological examination could not necessarily distinguish the two tumors from double cancers. It is emphasized that cellular DNA analysis by using FCM is of great benefit for this purpose. It is difficult to determine clinically whether double cancers are simultaneously existing two cancers or cancerous lesion accompanying metastatic lesions. Until recently histologic finding was the only method to identify them. The criteria of identifying double cancers from primary cancer with metastasis are that different types of histology should be individually revealed and no histologic sequence between both. lesions should be defined with or without submucosal lymphatic involvement. It is well known that malignant tumors are characterized by abnormalities in cellular DNA content. However, it is no doubt that metastatic tumors arising from the primary one display a similar pattern of DNA, suggesting identical stem cells with an original tumor when surgeons encounter in independent cancerous lesions in the same surgical specimen, two separated cancerous lesions should be identified whether double primary cancers or metastasis. Flow cytometry (FCM) provides a fast and precise means for determination of DNA-aneuploidy index. we experienced with independent double cancerous lesions in the esophagus and these were regarded as primary cancer with skipping metastatic lesions with the help of analysis of DNA histogram

Surgery for Multiple Primary Cancer Involving the Lung

Surgical treatment for synchronous multiple primary cancer involving the lung was evaluated on the basis of clinical experience with the treatment of three patients. It is emphasized that careful clinical examination to prevent overlook of secon

Bronchoplastic procedure with pulmonary angioplasty for lung cancer

Seventy-one patients with primary bronchogenic carcinoma Underwent bronchoplastic procedures (48 sleeve lobectomies and 23 wedge resection) from 1969 to 1986. In 16 patients the bronchoplasty with concomitant resection of pulmonary artery was performed. There were 48 squamous cell carcinomass, 13 adenocarcinomas, six large cell and four small cell carcinomas. There was no nodal metastasis in 26 patients (36.6%), 27 patients (38.0%) had mediastinal nodes involvement. Pathological stages of the disease were as follows : Stage I , one patients ; Stage II, 13 patients ; Stage III, 41 patients ; and Stage IV, one patient. Five year survival rate was 25.4%. Survival rates on the basis of nodal involvement indicate 44.1% at five years for patients without nodal metastasis and 18.4% for those with nodal involvement. Ten patients complained difficulty in expectoration after surgery, and frequent therapeutic bronchofiberscopy was necessary. Four patients had an early bronchial fistula. Bronchial stenosis or obstruction due to formation of suture granulation occurred in six patients, and local recurrence at bronchial suture line was observed in six patients. Three patients with resection of the pulmonary artery had vascular complications. In two patients obstruction of the pulmonary artery due to formation of thrombus occurred, and in one patient pulmonary artery was twisted. Bronchoplastic procedure can be perfomed safely, but if angioplasty of the pulmonary artery was concomitantly performed, it shoule be done carefully to prevent vascular distortion or stenosis. Since the description of bronchoplastic procedures by Paulson and Shaw in 1955 and Price Thomas in 1956, many reports have documented on the merits of these procedures. Sleeve lobectomy for lung cancer is an alternative to pneumonectomy, when the tumor extends into main bronchus. This operative procedure benifits the patients by conservation of lung tissues for whom pneumonectomy is not indicated because of poor pulmonary reserve. This report summarized our 17 years\u27 experience in lobectomy with bronchoplastic procedures and angioplasty of the pulmonary artery

Simultaneous Combined Resection of Adjacent Involved Organs for Carcinoma of Thoracic Esophagus

Ten patients with simultaneous combined resection of tumor-bearing esophagus with the trachea and/or the aorta were clinically evaluated in terms of its application and indication on the basis of a result of our clinical experience. 1) All the patients were in advanced disease stages with far extending nodal involvement. 2) Cancer recurrence at bronchial anastomosis occurred in one year after surgery. It is warned that the extent of a resection should be sufficient. 3) The circumferential resection of the aortic wall and replacement with artificial vascular graft were made with the aid of temporary bypass constructed in the same operation field of esophagectomy. However, there was no experience with grave complications such as postoperative infection. 4) The surgical outcome is not satisfactory but the necessity of proper early cares is required for keeping away from an operative death. In addition, multimodality adjuvant therapy is needed for avoidance of distant metastases

Bilateral Breast Cancer

Fifteen patients with bilateral breast cancer were clinically analyzed on the basis of a result of surgical treatment, in whom eight patients had bilateral synchronous breast cancer, four were non-synchronous and the remaining three were metastatic breast cancer, respectively. The prognosis of patients with bilateral breast cancer was not pessimistic, indicating that it depended on the disease stages of each cancer. On the other hand, it was emphasized that the prognosis of patients with bilateral metastatic breast cancer was extremely poor. Surgeons should be aware of high risk of contralateral breast cancer in careful follow-up following mastectomy for breast cancer. It is generally accepted that patients with cancer of one breast have a higher than average risk of developing cancer of the opposite breast. It is not so rare that bilateral breast tumors are seen in an identical patient on account of the effectiveness of high resolution mammography and sonography in early detection. It is known that a cancer of one breast means the most frequent precancerous lesion of the opposite breast. Bilateral breast cancer may occur in any of the following ways. 1. Bilateral simultaneous breast cancer occurring independently in both breasts and at the same time (syncronous). 2. Bilateral primary non-simultaneous breast cancer occurring independently in each breast but at different times (asynchronous). 3. Bilateral secondary breast cancer occurring either simultaneously or non-simultaneously but as one of the manifestations of metastatic dissemination. However, despite these simple definitions, there is often great difficulty in determining the exact type of bilateral breast cancer under consideration, in particular, identifying second primary cancer from metastatic one. In this study, bilateral breast cancers were clinicopathologically reviewed on the basis of a result of surgical treatment at the First Department of Surgery, Nagasaki University School of Medicine