LOCAL RECURRENCE OF RECTAL CANCER

One hundred twenty-six rectal cancers were operated upon in the First Department of Surgery, Nagasaki University School of Medicine. Local recurrence occurred in thirty-three (26.2%). In this study, contributing factors in causing local recurrence were local excision of the surgical approach, advanced stage, depth of cancer invasion, location of carcinoma of the rectum below the peritoneal reflection (Rb) or above (Rba) and nodal involvement of n2 or more. As far as advanced rectal cancer and cancer location of Rb are concerned, it is suggested on the basis of this study that the incidence of local recurrence should be high

Tumor Markers (CEA, CA19-9, TPA) in Portal Blood in Colorectal Cancer Patients

The Carcinoembryonic antigen (CEA), CA19-9 and Tissue Polypeptide Antigen (TPA) levels in portal blood in colorectal cancer patients were studied in correlation with the peripheral blood levels and histopathologic findings in order to know serum levels increased. 1) Portal blood CEA, CA19-9 and TPA increased by operative maneuver. 2) Mean values of these markers in portal blood were higher than those in peripheral blood. 3) Portal blood CEA was correlated with Dukes\u27 staging, and revealed higher positive rates than CEA in peripheral blood in each stage. Portal CA19-9 changed within normal value and strikingly rose in Dukes\u27 D stage. Portal TPA tends to be higher in all stages and correlated with grades, but the value in Dukes\u27 D were lower than that of peripheral blood. 5) Moderately differentiated adenocarcinoma revealed the highest level of portal CEA (P<0.05), but portal CA19-9 and TPA did not indicate any correlation with cell differentiation. 6) The mean values of portal and peripheral CEA, CA19-9 and TPA showed significant elevation in those with infiltration of cancer cells extending through the proper muscle layer. This study suggests that the mechanism of these markers\u27 transfer from tumor into the portal vein is the most important decisive factor of the peripheral levels

The Prognostic Significance of Subserosal and Serosal Extent of Cancer Invasion in Gastric Cancer

In order to determine the prognostic significance of subserosal and serosal extent of cancer invasion in gastric cancer, 78 patients were reexamined histologically. In these patients curative resection was performed and cancer invaded the subserosal layer with growth pattern of infiltrating type i.e."*"(30 patients), or exposed outside the serosal surface i.e. "*" (48 patients). The significantly favourable prognosis was seen only in patients with ssr cancer being less than 1 cm in extent with a five-year survival rate of 92.3%, and in patients with small amount of cancer cells in the subserosal layer, having a five-year survival rate of 81.8%. In patients with se cancer the five-year survival rate was less favorable

Management of Blunt Hepatic Trauma

One hundred and twelve consecutive cases with blunt hepatic trauma between January 1, 1965 and December 31, 1988 at the First Dpartment of Surgery, Nagasaki University were reviewed. Fifty-seven patients had minor injuries, 33 moderate injuries and 22 severe injuries. Sixty-five patients (58%) sustained also one of more associated injuries. Out of 43 patients over the last ten years 30 were diagnosed by US or CT. Eighty-eight patients (78.3%) underwent laparotomy ; laparotomy and drainage alone in 13, suture and packs in 57, debridement and minor liver resection in 11 and right lobectomy in 9. The results of treated patients were assessed according to the grading of liver injury and assocated injury. The overall mortality was 13.4% (15 of 112). True liver-related mortality due to hemorrhage was 26.7% (4 of 5), and the other 11 patients who died were due to refractory shock and the development of multiple organ failure (MOF). Twenty-one patients were conservatively managed with only one death, and the other 20 survivors had no complications and healed completely from 6 to 12 months after trauma. Although lobectomy or resectional debridement are advocated as an operative procedure for massive injury, a conservative management for mild or moderate ruptures is still recommended as far as possible

Primary malignant tumors of the small intestine

From 1967 through 1987, 43 of primary malignant tumors of the small intestine were experienced at the First Department of Surgery, Nagasaki University Hospital and affiliated hospital, and clinically analysed. 1) Carcinoma, leiomyosarcoma and malignant lymphoma occupied one third in number. The preferable location of carcinomas and malignant lymphomas was lower part of the small bowel although that of leiomyosarcoma was upper part. 2) Diagnosis was mainly made by means of laparotomy which was carried out by clinical signs of obstruction or peritonitis. poor prognosis attributed to extension of a disease to nodes and liver. An early and accurate diagnosis of small bowel tumors is necessary for improving the survival rate

A Study on the Expression of EGFR and c-erbB-2 and Nuclear DNA Content in the Stomach Cancer Tissue

The expression of EGFR and c-erbB-2 as well as the measurement of nuclear DNA content was evaluated in stomach cancer tissues. In addition, changes in the expression of EGFR in stomach cancer cells in mixed culture with lymphocytes were also studied by flowcytometry. The frequencies of expression of EGFR and c-erb B-2 and of the aneuploid pattern in analysis of nuclear DNA content were 35.5% and 59.3%, in the primary focus respectively. By histological types, the rates of positive c-erbB-2 expression and the appearance of aneuploidy were high in differentiated cancer, while the EGFR expression rate showed no difference according to histological types. As to lymph node metastasis, the involvement of the lymph nodes in EGFR-positive cases was more significant than that in EGFR-negative viz. 86.4% vs. 43.2%. On the other hand, the attitude of EGFR expression was clearly altered when stomach cancer cells were incubated with lymphocytes. It is possible to draw the conclusion that the weaker the expression of EGFR in stomach cancer cells, the greater the susceptibility to lymphocytes in gastric cancer cells