Simultaneous Combined Resection with Trachea, Bronchus and Aorta for Carcinoma of Thoracic Esophagus

Clinical experiences with combined sleeve resection of the trachea, bronchus and aorta with esophagectomy for esophageal cancer were reported in 6 cases including concurrent combined resection of the aorta and left main bronchus in one. 1) These cancers were advanced ones, showing nodal involvement of n2 in one, n3 in three and n4 in two. 2) In the three cases of combined resections of the aorta, it was made via left thoracotomy using preceding bypass with artificial vessel. There was no complication related to vascular surgery. 3) It must be prudent to determine the extent of the resection for involved trachea on the basis of an experience having recurrence at anastomosis. 4) It was sure that surgical outcome of combined resection was not necessarily satisfactory but improvement of it would be expected by avoiding early postoperative complication with meticulous postoperative care. 5) Based on our clinical experience with appearance of early lung metastasis following surgery, it is emphasized that potent multidisciplinary treatment is mandatory for improvement of the surgical result

Surgery for postoperative recurrence of gastric cancer

The six patients who underwent reoperation for recurrence of gastric cancer following surgery were clinically analysed, of whom one had lung metastasis and the other five local recurrences. The conditions of resectability are that carcinoma infiltration should be limited, the disease-free interval-after the first operation should be long and there are no blood-borne metastases into the lung and the liver. The surgical outcome for lung metastasis was pessimistic. It is emphasized that multidisciplinary therapy and early detection are indispensable for improving the surgical outcome in the treatment of recurrence of gastric cancer

Limited Resection for Lung Cancer

Based on clinical as well as experimental studies, limited operation of choice was evaluated for the management of lung cancer. From clinical analysis of 39 cases who underwent limited lung resection, our clinical experiences indicated that this operative procedure would be feasible for a large tumors of approximately 4cm in diameter. However, the incidence of lymphnode metastasis is more likely to be high when applied to the tumors of more than 3cm in diameter. The favorable indication, therefore, is for the cancer less than 3cm in diameter. By careful evalution of 7 cases with postoperative recurrence, it has become obvious that either the degree of cell differentiation or the existence of lymph nodes metastasis strongly participate in its prognosis. According to hemodynamic studies immediately after surgery, limited resection of the lung is preferred to conventional radical lobectomy for patients with cardiovascular malfunction because it serves to eliminate a possible left ventricular failure after surgery. An experimental research also demonstrated favorably hemodynamic benifits of limited resection for reducing left ventricular overloading on coronary diseased heart which is experimentally prepared by either creation of stenosis of the main left coronary artery or ligation of the left descending coronary artery. The immune response in the lymphnodes to a tumor growth also was attested in C3H mice with use of MH 134 tumor inoculated, especially in relation to the time of tumor resection. The results of our experiments confirmed that tumor resection on the 7th and 10t

An Experimental Evaluation of Tracheal Blood Flow with Special Referrence to Operative Procedure of Tracheal Mobilization

Based on the study with special referrence to blood flow in the trachea, the factors influential on the operative procedure of tracheal mobilization were carefully evaluated to ensure optimal surgical results. It has already been assumed with an aid of microangiographic technique that the main trancheal blood flow comprise two routes, namely, adventitial and submucosal layers. The amount of blood flow in the trachea divided into individual two layers were measured by hydrogen clearance test with wire electrodes placed in either adventitial or submucosal layer. When employed the procedure of extensive mobilization of the trachea, the level of tracheal blood flow reduced in adventitial layer rather lthan in submucosal layer. Blood flow in submucosal layer, however, remain closely near the normal level, which is thought to compensate a decreased blood supply in the tracheal adventitia. Meanwhile, when proposed an excessive tension of more than 800g at the site of anastomosis, a decrease in submucosal blood flow has become manifest despite of a slight decrease in adventitial blood flow simultaneously. Greater emphasis has been focused upo

Experimental Evaluation of Tumor Inhibitory Effect of Induced Infection on Tumor Growth

To evaluate as to whether coexisting infection is helpful to achieve the tumor regression, the inhibitory effect was experimentally assessed from the view point of survival, the degrees of reticuloendothelial activation (Congo-red clearance test) and immune response (Jerne\u27 plaque forming cell test and macrophage migration inhibition test). A 3×107 to 2×108 of β-streptococcus inoculated in C3H mice of 6 week-old were prepared for producing a varying models of infection. As a control study, survival challenging for a 1X106 of Ehrlich tumor inoculation was surveyed. It averaged 16.6 days, whereas it increased when added infection. The most longest survival was 24.4 days when infection was provoked when a 3×107 β-streptococcus were inoculated subcutaneously 5 days prior to Ehrlich tumor cell implantation. Phagocytic activity in the recticuloendothelial system was found to be consequent of stimulation by the varying variety of infection. To assess the inhibitory effect of induced infection on tumor growth, a directly weighing method was applied for inoculated methylcholantrene tumor at interval of 5 days. It is proved that infection is more effective in depressing tumor growth. Furthermore, our experiment indicated that infection enabled the host to enhance the immune response to various antigen, which might be originated from the reticuloendothelial hyperactivity. As the result of this study, we concluded that a mild and long-standing infection might play a key role in inhibiting tumor growth to some extent

Early Gastric Cancer Presenting Pyloric or Prepyloric Stenosis

Out of 390 patients with early gastric cancer (EGC) who underwent gastric resection between Jan. 1968 and Jul. 1987, four patients developed pyloric stenosis and one patient developed prepyloric stenosis. Macroscopic types of EGC were II c in three cases and II c + III in two cases. Histologic types were tubular adenocarcinoma in four patients, and poorly differentiated adenocarcinoma in one patient. Cancer existed just right on or immediately adjacent to the pyloric ring in all patients; and extended transversely to the gastric axis in four patients, and longitudinally in one patient. An associated open ulcer and/or ulcer scar in the cancer lesion was seen in four patients, and submucosal fibrosis in three patients to a variety of degree, both of which were thought to be greatly attributed to pyloric or prepyloric stenosis. A duodenal ulcer was not present in any patients