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  • 1
    ISSN: 1432-2323
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Résumé Les indications, l'efficacité et l'étendue de la lymphadénectomie élargie pour cancer de l'oesophage thoracique restent controversés et sont toujours l'object d'investigations cliniques. Ici sont rapportés la fréquence et le type de métastases ganglionnaires observées au moment de l'intervention ainsi que la fréquence des récidives postopératoires chez 70 patients ayant eu une dissection dite des trois champs (abdominal, thoracique et cervical) pour cancer de l'oesophage thoracique. Parmi ces patients, 75.7% avaient des métastases (71.4%) et/ou une récidive (21.4%) ganglionnaire. Des métastases et/ou des récidives des ganglions cervicaux et cervicothoraciques ont été retrouvées, respectivement, chez 40.0% et 90.0% des patients ayant un cancer du tiers supérieur de l'oesophage, chez 21.6% et 37.8% des patients ayant un cancer du tiers moyen et chez 4.3% et 26.1% des patients ayant un cancer du tiers inférieur. Les sièges des métastases les plus fréquemment retrouvées étaient les ganglions de la chaîne récurrentielle droite, les ganlions paracardiaux droits, les ganglions périoesophagiens et ceux de la petite courbure gastrique alors que les sites de récidives préférentiels étaient les chaînes récurrentielle supérieure gauche, susclaviculaire droite, coeliaque et para-aortique abdominale. Métastases et/ou récidive ont rarement été retrouvées dans les ganglions jugulaires internes, prétrachéaux, de la grande courbure, de la chaîne hépatique commune, ou splénique. Ces résultats suggèrent que la chaîne récurrentielle doit être réséquée dans tous les cas, et que les trois champs doivent être réséquées pour les cancers des tiers moyen et cervical.
    Abstract: Resumen La indicación, eficacia y extensión de la linfadenectomía ampliada en la cirugía del carcinoma del esófago torácico son motivo de continuada controversia y permanecen bajo investigación clinica. En el presente artículo informamos la frecuencia y el modo de las metástasis ganglionares en el momento de la operación y la recurrencia ganglionar luego de la operación en 70 pacientes que fueron sometidos a disección ganglionar de 3 campos. La disección de 3 campos difiere de la esofagectomía en bloque en que incluye, adicionalmente, la disección de los ganglios cervicales y mediastinales superiores. El 75% de los pacientes exhibió metástasis en 71.4% y recurrencia en 21.4%. Se encontraron metástasis y/o recurrencias en los ganlios cervicales y cervicotorácicos, 18.6% y 41.4% respectivamente. La frecuencia de las metástasis ganglionares cervicales y ceracotorácicas y/o recurrencias fue de 40.0% y 90.0% en los asos de carcinoma del esófago torácico superior, de 21.6% y 37.8% en los del esófago torácico inferior. Las metástasis ganglionares encontradas en la operación, fueron más comunes en la zona del nervio recurrente derecho, periesofágicos y de la curvature menor, en tanto que las recurrencias ganglionares después de la operación fueron halladas sobre los ganglios alrededor del nervio recurrente izquierdo superior, la región supraclavicular derecha, la región celíaca y la zona para-aórtica abdominal. Raramente se encontraron metástasis y/o recurrencias en los ganglios de la yugular interna, paratraqueales, de la eurvatura mayor, de la arteria hepática o esplénicos. Lo anterior sugiere la necesidad de efectuar la disección de los ganglios alrededor del nervio recurrente en todos los casos y de una disección de 3 campos en los pacientes con carcinoma del esófago superior o del esófago medio.
    Notes: Abstract The indication, efficacy, and extent of extended lymphadenectomy for a carcinoma in the thoracic esophagus remain controversial and under clinical investigation. Here we report the frequency and mode of lymph node metastasis at operation and of lymph node recurrence after operation in 70 patients who underwent three-field dissection and 75.7% of whom suffered from metastasis or recurrence in the lymph nodes (metastasis in 71.4% and recurrence in 21.4%). metastasis or recurrence in the cervical and cervicothoracic nodes were found in 18.6% and 41.4%, respectively. The frequency of cervical and cervicothoracic lymph node metastasis or recurrence was, respectively, 40.0% and 90.0% for a carcinoma in the upper thoracic esophagus, 21.6% and 37.8% for a carcinoma in the middle thoracic esophagus, and 4.3% and 26.1% for a carcinoma in the lower thoracic esophagus. Lymph node metastasis at operation was most frequently found in the right recurrent nerve nodes, right paracardiac nodes, periesophageal nodes, and lesser curvature nodes, whereas lymph node recurrence after operation was found in the left upper recurrent nerve nodes and the right supraclavicular, celiac, and abdominal paraaortic nodes. Metastasis or recurrence was rarely found in the internal jugular, pretracheal, greater curvature, common hepatic, or splenic nodes. This finding suggests the need for recurrent nerve node dissection for cases and for three-field dissection for a carcinoma in the upper or middle thoracic esophagus.
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  • 2
    ISSN: 1432-2323
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract. The results of endoscopic ultrasonography (EUS), used preoperatively in 74 endoscopically evaluable patients, were compared with the histopathology after subsequent total esophagectomy with radical lymphadenectomy involving a three-field dissection of the lower cervical, mediastinal, and abdominal nodes. Patients with obstruction to endoscopy were excluded from this study. Overall accuracy, specificity, and sensitivity were 87%, 90%, and 37%, respectively. EUS has an accuracy of more than 80% for detecting metastatic nodes in the cervical paraesophageal, supraclavicular, right recurrent laryngeal, left paratracheal, upper and lower paraesophageal, infraaortic, infracarinal, and lower posterior mediastinal regions. Its sensitivity is highest for cervical and upper thoracic paraesophageal, infracarinal, left paratracheal, and recurrent laryngeal nodes. Accuracy is maximum for periesophageal nodes and varies inversely with the axial distance of the nodes from the esophageal axis. We recommend that EUS be used routinely for preoperative assessment of the cervical and mediastinal nodal status.
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  • 3
    ISSN: 1432-2323
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract. To investigate the adequate extent of esophagectomy and lymphadenectomy for an esophageal cancer localized at the cervicothoracic junction, the mortality and morbidity rates, survival rates, and patterns of recurrence were retrospectively analyzed in two groups—14 patients who underwent total esophagectomy with or without laryngectomy and 15 patients who underwent proximal esophagectomy with or without laryngectomy—at Kurume University Hospital from 1981 to 1996. Proximal esophagectomy with or without laryngectomy resulted in a lower hospital mortality rate and better overall survival for patients who underwent curative esophagectomy compared with total esophagectomy with or without laryngectomy. Multivariate analysis indicated that the extent of esophagectomy (total esophagectomy versus proximal esophagectomy) was not a prognostic factor. The incidence of recurrence was not different between the two groups. Lymph node metastasis or recurrence from such esophageal cancers was localized to the neck and upper mediastinum. For an esophageal cancer localized at the cervicothoracic junction, therefore, proximal esophagectomy with or without laryngectomy and with cervical and upper mediastinal lymphadenectomy could be better indicated for preselected patients.
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  • 4
    ISSN: 1432-2323
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract. Factors responsible for recurrence of esophageal cancer were investigated in 90 patients who underwent extended radical esophagectomy with three-field dissection for a squamous cell carcinoma in the thoracic esophagus. The initial tumor recurrence was grouped as either locoregional (site of the primary tumor, anastomotic site, or lymph nodes) or as distant (distant organs, pleura, or peritoneum). Nineteen patients (21%) developed a locoregional recurrence, and 19 (21%) developed a distant recurrence. One (1%) developed both recurrences simultaneously and was classified as a distant recurrence. The locoregional recurrence was correlated with the stage factors, particularly the number of metastasis-positive nodes. For the distant recurrence, vascular invasion was found to have been the most important prognostic factor. Our findings suggested that locoregional recurrence was due to tumor progress related to the extent of lymph node metastasis, whereas distant recurrence was due to the oncologic behavior of the tumor. Locoregional recurrence in patients with limited disease may be reduced by extended radical esophagectomy with three-field dissection. Distant recurrence cannot be controlled by surgery. Adopted postoperative adjuvant therapies showed no effect on recurrence.
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  • 5
    ISSN: 1432-2323
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract. The impact on the outcome of an additional microvascular anastomosis—supercharge—on colon interposition for esophageal replacement was retrospectively evaluated by comparing it with colon interposition without supercharge. A series of 53 patients had undergone colon interposition for esophageal replacement at Kurume University Hospital from 1981 to 1996. The postoperative courses and the morbidity and mortality rates were compared between the 24 patients who underwent colon interposition without supercharge from 1981 to 1988 and the other 29 patients who underwent colon interposition with supercharge from 1989 to 1996. Risk factors for leakage of the esophagocolostomy and for hospital mortality after colon interposition were evaluated by multivariate analysis. Colon interposition with supercharge required a longer operation time but resulted in a lower incidence of necrosis in the colon graft and leakage in the esophagocolostomy (Odds ratio = 34), a shorter duration until peroral intake, and a shorter hospital stay compared to colonic interposition without supercharge. The addition of supercharge to colon interposition for esophageal replacement has been an effective option that has prevented serious complications caused by graft ischemia.
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  • 6
    ISSN: 1432-2323
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Résumé L'échographie per-opératoire avec des instruments d'une puissance de 7.5 MHz a été employée pour rechercher l'extension de 30 cancers gastriques et 25 cancers oesophagiens. En mettant en évidence 5 couches échographiques qui correspondent aux structures histologiques de l'estomac, l'échographie opératoire permet mieux que la palpation d'apprécier avec précision l'extension du cancer. Treize des 14 cancers précoces comprenant 8 cancers inpalpables furent localisés avec précision par l'échographie per-opératoire. De plus l'extension latérale de la tumeur le long de la paroi gastrique fut correctement diagnostiquée dans 26 des 30 cancers alors qu'elle ne fut reconnue par la palpation que dans 14 de ces 30 tumeurs. En ce qui concerne le cancer oesophagien, l'échographie per-opératoire permit d'apprécier avec précision l'extension locale extramurale du processus tumoral, en particulier l'extension aux vaisseaux. Trois des 25 cancers oesophagiens avaient histologiquement envahi l'aorte. Les méthodes d'imagerie pré-opératoire appréciant l'envahissement de l'aorte étaient à l'origine de resultats erronés: 1 faux négatif, 2 faux positifs alors que l'échographie per-opératoire donna des résultats toujours exacts. L'échographie opératoire permit également de réconnaítre les adénopathies qui n'avaient pas été décelées par les explorations per-opératoires, celles qui n'étaient pas palpables avant la dissection et celles d'un diamètre inférieur à 3 mm. Ces résultats démontrent que l'échographie opératoire est une technique efficace de dépistage de l'extension du cancer gastrique et du cancer oesophagien.
    Abstract: Resumen La ultrasonografía de alta resolución con instrumentos de 7.5 MHz fue utilizada para detectar extensión tumoral en el curso de 30 operaciones gástricas y 25 esofágicas. Con 5 capas ecogénicas correspondientes a estructuras de la pared del estómago, la ultrasonografía operatoria logró diagnosticar extensión tumoral con mayor precision que la palpación intraoperatoria. Trece de 14 cánceres gástrico tempranos, incluyendo 8 cánceres no palpables, fueron localizados con precisión por la ultrasonografía operatoria. Además, se pudo diagnosticar correctamente la extensión lateral del tumor sobre la pared del estómago por la ultrasonografía en 26 de 30 cánceres, mientras la palpación fue correcta en 14 de 30 cánceres. En el cáncer esofágico la invasión local extramural, especialmente de los vasos, fue detectada en forma precisa por la ultrasonografía operatoria. Tres de 25 cánceres esofágicos presentaban invasión histológica de la aorta. Los métodos imagenológicos preoperatorios mostraron un resultado falso negativo y 2 falsos positivos en cuanto a la determinación de la invasión aórtica. Sin embargo, la ultrasonografía operatoria no dió resultados falsos. Ganglios linfáticos no identificados en estudios preoperatorios, ganglios no palpables antes de iniciar la disección de los tejidos, y ganglios pequeños hasta de 3 mm pudieron ser identificados mediante ultrasonografía en el curso de operaciones gastroesofágicas. Estos resultados indican que la ultrasonografía operatoria de alta resolution puede representar una técnica valiosa para detectar la extension del cancer gástrico y esofágico en el curso de la cirugía.
    Notes: Abstract High-resolution ultrasound with 7.5-MHz instruments was employed to detect tumor extension during 30 gastric and 25 esophageal cancer operations. With 5 echo layers, which corresponded to histologie structures of the stomach wall, operative ultrasound diagnosed intramural tumor spread more accurately than operative palpation. Thirteen of 14 early gastric cancers including 8 nonpalpable cancers were precisely localized by operative ultrasonography. In addition, lateral extension of tumor along the stomach wall was correctly diagnosed by operative ultrasound in 26 of 30 cancers, while palpation was correct in 14 of 30 cancers. For esophageal cancer, extramural local invasion, particularly to vessels, was accurately detected by operative ultrasound. Three of 25 esophageal cancers had histological invasion of the aorta. Preoperative imaging methods showed 1 false-negative and 2 false-positive results in determining the aortic invasion. Operative ultrasound had no false results. Lymph nodes that were unrecognized at preoperative studies, nodes that were nonpalpable prior to tissue dissection, and nodes as small as 3 mm in size could be depicted by ultrasonography during gastroesophageal operations. The present results indicate that high-resolution operative ultrasound may be a valuable technique for the detection of gastric and esophageal cancer extension during surgery.
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  • 7
    ISSN: 1530-0358
    Keywords: Colorectal cancer ; SART1 ; Tumor-rejection antigen ; CTL ; Specific immunotherapy
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract PURPOSE: Colorectal cancer is one of the major causes of cancer death in the world, including in the United States and Japan. We recently identified the tumor-rejection antigen gene SART1, which encodes both the SART1259 antigen expressed in the cytosol of epithelial cancers and the SART1800 antigen expressed in the nucleus of the majority of proliferating cells. This study investigated the expression of these tumor antigens to explore a potential molecule for specific immunotherapy of colorectal cancer patients. METHODS: SART1 antigens were investigated by Western blotting in six colorectal cancer cell lines and in 33 colorectal cancer tissues. The cancer cell lines were tested for their ability to stimulate interferon-γ production by the human-leukocyte-antigen-A24-restricted and SART1-specific cytotoxic T lymphocytes and were also tested for their susceptibility to the lysis by the cytotoxic T lymphocytes. RESULTS: The SART1259 antigen was detected in the cytosol of four of six cancer cell lines, 13 of 33 (39 percent) cancer tissues, and 0 of 20 nontumorous colorectal tissues. The SART1800 antigen was expressed in the nucleus of all the colorectal cancer cell lines, 18 of 33 (55 percent) cancer tissues, and 0 of 20 nontumorous tissues. The human-lymphocyte-antigen-A24-restricted and SART1-specific cytotoxic T lymphocytes killed the human-lymphocyte-antigen-A24+ SART1259 + cancer cells. CONCLUSIONS: The SART1259 antigen could be an appropriate target molecule for specific immunotherapy of approximately 40 percent of the human-lymphocyte-antigen-A24+ patients with colorectal cancer.
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  • 8
    ISSN: 1436-2813
    Keywords: esophageal cancer ; surgical treatment ; hospital mortality ; risk analysis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract A series of 100 patients with thoracic esophageal cancer who underwent subtotal esophagectomy through a right thoractomy between 1985 and 1989, were statistically analyzed to assess the risk factors predicting hospital mortality from complications. Hospital mortality was termed as “complication death”, and the analyzed factors were age, pulmonary function [% vital capacity (%VC) or % forced expiratory volume1.0 (%FEV1.0)], cardiac function [ECG and Master test], renal function [creatinine clearance (CCR)], hepatic function [15′ indocyanine green test (R15·ICG)], diabetes mellitus [75 g oral glucose tolerance test (75OGTT)], depth of tumor invasion [T-factor], and the type of operative procedure [operation]. Each patient was scored according to risk severity on a scale from 0–3, with the higher numbers representing higher risk. Patients not succumbing to complication death had less than 8 points in the total score, while those who suffered a complication death had 8 or more points. Through stepwise logistic regression analysis, we produced a prediction formula. In cases where eight or more points are scored by the semi-quantitative analysis, or 0 or more, by the prediction formula, the operative procedure should be changed to a less radical one for improved prognosis. The introduction of this semi-quantitative analysis for postoperative risk reduced the incidence of complication death from 6% to 3%, and of hospital mortality from 13% to 3%.
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  • 9
    ISSN: 1436-2813
    Keywords: thoracic esophageal carcinoma ; transthoracic sophagectomy ; radical lymphadenectomy ; 3-field dissection ; lymph node metastasis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Lymph node metastasis is well-known as the most important prognostic indicator for esophageal carcinomas, and an accurate assessment of positive metastasis can only be made after total lymphadenectomy around the esophagus. However, prior to the development of 3-field lymph node dissection in Japan, no such operation existed for ascertaining the full positivity distribution. We report herein the results of a restrospective study conducted on 70 patients who underwent subtotal esophagectomy with 3-field dissection to discover the patterns of lymph node metastasis from carcinoma in the thoracic esophagus. Lymph node metastases tended to have an orderly spreading pattern in relation to the tumor location, even though the lymph node metastasis varied widely from the lower neck to the upper abdomen. The nodes along the right recurrent nerve and the paracardiac nodes were most frequently found to be positive for metastasis. In contrast, no metastasis was found in the internal jugular nodes, the pretracheal nodes, the common hepatic nodes, or the splenic nodes. Patients with carcinoma in the upper thoracic esophagus rarely had metastasis in the abdominal nodes, while those with carcinoma in the lower thoracic esophagus rarely had metastasis in the cervical nodes. Thus, surgical extirpation of the lymph nodes during 3-field dissection is effective not only to determine the correct tumor staging for the planning of adequate adjuvant therapies postoperatively, but also to produce a guideline for prospective lymphadenectomy for esophageal carcinomas.
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  • 10
    ISSN: 1436-2813
    Keywords: esophageal cancer operation ; latissimus dorsi muscle flap
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract In order to reinforce the difficult closure of the bronchial stump, or esophageal anastomosis, a pedicle flap, taken from the latissimus dorsi muscle, was applied to 7 patients with tracheal repairs, and 11 patients with extensively dissected areas, at the time of esophageal cancer surgery. Utilizing this technique, the complications associated with extended esophagectomy could be minimized. Intrathoracic application of the latissimus dorsi muscle flap is a useful method of supporting extended esophagectomy for esophageal cancer.
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