Proliferative activity of cancer cells in front and center areas of carcinoma in situ and invasive sites of esophageal squamous-cell carcinoma

Intraepithelial carcinoma contiguous with invasive squamous-cell carcinoma is a conspicuous feature of esophageal cancer. However, whether the mechanism of intraepithelial spreading is due to cell proliferation or field carcinogenesis has yet to be clarified. This study investigated the mechanism of intraepithelial spreading by measuring the cell proliferative activity using argyrophilic nucleolar organizer region (AgNOR) and proliferating cell nuclear antigen (PCNA)-positive cell counting. We examined the AgNOR number and PCNA-positive ratio (PCNA ratio) in the center and outer edge of intraepithelial carcinoma and in the center and deep margin of invasive squamous-cell carcinoma of the esophagus in 50 specimens from 18 cases of esophageal squamous-cell carcinoma concomitant with contiguous intraepithelial carcinoma. The proliferative activity was thus found to differ between the normal epithelium and cancerous lesions (p < 0.001), between intraepithelial carcinoma and invasive cancer (p < 0.001) and between deep margin and center areas of invasive cancer (p < 0.005). On the other hand, such activity was observed to be similar in the center and outer edge of the intraepithelial spread. These findings suggest that cell proliferation is the main mechanism of tumor progression at the invasive site of cancer, whereas in intraepithelial carcinomatous areas, "field carcinogenesis" or a paracrine mechanism, and not cell proliferation, is thought to be the cause of intraepithelial spread of esophageal cancer. These results therefore support the concept of field carcinogenesis.

Multifocal occurrence of gastric carcinoma in patients with a family history of gastric carcinoma

BACKGROUND

Smoking and alcoholic beverage drinking habits as well as a family history of cancer are well known risk factors for the multifocal occurrence of squamous cell carcinoma of the esophagus and the head and neck region. However, the role of these risk factors in multiple gastric carcinoma remains to be clarified. The purpose of this study was to examine the risk factors for multiple gastric carcinoma.

METHODS

The smoking and drinking habits as well as the family history of 157 patients with synchronous multiple gastric carcinoma and 157 patients with solitary gastric carcinoma who were similar with regard to gender, age, stage of the tumor, and year of admission were investigated. The risk of a multiple occurrence of gastric carcinoma also was elevated using the odds ratio (OR).

RESULTS

The ORs of a multifocal occurrence of gastric carcinoma in patients who currently smoked and drank alcoholic beverages were 1.1 and 0.8, respectively, although the ORs were not related to the quantity of smoking or drinking. In patients with a close relative with gastric carcinoma the OR was 2.1 (95% confidence interval [CI], 1.3-3.7). In those patients with > or =2 close relatives with gastric carcinoma, the OR increased to 5.1 (95% CI, 1.2-21.1). Conversely, no significant elevation in the ORs was recognized regarding a family history of other cancers.

CONCLUSIONS

In this study, a family history of gastric carcinoma was found to be clearly associated with the multifocal occurrence of gastric carcinoma; however, no significant correlation between the multifocal occurrence of gastric carcinoma in these patients and their smoking and drinking habits was recognized.

Esophageal cancer and second primary brain tumor

We report a rare case of a second primary brain tumor following esophageal cancer. A 56-year old Japanese man underwent a transhiatal esophagectomy for esophageal carcinoma. Two years after the operation, signs of increased intracranial hypertension including headache, nausea and left limb ataxia were observed. The tumor was totally removed by a suboccipital craniectomy, and the histological diagnosis was hemangioblastoma. The post-operative course was uneventful and the patient is still alive without any signs of recurrence. It is important to make a precise strategy for the second primary tumor.

Relationship between the expression of HLA-DR antigen and the effectiveness of preoperative hyperthermo-chemo-radiotherapy in oesophageal cancer

Based on the hypothesis that tumour cells expressing HLA-DR antigen would easily be damaged by the local immune response during preoperative treatments, the relationship was investigated between the expression of HLA-DR antigen in the oesophageal cancer and the effectiveness of the preoperative treatment. Immunohistochemical staining for the detection of HLA-DR antigen in cancer cells from biopsy specimens obtained before undergoing preoperative hyperthermo-chemo-radiotherapy (HCR therapy) in patients with oesophageal squamous cell carcinoma was performed, and the relationship between the expression of HLA-DR antigen and the effectiveness of HCR therapy was evaluated according to a histopathologic examination of resected specimen. A total of 35 cases were examined in which 14 showed strongly positive staining (+2), 14 weakly positive staining (+) and seven negative staining (-). No significant differences in the clinicopathologic factors between the groups were observed. In the 14 strongly positive HLA-DR antigen cases, nine were markedly effective (grade 3) (64.3%), four were moderately effective (grade 2) (28.6%) and one was slightly effective or ineffective (grade 1, 0) (7.1%). In the 14 weakly positive HLA-DR antigen cases, the markedly, moderately and slightly or ineffective cases numbered four (28.6%), eight (57.1%) and two (14.3%), respectively. On the other hand, in the seven patients showing no HLA-DR expression, the markedly, moderately and slightly effective cases numbered one (14.3%), two (28.6%) and four (57.1%), respectively. A statistical difference was observed between the cases of strongly positive and negative staining for HLA-DR antigen (p < 0.05). The expression of HLA-DR antigen in oesophageal cancer cells is thus considered to potentially be a valuable factor for predicting the effectiveness of preoperative treatment.

Significance of p53 protein expression in growth pattern of esophageal squamous cell carcinoma

The significance of intraepithelial carcinoma concomitant with esophageal squamous cell carcinoma during carcinogenesis and progression of the tumor has been discussed diversely. The purpose of the current study was to elucidate the relation between p53 protein expression and the growth pattern of the squamous cell carcinoma of the esophagus with attention to coexistence of intraepithelial carcinoma. Seventy cases with squamous cell carcinoma of the esophagus surgically resected without preoperative adjuvant therapy, including 49 cases with intraepithelial carcinoma contiguous to the invasive lesion, were analyzed immunohistochemically for p53 expression. Positive immunoreactivity of p53 was found in 36 (51.4%) of 70 cases. The frequency of p53 protein expression in cases with intraepithelial carcinoma (65.3%; 32/49) was significantly higher than that (19.0%; 4/21) in cases without intraepithelial carcinoma (p<0.001). The value of invasion coefficient, which indicates a ratio of the area of invasive cancerous lesion occupied in the whole lesion, in the cases with p53 protein expression was significantly smaller than that in the cases without p53 protein expression (p<0.001). In conclusion, p53 protein expression was found to be significantly related to the coexistence and spreading of intraepithelial carcinoma contiguous to squamous cell carcinoma of the esophagus.

Early experience of endoscopic extirpation of benign breast tumors via an extra-mammary incision

The early results of 6 patients with a benign breast mass who underwent an endoscopic extirpation via an extra-mammary incision were presented. Under general anesthesia in either a lateral or supine position, a 12-mm and two 5-mm incisions in the infra-mammary line in 2 patients and in the mid-axillary line in the remaining 4 patients were made. The tumors were then endoscopically extirpated. Preoperative aspiration needle cytology revealed six fibroadenomas in 5 patients and one intraductal papilloma in the other patient. All patients were single females with a mean age of 22.5 years. The maximal size of the masses was 5 cm on average. The average operation time was 3 hours 20 minutes. Regarding postoperative complications, subcutaneous emphysema extending to the neck due to CO2 gas inflation and a burn in the skin were seen in 1 patient each; however, no further treatment was required in these cases. The postoperative hospital stay was 1.7 days on average, and all patients were extremely satisfied with the cosmetic results of the procedure. The cosmetic results are drastically improved by the application of endoscopic removal via extra-mammary approaches, which are newly introduced, for benign breast tumors.

Transaxillary approach for the endoscopic extirpation of benign breast tumors

Cosmetic factors in the treatment of breast disease have long been neglected despite the fact that patients are highly concerned about the length and extent of the incision. Recent developments in both endoscopy and endoscopic devices have now made it possible to reach breast mass(es) from small incisions in the axilla. We describe the successful extirpation of a giant fibroadenoma of the breast in a 20-year-old woman, using a 3-mm or 10-mm endoscope and a 3-mm or 5-mm endoscopic device with a transaxillary approach. A scar-free breast with an excellent cosmetic result was achieved by use of this technique and these devices. Benign tumors (both single large tumors and multiple masses) are therefore considered to be ideal candidates for this type of minimally invasive endoscopic surgery.

Relationship between preoperative assessment of organ function and postoperative morbidity in patients with oesophageal cancer

OBJECTIVE

To find out if strict assessment of organ function preoperatively predicted morbidity and mortality in patients being operated on for oesophageal carcinoma.

DESIGN

Retrospective study.

SETTING

Teaching hospital, Japan.

SUBJECTS

178 patients operated on for oesophageal cancer 1989-1993.

INTERVENTIONS

Oesophagectomy and reconstruction (using either stomach or colon) in one stage by a right thoracoabdominal approach in 173, and transhiatal resection in 5 with either poor pulmonary reserve or early lesions.

MAIN OUTCOME MEASURES

Correlation between preoperative assessment of organ function and postoperative development of complications.

RESULT

79 patients (44%) developed complications and 6 died (3%). Pulmonary dysfunction preoperatively was significantly associated with the development of all complications (p=0.001) and of postoperative pulmonary complications (p=0.04). No other preoperative assessment correlated significantly with the development of postoperative complications.

CONCLUSION

Accurate preoperative assessment of pulmonary function is a valuable indicator of postoperative morbidity.

Family aggregation of carcinoma of the hypopharynx and cervical esophagus: special reference to multiplicity of cancer in upper aerodigestive tract

The role of family history in the multiple occurrence of cancer in the upper aerodigestive tract (UADT) remains unclear. The family histories of close relatives were examined in 167 patients with either hypopharyngeal or cervical esophageal cancer (PhCe cancer) and in 167 control subjects with benign diseases. The odds ratio for PhCe cancer was 2.6 in relation to family history of UADT cancers. Based on the family histories of close relatives, 167 cases with PhCe cancer were divided into 3 groups (Group I, 18 cases with a family history of UADT cancer; Group II, 37 cases with a family history of other cancers; Group III, 112 cases with no family history of any cancers). The mean age of the cases in group I was 59.4, which was younger than in group III (64.2). Second primary squamous-cell carcinomas in the UADT were more frequently recognized in group I (39%) than in group III (11%). However, no differences were observed in the smoking and drinking habits of male patients between each group. These results thus suggest that a family history of UADT cancers appears to be associated with the multiple occurrence of UADT cancers as well as the development of PhCe cancer.

Clinicopathologic features of patients with oesophageal cancer obtaining a histological complete response for preoperative hyperthermo-chemo-radiotherapy

From 1979 to 1993, 151 patients with resectable oesophageal cancer underwent preoperative hyperthermo-chemo-radiotherapy (HCR) followed by a subtotal esophagectomy. All resected specimens were histopathologically evaluated, and then were classified into two groups according to the efficacy of the preoperative HCR. Group A included 33 patients whose resected oesophagus was free of any cancer cells (grade 3). Group B included 118 patients, in which viable cancer cells remained in the resected specimens to various degrees (grade 1,2). The incidence of patients with well differentiated squamous cell carcinoma, node negative cases, or TNM stage I/II was significantly higher in group A than in group B (27.3% versus 9.3%, 72.7% versus 50.8%, 72.7% versus 50.8%, respectively). The recurrence rate was 33.3% (11/33) in group A, while it was 65.3% (77/118) in group B (p < 0.005). There was no case with any local recurrence in the former, while it was 8.5% (10/118) in the latter. The 1-, 3- and 5-year survival rates were 87.2%, 65.9% and 46.1% in group A, while they were 54.8%, 26.7% and 18.8% in group B (p < 0.005), respectively. Preoperative HCR may be expected of decreasing in the recurrence rate, including regional relapse when a grade 3 is obtained. Complete local control would further positively influence the prognosis.

Laparoscopic repair of a paraesophageal hiatal hernia with gastric volvulus

We report the case of a massive paraesophageal hiatal hernia with gastric volvulus which presented with the symptom of a precordial sense of pressure for over two years, which was successfully treated with laparoscopic surgery. The patient is presently in good condition, without any recurrence of either the hiatal hernia or other symptoms one year after surgery. This approach is considered to be a safe and effective procedure, and it also provides for rapid recovery from the operation.

[Long-term results of preoperative hyperthermo-chemo-radiotherapy (HCR) for patients with esophageal carcinoma invading neighboring structures (T4)]

PATIENTS

A total of 180 patients with esophageal carcinoma invading the neighboring structures (T4) were surgically treated by esophagectomy and reconstruction in the Department of Surgery II, Kyushu University from January 1965 to April 1997. Any of these cases with distant node metastasis and demonstrating organ metastasis or a combined resection of adjacent structures were excluded from this study. As a result, twenty-six patients treated with preoperative hyperthermo-chemo-radiotherapy (HCR Group), 39 treated either with preoperative radiotherapy or preoperative chemo-radiotherapy (R or CR Group) and 23 non-treated patients (Non-tx Group) were thus entered in this study.

RESULTS

The 3-year survival rates after esophagectomy in HCR Group, R or CR Group and Non-tx Group were 26.5%, 0% and 9%, respectively, while the 5-year survival rate of the HCR group was 15.9%. The group with preoperative HCR thus showed a significantly more favorable outcome than R or CR Group and Non-tx Group. (p < 0.05).

DISCUSSION

The significant difference observed in the prognosis was thought to be due to the reinforced effect of local regulation due to hyperthermia. Our data thus suggest that preoperative HCR contributes to the prolonged post-operative survival for carcinoma of the esophagus invading the neighboring structures.

Using endosonography to assess the effects of neoadjuvant therapy in patients with advanced esophageal cancer

OBJECTIVE

The aim of this study was to determine the usefulness of endosonography for evaluating the effect of neoadjuvant therapy for advanced esophageal carcinoma.

MATERIALS AND METHODS

Thirty-four patients with esophageal carcinoma (stage II, 16 patients; stage III, 18 patients) underwent various preoperative treatment. In all patients, endosonography was performed before and after treatment, and the percentage reduction in tumor size was calculated from the maximum area of the tumor. In the 27 patients who underwent surgery, the percentage reduction was compared with the pathologic response. Also, the overall survival rates were compared with the percentage reduction in tumor area.

RESULTS

Reduction in tumor area ranged from 0% to 47%. The patients were divided into three groups according to the percentage reduction in tumor area. Pathologic response was graded according to the number of viable cells in the entire lesion. Correlation between pathologic response and percentage reduction in tumor area was strong. We found a significant difference in survival rates among the three groups.

CONCLUSION

The percentage reduction in tumor area estimated by means of endosonography reflects the histologic effectiveness of neoadjuvant therapy in patients with advanced esophageal carcinoma and may enable clinicians to predict the prognosis of the disease.

Tumor invasion and angiogenesis in early esophageal squamous cell carcinoma

BACKGROUND AND OBJECTIVES

Although the relationship between angiogenesis and tumor proliferation or malignant potential has been previously demonstrated in several studies, early stage of cancer invasion and angiogenesis has seldom been investigated.

METHODS

From the esophageal specimens of eight recently resected cases with esophageal squamous cell carcinoma, 25 areas of carcinoma-in-situ or microinvasive carcinoma were selected, and then a serial histologic investigation and immunohistochemical staining for the detection of Factor VIII-related antigen to investigate microvessels in the lamina propria mucosae beneath the lesions as a measure of angiogeneses and staining for laminin to visualize basement membrane was performed. Lymphocyte infiltration below the lesions were also estimated. In view of early cancerous invasion, histologic patterns of the growth of the lesions were divided into "flat," "expansive," and "downgrowth" patterns.

RESULTS

Although downgrowth patterns are thought to be more invasive, relationships between the histologic patterns, and basement membrane staining patterns, and lymphocyte infiltration patterns were not demonstrated. However, the angiogenetic ratio (the number of vessels/cm under the lesions divided by that under normal epithelium) was observed to be significantly and closely related to tumor invasion patterns (P < 0.01), although it was not related to the destruction of the basement membrane or lymphocyte infiltration below the lesions.

CONCLUSIONS

The angiogenesis of esophageal squamous cell carcinoma is closely correlated to the tumor invasion patterns in early esophageal cancerous lesions.

Significance of routine annual esophagram for early detection of carcinoma of the esophagus

BACKGROUND/AIMS

In order to achieve increased survival rates for patients with carcinoma of the esophagus, early detection of the disease is vital. Serial esophagrams were evaluated to clarify which interval would be effective for early detection of carcinoma of the esophagus during routine examination.

MATERIALS AND METHODS

One hundred eighty-nine patients with carcinoma of the esophagus were grouped into three, according to the experience and the time of the previous roentgenograms before the definite diagnosis.

RESULTS

Five patients were in Group 1, in which roentgenographic examination had been done within 12 months prior to the diagnosis. Retrospective observation revealed a slight but certain abnormal shadow at the same location as the esophageal tumor seen on the second films. In Group 2, seven had received an esophagram between 12 and 24 months before the diagnosis. In contrast to Group 1, neither abnormality nor findings indicating esophageal tumors were detected on the former x-ray films, in all seven cases. Group 2 was characterized by relatively small tumors and low stage of the disease. Mean tumor length was 4.1 +/- 2.9 cm, and three of seven were classified as Stage I and two as Stage IIA. On the other hand, most of the 177 patients in Group 3, with no previous examination of the esophagus within 24 months before the diagnosis, had far advanced disease. Mean tumor length was 6.3 +/- 2.6 cm. Only nine (5.1%) were classified as Stage I, whereas 115 (65.0%) were classified as Stage III or IV.

CONCLUSION

In light of these data, for populations in which esophageal cancer frequently occurs, esophageal examination every 12 months will no doubt contribute towards the early detection of lesions.

Expression of p53 protein in glandular differentiation admixed with squamous cell carcinoma of the esophagus

BACKGROUND

Glandular differentiation in squamous cell carcinoma of the esophagus is occasionally recognized by serial histologic investigations. We previously performed histopathologic investigations of such tumors and suggested the possibility of field carcinogenesis in esophageal cancer.

MATERIALS AND METHODS

In the current study, we performed an immunohistochemistry analysis for p53 protein in such cases to investigate the mode of carcinogenesis from the view point of genetic changes. p53 protein expression in both ordinary squamous cell carcinoma and glandular differentiation of nine cases to demonstrate the coexistence of these components.

RESULTS

The expression of p53 in the areas of squamous cell carcinoma was diffusely detected in three and focally in two (five in all, 55.6%) and, in these five cases, p53 was also positive in the areas of glandular differentiation in four cases. On the other hand, the expression of p53 in the glandular components was negative in all four tumors with p53 negative squamous cell carcinoma.

CONCLUSIONS

The process of carcinogenesis within the tumor was thought to be similar in almost all cases even in the different histopathologic components.

Leiomyoma of the esophagus with special reference to the characteristics of this tumor in teenagers

BACKGROUND/AIMS

Leiomyoma, the most common benign esophageal tumor, occurs rarely in youths. We herein reported our experiences with this tumor, paying particular attention to two cases in teenagers.

MATERIALS AND METHODS

We have surgically treated 12 patients with leiomyoma of the esophagus from 1978 to 1995. Ten of them occurred in adult and two occurred in teenagers aged 17 and 18. We evaluated the characteristics, diagnosis and treatment of these cases, particularly in young patients.

RESULTS

The age range was from 17 to 55, and the mean was 40.5 years. The mean longitudinal size of 12 tumors in 10 adult cases was 4.9 cm, while both tumors in the teenagers were larger in size, over 10 cm. Endoscopic ultrasonography was useful in the diagnosis of the tumors. All tumors were enucleated without any complication. In young cases, in spite of the large size of the tumors, an enucleation was also possible and the long-term result was satisfactory.

CONCLUSION

Regarding the young cases, in spite of the large size of the tumor, an enucleation of the tumor should be tried whenever possible, in consideration of the patient's postoperative quality of life.

The clinical and histopathological contributing factors influencing the effectiveness of preoperative hyperthermo-chemo-radiotherapy for the patients with esophageal cancer

BACKGROUND/AIMS

The effectiveness of hyperthermic treatment combined with irradiation and chemotherapy for patients with esophageal cancer on local response as well as on long-time survival has been reported. In order to investigate the contributing factors influencing the effectiveness of preoperative hyperthermo-chemo-radiotherapy (HCR therapy), this study was performed.

MATERIALS AND METHODS

One hundred nineteen patients with esophageal cancer who underwent preoperative HCR therapy followed by esophagectomy were reviewed in this retrospective study. The rate of effectiveness of preoperative HCR therapy was then compared in resected tissue specimens with regard to such factors as age, sex, the location of the tumor, the longitudinal diameter of the esophagogram, the radiographic type of tumor, the histological type and the histological depth of invasion using univariate and multivariate analyses.

RESULTS

Both univariate and multivariate analyses showed that the clinical and histopathological factors which had the greatest effect on preoperative HCR therapy were well differentiated squamous cell carcinoma regarding the histological type and tumorous type regarding the radiographic types.

CONCLUSION

We thus conclude that preoperative HCR therapy shows great promise for the treatment of patients with esophageal cancer, especially in instances of well differentiated and radiographic tumorous type squamous cell carcinoma.

Simultaneous combination therapy of carboplatin and radiation for patients with carcinoma of the esophagus

BACKGROUND/AIMS

Carboplatin is a less nephrotoxic analog of cisplatin with a significant effect against a variety of malignancies including carcinoma of the esophagus. Furthermore, the supra-additive effect between carboplatin and radiation has been reported in both clinical and experimental studies.

METHODS AND MATERIALS

Seven patients with carcinoma of the esophagus underwent a combined therapy of carboplatin (30 mg/m2, total 1500-2000 mg) and radiation (1.6 Gy/day, five days/week, total 50-70 Gy).

RESULTS

Six patients had a complete tumor remission while in the remaining patient a partial response was observed. In five of these six cases, no evidence of recurrence has been recognized at 9-13 months after the treatment. Two patients survived without any evidence of recurrent disease 43 and 57 months after the initiation of the treatment. The major side effects were leukopenia and thrombocytopenia, which were grade II to IV but not fatal. However, no significant renal toxicity, gastrointestinal disorders nor liver toxicity were recognized.

CONCLUSIONS

These data thus indicate the clinical utility of the combined therapy of radiation and carboplatin for patients with carcinoma of the esophagus.

Effectiveness of hyperthermia and radiation treatments for patients with esophageal cancer predicted by the succinate dehydrogenase inhibition test

We used in vitro succinate dehydrogenase inhibition test (SDI test) to predict the combined effects of hyperthermia and irradiation on specimens of esophageal cancer obtained at endoscopy. The mean activity of succinate dehydrogenase (SD) after combined treatment of 6 Gy of irradiation and 43.0 degrees C for 20 hours of hyperthermia was significantly decreased compared to findings with each single treatment (to irradiation; p < 0.01, to hyperthermia; p < 0.05). A correlation between the SD activity and the clinical remedial value was also examined in tissues from 47 patients with esophageal cancer, and treated with hyperthermia and irradiation, in combination. The clinical effect, determined radiographically, showed a correlation of 76.6%. Thus, hyperthermia plus irradiation is effective clinical treatment and the SDI test facilitates prediction of the outcome of this combined treatment.

Oesophageal cancer coexisting with colorectal lesions

OBJECTIVE

To investigate the incidence of colorectal lesions in patients who present with oesophageal cancer.

DESIGN

Prospective open study.

SETTING

University hospital, Japan.

SUBJECTS

135 of 218 patients who presented with squamous cell carcinoma of the oesophagus during the seven year period 1988-1994 were randomly allocated to have a barium enema examination.

INTERVENTIONS

Barium enema examinations, and if colorectal lesions were found, colonoscopy and biopsy.

MAIN OUTCOME MEASURE

Incidence of coexistent colorectal lesions.

RESULTS

No abnormal findings were found in 52 (39%), diverticula were present on 37 (27%), benign polypoid lesions in 51 (38%), and malignant lesions in 6 (4%). We examined the clinical and histopathological details of all patients to see if it was possible to distinguish the patients at high risk of developing oesophageal and colorectal cancer but could find no differences among the groups.

CONCLUSION

Asymptomatic colorectal lesions are relatively common in patients with squamous cell carcinoma of the oesophagus in Japan.

Oesophageal cancer composed of mixed histological types

Glandular or adenoid cystic differentiation and sarcomatous features are sometimes encountered in oesophageal cancer and such histological variants often coexist with ordinary squamous cell carcinoma. So far no serial evaluation of such mixed histological types of oesophageal cancer has ever been performed, we therefore clinicopathologically investigated such cases While an immunohistochemical study of the p53 protein was also done on four available cases in order to discuss the histogenesis of these tumours. Among the 600 patients with surgically resected oesophageal cancer, seven cases were found to have a mixture of histological variants with ordinary SCC (squamous cell carcinoma) (adenocarcinoma 1, adenoid cystic cancer 3, sarcomatous component 2, basaloid cystic cancer and sarcomatous component 1). All but one case had an elevated type tumour while the predominant components of protrusion were not SCC but variant histological types. Six tumours were restricted to the submucosal layer. An immunohistochemical study of the p53 protein revealed that two of four cases were positive in both the SCC and variant patterns. Mixed histological types of oesophageal cancer composed of SCC and other variants often occur and thus the carcinogenesis of both histological types are considered to be aspects of the same mechanism.

Prognostic significance of immunological parameters in patients with esophageal cancer

BACKGROUND

The role of immunosurveillance in the fight against cancer is well known. In addition, cancer patients have been reported to have an impaired immune function. In patients with esophageal cancer, however, the relationship between the immunological parameters of the host and their survival has not yet been evaluated fully.

MATERIALS AND METHODS

Of 103 patients with esophageal cancer who underwent esophagectomy, lymphocyte subsets (CD4+ and CD8+), the PHA response, and natural killer cell (NK) activity were all assessed in relation to clinicopathological features and the prognostic significance was evaluated using both a univariate and multivariate analysis.

RESULTS

The CD4+/CD8+ ratio in 58 (56%) patients was higher than the mean of the control, while the PHA response and NK activity in 74 (72%) and 70 (68%) patients, respectively, were lower than 1 SD below the mean of the control. None of these three parameters demonstrated a low value in 5 patients, while 1, 2 and 3 parameters showed a low value in 28, 49 and 21 patients, respectively. The survival rate of the patients with low values in all of three of these parameters was significantly worse than that for the patients in whom the number of low parameters was less than two. A multivariate analysis revealed that tumor invasion and the number of low values in these parameters were independently significant prognostic factors.

CONCLUSIONS

This survival analysis revealed that low values in the CD4+/CD8+ ratio, the PHA response, and the NK activity will help predict a poor prognosis in patients with esophageal cancer.

Microvessel quantification and its possible relation with liver metastasis in colorectal cancer

BACKGROUND

Several studies have proven the usefulness of microvessel quantification as a prognostic factor for patients with various malignant tumors. The aim of this paper was to clarify the relationship between microvessel density (MVD) as a parameter of tumor angiogenesis and liver metastasis in colorectal cancer.

METHODS

A total of 175 patients with advanced colorectal cancer were evaluated (58 with concurrent liver metastases). Microvessel quantification was performed immunohistochemically, using monoclonal antibodies against endothelial protein Factor VIII-related antigen (F8RA) and against endothelial surface marker CD34. Finally, the relationship between MVD and liver metastasis was analyzed.

RESULTS

A significant correlation was observed between MVD for F8RA and MVD for CD34 (n = 175, r = 0.9560, P = 0.0001). MVD in the tumors stained for F8RA ranged from 15.2 to 78.6 microvessels per x 200 field (mean 32.8 +/- 11.7), while the tumors with liver metastatic disease compared with the tumors without liver metastasis (F8RA; mean 36.1 +/- 11.3 vs. 31.2 +/- 11.5, P = 0.0090; CD34; mean 64.4 +/- 20.4 vs. 52.0 +/- 19.4, P = 0.0010).

CONCLUSIONS

Microvessel quantification within a colorectal tumor using immunohistochemical staining methods has shown a significant correlation between MVD and liver metastasis. Tumors with a greater MVD may thus have a greater hematogenous metastatic propensity.

What is the earliest malignant lesion in the esophagus?

BACKGROUND

The incidence of early esophageal cancer is definitely increasing due to recent advances in diagnostics. When we discuss early carcinoma of the esophagus, however, there is still controversy as to whether dysplasia is either benign or the earliest malignant lesion.

METHODS

Nineteen resected esophaguses with both cancer and dysplasia (including 19 cancers concomitant with 26 dysplastic lesions) were studied for expression of p53 protein.

RESULTS

Immunohistochemical overexpression of p53 protein in esophageal dysplasia is almost the same as that in cancer.

CONCLUSIONS

Esophageal dysplasia should be recognized as the earliest malignant lesion which already demonstrates cancerous features although it is not immediately critical. A routine endoscopic Lugol's solution test is very useful for both detection and following-up of the early nests in the esophagus. These lesions are good candidates for endoscopic mucosal resection for the purpose of accurate diagnosis or curative treatment.

Is diabetic heart muscle disease related to cardiac ischemia or autonomic neuropathy?

Whether diabetic heart muscle disease is related to cardiac ischemia or autonomic neuropathy was investigated employing thallium-201 and [123I]meta-iodobenzylguanidine (MIBG) myocardial scintigraphy. Among ischemic hearts, displayed by TI201 scintigraphy, a distinctly dilated and hypokinetic left ventricle could not be detected. In autonomically denervated hearts, however, well demonstrated by MIBG imaging, distinct dysfunction was found. But, even in these hearts, interacting effects of some concomitant complications could not be excluded.

Biologic characteristics of esophageal epithelial dysplasia assessed by proliferating cell nuclear antigen

BACKGROUND

Proliferating cell nuclear antigen (PCNA) correlates with the cell proliferative state. Using a PCNA specific monoclonal antibody, various malignant neoplasms have been assessed for cell proliferation and malignant potential. However, there are few studies regarding the expression of PCNA in esophageal dysplasia.

METHODS

PCNA expression was immunohistochemically determined in resected specimens from 27 patients with superficial esophageal carcinoma that contained areas with various degrees of dysplasia, carcinoma in situ (CIS), and carcinoma invading the mucosal layer. The authors estimated the cell proliferative activity and biologic characteristics of the basal and parabasal cells of these esophageal epithelial disorders.

RESULTS

The degrees of PCNA labeling index (PCNA LI) of the basal layers were lower than those of the parabasal layers in normal epithelium and dysplastic lesions, respectively, whereas no difference in CIS was recognized between the two layers. The proportion of PCNA LI in the basal layer of moderate dysplasia was lower than that in the basal layer of severe dysplasia. Conversely, there were no statistical differences between severe dysplasia and CIS in both basal and parabasal layers. In terms of lymphocytic infiltration beneath the dysplasia, there was a close relationship between the degree of lymphocytic infiltration and the PCNA index of the basal and parabasal layers.

CONCLUSIONS

PCNA expression may be a useful marker to reflect the biologic characteristics of esophageal dysplasia, suggesting that a high grade of dysplasia is as serious a lesion as esophageal carcinoma.

Surgical treatment for advanced gastric cancer

BACKGROUND/AIMS

We herein report on the clinicopathological factors related to the unresectability of far advanced gastric cancer and the prognostic effect of gastrectomy on these cases.

MATERIAL AND METHODS

There are four main prognostic factors for advanced gastric cancer including 1) peritoneal dissemination, 2) hepatic metastasis, 3) lymph node involvement and 4) invasion to adjacent organs.

RESULTS

The rate of unresectability was high in the cases demonstrating both histologically undifferentiated type cancer and cancers located in the lower third of the stomach. It was difficult to resect the main tumor based on an increase in the factors regulating the macroscopical stage. The rate of unresectability tended to be higher in cancers with peritoneal dissemination or invasion to adjacent organs. The pancreas was the most frequently invaded organ. accounting for the unresectability of the disease. The prognosis for cases with unresected gastric cancers was poor and all died within 2 years of the operation. In addition, the prognosis for cases with Stage IV gastric cancer, demonstrating either 1 or 2 factors, improved after gastrectomy while no such improvement was seen in cases with 3 or 4 factors.

CONCLUSIONS

To improve prognosis, gastrectomy should be performed when a patient has far advanced gastric cancer but only demonstrates 1 or 2 of the above 4 factors.

Hyperthermia combined with chemotherapy and irradiation for the prolongation of the postoperative prognosis in the patients with esophageal carcinoma invading neighbouring structures

Preoperative hyperthermo-chemo-radiotherapy (HCR) has been performed on patients with esophageal carcinoma, especially in advanced cases with invasion to the neighbouring structures (a3 carcinoma), and is considered to have contributed to the favorable postoperative prognosis. 163 patients with operated locally advanced esophageal carcinoma with invasion to the neighbouring structures (a3 carcinoma) were analyzed. 40 cases were treated with preoperative HCR (HCR group), while 85 cases were treated with other preoperative adjuvant therapies including 35 with chemo-radiotherapy (CR group) and 42 with radiotherapy (R group), and the remaining 38 were operated on without any preoperative treatments. The effectiveness of the therapies and the prognosis were investigated. The survival rates of the HCR group were significantly better than those of the CR group (p < 0.05). The prognosis of cases with Grade 3 effectiveness was significantly better than those of others, moreover, in 5 cases with Grade 3 effectiveness in the HCR group, there was no case of early recurrence or metastasis after resection, while in addition, three patients have since survived for 4, 5, and 7 years, respectively. Our data showed that for the patients with locally advanced esophageal carcinoma with invasion to the neighbouring structures (a3 carcinoma), hyperthermia combined with chemotherapy and irradiation has demonstrated a favorable influence on the prognosis.

[Reevaluation of precancerous lesion of squamous cell carcinoma]

One hundred fifty-nine cases of esophageal carcinoma were reviewed retrospectively. There were 75 dysplastic lesions in 32 cases (20.1%). Although the continuity of dysplastic lesions to the areas of carcinoma was not so frequent (48.0%), it was more often encountered in severe rather than in moderate or mild dysplasia, which suggested some relationship between the severity of dysplasia and carcinoma. Using a silver colloid staining technique, nucleolar organizer region-associated proteins (NOR) were studied in paraffin sections of 22 normal epithelia, 22 dysplasias, 17 carcinomas in situ (CIS), and 14 invasive carcinomas. The mean numbers of NOR in the nucleus were 1.77 +/- 0.14 (mean +/- SD) in normal epithelium, 2.16 +/- 0.30 in dysplasia, 2.78 +/- 0.51 in CIS, and 3.67 +/- 0.85 in invasive carcinoma. On the other hand, the NOR number in the atypical layer of the dysplasia was 2.60 +/- 0.39, which was almost the same level as that of CIS. These results suggest that atypical layers in esophageal dysplasia already have the same level of proliferative activity judging from the NOR numbers. Immunohistochemical staining for P53 protein revealed that, in the 13 cases with positive staining of the cancer tissue, 79.1% of dysplastic lesions were also positively stained. These results suggested that, although dysplasia was not carcinoma because of the restriction in the mucosa without invasion, the biological nature of dysplasia might be considered as serious a lesion as carcinoma itself.

A long-term surviving patient with hepatocellular carcinoma including lymphocytes infiltration--a clinicopathological study

In patients with hepatocellular carcinoma, a diffuse lymphocyte infiltration into the tumor has been reported to be a favorable prognostic factor. Nevertheless, the mechanism of the lymphocyte infiltration is still unknown and HLA-DR antigen expression, which is the cause of lymphocyte infiltration, has never to our knowledge been previously reported in such cases. The patient in this case had hepatocellular carcinoma with a diffuse lymphocytes infiltration into the tumor and was able to survive for 6 yrs and 11 months without any cancer recurrence. The tissue was studied using histologic and immunohistologic methods. Microscopically, lymphocytes infiltrate along the trabeculae of cancer cells. Immunohistochemically, such infiltrated lymphocytes are mainly T lymphocytes. No lysozyme positive cells were seen in the tumor. HLA-DR antigen was diffusely and strongly expressed on the endothelial cells in the tumor, however its expression was minimal on the endothelial cells in the non-cancerous parenchyma. T lymphocytes infiltrated selectively towards the HLA-DR antigen of the endothelial cells in the tumor and the inflammatory infiltrate may thus be related to a distinct category of patients with a favorable prognosis.

Histological suggestions of 'paratransformation' in oesophageal squamous cell carcinoma

We have postulated that oesophageal squamous cell carcinoma arises from multifocal areas and not from one cell, and we present the circumstantial evidence for field carcinogenesis in oesophageal cancer. Among 290 cases examined with oesophageal squamous cell carcinoma, lymphatic permeation or intramural metastasis was evident in 110 cases. Of these carcinomatous transformation of the epithelium adjacent to either lymphatic vessel permeation or intramural metastasis of the squamous cell carcinoma was recognized in six cases. It is considered that the cancer tissue either in the lymphatic vessel or intramural metastasis promotes a malignant transformation of the squamous epithelium over these foci. 'Paratransformation' is therefore thought to be one of the potential models of origin for oesophageal squamous cell carcinoma.

Extensive spreading carcinoma of the esophagus with invasion restricted to the submucosa

OBJECTIVES

The aim of this study was to examine the clinicopathological features of extensive spreading type of squamous cell carcinoma (SCC) of the esophagus with invasion restricted to the submucosa.

METHODS

Thirty-eight submucosal SCC were studied histopathologically, and five of these 38 submucosal SCC, which demonstrated an extensive spreading-type SCC in which the size of the SCC was over 5 cm in longitudinal length while extending entirely across the esophageal lumen in a circumferential spread, are described in detail.

RESULTS

The extent of SCC depended mainly on the extent of intraepithelial carcinoma (IEC) and ranged from 50 to 135 mm in longitudinal length. IEC existed continuously in four cases, and multiple IEC existed separately in one case. An epithelium showing dysplasia was present in all cases, and the involvement of the glands and ducts by IEC was present in two cases. There was only one invasive part of SCC observed in one case, and three to 10 invasive parts of SCC were observed in the other four cases; various features of invasion, including an invasive SCC from the esophageal glands and ducts, were also present.

CONCLUSIONS

The extensive spreading-type SCC of the esophagus, which was considered to result from the widespread or multiple carcinomatous changes of the esophageal epithelium, was found to not be as rare as generally thought. The multiple and various features of the invasive parts of SCC suggested the simultaneous development of a downward invasion of SCC at different areas in extensive IEC.

Prospective randomized study of hyperthermia combined with chemoradiotherapy for esophageal carcinoma

From January 1988 to June 1992, 66 patients with resectable squamous cell carcinoma of the thoracic esophagus underwent preoperative adjuvant therapy. These patients were prospectively divided into two treatment groups; 32 were treated with radiofrequency wave local hyperthermia combined with chemoradiotherapy (hyperthermochemoradiotherapy; HCR), while the remaining 34 patients were treated with chemoradiotherapy alone (CR). There were no procedural complications in either group and the postoperative mortality was zero. In the HCR group, no viable cancer cells were found within the entire 5 mm-width slices of the resected specimen in eight patients (25%), while only two (5.9%) in the CR group (P < 0.05) demonstrate no viable cancer cells. The cumulative 3-year survival rate was 50.4% in the HCR group and 24.2% in the CR group. The present prospective trial demonstrated that the addition of hyperthermia to chemoradiotherapy resulted in a better local control and an improved long-term survival when treating patients with advanced esophageal carcinoma.

Mastopathy of the accessory breast in the bilateral axillary regions occurring concurrently with advanced breast cancer

We herein report a 41-year-old Japanese woman who demonstrated advanced cancer in the left breast occurring concurrently with mastopathy of the accessory breast tissue in the bilateral axillary regions, which appeared to be metastatic lymphadenopathy. A preoperative examination, including a mammogram, US, and CT, did not provide us with a definite diagnosis of the axillary masses: it was essential to diagnose the masses preoperatively since a bilateral mastectomy with nodal dissection is called for if the right axillary masses are metastatic from a cancer in the right breast. An intraoperative cytological examination from the bilateral axillary masses revealed adenosis with fibrocystic changes in the accessory breast tissue. We therefore performed a modified radical mastectomy only on the left side. The patient was thus saved from an unnecessary mastectomy of the right breast. Based on our experience, we wish to emphasize that the accessory breast tissue should be considered for a differential diagnosis when evaluating the axillary masses in order to avoid over-surgery, especially when a patient has been diagnosed to have massive breast cancer. An intraoperative cytological examination is strongly recommended to reach a final diagnosis in such confusing cases.

Esophageal squamous cell carcinoma occurring in the surface epithelium over a benign tumor

The coexistence of a benign tumor and carcinoma in the same esophagus is uncommon, while the occurrence of carcinoma in the surface epithelium over a benign tumor is considered to be extremely rare. Among 587 patients with surgically resected esophageal cancer, the cases with carcinoma located over a benign tumor of the esophagus were histopathologically investigated and the carcinogenesis of such cases was discussed. Only three cases were found to have esophageal squamous cell carcinoma located over benign tumors (two were leiomyomas and one was a lipoma). All three benign tumors protruded to the esophageal surface, and the carcinoma was located just over such tumors without coexisting epithelial dysplasia. Moreover, the epithelium, except for portions around these tumors, was intact in all three cases. From these findings it was suggested that chronic stimulation of the epithelium covering the benign tumors might have induced the carcinoma.

Development of esophageal cancer after endoscopic injection sclerotherapy for esophageal varices: three case reports

We report here three cases of squamous-cell carcinoma of the esophagus following endoscopic injection sclerotherapy for esophageal varices. All three patients were men and cigarette smokers, with a mean age of 58.3 +/- 5.0 years. Hepatitis B and C virus infection tests were negative, and alcoholic cirrhosis was present in each patient. The interval between sclerotherapy and the development of carcinoma was 9, 10, and 33 months, in the respective cases. The sclerosant used was 5% ethanolamine oleate with a mean total volume of 51.0 +/- 18.9 ml. While we have no evidence of a direct relationship between sclerotherapy and esophageal cancer, in patients with alcoholic cirrhosis who have risk factors for esophageal cancer there may be an acceleration of the potential malignancy, as a result of the chronic inflammation related to sclerotherapy. Such patients should be closely followed, using endoscopy.

Resection margin for squamous cell carcinoma of the esophagus

OBJECTIVE

The safe resection margin in esophagectomy for esophageal squamous cell carcinoma (SCC) was determined based on the extent of epithelial and subepithelial accessory lesions from the main lesions of esophageal SCC.

BACKGROUND

There have been many reports on the high incidence of a positive resection margin for esophageal cancer. Although there were some studies on the relationships of the proximal clearance to postoperative local recurrence, no pathologic study on the resection margin has been reported.

METHODS

Four hundred twenty specimens of a whole resected esophagus were examined histopathologically and the longitudinal length from the main lesion to the five types of accessory lesions was measured on microscopic slides.

RESULTS

Contiguous intraepithelial carcinoma existed in 69 (46%) of 150 sites of main lesions restricted to the mucosa or submucosa and subepithelial lesions existed in 131 (54%) of 245 sites and 82 (55%) of 150 sites of main lesions invading an adventitia and into neighboring structures, respectively. The risk of a positive resection margin due to subepithelial lesions was below 5% at 10 mm in the main lesion, restricted to the submucosa or the muscularis propria, and at 30 mm in the main lesion, invading the adventitia in the potentially curative operation cases.

CONCLUSION

These clearances of the resection margin, in which the risk of a positive resection margin is below 5%, are acceptable, although these clearances should only be accepted after the extent of epithelial accessory lesions is accurately determined by the Lugol's stain method.

The prognostic significance of the cytophotometric DNA content and its relationship with the argyrophilic nucleolar organizer regions (AgNOR) and proliferating cell nuclear antigen (PCNA) in oesophageal cancer

We examined the DNA pattern, AgNOR number and PCNA-positive ratio (PCNA ratio) from biopsy specimens of oesophageal carcinoma, and attempted to identify any prognostic factors for oesophageal carcinoma. DNA analysis: the cell nuclear DNA content was measured and the distribution pattern of the DNA content was grouped into four types according to the ploidy pattern (n = 182). The survival rate of patients with high-ploidy tumours (type III and IV) was shorter than that for low-ploidy tumours (type II), (P < 0.05). AgNOR number (n = 99) and PCNA ratio (n = 41): the AgNOR number and PCNA ratio were measured from 100 cancer cells in each specimen. Both the high-AgNOR-number patients (> or = 5) and the high-PCNA-ratio patients (> or = 35) demonstrated poorer prognoses than the low-rate patients (P < 0.05). These results suggest that the DNA pattern, AgNOR number and PCNA ratio may thus reflect the proliferative activity of tumours and therefore also offer the possibility of interdependence among these three factors.

The long-term results of pre-operative hyperthermo-chemo-radiotherapy for oesophageal carcinoma--a comparison with preoperative radiation therapy alone

The long-term results of patients with oesophageal carcinoma treated with pre-operative hyperthermo-chemo-radiotherapy (HCR) and pre-operative radiation therapy alone were compared. Twenty-six patients treated with pre-operative hyperthermo-chemo-radiotherapy (HCR Group) and 25 treated with radiation therapy alone (R Group), which demonstrated histopathologically marked effective results (Grade 3), were entered into the study. The 3-year survival rates after oesophagectomy in the HCR Group and the R Group were 67.4% and 41.8%, respectively, while the 5-year survival rates were 50.5% and 34.9%, respectively. Thus post-operative prognosis in the HCR Group was significantly more favourable than that in the R Group (P < 0.05). The local recurrence and distant metastasis rate in the HCR Group was significantly less than in the R Group (P < 0.01). This significant difference in prognosis was thought to be due to the reinforced effects of local regulation by hyperthermia and the systemic control of micrometastasis by chemotherapy in addition to radiation. Our data suggest that for carcinoma of oesophagus, pre-operative hyperthermo-chemo-radiotherapy contributes to prolonged post-operative survival while reducing both local recurrence and micrometastasis.

Effect of dietary vitamin A on forestomach tumorigenesis during the total and postinitiation stages in mice treated with high- or low-dose benzo(a)pyrene

The effects of dietary vitamin A on forestomach tumorigenesis during the total stage of the initiation and postinitiation periods and during the postinitiation stage were evaluated in ICR/Jcl mice treated with either high or low doses of benzo(a)pyrene (B(a)P). In experiment 1, the animals were initiated with a high carcinogenic dose of B(a)P to a total of 20 mg, while in experiment 2 the animals were treated with a low dose of B(a)P to a total of 2 mg. A control group of animals received no carcinogens. Five different dietary levels of vitamin A supplements were used in each experiment and in the control study. In experiment 1, a high incidence of tumorigenesis was observed in every group, with 74% to 96% developing papilloma and 19% to 46% developing carcinoma. In experiment 2, the incidence of tumorigenesis in the high-dose vitamin A groups, including those given during the total and postinitiation stages, was found to be significantly reduced at 7.4%, compared with that in the low-dose vitamin A group of 57.7% (P < 0.05). These results suggest that a high dietary level of vitamin A can reduce the incidence of tumorigenesis when low carcinogenic dose levels of B(a)P are given in both the total and postinitiation stages.

Hyperthermochemoradiotherapy is effective for small cell carcinoma of the esophagus

Esophageal small cell carcinoma is a highly aggressive disease, and no effective treatment has yet been reported. We present here two cases of esophageal small cell carcinoma preoperatively treated with a combination of hyperthermia, irradiation, and an intravenous infusion of cis-diammine-dichloroplatinum (CDDP). The first case concerned a 67-year-old Japanese woman. Hyperthermochemoradiotherapy (HCR) was performed before surgical treatment. A histopathologic study of the resected specimen showed no residual viable cancer cells either in the esophagus or in the dissected lymph node. The second case involved a 59-year-old Japanese man who received HCR therapy before surgical treatment. This patient survived for 33 months, the longest known period of survival for small cell carcinoma of the esophagus. These cases indicate that preoperative hyperthermochemoradiotherapy may be considered one promising adjuvant therapy alternative for this aggressive disease.

Carcinogenesis and histogenesis of esophageal carcinoma

Dysplasia is one of the most important subjects regarding carcinogenesis of the esophagus, because there is continuing controversy as to whether esophageal dysplasia is a cancerous lesion or a noncancerous lesion. In this study, it is histopathologically shown that dysplasia has a close correlation with cancer itself and that there is no substantial difference in the cell proliferative activity of dysplasia and intraepithelial carcinoma. These findings thus show that dysplasia has as high a potential for malignancy, thus it should be treated as an extremely early cancerous lesion of the esophagus to substantially improve the long term results of this disease. Conversely, esophageal carcinoma with glandular and/or mucus-secreting components is commonly found in addition to the ordinary component of squamous cell carcinoma, which indicates that this type of esophageal tumor originates not only from the squamous epithelium but also from the esophageal mucus gland or the ductal epithelium. These findings support the concept of field carcinogenesis in esophageal carcinoma.

Platelet aggregability and the occurrence of anastomotic leakage after esophageal reconstruction

In 21 patients who had undergone resection and reconstruction for esophageal carcinoma, the postoperative platelet aggregability was measured and the correlation between the occurrence of anastomotic leakage and platelet aggregability was investigated. There was no statistical difference in the clinical features of the patients between those with (n = 5) and without (n = 16) anastomotic leakage. Platelet aggregability was measured by the turbidimetric method from blood samples taken preoperatively, and at 1, 3, and 7 postoperative days (POD). The average values of platelet aggregability in patients without anastomotic leakage were 81.2, 70.4, 80.1, and 81.8%, while those with leakage were 81.3, 47.6, 52.3, 70.6% preoperatively, and 1, 3, and 7 POD, respectively. Thus, platelet aggregability significantly decreased in patients with anastomotic leakage on the first postoperative day (p < .05), and then gradually recovered postoperatively as time passed. Therefore, the measurement of platelet aggregability is considered to be one of the parameters predicting the occurrence of anastomotic leakage, and a prevention in the decrease of platelet aggregability as well as its activation could become a treatment for preventing anastomotic leakage.

Pre-operative estimation of complete resection for patients with oesophageal carcinoma

Three hundred and seventy-nine patients were studied retrospectively regarding the possibility of a complete resection of the oesophageal carcinoma based on the combined findings of pre-operative oesophagogoraphy and computed tomography (CT). One hundred and four out of 129 patients (96.1%) having lesions which did not demonstrate all three of the aforementioned factors (a lesion shorter than 8 cm, a normal oesophageal axis, and normal contact of the lesion with neighboring organs in CT) underwent a complete resection of the oesophageal lesion. Fifty-three percent of the patients (52/97) with a lesion showing only one of these factors had a complete resection. Whereas, on the other hand, a complete removal of the malignancy was only possible in 22% of the patients with two or all three of the findings. Moreover, as a result of further analysis limited for resected cases, the number of positive factors in these pre-operative findings correlated with the advancement of the surgical stage, which reflected a curability in surgery and a rate of postoperative complications. In order to make adequate plans for the treatment of patients with advanced oesophageal cancer, the finding of (i) the length of lesion, (ii) a deep ulceration and deformity of the oesophageal axis and (iii) any abnormal contact in CT, are considered to be very useful.