This study investigated indications and limitations of 3-field lymph node dissectionin thoracic esophageal carcinoma. The subjects were 446 patients who underwent resection including EMR. There were ...61 cases of Ut, 268 cases of Mt and 117 cases of Lt. Fifty-five patients showing pEP or pLPM as the depth of the lesion did not develop any lymph node metastasis or recurrence, and were considered indications for EMR or blunt dissection. Lymph node metastasis and recurrence were extremely rare in the abdomen in cases of Ut/pMM to SM, and in the neck in cases of Lt/pMM to SM, and therefore, it seemed that dissecion could be omitted. In patients showing Adj, curability C, 3-field lymph node metastasis of 5 or more metastatic lesions showed a very poor prognosis, and were classified as the poor-prognosis group (F group). Other patientswere categorized as the A group. In the F group, the recurrece rate was 90% or more, and 3-year survival without recurrence was noted in 2 patients undergoing 3-field dissection, but not in any in patients undergoing 2-field dissection. In the A group, the recurrence rate was approximately 30%, and the 3-year survival rate without recurrence ranged from 40 to 50%. Three-field dissecion achieved significant improvementin prognosis compaired with 2-field dissection in cases showing pMP to Ad and Ut, Mt/SM to Ad in the A group. In the F group, 3-year survival without recurrence was notobserved in any patients undergoing 3-field dissection alone, but the prognosis was prolonged in patients receiving additional postoperative treatment. It is considerednecessary to aggressively administer chemo-radiotherapy to patients in the F group.
The authors report the successful use of endoscopic ultrasonography (EUS) for finding the etiology and subsequent treatment strategy for esophageal stenosis in 2 children. In case 1, EUS showed ...anterior wall thickening and multiple low echoic regions in the mp layer. These regions were believed to be cartilage. Esophageal resection therefore was performed. In case 2, EUS showed disruption of the sm and mp layers at the stenosis, leading us to speculate that the stenosis was caused by gastroesophageal reflux. After balloon dilatation, he underwent antireflux surgery of Nissen's fundoplication. EUS was useful for determining the etiology of esophageal stenosis and, thus, the appropriate treatment strategy. J Pediatr Surg 37:934-936. Copyright 2002, Elsevier Science (USA). All rights reserved.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
In order to determine the optimal extent of resection for thoracic esophageal carcinoma, a retrospective study was carried out on 1, 023 patients receiving resection between 1959 and 1995. Partial ...resection of the esophagus followed by intrathoracic anastomosis resulted in a higher incidence of recurrence in the residual esophagus than total resection of the intrathoracic esophagus with cervical anastomosis. Because minute foci of intramural metastasis or lymphovascular infiltration cannot be determined by any equipment for image diagnosis at present, total resection of the intrathoracic esophagus should be performed. Cervical lymph node metastases were observed when cancer invasion reached the submucosa in cases of upper or middle third cancer, and the muscularis propria in cases of lower third cancer. So in these cases 3-field lymph node dissection is recommended in principle. On the other hand carcinoma in situ or cancer limited within the lamina propria mucosa showed no lymph node metastasis or lymphovascular infiltration, so endoscopic mucosal resection or transhiatal esophagectomy without thoracotomy can be performed. In p-T4 cases, combined resection of the esophagus and the lung resulted in a high mortality rate and very poor prognosis. Radical surgery for p-T4 cases should be limited toresponders to neoadjuvant chemoradiotherapy.
In recent years, early esophageal cancer has become a target for endoscopic treatment, and resection of the cancer in aged patients is increasing. Under these circumstance, preoperative diagnosis is ...expected to be almost 100% accurate, especially in regard to the depth of cancer invasion and the extent of lymph node metastasis, in order to decide on the operative method. Diagnosis of the depth of cancer invasion has become 82.7% in accuracy by using a new endoscopic classification for superficial esophageal cancer. Endoscopic ultrasonography (EUS) is the best examination at present as to lymph node metastasis. According to the preoperative information from EUS, an endoscopic mucosectomy is performed for a small lesion of ep-mml cancer, and laser photodynamic therapy or surgical blunt descetion is selected for a spreading lesion. Esophagectomy by thoracotomy is required for mm2-sml cancers, and when blunt desection is selected radiotherapy must be added for a swelled lymph node detected preoperatively. For sm2-a2 cancers, usual thorachotomical esophagectomy and extended lymph node descetion should be performed. For a3 cancers, when invasion to the surrounding organs is limited esophagectomy should be tried as far as possible. However when the invaded area is relatively widespread a radical operation should be resingned and a by-pass operation should be conducted or an indwelling tube inserted to improve the quality of life for the patients.
The significance of serum p53-Abs in patients with esophageal squamous cell carcinoma was determined. Examination of clinicopathological features and assessment of tumor marker sensitivities of ...carcinoembryonic antigen (CEA), squamous cell carcinoma antigen (SCC-Ag) and CYFRA21-1 were performed. Thirty-three (58%) of 57 patients were positive for serum p53-Abs, however, no relation with cancer progression existed. Fourteen of the 33 sero-positive patients revealed normal levels of all tumor markers tested. Thus, serum p53-Abs appears to be a useful marker for the detection of esophageal squamous cell carcinoma.
The possibility of the practical use of endoscopic ultrasound (EUS)-guided puncture technique was examined. The aim of this study was to establish the safety and reliability of fine needle aspiration ...biopsy (FNAB) via gastrointestinal lumen under realtime ultra-sound guidance. All studies were performed with Toshiba-Machida echoendoscope EPE-703FL (7.5 MHz) and EPB-503 FS (5 MHz) with linear transducers. The results were as follows; 1) EUS-guided puncture and FNAB was performed with a modified EIS needle gauge 23, 20 mm in length set up on the EUS fiber with the rising device. 2) A transesophageal puncture model was made and several lymph nodes resected from an adult mongrel dog embedded in an agar. The tissue material obtained from EUS-guided FNAB was satisfactory for cytological examination. 3) EUS-guided transesophageal puncture was performed in 2 dogs under general anesthesia with no complications. We conclude that EUS-guided puncture technique was expected to be a new diagnostic procedure.
Diagnosis, treatment and prognosis of 7 resected gastric cancer patients with Virchow's node metastasis were investigated. One patient died of acute renal failure 2.5 months after operation and ...another patient had metachronous Virchow's node metastasis and survived for 118 months. The mean survival time for the patients except for these two patients was 10.8months with 3 aliving patients. One patientin whom endoscopic ultrasonography revealed no sign of mediastinal node metastasis underwent total gastrectomy accompanied by lymph node dissection in the abdominal cavity and the neck. Eighteen months after the operation, he is alive and has no sign of recurrence. Two patients with mediastinal node metastasis were treated by high dose chemothrapy and autologous bone marrow transplantation. After the treatment Virchow's node andthe mediastinal nodes disappeared. Therefore, for patients without an inoperable factor other than Virchow's metastasis, palliative gastrectomy and adjuvant therapy seemed to improved the prognosis for gastric cancer with Virchow's node metastasis. Furthermore for patients without mediastinal node metastasis, radical gastrectomy withlymph node dissection in the abdominal cavity and the neck is recommended.
Endoscopic ultrasonography (EUS) was performed in 9 cases with untreated malignant lymphoma (non-Hodgkin lymphoma ; 8, cutaneous T-cell lymphoma; 1 case). Proven gastric involvement was observed in 3 ...patients, EUS could detected all. Tumor was presented as hypoechoic area with the destruction of normal layer-structure and involved gastric wall was thickened diffusely or lumpily to 8 mm or more. At tumor periphery, EUS shows a broken third layer. Swollen lymph nodes of mediastinum and/or upper abdomen were detected with EUS in 6 patients. Proven or possible lymph node lesions in three patients were presented as inhomogeneous hypoechoic areas which showed generally in round shape. The size of most of them ranged from 5 to less than 20 mm in diameter. However, similar findings were noted in one false positive case with non-involved lymph nodes. In the follow-up of 4 patients after chemotherapy, EUS revealed the reduction of wall thickness and the reappearance of layer-structure for gastric lymphoma. The decrease in the size and number or the disappearance of involved lymph nodes were also seen. EUS was useful in staging or follow-up after chemotherapy and could provide the further information.
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