Clinical study of clonogenic assays--with reference to adjuvant cancer chemotherapy after operation

One hundred surgical specimens were used for the clonogenic assay to determine the chemosensitivity in vitro and the results were compared with the antitumor effect of the adjuvant cancer chemotherapy after operation. The clonogenic assay was performed according to the method of Salmon et al. The dissociated tumor cells were contacted with drugs in a concentration of 1 microgram/ml for 1 hr. (mitomycin C; MMC) or 2-3 wks. (5-fluorouracil; 5-FU). Fifty percent or more inhibitory rate of the colonies were evaluated as positive. The clinical antitumor effects were assessed by the tumor reduction in non-curatively operated cases and by the survival period after the operation in curatively operated cases. Overall evaluable cases were 52 of 100 cases with a median cloning efficiency rate of 0.1%. The efficacy rates of the drugs in vitro were found to be 21.3% for MMC and 31.8% for 5-FU. The histological differentiations, Stages, pretreatments and cloning efficiency rates were observed to have few influence on the chemosensitivity. Nineteen non-curatively operated cases were eligible for the comparison between in vitro and in vivo, showing 40% true positive, 100% true negative and 84.2% predictable rates. In curatively operated cases, whereas 2 of 14 cases have died of cancer in not adapted adjuvant cancer chemotherapy group, no cancer deaths were encountered in 7 cases whose adjuvant cancer chemotherapy was evaluated as effective in the clonogenic assay. From these findings, it was concluded that in vitro clonogenic assay might be useful to select a suitable adjuvant cancer chemotherapy in curatively operated cases as well as cases with advanced carcinomas.     

Tracheobronchoplasty for lung cancer: operative indications by limited category

Three limited categories of tracheobronchoplasty are applicable in lung cancer patients. A1 is for patients who would otherwise be inoperable due to the lack of cardiopulmonary reserve. R1 is for early-stage cancer localized to the hilar bronchus and which aims to preserve lung function by active limited category. R3 tracheo-bronchoplasty preserves respiratory function in noncurative cases. The percentage of patients undergoing A1, R1, and R3 tracheo-bronchoplasty were 14.2%, 16.8% and 4.2%, respectively (35.2% of total patients undergoing bronchoplasty). Of the total patients, 18.9% underwent carinoplasty, and of these only 4 (2.6%) were eligible for the 3 categories of tracheo-bronchoplasty. Of lung cancer patients who underwent bronchoplasty, A1 was performed in 12.6%, R1 in 16/3%, and R3 in 3.7% (32.6% of the total). The use of bronchoplasty increased from 7.8% to 21.9% of lung cancer surgery after the introduction of dose-intensive induction chemotherapy (DIIC), mainly due to the increase in the use of interlobar techniques (20.5% of the total) in the smaller bronchial lesions present after DIIC. The 5-year survival rates of patients undergoing A1, R1, and R3 tracheo-bronchoplasty were 59.6%, 64.9%, and 0%, respectively. No anastomotic recurrence was seen in the 32 patients who underwent R1. Based on these results, tracheo-bronchoplasty increases survival in patients who receive the A1 category and preserves lobar function in those who receive R1 and R3.     

Complication related to operative procedure in lung cancer and mediastinal malignancy--report of 6 cases

Of the patients who underwent surgical treatment for the respiratory system at our hospital over the past 9 years, 6 were postoperatively complicated with chylothorax, 1 with liquorrhea and the other one with paraplegia. Chylothorax occurred after mediastinal lymph node dissection which was carried out for the treatment of malignant tumors. In five cases, it occurred on the left side, and in the sixth case, it occurred on the right side. In 2 patients who received conservative treatment, there was no reduction in chyle outflow, and they died of cerebral infarction and sepsis. The other 4 cases were surgically treated. In 3 of them, the impaired site of the thoracic duct was confirmed by administration of Sudan III before surgery. We confirmed that early reoperation for the chylothorax after lung resection should be performed. Liquorrhea occurred from the 5th costvertebral joint which had been directly infiltrated by lung carcinoma. Fortunately, the postoperative course was uneventful, though the patient complained of dizziness and headache until 14 postoperative days. The case of paraplegia was caused by oxydized cellulose cotton that entered the epidural space via the intervertebral foramen. It was used for hemostasis in the 5th costvertebral joint. This case indicates that oxydized cellulose cotton, which swells when it absorbs water, should be carefully used for hemostasis around the nerves.     

The feasibility of a limited operation for primary lung cancer]

We reviewed 33 patients who underwent a limited operation for primary lung cancer between 1980 and 1998. These cases were divided into three groups; a poor risk group consisting of 18 patients who had a high risk such as pulmonary or cardiac dysfunction and who underwent partial resection of a lung, a reduction group consisting of 9 patients who had advanced lung cancer or uncontrolled cancer of an organ other than the lung and who underwent partial resection, and an active limited operation group consisting of 6 patients who underwent segmentectomy with lymphoadenectomy for the treatment of early lung cancer. The 1 and 3-year survival rates in the poor risk group, reduction group and active limited operation group were 73.9, 60.0, 100%, and 63.4, 0.0, 100%, respectively. The results of limited operations performed for poor risk cases were satisfactory in terms of both functional state and prognosis. Limited operations performed to reduce tumor in advanced lung cancer cases did not improve the prognosis. Although an active limited operation for a case of early lung cancer remains controversial with respect to indication, it is thought that this operation is not inferior to a standard radical operation (lobotomy with mediastinal lymphoadenectomy) in selective cases in which the maximum tumor diameter is 2 cm or less. The indication for a limited operation must be further examined from aspects of tumor size, tumor histology and the other factors of the tumor.     

Clinical analysis of operative and hospital deaths in primary lung cancer

In our department, there were 313 thoracic surgeries for primary lung cancer from January 1994 to December 2003. We clinically reviewed for the operative and hospital death (n=18, 5.8%). The patients were 16 males and 2 females (70.6 +/- 5.6 years old). The surgical procedures were 4 pneumonectomies, 13 lobectomies (3 bronchoplasties) and 1 partial resection. The mean interval until postoperative death was 122.5 +/- 156.1 days. There were 5 direct operative deaths within 30 days (1.6%). There were 4 cancer deaths, 2 hemoptyses, 2 operative bleeding, 2 thromboses, 2 cerebral hemorrhages, 1 pyothorax, 1 pneumonia, 1 respiratory failure, 1 multiple organ failure after chemotherapy and 2 unexplained deaths. The patients with pneumonectomy or aged significantly had high mortality. For postoperative complications such as hemoptysis or bleeding, perioperative management that takes these issues into consideration is needed. Furthermore, we must carefully review the preoperative evaluation and combined treatment, because there were many cancer deaths among cases showing early recurrence and metastasis.     

Intentional limited operation for minute peripheral adenocarcinoma of the lung

The purpose of this report is to evaluate the limited operation for peripheral minute adenocarcinoma of the lung. Firstly, 44 cases (47 lesions) of surgically resected minute peripheral lung adenocarcinoma, 10 mm or less in diameter, were reviewed using Noguchi's classification, and the correlation between high resolution CT (HRCT) images and the clinicopathological features was examined retrospectively. All type A and B adenocarcinomas (n = 14) had no recurrence and all cases were the air containing type by HRCT. Lymph node metastasis and lymphatic/vascular involvement were detected with type C, D, E, F and 3 cases among them were died for recurrence. Based on those results, from April 2000, intentional limited operation was prospectively performed for 14 patients (16 lesions) with peripheral nodule showing ground-glass opacity on HRCT. The pathological findings were type A (n = 9), type B (n = 5), and atypical adenomatous hyperplasia was one case (If the findings were confirmed type C, D, E, F by permanent section diagnosis, VATS lobectomy will be performed). We recommend limited operation should be performed in only type A or B adenocarcinoma and permanent section diagnosis is necessary to determine whether or not.     

重症急性胰腺炎手术时机与术式选择

目的 探讨重症急性胰腺炎(SAP)的最佳手术时机及术式，方法 对收治的56例患者并经手术治疗的临床资料进行回顾性分析。结果 54例(96．4％)在发病后48h内手术，均治愈；2例(3．6％)在发病后5～6d手术者，均于术后24h死于多器官衰竭。结论 SAP无论发病时间长短，只要病情在某一时期发展到具备特定的手术指征时即应尽早手术。     

Damage to anal sphincter/levator ani muscles caused by operative procedure in anal sphincter-preserving operation for rectal cancer

Background

Details of postoperative damage to anal sphincter tonus following sphincter-preserving operation for rectal cancer remain unclear.

Methods

Postoperative anal tonus was measured using 3-dimensional (3D) vector manometry in 56 patients. Anal length with pressure from any direction was defined as total length (TL). Length with circular pressure (LCP), which is only measurable using 3D manometry, was also evaluated.

Results

In operations associated with low anastomosis, both TL and LCP at rest were significantly shortened when compared with control (high interior resection [HAR]). In particular, degraded LCP at rest was obvious. Anal lengths in squeezing state were preserved except in cases with intersphincteric resection (ISR). Postoperative incontinence score inversely correlated with functional anal length at rest.

Conclusions

Although the sphincter muscles are mechanically preserved, function of the internal sphincter and subsequent defecatory function can be degraded in cases with operative procedures including surgical maneuvers at the pelvic floor.     

保乳手术加综合治疗治疗乳腺癌的临床研究

目的　探讨保乳手术加综合治疗乳腺癌的手术适应证、治疗方法和疗效。方法　对 46例I～IIb 期乳腺癌施行保乳手术加术后放疗、化疗及内分泌治疗等综合治疗 (保乳组 ) ;并与同期施行改良根治术加综合治疗的 5 0例I～IIb 期乳腺癌 (对照组 )进行对比。两组患者术后均随访 0 .5～ 14年 ,平均 4年。结果　保乳组 46例双侧乳房乳头基本对称、外形丰满 ,外观优良。保乳组、对照组的平均手术时间分别为 (14 3 .7± 2 1.6)min ,(181.9± 16.0 )min ;术中平均出血量分别为 (2 42± 73 )ml ,(3 76± 5 6)ml ,手术并发症率分别为 15 .2 %,3 4.0 %;保乳组均优于对照组 (均P <0 .0 5 )。保乳组 3 ,5 ,10年期生存率分别是 96.8%,88.9%,85 .7%,总局部复发率是 6.5 %;对照组 3 ,5 ,10年期生存率分别是 97.1%,89.5 %,87.5 %,总局部复发率是 4.0 %。两组生存率和复发率比较差异无显著性(均P >0 .0 5 )。结论　临床早期乳腺癌采用保乳手术加综合治疗可以取得满意的临床疗效 ,可作为早期乳腺癌的首选治疗方法。     

低位直肠癌手术方式的选择

<正>低位直肠癌是指距离肛缘8cm的直肠癌,其中包括超低位直肠癌,即距离肛缘5cm以下的直肠癌。直肠癌治疗的最终目标是最大地局部控制肿瘤和提高病人总体长期生存率。从此基本点出发,     

原发性肝癌外科治疗方法的选择(修订版)

近半个世纪以来，经过几代人的共同努力，我国原发性肝癌的外科治疗有了很大发展，取得了较好的效果。当今的肝脏外科，已不存在手术禁区，也不认为巨大肝癌不能切除。目前，全世界比较一致的意见是，外科手术切除仍是治疗本病的首选方法和最有效的措施。     

胆总管结石首次即行内引流术的临床研究

目的　探讨胆总管结石首次即行内引流术的可行性。方法　选择管径 >1 5cm的胆总管结石患者 2 2 4例 ,随机分为内引流术组 (治疗组 ) 12 2例和T管引流术组 (对照组 )10 2例 ,进行前瞻性对比分析。结果　治疗组出现近期并发症 15例 ,远期并发返流性胆管炎 6例 ,再发结石 3例 ,均在局麻下行胆道镜取石及对症治疗而痊愈。对照组近期并发症10例 ,远期并发胆管炎 2 4例 ,再发结石 2 3例 ,2 3例均行二次手术 ,改行内引流术 2 0例 ,3例因病重而再行T管引流 ,死亡 2例。结论　对管径 >1 5cm的胆总管结石宜首次即行内引流术。     

The diagnosis of primary lung cancer with special reference to sputum cytology

Of 2,545 in-patients with primary lung cancer, pathological proof of the diagnosis was obtained by sputum cytology in 48%, by bronchoscopy in 32%, by biopsy from miscellaneous sites in 12%, and at thoracotomy or necropsy only in 19%. The diagnosis was made solely on clinical and radiological evidence in 8%.     

Evaluation of limited resection of the lung for treatment of lung cancer

The validity and indications of limited resection for lung cancer were studied based on the results of 34 patients with lung cancer who underwent surgery. This method appeared to be an effective technique for the preservation of the cardiopulmonary function after surgery, particularly in elderly patients. The prognosis of those who underwent limited resection for selected cases was not significantly different from that of those treated by lobectomy. Recurrences were seen exclusively in Stage II patients, most of whom had a poorly differentiated type of cell pathology and developed blood vessel involvement. It was concluded from this study that this technique can be feasibly applied to patients with a tumor of less than 3 cm located at the periphery of the lung and with the histologic picture of highly differentiated type.