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A 59-year-old man with lung cancer invading the descending aorta was treated with vascular surgery techniques. The tumor, located in the left S1+2, had invaled the descending aorta. Under partial left heart bypass from the left atrium to the distal descending aorta using a Biomedicus Centrifugal Pump, the descending aorta and the tumor were resected en bloc. Then, the aorta was reconstructed with a coated Dacron graft. Histologically, the tumor invaded the tunica adventitia of the aorta. Furthermore, tumor cells were seen in the tunica media and interna, 10mm from invasion of the tunica adventitia. The surgical line should be determinated carefully so as not to leave tumors but also to avoid overresecting the aorta.

With the view to elucidating risk factors on aged patients with stomach cancer, the correlations of preoperative test results and degree of surgical stress with postoperative complications were examined in 58 patients with stomach cancer, aged of 80 and over. For risk factors, a correlation of abnormal ECG and respiratory dysfunction with postoperative complications was noted, while for surgical stress, combined resection of other organs and intraoperative bleeding showed a correlation with postoperative complications, but the degree of lymph node dissection did not therwith. These results suggest that combined resection of other organs, which causes excess stress and intraoperative bleeding should be avoided as possible as we can, thereby making it possible to carry out radical operation for stomach cancer associated with lymph node dissection R2 or so even in aged patients.

Since 1985, we have been performing an extensive combined resection of the unilateral diaphragm under left thoracotomy in cases of gastric cancer with esophageal invasion, involving invasion to the serosa without distant or disseminated metastasis. From 1976 to 1988, the resection was performed in 111 cases of upper gastric cancer with esophageal invasion. When classified by the approach route, there were 77 cases of left thoracoabdominal approach and mediastinal incision, and 34 of abdominal approach alone. Of the 77 cases of left thoracoabdominal approach, combined resection of the diaphragm was performed in 22, and the surgical results were evaluated form 17, after excluding 3 of only partial resection of the diaphragm, one of remnant gastric cancer and one of multiple cancer. The 2 year survival rates all ps (+) cases were 64% for combined resection and 41.8% for non-combined resection. When classified by stage, the survival rates in stage IV cases were 55.6% for combined resection, and 12.5% for non-combined resection, showing a significant different.

Of 499 cases of colorectal cancer operated on during a 16-year period, 108 (21.6%) had macroscopic invasion into the surrounding organs. Seventy-one of the 108 patients underwent combined resection of colorectal tumor and the adjacent organs, resulted in curative resection in 54 patients. The invasion was predominantly seen in the small intestine and urine bladder in colon cancers, while in the bladder and uterus in rectal cancers. However, only 22 (40.7%) of them were verified to have the tumor invasion microscopically. In a postoperative follow-up study, 12 cases had recurrence of cancer and 4 out of the 12 had local recurrence. The five-year survival rates were as relatively high as 82.9% in colon cancers and 72.2% in rectal cancers (by Kaplan-Meier method). No significant difference in prognosis was found between patients with direct histological invasion and those without such invasion. From these results, suggest that combined resection of the surrounding organs is recommended for better prognosis in colorectal cancers, if those are suspected to have the direct invasion.

We investigated the indication for combined resection of the stomach and adjacent organs in patients diagnosed as having gastric cancer with macroscopic invasion to adjacent organs. The aim of the study was to determine whether the prognosis was related to regions of the gastric wall showing carcinoma invasion, macroscopic type, histological type, location, numbers of invaded adjacent organs, grade of disseminated peritoneal metastasis, grade of liver metastasis, curability of lymph nodes and the histological vertical depth of the lesion. It was found that in patients who underwent combined resection of the stomach and adjacent organs, the prognosis was related to the number of invaded adjacent organs, grade of disseminated peritoneal metastasis, presence or absence of liver metastasis and the grade of curability of lymph nodes, whereas it was not related to the regions of gastric wall showing carcinoma invasion, macroscopic type, histological type, location or vertical depth of the lesion. As mentioned above, combined resection of gastric cancer with macroscopic invasion to adjacent organs is indicated for patients who have only one invaded organ, little or no disseminated peritoneal metastasis and no liver metastasis. Consequently, it is concluded that it is important to perform this type of operation in which the metastatic or majority of the regional lymph nodes are resected.

From 1970 to 1982, 103 primary Borrmann type 3 gastric cancers were curatively resected in our department. The prognosis of these patients was investigated according to the location of the cancer, namely C (upper portion), M (middle portion), A (lower portion). The survival rate for patients with cancers located in M was best, and it was the worst if the cancers were located in C. However, there was no significance in the three groups in histopathological factors, such as depth of invasion and lymph node metastasis. Only the type of gastrectomy and combined resection of other organs showed a significant difference, but the difference was not enough to explain the defference in the prognosis. From this study, it has become apparent that more efforts in the treatment and earlier diagnosis are necessary to improve the prognosis for patients with gastric cancers located in C.

Fifty-five consecutive patients who underwent operation for p-T3 or p-T4 non small cell lung cancer by new-TNM classification from 1977 through 1987 were reviewed. The 5-year survival rates were 14% and 0% for stage III and stage IV, respectively. Among M0 (stage III) group, the prognosis for relatively curative operation was significantly better than that for non-curative operation (p