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An increasing number of patients with lung cancer are undergoing outpatient chemotherapy, and thus, it is very important to maintain the quality of life(QOL)of these patients. Ninjin-Youei-To(TJ-108), a Japanese traditional medicine, has been reported to improve the QOL of patients with advanced cancer. However, the effect of TJ-108 in patients with lung cancer undergoing outpatient chemotherapy is unknown. Therefore, we conducted this study. To investigate factors influencing the QOL of these patients, we administered a QOL questionnaire,"The QOL Questionnaire for Cancer Patients Treated with Anticancer Drugs"(QOL-ACD)to 15 patients with non-small cell lung cancer. Factors related to the overall QOL scores and other categories indicating"activity","physical condition","psychological condition","social relationship", and"face scale" were analyzed. No significant decrease in each of the evaluated factors was observed in this study.

A ciliated muconodular papillary tumor (CMPT) has been reported to be a low-grade malignant tumor or benign tumor, consisting of ciliated columnar cells and goblet cells with basaloid cell proliferation, occur in the peripheral lung. We present a case of CMPT in this report. A 42-year-old male was referred to our department due to a nodule detected in the peripheral left lower lobe of lung. The nodule was resected via wedge resection based on a suspected diagnosis of carcinoma. Intraoperative analysis of the frozen sections was suggestive of mucinous adenocarcinoma. A left lower lobectomy and mediastinal lymph node dissection were performed. The resected specimen was characterized as a papillary tumor with central fibrosis, proliferating along the alveolar walls, surrounded by mucous lakes, and consisting of ciliated columnar cells and goblet cells. Nuclear atypia was mild, and no mitotic activity was observed. Based on these findings, the tumor was finally diagnosed as CMPT. No recurrence has been noted for 24 months after surgery.

An increasing number of patients with lung cancer are undergoing outpatient chemotherapy.It is very important to retain the quality of life (QOL) of these patients.Japanese traditional medicine, TJ-48, has been reported to improve the QOL of patients with advanced cancer. However, the effect of TJ-48 in patients with lung cancer undergoing outpatient chemotherapy is unknown. The present study was conducted to investigate the factors influencing the QOL of these patients. We used "The QOL questionnaire for cancer patients treated with anticancer drugs" (QOL-ACD) with 16 patients with non-small cell lung cancer. The medical factors related to the overall QOL scores and other variables indicating "activity," "physical condition, "psychological condition,""social relationships," "psychological condition," and "face scale" were analyzed. Significant improvement was observed in the total QOL score, mainly owing to the improvement in the patients "physical condition."

当科で経験した胸腺癌切除症例6例について臨床的に検討した．平均年齢は57.7才，男性4例，女性2例であった．組織型は明細胞癌1例，扁平上皮癌1例，未分化癌4例で，病理病期は正岡III期1例，IVa期1例，IVb期4例であった．心膜播種を認めたIVa期の症例は術前放射線化学療法を受けた．全例に胸腺全摘と縦隔リンパ節郭清を施行した．また各症例で浸潤された肺，心膜，胸膜，無名静脈，上大静脈，横隔神経の合併切除を行った．IVa期の1例を除き肉眼的完全切除であった．4例に術後照射，1例に術後化学療法を施行した．長期生存例は全例放射線療法が施行されていた．IVb期の1例は9年以上，III期の1例は7年以上無再発生存中である．一方，自験では化学療法の効果はあまり認められなかった．治療成績の向上には完全切除と放射線療法およびさらに効果的な化学療法を組み合わせた集学的治療の確立が重要である．

G-CSF産生肺癌6例の臨床病理学的検討を行った．平均年齢は56才，全例男性で，発熱を主訴に来院した．白血球増多（14000～39000/μl）と血清G-CSF値の上昇（78.0～2150.0pg/ml）のみならず，血小板増多，CRP上昇が認められ，Interleukin-6などG-CSF以外のサイトカインの関与も示唆された．全例完全切除を施行した．組織型は多形癌・大細胞癌・低分化型扁平上皮癌が各2例であった．免疫組織化学染色にてG-CSF産生肺癌であると診断した．進行度は，stage IBが1例，IIBが3例，IIIAが2例であった．術後化学療法は3例に施行した．3年生存はstage IBとIIBの各1例のみで，うち1例は無再発生存中であるが，残りの1例は肺と骨転移で術後36ヵ月に死亡した．他の4例は脳・肝・副腎・骨・胸腔内再発をきたし，術後10ヵ月以内に癌死した．G-CSF産生肺癌は完全切除が行われても予後不良で，有効な補助療法の確立が望まれる．

A 48-year-old woman was admitted to our hospital for sixth-line chemotherapy. A chest X-ray film and computed tomographic (CT) scan revealed a right-sided massive tumor with multiple lung tumors. Repeated treatment with carboplatin (AUC 6) on day 1 and nab-paclitaxel (100mg/m2) on days 1, 8, and 15, every 28 days were effective in this patient. Chemotherapy with nab-paclitaxel may be effective for patients with multi-recurrent adenocarcinoma.

症例は75才男性.検診で右下肺野の嚢胞性病変を指摘され当院を受診した.右肺S10に主座をおき, 超鶏卵大で, ニボーを伴う単房性の嚢胞性陰影を認めた.嚢胞壁は厚く不整であり, 所々で乳頭状かつ腫瘤状に嚢胞内腔へ突出していた.B10からのTBLBにて腺癌が得られたため, cT2 N0 M0の腺癌の診断で右肺下葉切除とND2a郭清を施行した.病理組織学的には, 嚢胞は内腔が多列線毛上皮に被覆された気管支嚢胞で, 嚢胞壁には乳頭状腺癌と気管支肺胞上皮癌, 上皮内腺癌, 種々の程度の異型上皮が認められた.これより癌の中心性壊死によって嚢胞性変化が起こったのではなく, 既存の肺内気管支嚢胞を背景に発生したpT2 N0 M0 stage IBの乳頭状腺癌であると診断した.肺内気管支嚢胞における不整な壁肥厚や腫瘤の存在などの異常所見は, 癌の合併の可能性を示唆しており, それが証明された場合には根治的切除が必要である.

末梢型肺腺癌の術後に, 稀な再発形式である気管壁内転移を来した1例を経験した. 症例は65歳男性. 1995年に右肺S1a原発の腺癌にてS1+S2a区域切除および縦隔郭清術を受けた. pT1N0M0のstage IAの低分化型腺癌であった. 3年9ヶ月後に, 血痰を主訴に再来した. 気管支鏡検査にて, 中部気管に長径3, 0cm, 表面平滑で赤色, 無茎性の粘膜下腫瘍を認めた. 気管左側壁より発生し, 内腔の半分を占めるように突出していた. 腫瘍は気管壁内に限局しており, 周囲リンパ節腫大や遠隔転移はみられなかった. 組織生検により肺癌の気管転移を疑った. 気管を縦切開し, 腫瘍を摘出した. 術後に60Gyの照射を施行した. 肺野病巣と気管病巣はともにCEA産生型低分化型腺癌で, 両者は組織学的に酷似しており, また治療により血清CEA値が低下した. 以上より, 末梢型肺腺癌の気管壁内転移であると診断した.

The results of surgical treatment were analyzed in 275 primary lung cancer patients who underwent pulmonary resection between 1984 and 1997. The overall 5-and 10-year survival rates for patients with non-small cell lung cancer were 48.7% and 46.0%, respectively. According to pathological stage, 5-and 10-year survival was 100% and 100% in stage 0, 75.2% and 75.2% in stage I, 67.2% and 67.2% in stage II, 36.8% and 28.4% in stage IIIa, 0% and 0% in stage IIIb, and 10.2% and 0% in stage IV. Extended resection and adjuvant chemo-radiotherapy did not improve the 5-year survival rate of patients with stage IIIb cancers. According to the operative procedure, the 5-year survival rate was 100% (4-year) for extended radical segmentectomy, 56.0% for lobectomy, 13.0% for pneumonectomy, and 23.4% for partial or segmentectomy. The criteria for extended radical segmentectomy included a peripheral tumor less than 2cm in diameter on chest CT films. Nodes around the segmental and lobar bronchi should be examined during surgery by preparing frozen sections, and dissection or sampling of the mediastinal lymph nodes should be documented. All patients with N1 and N2 disease underwent lobectomy or some type of operation. The amount of lung tissues resected was actually more than one segment, because the resection lines entered the adjacent segment. Extended radical segmentectomy is suitable for patients with small tumors less than 20mm in size and N0 disease. According to detection methods, the 5-and 10-year survival rates were 64.2% and 60.2% for mass screening, 39.4% and 32.1% for consultation for another disease, and 32.4% and 32.4% for subjective manifestations, respectively. Early detection of lung cancer by mass screening contributed to a better survival rate.

胸郭内原発 (肺1例, 縦隔2例, 胸壁1例) のMalignant fibrous histiocytoma (MFH) の4例を報告した.男性3例, 女性1例, 平均年齢65歳で全例に炎症所見を認めた.腫瘍マーカーとして血清フェリチン値を測定した2例では, 腫瘍の増大とともに血清フェリチン値の上昇が観察された.4例の腫瘍組織内フェリチン分布を免疫組織化学的に検討した結果, 腫瘍細胞の胞体および腫瘍内外に浸潤する組織球に陽性に染色された.フェリチンは腫瘍細胞から, あるいは随伴する炎症反応により産生されると考えられ, MFHの腫瘍マーカーとなり得る可能性が示唆された.4例とも増殖速度が極めて速く, 術前診断が困難であった.2例に切除術を施行したが, 全例の最長生存期間は7ヵ月で極めて予後不良であった.より早期の, 開胸生検による確実な組織診断と手術, 放射線, 化学療法を組み合わせた積極的な集学的治療が必要である.

A successful case of thoracotomy in a patient with contralateral destroyed lung using a percutaneous cardiopulmonary support system (PCPS) is presented. A 46-year-old man with right tuberculous destroyed lung was in the state of shock due to left pneumothorax in our hospital. Chest drainage was immediately performed, and general condition was recovered. But severe air leakage from the drain was revealed regardless of thoracoscopic treatment with fibrin glue. So thoracotomic radical operation was performed using PCPS. PCPS is a V-A bypass system consisted of centrifugal pump and membrane oxygenerator, and a pump perfusion rate of 2.0-4.8 l/min was achieved. During the operation, PaO2, SaO2, P_??_O2, S_??_O2 values and blood pressure were favorable, and the operation was successfully done. On the 3rd month after the operation, the patient was restored to his job. Further use of PCPS for the chest surgery is expected.

胃癌手術後の残胃十二指腸間にpouchを形成した空腸を間置する再建 (JPI法) を評価した. 術後の胸やけや下痢の出現頻度は, JPI法による再建例で, 従来のBillroth法による再建と比較して低率であった. 残胃からの食物排泄を核医学的に観察すると, JPI法では食物は残胃およびpouchに貯留し, 緩徐に十二指腸へと流出するのが認められ, 残胃からの排泄時間T1/2は, Billroth I法の29±6分, Billroth II法の50±37分に対し, JPI法では104±45分と有意に延長していた. 残胃内への胆汁逆流はBillroth法では全例に認められたが, JPI法では15%にみられるのみであり, 胆汁と食物の混和異常も, Billroth法に比較してJPI法では低率であった. 以上より, JPI法は従来のBillroth法よりも術後愁訴の少ない, より生理的な状態が得られる再建法と考えられた.

A 36-year-old man was admitted to our hospital for examination of a nodular shadow in the left lung. Chest 3-dimensional computed tomography (3D-CT) revealed a pulmonary arteriovenous fistula (PAVF) of 21 mm in diameter composed of the feeding artery (A4) and the draining vein (V4) in the left S4. Abdominal enhanced CT revealed multiple hepatic arteriovenous fistula. Brain CT revealed a cavernous hemangioma in right occipital cerebrum. He had a family history, habitual epistaxis, and oral telangiectasia and was diagnosed as Rendu-Osler-Weber disease (hereditary hemorrhagic telangiectasia:HHT). According to his family history, PAVF was likely to be a risk factor of brain infarction and abscess, and the wedge resection of the lingual lobe was performed to remove PAVF.

A 61-year-old man was pointed out a solitary nodule located in the left lung (S9) measuring 18 × 29 mm in size along with lymphadenopathy by chest computed tomography (CT). Positron emission tomography( PET) scan showed a positive sign corresponding to the nodule[ standardized uptake value (SUV) max 5.8]. No diagnostic material was obtained from the transbronchial tumor biopsy, since it was difficult to rule out malignancy, surgical biopsy was performed with sampling of mediastinal lymph nodes. Histopathological examination showed marked infiltration of inflammatory cells, many of which were demonstrated to be immunoglobulin (Ig) G4-positive plasma cells by immunohistochemical staining. Hence, IgG4-related inflammatory pseudotumor of the lung was diagnosed.

Cowden's disease is a multisystem disease. It is composed of a complex mixture of ectodermal, mesodermal, endodermal hamartomatous lesions of which mucocutaneus, breast, thyroid and gastrointestinal tract are most often encountered. Its mucocutaneous findings including small keratotic papule on the face and extremities and papillomatous lesions in the oral cavity and pharynx are the most characteristic feature of the syndrome and the key to the diagnosis. In addition to the mucocutaneous lesions, gastro-intestinal polyposis is characteristic feature, too. In a review of the Japanese literature, gastrointestinal polyposis have been reported in 92% (35/38). The most important feature of Cowden's disease is an increased prevalence of malignant neoplasia primarily in affected female patients, and principally involving the breast and thyroid gland. We clinical surgions should entertain the presence of the disease as a differential diagnosis and have to screen an occlut malignancy, when gastrointestinal polyposis is suspected. This paper describes a typical case of Cowden's disease in a 42-year-old woman with a previous history of breast cancer. The patient developed papule on the face and extremities, papillomatous oral and pharyngeal lesion, nodular goiter, lung tumor, gastric and duodenal polyposis, and colorectal polyposis.

Twenty-three cases with blunt hepatic injury (type Ia: 1 case, Ib: 8, II: 5, IIIa: 4 and IIIb: 5) experienced at the hospital for the past 9 years were clinically analyzed to elucidate the diagnosis, therapeutic course and operative procedure for hepatic injury. For the diagnosis of hepatic injury, value of GPT reflected the extent of hepatic injury. Especially, over 500 IU/l elevation was found on most cases of type III. Roentogenologically, only hepatic injury and bleeding around there was recognized on type II, but massive bleeding and lacerations reached to the surface of the liver were recognized on most cases of type III. These findings are effective on preoperative indexes of degree of hepatic injury or classification, and criteria of indication of laparotomy. For the therapeutic course, conservative treatment is possible to the cases on which vital sign is stable, without muscular defense. But laparotomy is necessary to the cases on which muscular defense or shock state is recognized. At that time, operative procedure on type II or III is inhibition of bleeding at the portion of the hepatic injury as a general rule. For the cases on which hepatic resection is necessary, it is thought to put an end to resectional debridement as much as possible.

Four cases of localized mesothelioma were clinicopathologically analyzed. There were one male and three females, with an average age of 54.8. All patients were asymptomatic and pointed out an abnormal shadow on chest X-ray examination at routine medical checkup. With diagnostic imagings and needle biopsy no definitive diagnosis could be made preoperatively. Under a possible diangosis of benign lung tumor, diaphragmatic tumor or mediastinal tumor, thoracotmy was performed. The tumors in case 1, 2 and 4 were present on the visceral pleura. In case 3, the tumor arose from the parietal pleura. Tumors in case 1 and 4 were pedunculated and those in case 2 and 3 were sessile. The size of tumor was 2.8×1.7cm in case 1, 3.5×3.0cm in case 2, 13.0×7.0cm in case 3, or 4.7×4.5cm in case 4. In all cases, the tumors were localized and were removed completely together with a part of surrounding structure. Pathologically the resected tumors were comprized of non-invasive proliferation of fibroblast-like cells without atypia and mitosis, and were diagnosed as benign localized mesothelioma. These tumors were thought to originate from mesenchyme, because electron microscopic examination revealed features of fibroblasts and mesothelial cells. All the patients are doing well and have no signs of recurrence, with the longest disease-free period for 4 years in one patient.

A 64-year-old man was admitted to our hospital for 6th-line chemotherapy. Chest X-ray film and computed tomographic (CT) scan showed right-sided pleural thickening with multiple lung tumors. Repeated treatment with carboplatin (AUC 6), paclitaxel (200 mg/m(2)) and bevacizumab (150 mg/kg) on day 1 every 21 days was effective for this patient. Chemotherapy with bevacizumab may be effective for patients with multi-recurrent adenocarcinoma.

Eleven carcinomas of the papilla Vater by pancreatoduodenectomy with lymph node dissection (curative resection rate was 84.6%) for the past 13 years and 10 months were analyzed clinicopathologically to elucidate the problems on improvement of the surgical results on carcinoma of the papilla Vater. Two patients with the carcinoma of Tumor type recognized no lymph node metastasis and survive for 6 years and 10 months, 13 years and 10 months respectively. All 4 patients of Tumor-Ulcer type survive, including 1 patient surviving for 4 years and 11 months, but 2 patients of this type were found having lymph node metastases. Five year survival rate for 5 patients of Ulcer-Tumor type and Ulcer type was 60% and 4 patients of them recognized lymph node metastases in over group 2 lymph nodes. Lymph nodes metastasis was found in 4 of 11 patients in No. 14 lymph node and 3 in No. 16 lymph node conspicuously. In these patients, one patient with No. 14b lymph node metastasis survives for 2 years and 3 months, and another one patient both with No. 14 and No. 16 lymph node metastases survived for 6 years and 6 months. From the above, it is suggested that in the treatment of carcinoma of the papilla Vater of Tumor-Ulcer, Ulcer-Tumor, or Ulcer type, over group 2 lymph nodes, emphasising No. 14 lymph node, dissection may produce improvement of the surgical results.

Syndrome of inappropriate secretion of antidiuretic hormone (SIADH) shows various symptoms based on hyponatremia and brings catastrophic outcome occasionally. A 75-years-old man was found to have an abnormal shadow of the right lung on chest X-ray. Bronchoscopic examination showed that the abnormal shadow was aterectasis caused by the squamous cell carcinoma of middle lobe bronchus, and middle and lower lobectomy of the right lung was performed. On the postoperative day 2, suddenly the serum sodium concentration decreased to 116 mEq/l and serum osmolarity also decreased to 246 mOsm/l. Inspite of hyponatremia, the urine sodium level elevated to 73 mEq/l. So the urine osmolarity elevated to 752 mOsm/l, too. In addition to these data, edema and dehydration were absent, and both renal and adrenal function were normal. So we diagnosed that this abnormal conditions-hyponatremia with corresponding serum hypoosmolality and an inappropriately high urinary osmolality due to continued sodium excretion was induced by SIADH. Fluid restriction and antibiotics therapy for pneumonia resulted in an appropriate rise in the serum sodium level to 138 mEq/l on the postoperative day 21. To avoid catastrophic outcome in the cases of hyponatremia after surgery, it is important to remember that hyponatremia may be induced by SIADH.

A 61-year-old male, complaining of cough was pointed out to have a palpable upper abdominal mass. Blood biochemical examination revaled mild anemia and elevated tumor makers such as CEA 104.4 ng/ml and CA19-9 1.270 U/ml. Gastric endoscopy indicated a gastric cancer of Borrmann type 3 a rising in the posterior wall of angular notch. However, ultrasonic endoscopy revealed a presence of extramural huge tumor presenting as low echo area. Abdominal CT and angiography offered a suspicion of extragastric developing type carcinoma. Operation was carried out. During operation a 10×9 cm tumor extramurally growing from antrum was found. Subtotal gastrectomy with right hemicolectomy (R3) was performed, leading to curative resection. Macroscopic observation of the resected specimen included a type 3 suggestive finding on the mucosal surface and a huge tumor with yellowish fur on the serosal surface.Histopathologically the tumor was Pan, med, INFα, ssβ, ly0, v0, n1 (+) (No.4, No.6) in stage II. The patient was treated with sustained thermochemotherapy involving cisplatin and mitomicin C during surgery, followed by long-term oral tegafur regimon, there has no recurrence up to now, 8 month after operation.

The management of cervical lymph node metastases in well-differentiated carcinoma of the thyroid has been controversial. In our department, node plucking was performed only in patients with cervical lymphadenopathy from 1963 to 1972. From 1973 to 1983, however, modified radical neck dissection was therapeutically or electively carried out. In order to determine whether the more extensive dissection is adequate or not, a retrospective analysis was performed by dividing patients into two groups which were differently managed for cervical lymph node metastases. This series of 206 patients with more than five years follow-up periods revealed that the rates of survival and lymph node recurrence were not different between the two groups. Since the well-differentiated carcinoma of the thyroid has a relatively indolent biological behaviour, however, further long-term follow-up seems to be necessary for demonstrating the efficacy of the neck dissection.

Granular cell tumor is found in various organs but is rare in the mediastinum. We report a case of 36-year-old woman with a granular cell tumor in the left upper mediastinum. She was admitted to our hospital because of hoarseness. Laryngoscopic examination revealed left vocal cord paralysis. Chest computed tomography (CT) showed a 3.0 x 2.0 cm well circumscribed tumor at the left side of the trachea in the left upper mediastinum. As hoarseness was suspected to be attributable to the mediastinal tumor, tumor resection was performed. It was found that the tumor involved the left recurrent nerve. The tumor was completely excised with combined resection of the left recurrent nerve. Histopathologically, the tumor consisted of cells with eosinophilic granules and S-100 protein positive materials in the cytoplasm, and diagnosed a granular cell tumor.

The experiment was designed to sequentially examine the histogenesis of Barrett's esophagus and esophageal adenocarcinoma induced by duodenal reflux without exogenous carcinogens.Wistar male rats, 200 in all, each weighing approximately 250 g were used. The totally gastrectomized animals were reconstructed by Schlatter's method to produce duodeno-esophageal reflux (n = 100), for comparison with no reflux, Roux-en-Y reconstruction (n = 100). The excised esophagus was histopathologically examined every 10 weeks after surgery until 50 weeks.Among the animals with reflux, Barrett's epithelium developed near esophago-jejunostoma 10 weeks after surgery and subsequently spread upward. Columnar dysplasia was first identified in the zone of Barrett's epithelium at 20 weeks, simultaneously with adenocarcinoma. As the incidence of Barrett's esophagus increased over time, the incidence of both dysplasia and adenocarcinoma also increased. Adenocarcinoma developed in the area of columnar dysplasia.The temporal progression from Barrett's esophagus to columnar dysplasia and adenocarcinoma is induced by duodeno-esophageal reflux. Columnar dysplasia is a morphological marker for adenocarcinogenesis.

Esophageal adenocarcinoma arises from Barrett's esophagus, which is induced by gastro-esophageal reflux. This refluxate often contains duodenal contents, whose backflow triggers gastric carcinoma, suggesting the hypothesis that refluxed duodenal contents cause esophageal carcinoma. This study examines the role of duodenal and gastric reflux in the absence of exogenous carcinogens in esophageal carcinogenesis. Wistar male rats, 120 in all, each weighing approximately 250 g, were used. Three experimental procedures were performed to produce gastro-duodeno-esophageal reflux, duodeno-esophageal reflux and gastro-esophageal reflux, for comparison with 2 control procedures, Roux-en-Y reconstruction and a sham operation. The animals were fed a standard diet and were examined 50 weeks after surgery. While no carcinoma was found among the 16 gastro-esophageal-reflux, 11 Roux-en-Y and 12 sham-operation animals, 10 of the 12 animals with gastro-duodeno-esophageal reflux (83%) and 10 of the 13 with duodeno-esophageal reflux (77%) developed esophageal carcinoma. The difference between groups was significant (p < 0.001). Two animals with gastro-duodeno-esophageal reflux had esophageal double and triple carcinomas respectively. Of the 23 carcinomas, 16 were adenocarcinoma, 4 adenosquamous carcinoma, and 3 squamous-cell carcinoma. Adenocarcinoma developed from the columnar-lined epithelium near the esophago-jejunostoma, while adenosquamous and squamous-cell carcinoma arose from the squamous esophagitis. These observations demonstrate that refluxed duodenal contents per so are responsible for esophageal carcinogenesis.

Because gastric cancers located in the upper third of the stomach are difficult to detect at an early stage, the surgical results remain poor. We performed R4 gastrectomy as a radical procedure for 25 patients, involving complete resection of the latero-aortic and interaorticovenous lymph modes above and below the left renal vein, in combination with the ordinary R2 or R3 gastrectomy (the R4 group). These patients were compared with 156 others who underwent R2 gastrectomy alone (the R2 group). There were no significant differences in operation time, blood loss, or the incidence of complications between the two groups; however, when the survival rates of the patients with tumors invading beyond the subserosa were compared, the 5-year survival rate was found to be significantly higher in the R4 group than in the R2 group. Furthermore, in patients with para-aortic nodal involvement, a significant survival advantage was observed in the R4 group, as compared with the R2 group. These results suggest that the R4 gastrectomy is a rational approach for patients with advanced gastric cancer located in the upper third of the stomach.

Gastroesophageal reflux is associated with a high incidence of complications such as ulcer or cancer of the esophagus [1]. Gastrectomy results in regurgitation of bile into the esophagus. However, the etiologic role of gastrectomy in esophageal cancer is still controversial [2]. Surgical treatment of postgastrectomy esophageal cancer is also investigational, because esophageal reconstruction with vascularized graft in the patient who has undergone gastrectomy is sometimes difficult due to the presence of adhesion. In this connection, we reviewed 14 cases of postgastrectomy esophageal cancer among our series.

The management of cervical lymph node metastases in well-differentiated carcinoma of the thyroid is controversial. In our department, from 1963 to 1972, node plucking was performed only in patients with cervical lymphadenopathy whereas, from 1973 to 1983, modified radical neck dissection was therapeutically or electively performed. In order to determine whether the more extensive dissection is adequate, a retrospective analysis was performed using two groups of patients who were managed differently with regard to the treatment of cervical lymph node metastases. From this series of 206 patients with more than five years follow-up, it was found that the rates of survival and lymph node recurrence did not differ between the two groups. However, since the well-differentiated carcinoma of the thyroid has relatively indolent biological behaviour, further long-term follow-up seems to be necessary for demonstrating the efficacy of neck dissection.