Degree Of Lymph Node Dissection Research Articles

SURGICAL TREATMENT AND ITS COST FOR THE PATIENTS WITH GASTRIC CANCER OVER EIGHTY YEARS OLD OF AGE

Among two hundreds and twenty eight patients with gastric cancer surgically treated in our department from April, 1991 to March, 1994, 26 patients over 80 years of age were subjected to this study and analyzed from both clinical and economical aspects in comparison with other younger patients. These aged patients were on the average of 82.7 years old. Their cancers were predominantly located in the antrum. Fifteen patients (57.7%) were categorized as stage I. Forty-two point three percent of the patients underwent operations with lymph node dissection greater than or equal to D2, 26.9% underwent total gastrectomy, 38.5% underwent combined resection of other organs. The degree of lymph node dissection and combined resection of other organs were significantly lower than those of younger patients. Postoperatively, there were respiratory complications in a frequency of 34.6%. Having complications postoperatively, however, there were longer hospital stay and more expensive medical cost than those other patients having no complication. Their costs had significantly higher in medication, examination and surgical management. From these results, we should try to reduce postoperative respiratory complications by choosing a less invasive surgery. We should also take much effort to shorten their hospital stay with the cooperation of home doctors. These efforts may improve the patients' QOL and reduce their medical costs.

Pancreatojejunal Sutural Insufficiency Occurring after Pancreatoduodenectomy and Countermeasures.

Pancreatojejunal sutural insufficiency occurring after pancreatoduodenectomy and countermeasures are discussed. In the Department of Surgery at Kurume University School of Medicine, 318 patients underwent pancreatoduodenectomies. The present study includes 15 of these patients, all of whom had pancreatojejunal sutural insufficiency. The frequency of sutural insufficiency was 4.7%. Five patients had bile duct cancer, 5 had cancer of the papilla of Vater, 2 had a carcinoma of the pancreatic head, 1 each had gallbladder cancer, chronic pancreatitis, and papillitis. Six (40%) of the 15 patients died during hospitalization. The presence or absence of sutural insufficiency was confirmed mainly by radiography and determining the properties and amylase levels of the drainage fluid. There was no significant difference due to the method of anastomosis. End-to-side anastomosis had a rate of 5 (5.9%) of 85 patients, while end-to-end had 10 (4.3%) of 233 patients. The sutural insufficiency was manifested as a major leakage in 6 patients and a minor leakage in 9. The degree of lymph node dissection was D0 in 6.1%, D1 in 1.4%, D2 in 4.8% and D3 in 10.8%, with a high incidence of sutural insufficiency in D3 patients. The pancreatic duct diameter was smaller than 4 mm in 10, 5-7 mm in 4 and over 8 mm in 1 patient. The intraoperative pancreatic findings were a soft pancreas in 8, slightly hard in 3, and hard in 4 patients. Fibrosis of the pancreas was normal to slight in 11 and moderate in 4 patients. Drainage by relaparotomy was performed in 4 of the 6 patients with major leakages to control sutural insufficiency, and the other 2 underwent continuous aspiration with an intraperitoneal drain inserted during the operation. The 9 patients with minor leakage underwent conservative treatment including continuous aspiration via an intraperitoneal drain inserted during surgery, fasting, intravenous hyperalimentation, and antibiotic administration. All of the patients with major leakage died from an associated occurrence of hepatic insufficiency, renal insufficiency, intraperitoneal hemorrhage or diffuse peritonitis during hospitalization. However, 8 of the 9 patients with minor leakage had some healing, and the 1 remaining patient developed a pancreatic fistula. The frequency of pancreatojejunal sutural insufficiency was high in patients with minimal pancreatic fibrosis, with soft pancreatic tissue without dilatation of the pancreatic duct, and with relatively good pancreatic function.

THE INFLUENCE OF THE NUMBER OF LYMPH NODES UPON SURVIVAL RATES IN COLORECTAL CANCER

One hundred and ninety-four colorectal cancer patients (colon cancer 111, rectal cancer 83) who underwent a curative resection were analized in order to evaluate the influence of the number of dissected lymph nodes upon the postoperative long-term survival rate. The tumor depth of invasion was pm or more in all cases, but none had distant metastasis before surgery. In colon cancer, the group of cases with 20 or more dissected lymph nodes showed better 5-year survival rate than that with 10 or less lymph nodes dissected though the degree of lymph node dissection is the same between both groups (p<0.05). Between the cases with the tumor depth of invasion “s” and those of “ss” in colon cancer having no lymph node metastasis, no stastistical significant difference was observed in 5-year survival rate. Furthermore, the maximal diameters of the serosal invasion showed a statistical difference between the group that lived for over 5 years and the group that died within 2 years postoperatively. Accordingly, it seems likely that the number of dissected lymph nodes has an important significance for the postoperative local recurrence in colon cancers. On the other hand, no relationship was found between the number of dissected lymph nodes and the postoperative long-term survival rate in rectal cancers. Other factors rather than the lymph node metastasis may be responsible for the local recurrence in rectal cancers.

THE INFLUENCE OF SURGICAL STRESS AND RISK FACTORS ON AGED PATIENTS WITH STOMACH CANCER

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.

FACTORS INFLUCING LOCAL RECURRENCE AFTER CURATIVE SURGERY FOR RECTAL CANCER

This study was designed to select factors which influence the local recurrence after curative resection for rectal cancer. The subjects were 159 such patients who were able to be followed for 2 years or more.Local recurrence developed in 11 (6.9%) out of the 159 patients, whose 5-years survival rate was as poor as 10.9%. With a statistical analysis the important clinicopathological factors influencing the local recurrence were: Infilitrating type in macroscopic form, lymph vessel invasion, aneuploid pattern in DNA ploidy pattern by flow cytometry, and degree of lymph node dissection as operation procedure.On the other hand, hematogenous recurrence developed in 24 (15.1%). The important factors influencing the hematogenous recurrence were: depth of invasion, lymph node metastasis, lymph vessel invasion, and clinical staging. No correlation with operative procedures was noted.These findings indicate that exhaustive dissection of lymph nodes is important for prevention of local recurrence and multidisciplinary therapy including chemotherapy and radiotherapy is important for prevention of hematogenous recurrence.