Gastric Cancer Invading the Esophagus. Improved Management.:Improved Management
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概要
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From 1978 to 1989, a total of 1272 patients with gastric cancer were admitted to Kurume University Hospital. Of these, 1184 (93%) underwent gastric resections. Of the resected cancers, 140 cases were gastric cancers invading the esophagus, as confirmed by postoperative pathological studies. For all 168 gastric cancers invading the esophagus, the resectability rate was 83% (140/168). These cancers were subdivided chronologically, with those during 1978-1983 included in Group 1 and those during 1984-1989 in Group 2. Group 2 patients were treated with a higher proportion of aggressive extended radical operations, such as combined resections of the diaphragm and lymph node dissections as far as the paraaortic lymph nodes (N4). The resectability rate was 76% in Group 1 and 93% in Group 2, due to the more aggressive operations. A lower esophagectomy with a total gastrectomy, mainly from a left thoracoabdominal approach, was performed for 71% of the patients in Group 1, and for 90% in Group 2. Lymph node metastasis was related to the extent of esophageal invasion and inversely related to the 5 year-survival rate. In all cases of esophgeal invasion of less than 1 cm, there were no mediastinal lymph node metastases, and the 5 year-survival rate was 76%. On the other hand, when esophageal invasion was more than 4cm, 50% had mediastinal lymph node metastases and the 5 year-survival rate was zero. The tumor size was also related to lymph node metastasis. When the maximal tumor length was less than 5cm, a negative lymph node metastasis was found in 78% of cases, and the 5 year-survival rate was 76%. On the other hand, when the tumor length was more than 10 cm, only 6% had a negative lymph node metastasis and the 5 year-survival rate was only 15%. The 5 year-survival rate with curative resection was 45% for Group 1, and 71% for Group 2. For those at stage III, 12% of Group 1 could be curatively resected with an extended radical operation, 46% of Group 2 (p<0.05) were cured due to the more aggressive operations in this group. The more aggressive extended radical operation is useful for improving the cure rate without increasing operativemortality.
- 久留米大学医学部 The Kurume Medical Journal 編集部の論文
著者
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Koufuji Kikuo
Departments Of Surgery Kurume University School Of Medicine
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Hashimoto Ken
Department Of Cardiology National Hospital Organization Okayama Medical Center
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TAKEDA JINRYO
Department of Surgery, Kurume University School of Medicine
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KODAMA ISSEI
Department of Surgery, Kurume University School of Medicine
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KAKEGAWA TERUO
Department o f Surgery, Kurume University School of Medicine
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TANAKA TAKAHO
Department of Surgery, Kurume University School of Medicine
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TANAKA TAKAHO
Department o f Surgery, Kurume University School of Medicine
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OHTA JUNJI
Department of Surgery, Kurume University School of Medicine
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OHTA JUNJI
Department of Gastroenterology and Surgery, Kurume University School of Medicine
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KODAMA ISSEI
Department of Gastroenterology and Surgery, Kurume University School of Medicine
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KOUFUJI KIKUO
Department o f Surgery, Kurume University School of Medicine
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HASHIMOTO KEN
Department o f Surgery, Kurume University School of Medicine
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TAKEDA JINRYO
Department o f Surgery, Kurume University School of Medicine
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