This study was undertaken in order to evaluate the effect of intraoperative intraperitoneal (IP) administration of cisplatin (CDDP) and/or mitomycin C (MMC) on patients who underwent an operation for gastric cancer, compared with an untreated group. There were no differences between the effect of CDDP and that of MMC. No differences were found between the survival rate of IP and untreated group in no liver and no peritoneal metastasis cases, nor in non-resection cases. However, the median survival time was longer at 377 days in IP group than at 213 days in the untreated group (p less than 0.1). The free CDDP levels in the serum after 50 mg IP injection remained effective for 15-30 min. On the other hand, the MMC levels in the serum after 20 mg IP proved in effective.
With colorectal cancer, the therapeutic outcome for multiple hepatic metastasis extending to the bilateral lobe, even when various chemotherapies are administered, is extremely poor. For multiple hepatic metastases at our clinic, from November, 1985, through February, 1991, we used an implantable reservoir to administer intra-arterial infusion chemotherapy and reviewed the results. We treated 16 patients with hepatic metastases of colorectal cancer, H2 in 3 cases and H3 in 13 cases. When we used the reduction rate of the tumor diameter as seen by CT scan as a criteria for antitumor effectiveness, 1 case was CR and 3 cases were PR, for an efficacy rate of 25.0%. Changes in the serum CEA level were related to antitumor effectiveness. Among the evaluable cases, the 1-year survival rate was 60.0%, which was significantly more favorable than the 20.0% obtained in the systemic chemotherapy group (p less than 0.05). Given the above, although there are a few problems such as the kind and dose of drugs, the use of intra-arterial infusion chemotherapy with an implantable reservoir to treat hepatic metastases of colorectal cancer permits a form of chemotherapy providing a better QOL out of hospital.
The results of surgical treatment of patients with gastric carcinoma infiltrating into the duodenum and the pancreas head and with N3 metastases are very poor. We have employed pancreaticoduodenectomy in combination with right hemicolectomy (PD + LH) with the aim of leaving no remnant of cancer cells in the vicinity of the primary lesion, in patients with carcinomas of the distal third of the stomach, associated with duodenal invasion, presence of fixity to the pancreas head or N3 metastases, in the last ten years. Twenty-six cases were treated with this technique (Group A). These cases were compared with 63 patients who underwent subtotal gastrectomy (Group B) in the same period. The operation time, amount of blood loss and numbers of operative complications were greater in Group A than in Group B. Operating mortality was found in 2 cases in Group B but was 0 for Group A. When the survival rates were compared, PD + LH can provide better long-term results than subtotal gastrectomy, especially in the patients with tumors infiltrating into the pancreas head or metastasizing to N3. The PD + LH is a rational and safe method for the treatment of gastric carcinoma infiltrating into the pancreas head or metastasizing to N3.
A 72-year-old woman developed adenocarcinoma of the left parotid gland. Because of the excessive size of her tumor and the fact that she suffered from severe liver dysfunction, she was treated by hyperthermo-chemo-radiotherapy (HCR therapy). After ten sessions of radiofrequency hyperthermia with HEH 500 (13.56 MHz radiofrequency wave), 50-Gy irradiation from a linac and administration of 33.0g of tegafur in suppository form, the tumor mass showed remarkable regression decreasing in size by as much as 84% on computed tomography. Histologically the tumor which was resected under local anesthesia, showed almost total necrosis. The multidisciplinary HCR therapy was well tolerated and effective as a therapy for cancer in this case.
A 53-year-old man was found to have a gallbladder tumor during a routine follow-up more than 10 years after nephrectomy for renal cell carcinoma in 1991. Computed tomography demonstrated a 2.5 × 2.5 cm pedunculated mass with strong contrast enhancement that was hypervascular on celiac angiography. Laparoscopic cholecystectomy was performed. The grossly resected surgical specimen contained two pedunculated polypoid tumors originating from muscular layer. The histopathology showed clear cell carcinomas that were predominantly below the mucosal layer. The cancer cells stained positive for glycogen and epithelial membrane antigen, but not for carcinoembryonic antigen, vimentin, or cytokeratin 7. The final pathologic diagnosis was gallbladder metastasis from renal cell carcinoma. Our case is only the 8th reported case of a solitary metastasis within the gallbladder from renal cell carcinoma.
A 47-year-old woman presented with right lower quadrant pain, diarrhea, and anorexia. Abdominal ultrasonography revealed a tumor with 'target-like sign'. Computed tomography demonstrated a tumor consisting of abundant fat and ileocolic intussusception. A barium enema revealed a polypoid filling defect in the ascending colon with a 'coiled-spring' appearance and a 2 × 2 cm well-circumscribed mass at the leading edge of the intussusception. Colonoscopy showed a large, round, smooth, yellow lesion on a large stalk in the proximal ascending colon causing partial obstruction. The tumor was positive for 'cushion signs', and biopsy specimens did not show any neoplastic cells. Ileocolic intussusception caused by ileal lipoma was confirmed by laparoscopic surgery. The terminal ileum, including the tumor, was partially resected. Histopathology revealed a lipoma derived from the muscular layer of the terminal ileum. Our case is only the 8th reported case of a lipoma derived from the muscular layer.
