PubMed · 6909522
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R D Bordiug. 1981. [Endoscopic study, an important diagnostic method].. https://pubmed.ncbi.nlm.nih.gov/6909522/
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Gastric cancer, the leading cause of death from cancer in Japan, has long been studied. We received our first patient with early gastric cancer in 1950 and have since treated 2382 patients with this cancer up to 1990. The percentage of early gastric cancers diagnosed has been on the increase following the improvement in diagnostic skills and the establishment of mass screening. At present, more than half of the gastric cancers presenting are in the early stages. Chronological changes in diagnoses of early gastric cancer are characterized by the increased findings of (a) small tumors less than 4 cm in diameter (b) depressed-type carcinoma (c) lesions of the upper part of the stomach, and (d) undifferentiated-type adenocarcinoma. The standard method of treatment for early gastric cancer was standard radical operation in the 1970s. In the 1980s endoscopic mucosal resection and limited operation were adopted and their use has been increasing annually. The prognosis for early gastric cancer is quite favorable (the 5-year survival rate is more than 90%), and it is regarded as a disease with good prognosis. To obtain still better therapeutic results, it is essential to increase the proportion of early gastric cancers where endoscopic mucosal resection or limited operation is indicated, and improve the techniques of those procedures.
We report on the case of a 63-year-old woman with a gastric stenosis caused by peritoneal carcinomatosis. Vomiting and nausea disappeared after the implantation of a self-expanding metal stent in the 5 cm-long stenosis, and the patient was able to maintain a normal diet. She was discharged from hospital and remained in good condition for 14 weeks. Then, 16 weeks after stent implantation, the patient died of metastatic tumor spread, having remained free of nausea and vomiting. An autopsy showed complete patency of the stent, and no signs of ulceration or tumor ingrowth. The success of the treatment in this patient suggests the importance of further investigations.
Endoscopic surgical techniques were employed in 5 patients to harvest the sural nerve atraumatically with a minimal number of skin incisions. The medial sural nerve was harvested by two 2-cm-wide transverse incisions made under endoscopic-magnified visualization, which allowed the surgeon to see the detailed structure of the nerve and surrounding tissue. This method requires minimal traction of the nerve during nerve dissection, and postoperative pain and swelling were less than encountered with conventional methods, because the method we have employed is less invasive and atraumatic.