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Preoperative assessment of the depth of tumor invasion in patients with esophageal cancer is of vital importance for ensuring completeness of excision. It is also useful for making a precise diagnosis of metastasis to the mediastinal lymph nodes and determining the range of mediastinal dissection, which affects postoperative pulmonary complications. In the present study we investigated the diagnostic value of endoscopic ultrasonography in assessing the extent of cancer invasion and detecting lymphatic metastasis in esophageal cancer.

To prevent intraoperative injury of the bile ducts, we designed a balloon catheter and used it in the intraoperative cholangiography of 36 patients undergoing hepatectomy for primary carcinoma of the liver at the Second Department of Surgery of Osaka City University Hospital during the past 4 years. After cholecystectomy, the balloon catheter was inserted through the cystic duct up to the common bile duct, and cholangiography was performed before and after liver resection. This method makes intrahepatic bile ducts easier to visualize. In 14 of the 53 patients in whom cholangiography using a balloon catheter or conventional catheter was done, the abnormal branching of the intrahepatic bile ducts was found before resection, and the liver was resected without injuring the ducts. In 2 of the 36 patients in whom cholangiography with a balloon catheter was performed, leakage of the contrast medium from the resected liver surface was visible, and this part of the liver was sutured. With this new method, postoperative complications caused by bile leakage decreased. No side effects developed after the balloon catheter was used. We have used basically the same technique in other kinds of hepatobiliary disease.

We operated on 108 patients with hepatocellular carcinoma between July 1980 and July 1985. Eighteen (16.7%) had a tumor thrombus in the portal branch. The sensitivity of detection of these thrombi was 11.1% (2/18) by computed tomography, 22.2% (4/18) by transarterial portography, 50% (9/18) by sonography, and 70.6% (12/17) by percutaneous transhepatic portography. The outcome of hepatocellular carcinoma in the patients with such a tumor thrombus was poor. We think that percutaneous transhepatic portography should be done before operating for hepatocellular carcinoma to see if there is a tumor thrombus in the portal branch.

A 52-year old man underwent successful surgical removal of renal cell carcinoma with inferior vena caval and right atrial involvement, under cardio-pulmonary bypass. The postoperative progress was uneventful and at this writing he is doing well, with no evidence of metastasis.

As a countermeasure to portal tumor thrombi, which are a serious danger in liver cancer, we did portal vein embolization (PVE) during percutaneous transhepatic portography. Our 21 patients later underwent hepatic resection. After PVE, portal pressure increased and there was slight liver function damage, but this procedure was safer than transarterial embolization (TAE). We examined the pathologic specimens to view the state of occlusion achieved and also for histological findings, and found that Lipiodol ® mixed with fibrin was most effective. PVE done before hepatic resection strengthened the anticancer effect of TAE, prevented intrahepatic metastases, and caused permanent hypertrophy of the liver that may be useful as a kind of preparation for surgery.

During the 15 years and 7 months from January, 1965 to July, 1980, a total of 306 patients were subjected to proximal or total gastrectomy. In the latest period of 7 years, various operative procedures were employed depending on the pathological conditions of individual patients, as follows: patients with benign lesions or stage I and II tumors were subjected mainly to proximal gastrectomy plus pedicled jejunal interposition between the esophagus and gastric stump; those with stage III tumors were subjected to total gastrectomy plus pedicled jejunal interposition between the esophagus and duodenum; and those with stage IV tumors were subjected to total gastrectomy plus Roux-en-Y esophagojejunostomy. The incidence of postoperative complications was lowest after pedicled jejunal interposition between the esophagus and gastric stump, followed by pedicled jejunal interposition between the esophagus and duodenum. Roux-en-Y esophagojejunostomy had the highest incidence of complications.