Background and Objectives The correlation between various levels of perineural invasion by pancreatic carcinoma and the patient's prognosis has never been cleared. The authors carried out a histopathologic study of resected pancreatic carcinoma to elucidate the significance of a new histologic finding concerning perineural invasion, which we designated “ntrapancreatic, extratumoral perineural invasion (nex),” and also to determine its predictive value for prognoses of patients after surgical removal of the tumor. Methods We investigated 90 patients with pancreatic adenocarcinoma who had undergone pancreatic resection. The prognoses of all patients were explored, and correlations between survival and pathologic factors were statistically examined for neural invasion. Results Nex was found in more than 50% of resected pancreases. A statistically significant association was found between the presence of nex and the grade of intrapancreatic neural invasion or the presence of extrapancreatic neural plexus invasion. Nex was also found to be associated with patient survival after removal of the tumor. Conclusions Nex appears to be an element predicting pancreatic cancer infiltration to the extrapancreatic nerve plexus and also to be a factor influencing postoperative survival of patients with pancreatic carcinoma. J. Surg. Oncol. 1997;65:164–170. © 1997 Wiley‐Liss, Inc.

Background and Objectives:The correlation between various levels of perineural invasion by pancreatic carcinoma and the patient's prognosis has never been cleared. The authors carried out a histopathologic study of resected pancreatic carcinoma to elucidate the significance of a new histologic finding concerning perineural invasion, which we designated ''intrapancreatic, extratumoral perineural invasion (nex),'' and also to determine its predictive value for prognoses of patients after surgical removal of the tumor. Methods: We investigated 90 patients with pancreatic adenocarcinoma who had undergone pancreatic resection. The prognoses of all patients were explored, and correlations between survival and pathologic factors were statistically examined for neural invasion. Results: Nex was found in more than 50% of resected pancreases. A statistically significant association was found between the presence of nex and the grade of intrapancreatic neural invasion or the presence of extrapancreatic neural plexus invasion. Nex was also found to be associated with patient survival after removal of the tumor. Conclusions: Nex appears to be an element predicting pancreatic cancer infiltration to the extrapancreatic nerve plexus and also to be a factor influencing postoperative survival of patients with pancreatic carcinoma.

Our experience with four patients who underwent immediate reconstruction following total laryngopharyngoesophagectomy and extensive resection of the superior mediastinum is presented. The reconstructive procedures included free jejunal graft or microvascularly augmented gastric pedicle for esophageal reconstruction, pectoral fasciocutaneous or myocutaneous flap for tracheal reconstruction, and mesenteric flap connected with jejunal graft omental flap, or pectoral flap for protection of the great vessels and obliteration of the dead space in the cervical and superior mediastinal region. The reconstructive procedures were successful, and no pharyngocutaneous fistula, mediastinitis, or great vessel rupture was noted in any patient. There was one patient who developed lung edema and liver dysfunction postoperatively. Combinations of reconstructive procedures using well-vascularized soft tissues can be expected to provide well-tolerated reconstruction following extensive cervical and superior mediastinal resection.

A rare autopsy case of primary squamous cell carcinoma of the thyroid gland is reported herein. A 61-year-old Japanese woman with a swelling of the left neck underwent surgery and the resulting tumor was histopathologically diagnosed as pure squamous cell carcinoma of the thyroid gland. She had had the nodule for 20 years, and it was histologically diagnosed as having been a well-encapsulated, follicular adenoma. Histopathological observation of the resected glands also revealed the coexistence of pure squamous cell carcinoma, which presumably originated from the adenoma. Postoperatively, an esophagotracheal fistula formed due to local invasion of the tumor cells. The patient's state gradually deteriorated and she died of severe bronchopneumonia and renal dysfunction, 4 months after the operation. Autopsy revealed no distant metastases, but severe septicemia caused by bacterial infection affecting the systemic organs was found, which presumably resulted in multiple organ failure.

Use of the gastric pedicle is an established method for esophageal reconstruction. However, fistula or necrosis of the pedicle occasionally occur due to vascular insufficiency or the severity of the surgery. During the past 4 years, the authors encountered six patients with necrosis of the gastric pedicle, who required reconstruction of circumferential defects of the cervical and thoracic esophagus. In such secondary reconstructive cases, primary closure of the wound is very difficult because the surrounding soft tissue becomes fibrous from infectious and fistulous complications of the first operation. Free jejunal transfers were utilized for restoring continuity of the alimentary tract, a platysma myocutaneous and pectoral fasciocutaneous flap for covering the intestinal anastomoses, and a mesenteric flap connected with the jejunal graft for covering the remaining skin defects in these cases. In follow-up periods from 3 to 21 months, satisfactory results were obtained in all but one patient. Five patients could eat a normal diet without difficulty. This reconstructive method is advocated as safe and well-tolerated physiologically in the salvage of necrosis of the gastric pedicle.