Medical history: Seishu Hanaoka and his success in breast cancer surgery under general anesthesia two hundred years ago.

In 1804, Seishu Hanaoka performed the first successful surgical treatment of breast cancer under general anesthesia in the world. It preceded by 38 years C W Long's trial of ether anesthesia in 1842. In this paper, Hanaoka's biography and his contributions to surgery and anesthesiology in those days, and also his advanced ideas about medicine and sanitation are presented. Hanaoka had made many efforts to develop the optimal prescription of the anesthetic " Tsusensan(or Mafutsu-To)" for almost 20 years. Finally, he succeeded in using it clinically for breast cancer surgery, on October 13, 1804. Hanaoka performed operations for breast cancer in a total of 156 cases, and also for many other kinds of surgical procedures. He also eagerly contrived and modified many surgical instruments. In spite of such a busy daily schedule, he eagerly trained and educated many students, using his own philosophy for medical management. Details of his background and some discussion from a present-day viewpoints are included.

The effect of adjuvant 5'-deoxy-5-fluorouridine in early stage breast cancer patients: results from a multicenter randomized controlled trial.

To assess the efficacy of 5'-DFUR, an intermediate of capecitabine, for adjuvant treatment of early breast cancer, we conducted an open-labeled multi-center randomized controlled trial to compare postoperative 5'-DFUR treatment with surgery alone. We enrolled 1217 primary breast cancer patients and randomly assigned them into two treatment groups; one received six-month postoperative 5'-DFUR treatment by consecutive or intermittent administration, and the other surgery alone. Follow-up surveys were conducted once a year for all subjects simultaneously and examined their outcome/presence or absence of the cancer recurrence. The central study committee reviewed all follow-up data and judged the recurrence data to be used for the analysis. Eight-year follow-up data showed no significant differences in relapse-free and overall survival between the two groups, and 5'-DFUR treatment regimen showed an extremely high tolerance. Possible explanations are discussed for the finding of no significant survival difference between adjuvant 6-month 5'-DFUR monotherapy and surgery alone in early breast cancer.