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D A Rothenberger

Publications and source records attributed to D A Rothenberger.

97 records · Page 6Linked to original sources
PubMedDate not supplied

Multifactorial analysis of local recurrences in rectal cancer, including DNA ploidy studies: a predictive model.

DNA ploidy studies were performed in 188 patients operated on for rectal cancer. In order to define different risk groups of patients, a stepwise logistic regression was carried out in 138 patients who underwent abdominal "curative" resections. Thirty-seven variables were analyzed. Although several variables were significant, only three improved the prognostic value: (1) more than three positive lymph nodes (p = 0.0007); (2) macroscopic local tumor invasion (p = 0.01); and (3) DNA ploidy (p = 0.03). Standardized discriminant coefficients were used to obtain a model and format for predicting local recurrences. This is the first time that a predictive model for rectal cancer, using DNA ploidy as a variable, is reported. Based on calculated discriminant values (DV), patients can be divided into three subgroups: (1) low risk for local recurrences (DV < -1.9, n = 56)--local recurrences were observed in two patients (3.6%); (2) moderate risk (DV between -1.9 and -0.6, n = 55)--local recurrences occurred in nine patients (16.4%); and (3) high risk (DV > -0.6, n = 27)--local recurrences occurred in 14 patients (51.8%). This predictive model for local recurrences has much better prognostic value than Dukes' staging (p < 0.0001).

Adult↗
PubMedDate not supplied

Cost-effective management of colon and rectal cancer.

Health care costs in the United States of America continue to rise. Legislators, economists and third party payers are becoming increasingly concerned with intervention outcomes and the distribution of resources. It is the responsibility of the medical profession to assume a leading role in assessing the cost-effectiveness of health care interventions. Although many physicians perform informal cost-effectiveness analyses on a daily basis, health economists employ a variety of more complex methodologies. This article will attempt to provide physicians with an understanding of the value and limitations of the tools used in formal cost-effectiveness analyses and demonstrate how these tools may be applied to the management of colon and rectal cancer.

Colonic Neoplasms↗
PubMedDate not supplied

Abdominoperineal resection for adenocarcinoma of the low rectum.

Current understanding of the routes of spread of rectal cancer along with technical innovations such as the circular stapler have allowed surgeons to treat most rectal cancers with an anterior resection and low anastomosis. Appropriate use of local therapy options has further decreased the need for abdominoperineal resection (APR). Nonetheless, APR remains the procedure of choice for many distal rectal adenocarcinomas. Numerous factors influence the decision to perform an APR and are discussed in detail. Although mortality for APR has been reduced significantly, morbidity remains high. Specific complications commonly seen after APR are discussed. Operative technique is outlined since much of the specific morbidity of APR can be reduced by attention to detail in the conduct of this complex procedure.

Abdomen↗
PubMedDate not supplied

Endorectal advancement flap for treatment of simple rectovaginal fistula.

An endorectal advancement flap technique has been utilized in 35 women for repair of "simple" rectovaginal fistulas, i.e., those of low or midseptal location, less than 2.5 cm in diameter, and of traumatic or infectious etiology. Colostomy is unnecessary. Concomitant sphincteroplasty for correction of associated anal incontinence is readily accomplished. Results are excellent with healing ultimately achieved in 32 of 35 women (91 per cent).

Adolescent↗
PubMedDate not supplied

Abdominoperineal resection for recurrent cancer following anterior resection.

Cases are reviewed of 12 patients who had abdominoperineal resections for cancer recurrence subsequent to anterior resection. Although this procedure is technically more difficult, we experienced no mortality or significant morbidity, and the postoperative hospital stay was similar to that of patients who received an abdominoperineal resection as a primary procedure. Although we have no long-term cures, at least significant palliation can be achieved in selected patients who have no evidence of distant metastases.

Abdomen↗
PubMedDate not supplied

Prognostic significance of tumor markers in colorectal cancer patients: DNA index, S-phase fraction, p53 expression, and Ki-67 index.

Risk of colorectal cancer recurrence has traditionally been determined by use of pathologic staging. However, it is apparent that subgroups of patients exist within tumor stages whose clinical behavior differs. This study was undertaken to identify tumor-associated factors that might be predictive of outcome in patients with intermediate stages who will benefit the most from postsurgical adjuvant therapy. Seventy patients with stage II and III colorectal cancer were assessed for DNA index, S-phase fraction, p53 expression, and Ki-67 index. Tumor recurrence was analyzed by means of nonparametric tests and Cox proportional hazard models incorporating standard clinical and pathologic criteria. Of the four prognostic markers evaluated, Ki-67 index was significantly associated with disease recurrence (P = 0.02), whereas DNA index, S-phase fraction, and p53 expression were not. After stratification by tumor stage, significant associations between Ki-67 index and disease recurrence were retained in stage II tumors (P = 0.01) but not in stage III tumors (P = 0.23). Cox proportional hazard regression analysis indicated that among stage II patients, those with a Ki-67 index >45% were associated with 6.5 times greater risk for disease recurrence than those with a Ki-67 index >/=45%. It was concluded that an elevated Ki- 67 index is associated with an increased risk of tumor recurrence in stage II colorectal cancer.

Aged↗