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Biomedical subjects

G A Higgins

Publications and source records attributed to G A Higgins.

At least 145 records · Page 8Linked to original sources
PubMed1977

Surgical considerations in colorectal cancer.

The large bowel, functioning largely as a wast storage receptacle, and with its long mesentery permits wide local excision and liberal removal of the lymphatics and blood vessels following the principles of cancer surgery. Rectal lesions with no mesentery or peritoneum, located in the narrowing lower pelvic cone are exceptions. With improved general patient support, antibiotics and technical improvements, 5-year survival in patients with localized disease now approaches 70%. "No-touch" principles with early ligation of the vascular pedicle, constricting tapes above and below the lesion, and local management of the resected bowel margins, have presumably diminished the dissemination of tumor cells at operation and lessened the chance of local implantation. Abdominoperineal resection, first described by Miles in 1908, is being reassessed because operative mortality and morbidity with a permanent colostomy is high, especially in the elderly patient. Local treatment by electrofulgeration, cryosurgery or radiotherapy are under intensive study as possible alternatives to surgery. The overall national death rate has improved only slightly during recent years. Thus the search for effective systemic measures to destroy small foci of cancer cells beyond the surgeon's reach must continue at a vigorous pace.

Anti-Bacterial Agents↗
PubMed1977

Factors related to survival following resection for gastric carcinoma: analysis of 903 cases.

This report is based on 903 patients with resections for gastric carcinoma between October 1957, and July 1969, entered in controlled trials of adjuvant therapy with Thio-TEPA and FUDR. Neither Thio-TEPA nor FUDR, as administered, prolonged survival. The extent of disease at the time of curative surgery is related to survival for the first 36 months postoperatively. Involvement of lymph nodes, resection of the esophagus, and serosal penetration are predictive of recurrence up to 36 months. There appear to be three groups of patients: 1) Cured (26%); 2) Slowly growing tumor--23% (median survival, 25 months); and 3) Rapidly growing tumor--51% (median survival, eight months). The absence of blood-vessel invasion, lymphatic invasion, lymph-node involvement, and serosal penetration characterize those patients in Group A.

Adult↗
PubMed1976

Adjuvant chemotherapy in the surgical treatment of large bowel cancer.

In two large controlled cooperative trials, 1118 patients undergoing surgical resection for large bowel cancer were randomized to be treated by surgery alone or to receive 5-fluorouracil during postoperative followup. The two studies differed slightly in the selection of patients for entry and in the dose regimens of 5-fluorouracil. Following examination of the removed specimen, "curative" and palliative stratifications based on evidence of residual disease were made, so that the two trials actually consisted of five separate patient groups, two groups of patients who had "curative" resections and the other three smaller groups of patients who had palliative resections with residual disease or tumor at a margin of the resected specimen. In all five groups, survival was slightly better in patients receiving chemotherapy although no single difference is statistically significant. Any suggestion that these slight advantages represent a true therapeutic 5-FU effect must be tempered by previous negative adjuvant studies by this group as well as others. Currently the group is conducting a trial using a combination of methyl-CCNU and 5-fluorouracil and has recently added a nonspecific immunostimulant, methanol extraction residue of BCG (MER), to one subgroup.

Clinical Trials as Topic↗
PubMed1975

The solitary pulmonary nodule. Ten-year follow-up of veterans administration-armed forces cooperative study.

Over a five-year span 1,134 patients with asymptomatic solitary pulmonary nodules were entered into a cooperative study. Of the 392 lesions found to be primary bronchogenic carcinoma, 67 patients were living and under observation ten years following operation. In the study, 32% of lesions were primary bronchogenic carcinoma, the incidence being 51% in patients above the age of 50 years. "Curative" resection was possible in 309 patients (78.9%) with a five-year observed survival of 38.5% and a ten-year observed survival of 20.1%. Factors that influenced long-term survival were size of lesion, age at operation, and interval between the last normal and the first abnormal x-ray film. Histologic cell type and extent of resection were not found to influence long-term survival.

Age Factors↗
PubMed1975

Preoperative irradiation for carcinoma of the rectum and rectosigmoid colon: reportof a National Veterans Administration randomized study.

In 1964 the Veterans Administration Surgical Adjuvant Group (VASAG) initiated a large-scale, controlled, randomized protocol to study the role of low-dose preoperative irradiation (2000-2500 rads/10fractions/12 days) in patients with operable adenocarcinoma of the sigmoid colon and rectum. This report analyzes the data in 700 patients, all at 5-year risk. There appears to be a definate benefit to irradiated patients who undergo abdominoperineal resections, when compared with the controls. This advantage is reflected in improvement of 5-year survival, and reduction in lymph node invasion, local recurrence, and distant metastases. A second protocol has been initiated in 30 VA hospitals employing a higher dose (3150 rads) to extended portals (toL2) to male patients who require abdominoperineal resections.

Adenocarcinoma↗
PubMed1975

Preoperative radiotherapy for colorectal cancer.

In a prospective randomized trial, 700 patients with a confirmed histological diagnosis of adenocarcinoma of the rectum or rectosigmoid were randomized to receive radiotherapy prior to operation (2000 to 2500 rads in two weeks) or surgery alone. Five year observed survival in the 453 patients on whom "curative" resection was possible was 48.5% in the X-ray treated group compared with 38.8% in controls, while in the 305 having low lying lesions requiring abdominoperineal resection, survival in the treated group was 46.9% compared with 34.3% in controls. Although suggestive of a treatment benefit, neither is considered statistically significant. Histologically positive lymph nodes were found in 41.2% of the control group and in only 27.8% of the patients receiving radiotherapy. Reveiw of all patients who died during the study shows a consistently lower death rate from cancer in the radiotherapy group. Although this study suggests a treatment benefit from preoperative radiotherapy, further studies now in progress by this group and others are necessary to determine the optimal dose regimen.

Abdomen↗