Biomedical subjects

Heidi Nelson

Publications and source records attributed to Heidi Nelson.

29 records · Page 2Linked to original sources

PubMed2003

Intraoperative electron radiotherapy as a component of salvage therapy for patients with colorectal cancer and advanced nodal metastases.

PURPOSE: To define the survival rates and relapse patterns in patients with isolated advanced nodal metastases secondary to colorectal cancer, treated with curative intent using aggressive combined-modality treatment. METHODS AND MATERIALS: Forty-eight patients with isolated advanced lymph node metastases secondary to colorectal cancer received intraoperative radiotherapy as part of curative-intent treatment. Forty-seven patients also received external beam radiotherapy (EBRT). Chemotherapy was delivered concomitantly with EBRT in 35 patients. The median intraoperative radiotherapy dose was 1250 cGy. End points included local failure within the EBRT field, central failure within the intraoperative radiotherapy field, distant metastases, survival, and toxicity. RESULTS: The median survival time and 5-year survival rate were 35 months and 34%, respectively. At 3 years, the local control and central control rates were 81% and 93%, respectively. Macroscopically complete resection and colonic primary site were predictors of survival and disease control. The median survival time and 5-year survival rate in patients with colonic primary sites and macroscopically complete resection were 53 months and 49%, respectively. Intraoperative radiotherapy-related neuropathy occurred in 3 patients and ureteral fibrosis in 1. CONCLUSION: With aggressive combined-modality therapy that includes intraoperative radiotherapy, long-term survival is achievable in colorectal cancer patients presenting with nodal relapse or advanced nodal disease. Survival and disease control rates are highest in those without gross residual disease.

Adult↗

PubMed2003

Vaginal reconstruction following resection of primary locally advanced and recurrent colorectal malignancies.

HYPOTHESES: Vertical rectus abdominus myocutaneous flap reconstruction facilitates healing within the radiated pelvis and preserves the possibility of subsequent sexual function in patients with colorectal cancer who require partial or complete resection of the vagina. DESIGN: A retrospective review of a consecutive series of patients. SETTING: A tertiary referral center. PATIENTS: All patients undergoing surgical treatment of locally advanced or recurrent colorectal cancer and vertical rectus abdominus myocutaneous flap reconstruction of the vagina. INTERVENTION: Vertical rectus abdominus myocutaneous flap reconstruction. MAIN OUTCOME MEASURES: Operative feasibility, complications, and sexual function. RESULTS: Twelve patients underwent extended resection for primary locally advanced or recurrent colorectal cancer including total or near total vaginectomy. Median age was 47 years. Tumors included 9 rectal adenocarcinomas, 2 anal squamous cell carcinomas, and 1 recurrent cecal adenocarcinoma. Surgical procedures included 8 abdominoperineal resections with posterior exenteration; resection of pelvic tumor and partial vaginectomy in 2 patients with previous abdominoperineal resection; 1 total exenteration; and 1 total proctocolectomy with posterior exenteration. The average operative time for tumor extirpation, irradiation, and reconstruction was more than 9 hours and all patients required blood transfusions. Despite 2 patients having superficial necrosis and 4 having mild wound infections, no patient required reoperation and all achieved complete healing. Five patients reported resuming sexual intercourse. CONCLUSIONS: The vertical rectus abdominus myocutaneous flap can be successfully used for vaginal reconstruction following resection of locally advanced colorectal cancer. It provides nonirradiated, vascularized tissue that fills the pelvic dead space, allows for stomal placement, and provides a chance for sexual function.

Adult↗

PubMed2003

Intraoperative radiotherapy in the multimodality approach to colorectal cancer.

The addition of intraoperative radiotherapy (IORT) to the multimodality approach for the treatment of locally advanced and locally recurrent colorectal cancer seems to result in improvements in local control and long-term survival. Local control and survival are most likely in patients in whom a gross total resection is accomplished. Peripheral nerve is the dose-limiting structure for patients treated with IORT. Further improvements in local control require the addition of dose modifiers during external beam radiotherapy or IORT. Distant relapse remains problematic, and effective systemic therapy is necessary to significantly improve long-term survival.

Colectomy↗

PubMed2003

Curative potential of multimodality therapy for locally recurrent rectal cancer.

OBJECTIVE: To assess the results of multimodality therapy for patients with recurrent rectal cancer and to analyze factors predictive of curative resection and prognostic for overall survival. SUMMARY BACKGROUND DATA: Locally recurrent rectal cancer is a difficult clinical problem, and radical treatment options with curative intent are not generally accepted. METHODS: A total of 394 patients underwent surgical exploration for recurrent rectal cancer. Ninety were found to have unresectable local or extrapelvic disease and 304 underwent resection of the recurrence. The latter patients were prospectively followed to determine long-term survival and factors influencing survival. RESULTS: Overall 5-year survival was 25%. Curative, negative resection margins were obtained in 45% of patients; in these patients a 5-year survival of 37% was achieved, compared to 16% (P <.001) in patients with either microscopic or gross residual disease. In a logistic regression analysis, initial surgery with end-colostomy and symptomatic pain (both univariate) and increasing number of sites of the recurrent tumor fixation in the pelvis (multivariate) were associated with palliative surgery. Overall survival was significantly decreased for symptomatic pain (P <.001) and more than one fixation (P =.029). Survival following extended resection of adjacent organs was not different from limited resection (28% vs. 21%, P =.11). Patient demographics and factors related to the initial rectal cancer did not affect outcome. Perioperative mortality was only 0.3%, but significant morbidity occurred in 26% of patients, with pelvic abscess being the most common complication. CONCLUSIONS: This study demonstrates that many patients with locally recurrent rectal cancer can be resected with negative margins. Long-term survival can be achieved, especially for patients with no symptoms and minimal fixation of the recurrence in the pelvis, provided no gross residual disease remains.

Adult↗

PubMed2002

Short-term quality-of-life outcomes following laparoscopic-assisted colectomy vs open colectomy for colon cancer: a randomized trial.

CONTEXT: Laparoscopic-assisted colectomy (LAC) has emerged as the preferred minimally invasive surgical strategy for diseases of the colon. The safety and efficacy of LAC for colon cancer are unknown, and the nature and magnitude of any quality-of-life (QOL) benefit resulting from LAC for colon cancer is also unknown. OBJECTIVE: To compare short-term QOL outcomes after LAC vs open colectomy for colon cancer. DESIGN, SETTING, AND PARTICIPANTS: Multicenter, randomized controlled trial (Clinical Outcomes of Surgical Therapy [COST]). Between September 1994 and February 1999, 37 of 48 centers provided data for the QOL component of the trial for 449 consecutive patients with clinically resectable colon cancer. MAIN OUTCOME MEASURES: Scores on the Symptoms Distress Scale (SDS), Quality of Life Index, and a single-item global rating scale at 2 days, 2 weeks, and 2 months postoperative; duration of postoperative in-hospital analgesic use; and length of stay. RESULTS: Of 449 patients, 428 provided QOL data. In an intention-to-treat analysis comparing SDS pain intensity, SDS summary, QOL Index summary, and global rating scale scores at each time point, the only statistically significant difference observed between groups was the global rating scale score for 2 weeks postsurgery. The mean (median) global rating scale scores for 2 weeks postsurgery were 76.9 (80) for LAC vs 74.4 (75) for open colectomy (P =.009). While in the hospital, patients assigned to LAC required fewer days of both parenteral analgesics compared with patients assigned to open colectomy (mean [median], 3.2 [3] vs 4.0 [4] days; P<.001) and oral analgesics (mean [median], 1.9 [1] vs 2.2 [2] days; P =.03). CONCLUSION: Only minimal short-term QOL benefits were found with LAC for colon cancer compared with standard open colectomy. Until ongoing trials establish that LAC is as effective as open colectomy in preventing recurrence and death from colon cancer, this procedure should not be offered to patients with colon cancer.

Adult↗

PubMed2002

The Mayo Clinic experience with multimodality treatment of locally advanced or recurrent colon cancer.

BACKGROUND: Patients with incompletely resected locally advanced and recurrent colon cancers have a dismal prognosis. Since 1981, 100 colon cancer patients have been treated with combination therapy including surgical resection, chemotherapy, and external plus intraoperative radiotherapy. METHODS: A prospective computerized intraoperative radiation database identified patients for this retrospective review. Data collection included patient demographics, tumor and treatment variables, and morbidity, recurrence, and survival statistics. RESULTS: The mean age was 55.2 years. Follow-up was available for all patients. Fifty-nine patients have died. Median follow-up of survivors was 70.5 months. Twenty-five patients with locally advanced colon cancer had a median survival of 38.2 months and a 5-year survival of 49%. Eleven of these patients are still free of disease. Seventy-three patients treated for recurrent colon carcinoma had a median survival of 33.3 months from the time of recurrence, with a 5-year survival of 24.7%. Twenty-one are alive without evidence of recurrence. The 38 patients with recurrent disease whose disease was completely resected had a 37.4% 5-year survival. CONCLUSIONS: A multimodality approach using en-bloc surgical resection with radiotherapy and chemotherapy affords some patients with locally advanced and recurrent colon cancer a chance for long-term survival.

Adult↗

PubMed2002

Predictors of surgical outcomes.

The foundation of surgical decision-making has always been the risk-to-benefit ratio. Traditionally, the risks of complications and death, predicted by comorbid conditions, have been balanced against the benefits of disease management; that is, relief of symptoms or prevention of disease-related complications. Increasingly, patient preference and quality-of-life outcomes are entering into the decision-making process even at the price of modest increases in risk. In addition, the role of the surgeon as a predictor of outcomes has come under close scrutiny and has been demonstrated as having an effect on a number of important surgical outcomes. In the future, our methods for analyzing and reporting surgical outcomes will have to accommodate new predictors.

Colon↗

PubMed2002

A prospective, blinded assessment of the impact of preoperative staging on the management of rectal cancer.

BACKGROUND & AIMS: The influence of preoperative staging of rectal carcinoma on therapeutic decisions is uncertain. The use of fine-needle aspiration (FNA) of perirectal nodes in this setting has not been evaluated. The aim of this prospective, blinded study of patients with rectal cancer was to assess the impact of preoperative staging on treatment decisions and compare the tumor (T), nodal (N) staging performance characteristics of pelvic computed tomography (CT), rectal endoscopic ultrasonography (EUS), and EUS FNA. METHODS: Eighty consecutive patients with newly diagnosed rectal cancer were prospectively evaluated. Therapy decisions were recorded after sequential disclosure of staging information to the patient's surgeon. RESULTS: In 31% of patients (95% confidence interval, 21%-42%), EUS staging information changed the surgeon's original treatment plan based on CT alone. The further addition of FNA changed therapy in one patient. T staging accuracy was 71% (CT) and 91% (EUS) (P = 0.02); N staging accuracy was 76% (CT), 82% (EUS), and 76% (EUS FNA) (P = NS). CONCLUSIONS: Preoperative staging with EUS results in more frequent use of preoperative neoadjuvant therapy than if staging was performed with CT alone. The addition of FNA only changed the management of one patient, whereas FNA did not significantly improve N staging accuracy over EUS alone. FNA seems to offer the most potential for impacting management in those patients with early T stage disease, and its use should be confined to this subgroup of patients. EUS is more accurate than CT for determining T stage of rectal carcinoma.

Aged↗

PubMed2002

Contrast-enhanced CT colonography in recurrent colorectal carcinoma: feasibility of simultaneous evaluation for metastatic disease, local recurrence, and metachronous neoplasia in colorectal carcinoma.

OBJECTIVE: Contrast-enhanced CT colonography has the potential to detect local recurrence, metachronous disease, and distant metastases in patients with a history of invasive colorectal cancer. The purpose of our study was to determine whether colonic anastomoses prohibit adequate colonic distention on contrast-enhanced CT colonography and to estimate the performance of contrast-enhanced CT colonography in detecting recurrent colorectal carcinoma. MATERIALS AND METHODS: Fifty patients with a history of resected invasive colorectal carcinoma underwent contrast-enhanced CT colonography and colonoscopy. Colonic distention was graded for different colonic segments. Two radiologists evaluated for the presence of local recurrence, metachronous disease, and metastatic disease. Results were compared with colonoscopy, histology, and clinical follow-up. RESULTS: Most patients had adequate colonic inflation (37/50, 74%). Eleven of 13 patients with inadequate distention had collapse in the sigmoid colon, usually associated with ileocolic anastomoses. Contrast-enhanced CT colonography detected local recurrences with an accuracy of 94% (95% confidence interval, 83-99%). The accuracy of contrast-enhanced CT colonography for metachronous lesions greater than or equal to 1 cm was 92% (95% confidence interval, 80-98%), but there was only one such lesion, which was missed on initial colonoscopy. Stool, granulation tissue, and inflammation can mimic the CT appearance of local recurrence or metachronous disease and account for false-positive examinations. Contrast-enhanced CT colonography identified five patients with metastatic disease. CONCLUSION: Suboptimal sigmoid distention can be seen on contrast-enhanced CT colonography, predominantly in patients with right hemicolectomies. Contrast-enhanced CT colonography is a promising method for detecting local recurrence, metachronous disease, and distant metastases in patients with prior invasive colorectal carcinoma. The technique can also serve as a useful adjunct to colonoscopy by detecting local recurrences or metachronous disease that are endoscopically obscure or by serving as a full structural colonic examination when endoscopy is incomplete.

Adult↗

PubMedDate not supplied

Laparoscopic colectomy for cancer.

Laparoscopic segmental colectomy has been widely accepted as a surgical procedure for benign colonic disease. With improving technology and surgeon experience, more complex procedures have been performed. However, a minimal invasive approach may not be justified for all colonic diseases. The use of laparoscopic surgery for colonic cancer, for example, has been controversial and the results of our national and international trials are yet unknown. We anticipate, given the positive findings of multiple small randomized and nonrandomized trials, that laparoscopic colectomy for cancer may soon prove to be appropriate in this setting. Our aim in this paper is to explore the indications, contraindications, and techniques regarding laparoscopic surgery that we have used in the treatment of colon cancer for patients enrolled in the national trial.

Colectomy↗

PubMedDate not supplied

Influence of postoperative acute-phase response on angiogenesis and tumor growth: open vs. laparoscopic-assisted surgery in mice.

Inflammatory responses and tumor growth are increased after laparotomy compared with laparoscopy in some animal models. Proinflammatory cytokines interleukin-6 (IL-6) and interleukin-1 beta (IL-1 beta) upregulate the expression of vascular endothelial growth factor (VEGF). Our aim was to investigate the influence of postoperative inflammatory responses on angiogenesis and tumor growth. 5 x 10(6) B51LiM cells were injected into the cecal wall of Balb/c mice. After 2 weeks, the animals were randomized into the following three groups: open cecectomy (OC), CO(2)-laparoscopic-assisted cecectomy (LC), and helium-laparoscopic-assisted cecectomy (LH). On postoperative day 12, the mice were killed. Tumor load scores and weight were significantly greater after laparotomy than after laparoscopy. Serum IL-6 levels 6 hours after surgery (OC: 4157+/-1297 pg/ml vs. LC: 2514+/-1417 pg/ml vs. LH: 2255+/-1714 pg/ml) and VEGF levels on postoperative day 12 (OC: 231+/-125 pg/ml vs. LC: 45+/-9 pg/ml vs. LH: 49+/-8 pg/ml), measured by enzyme-linked immunosorbent assay, were significantly higher in the laparotomy group. Microvessel density was also significantly higher in the OC group (OC: 34.3+/-11.5 vs. LC: 15.5+/-12.5 vs. LH: 18.5+/-11.9). There was a positive correlation between IL-6 and VEGF postoperative serum levels (rho=0.67; P<0.001). We concluded that increased systemic levels of proinflammatory cytokines and VEGF are associated with increased angiogenesis and tumor growth after laparotomy compared to laparoscopy in mice.

Acute-Phase Reaction↗