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Biomedical subjects

T Lerut

Publications and source records attributed to T Lerut.

At least 55 records · Page 3Linked to original sources
PubMed1999

Revisional surgery after colon interposition for benign oesophageal disease.

Although the short-term results of colon interposition for replacement of the oesophagus in part or as a whole are known to be satisfactory, there have been several reports of functional problems associated with total replacement in the long-term follow-up of patients. We have retrospectively studied patients who have required revisional surgery for anatomical and functional sequelae over a 7- to 38-year period. Although the short-segment colon interpositions have been relatively trouble free, several mechanical and functional problems requiring revisional surgery have been encountered in the long-term follow-up of patients who underwent long-segment colon interposition.

Adult↗
PubMed1999

Esophageal cancer.

Carcinoma of the esophagus and gastroesophageal junction continues to be an aggressive cancer with poor prognosis, despite improved surgical results and the potential benefit of combined multimodality regimens. Additional data seem to confirm the rising incidence of adenocarcinoma, although users of nonsteroidal anti-inflammatory drugs seem to have a decreased risk. Much attention is focused on detecting high-grade dysplasia and early carcinoma with promising results using red fluorescence after preceding 5-aminolevulinic acid (ALA) sensitization. Positron emission tomography made a major breakthrough and seems to be superior to computed tomography in detecting distant metastasis as well as lymph node metastasis. Endoscopic ablation of early carcinoma results in promising early results, but a major issue remains the EUS discrimination between Tis-T1a and T1b, as the latter is frequently associated with lymph node metastasis. In the field of molecular biology, research is unraveling the role of cadherins and catenins in the mechanism underlying cell adherence, cell movement, and progress toward tumor formation. Mutations of p53 are correlated with loss of apoptosis and form an early step in progress toward carcinoma as well as mutations of other tumor-suppressing genes (eg, p16 and Rb mutations). Detection of such mutations may become useful prognostic indicators, but illustrate the genetic polymorphism influencing the susceptibility to carcinoma. Several lines of evidence suggest that the stabilizing or overriding of p53 mutant cancer cells and restoration of the wild-type tumor suppressor gene p53 may improve results of DNA damaging treatment modalities. Further research in this field may lead to new forms of anticancer therapy.

Journal Article↗
PubMed1999

Treatment of esophageal carcinoma.

Cancer of the esophagus and gastroesophageal junction remains a virulent malignancy with an overall poor prognosis. Especially in the Western hemisphere, the incidence of adenocarcinoma is sharply rising. Over the last two decades, surgery has become the mainstay of treatment. Decreased surgical mortality and standardization of oncologic principles focusing on the completeness of resection are believed to be responsible for the improved 5-year survival rates, which are reaching > or = 30%. Until now, there has been no proven benefit from combined neoadjuvant treatment modalities using chemotherapy or chemoradiotherapy except for the subset of patients showing a complete response at pathologic examination. Further research should focus on new chemotherapeutic agents and the development of molecular markers that allow better identification of candidates for multimodality regimens.

Adenocarcinoma↗
PubMed1998

Present status of induction treatment in stage IIIA-N2 non-small cell lung cancer: a review. The Leuven Lung Cancer Group.

BACKGROUND: Surgical exploration in mediastinoscopy proven N2 non-small cell lung cancer (NSCLC) is unrewarding. Theoretical concepts suggest a beneficial role for preoperative induction treatment. The solidity of the therapeutic results with this approach in the currently available data is examined. METHODS: Literature on induction therapy followed by surgical exploration, consisting of randomized reports and phase II reports meeting some essential criteria, are reviewed. RESULTS: Of the twenty-four analyzed phase II studies, thirteen lack adequate surgical staging. Stratification for various important prognostic factors in N2 disease is missing in many instances. Results with induction with a cisplatinum dose of less than 80 mg/m2 seem to be inferior. The use of mitomycin-C in patients scheduled for lung resection or irradiation deserves caution. No evident difference in efficacy between induction chemotherapy or chemo-radiotherapy is suggested, but toxicity and mortality appear to be somewhat higher with chemo-radiotherapy. Pathological complete response is mainly found after an at least partial clinical response. Effect on survival in non-controlled phase II studies and small randomized reports is encouraging. CONCLUSIONS: the role of chemotherapy induction in improving the long-term survival of N2 NSCLC is promising, but needs to be confirmed by large multi-center randomized data. Adequate surgical staging and attention to important prognostic factors in N2 disease should minimize the numerous institution based differences interfering in the currently available non-controlled studies.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1998

Possible recurrence of desquamative interstitial pneumonitis in a single lung transplant recipient.

Idiopathic pulmonary fibrosis (cryptogenic fibrosing alveolitis) is a disorder with a very poor prognosis for patients who do not respond to therapy with corticosteroids alone or in combination with immunosuppressive drugs, e.g. cyclophosphamide or azathioprine. For patients with end-stage disease, lung transplantation remains the only possibility for long-term survival. We describe a patient who received a left single lung transplant for end-stage desquamative interstitial pneumonitis. One year later, the patient again began complaining of exertional dyspnoea and a gradual decline in the transfer factor of the lung for carbon monoxide (TL,CO) was apparent. A recurrence of the primary disease in the transplanted lung was suspected on transbronchial biopsies. During treatment with high doses of steroids, a Pneumocystis carinii pneumonia developed, which was treated with co-trimoxazole. The patient completely recovered and, after a period of over 2 yrs, remained in an excellent condition, after which time he was lost from follow-up.

Adult↗
PubMed1997

Esophageal replacement with colon in children using either the intrathoracic or retrosternal route: an analysis of both surgical and long-term results.

A total of 28 colon esophageal replacements performed in children for long gap esophageal atresia (22 patients), and intractable caustic stricture (6 patients) were reviewed. Emphasis was placed on identifying the pros and cons of the different reconstruction techniques: intrathoracic route (ITR) (19 patients) and retrosternal route (RSR) (9 patients). No hospital mortality occurred, whereas a higher morbidity rate occurred among patients operated on using the ITR as opposed to the RSR (68% vs 55%; P not significant). Six patients developed an anastomotic fistula (21% with the ITR vs 22% with the RSR; P not significant), whereas an anastomotic stenosis occurred in 13 patients (67% with the RSR, and 37% with the ITR; P < 0.07). Overall, dysphagia was the most prevalent symptom at 3 months follow-up, but had significantly decreased at the final follow-up (54% vs 16%; P < 0.0027). Functional results improved significantly during the follow-up (score 1-2 vs score 3-4; Fisher test: P = 0.001). However, despite the higher morbidity rate, better functional results were achieved using the ITR as opposed to the RSR.

Anastomosis, Surgical↗
PubMed1997

Thoracoscopic transdiaphragmatic left adrenalectomy. An experimental study.

The endoscopic approach to adrenal glands has been limited to laparoscopic and retroperitoneal access due to the relative inaccessibility of the retroperitoneal space in the former case and to the limited working space in the latter. We undertook this study to investigate the possibility of performing a left adrenalectomy through a thoracoscopic transdiaphragmatic approach in a swine model. Five pigs were anesthetized, intubated, and ventilated. Four laparoscopic trocars were inserted and a left pneumothorax was accomplished by CO2 insufflation. A peripheral posterior phrenotomy was made starting from the aortic hiatus and extended laterally for about 6 cm. The resulting pneumoretroperitoneum facilitated the subsequent identification of anatomic structures, allowing an easy exposure of the left adrenal gland. The gland was progressively dissected downward, interrupting the tributary vessels with endoscopic clips, and it was finally extracted through one of the trocar ports. Adrenalectomy was accomplished in all the animals without intraoperative mortality. Complications included splenic injury with prolonged bleeding and difficulty in performing the diaphragmatic suture (one case each). Through this approach direct and rapid exposure of the left adrenal gland was allowed, and adrenalectomy was accomplished in all the animals. These results suggest further investigations of the clinical application of this procedure.

Adrenalectomy↗
PubMed1997

Do cell kinetics have prognostic and/or predictive value in oesophageal cancer treated by surgery?

Tumour cell kinetics could help in predicting the optimal duration of treatment for the individual patient. In order to assess the importance of cell kinetics in oesophageal cancer, 63 patients with cancer of the oesophagus and/or gastro-oesophageal junction were studied. Seven patients had T1 tumours, six T2, 47 T3, and three T4. Twenty patients had no pathological nodes, while 43 patients had node-positive disease. Thirty-one patients had squamous cell carcinoma, 31 patients suffered from adenocarcinoma and one patient had signet ring cell carcinoma. The primary treatment was surgery. 5-iodo-2'-deoxyuridine (IUdR) was injected 6 to 10 h before surgery, and five biopsies per tumour were taken. The labelling index (LI), S-phase duration (Ts) and potential doubling time (Tpot) on the 305 biopsies taken were measured using flow cytometry. Overall, 1-year disease-free survival (DFS) was 57%, with the 2-year DFS being 38%. T-stage, pathological node status and sex significantly influenced the DFS. The mean Tpot from our 63 patients was 5.6 days, with a standard deviation of 3.6 days. When DFS was studied as a function of Tpot, no statistically significant difference was found between fast- and slow-proliferating tumours (log-rank, P = 0.84). A trend developed with fast-proliferating tumours recurring earlier than slow-proliferating ones. From our results it was also clear that intratumour variability exists, and is a confounding factor using Tpot as a predictor for treatment outcome. When tumours were classified into two categories, 'fast' or 'slow', according to their mean Tpot value (with the median Tpot (4.6 days) as the cut-off value), the trend for fast tumours recurring earlier was less clear than when the classification of tumours was based on the confidence interval (CI) being situated entirely below or above the mean. This classification into 'fast' or 'slow' included 27 of 63 tumours. The other tumours (n = 36) had a CI which included the cut-off, and could thus not be classified in this way. DFS at 1 year was 55% for the fast-proliferating tumours (n = 32) vs 63% for the slow-proliferating ones (n = 31). DFS at 1 year on the basis of the CI, however, was 38% for the fast-proliferating tumours (n = 17) vs 45% for the slow-proliferating ones (n = 10). Tumour cell kinetics have the greatest chance of predicting outcome in relatively long treatment schedules, where proliferation will have more time to occur. The fact that oesophageal tumours are almost all fast-proliferating tumours means that for new treatment schedules overall treatment time should not be unduly prolonged, whichever combination of surgery, radiotherapy and chemotherapy is used.

Adenocarcinoma↗
PubMed1997

Laparoscopic antireflux surgery and the thoracic surgeon: what now?

OBJECTIVE: Minimal invasive antireflux surgery is now a well accepted technique gaining a wide spread popularity. Simultaneously there is a growing tendency to fit all surgical candidates into one single type of operation, i.e. laparoscopic Nissen antireflux operation. This study evaluates the impact of this new technology on the strategy and practice of a major referral centre for antireflux surgery. METHODS: An analysis was made of indications for the different types of antireflux techniques performed between July, 1993 and 1995. If on Barium swallow the gastro-oesophageal (GO) junction proved to be reducible, a laparoscopic approach was proposed, if not, an open transthoracic access was preferred. RESULTS: One hundred and fifteen patients were operated. Fifty five patients underwent a minimal invasive approach: 49 Nissen (are the total fundoplication) and 3 Lind (are the partial fundoplication) operations through laparoscopy, 3 Belsey Mark IV through video assisted thoracic surgery (VATS). Sixty patients were treated by open surgery for following reasons: conversion to open surgery in 2 cases, redo surgery in 15 cases, previous other major abdominal surgery in 12, irreducible GO junction in 5, paraoesophageal or mixed type hernia in 12, Barrett and or oesophagitis IV in 4, combined antireflux surgery and feeding gastrostomy in 5, abdominal partial fundoplication by principle in 1, associated motility disorder in 1, combined reflux and gastric ulcer disease in 2, and severe emphysema in 1. In the laparoscopic series reflux control at 1 year post surgery as measured by 24 h pH study in 28 patients was obtained in 89.5%. One patient required a reoperation for symptomatic recurrence. CONCLUSIONS: (1) Laparoscopic antireflux surgery is a feasible and well accepted technique; (2) careful study of each individual patient is of paramount importance to choose the correct type of operation and access as well. Therefore, fitting every patient into a single type of operation, i.e. laparoscopic Nissen, should be avoided; (3) thoracic surgeons with a major interest in GO reflux disease should familiarize themselves with laparoscopic antireflux procedures.

Fundoplication↗
PubMed1997

Role of cervical mediastinoscopy in staging of non-small cell lung cancer without enlarged mediastinal lymph nodes on CT scan.

OBJECTIVE: The results of primary surgery for non-small cell lung cancer (NSCLC) with involved ipsilateral mediastinal or subcarinal lymph nodes (N2 disease) remains poor. However, several studies suggest that induction chemotherapy could increase long-term survival in patients with N2 disease. Therefore, accurate preoperative staging of the mediastinum remains of paramount importance for the treatment policy in patients with NSCLC. Enlarged mediastinal lymph nodes (MLN) on CT scan are positive in only half of the patients. Small lymph nodes can contain metastatic deposits of clinical importance. However, many surgeons believe that a normal mediastinum at computed tomography allows them to cancel their preoperative mediastinal exploration. It was the aim of this study to evaluate the results of cervical mediastinoscopy in patients without enlarged MLN on CT scan. METHODS: Between January 1990 and June 1994, 235 patients with potentially operable NSCLC underwent a cervical mediastinoscopy despite the absence of enlarged MLN on CT scan. MLN were considered enlarged if they were equal to or larger than 15 mm at their maximal cross-sectional diameter. RESULTS: Cervical mediastinoscopy was positive in 47 patients (20%). In 21 patients, N2 disease was extranodal and in 16 patients more than one level was involved. Mediastinoscopy was positive in 9.5% of the cT1N0 cases, in 17.7% of the cT2N0 lesions, in 31.2 and 33.3% of cT3N0 or cT4N0 tumors, respectively. After a negative cervical mediastinoscopy, resectability for unforeseen N2 disease was as high as 95%. CONCLUSION: We recommend a cervical mediastinoscopy in every patient with potentially operable NSCLC.

Carcinoma, Non-Small-Cell Lung↗
PubMed1997

Induction therapy for clinical T4 oesophageal carcinoma; a plea for continued surgical exploration.

OBJECTIVE: Complete resection of a locally advanced oesophageal carcinoma is not always feasible when invading mediastinal structures. The use of induction therapy prior to surgical exploration in patients with these clinical T4 tumours is anticipated to improve the resectability rate. METHODS: Patients, 18, who presented with a carcinoma of the thoracic oesophagus with clinical invasion into the carina (n = 6), trachea (n = 5), aorta (n = 4), lung (n = 2) and diaphragm (n = 1) were treated with concurrent chemotherapy and radiotherapy followed by surgical exploration. Follow-up was complete (mean of 17 +/- 3 months in all patients and 27 +/- 2 months in surviving patients). RESULTS: All patients completed the induction therapy with acceptable toxicity and no mortality. Subjective improvement in dysphagia was substantial in 11 patients (in 8/11 patients (73%) however, there was still viable tumour in the resected specimen), it was minimal in six patients and absent in one patient. Objective response on imaging was complete in one patient, partial in eight patients and minimal in nine patients [in two of these nine patients (22%) nevertheless, the primary tumour had disappeared completely in the resected specimen (pT0)]. Resection was complete (R0) in 14 patients (78%) and incomplete (R1) in one patient (5%). Resection of the primary tumour was impossible (R2) in three patients (17%) because of macroscopic airway (n = 2) and hilar (n = 1) invasion on exploration. In these three patients the tumour was bypassed using a retrosternal split stomach. One patient was proven at the time of surgery to have a previously unidentified lung metastasis. In three patients (17%), no residual tumour cells were found in the resected oesophagus nor in the lymph nodes (pT0N0M0). There have been no in-hospital deaths. Actuarial 3 year survival was 43% in all patients, 55% in completely resected patients and 100% in sterilized patients (pT0N0M0). Median survival was 18 months in all patients. CONCLUSIONS: Chemo/radiotherapy followed by surgery in patients with a clinical T4 oesophageal carcinoma is feasible with acceptable toxicity and no treatment-related mortality. Operability and resectability rate were high (100 and 83%, respectively) compared with historical controls. The primary tumour disappeared completely (pT0N0-1M0-1) in 28%. Tumour sterilization rate was 17%. Survival looks promising compared with historical controls. Subjective neither objective response following induction therapy clearly correlated with the final pTNM staging. This indicates that, in the absence of tumour progression, neither the patient nor the treating physician should jeopardize the chance for ultimate cure by denying surgical exploration following induction therapy.

Actuarial Analysis↗
PubMed1996

Tumors of the esophagogastric junction. Long-term survival in relation to the pattern of lymph node metastasis and a critical analysis of the accuracy or inaccuracy of pTNM classification.

From 1983 to 1989, 95 patients with carcinoma of the esophagogastric junction underwent resection. Overall hospital mortality rate was 6.2% (6/95). Actuarial survival analysis showed 5- and 10-year survivals of 33% and 31%, respectively. Five- and 10-year survivals of patients according to TNM stages were as follows: stage I (n = 13), 90% at both 5 and 10 years; stage II (n = 13), 70% at both intervals; stage III (n = 28), 28% at both intervals; and stage IV (n = 40), 11% and 8%, respectively. For patients with undiseased nodes (n = 26), 5- and 10-year survivals were 72% and 72%, compared with 18% and 16% for patients with diseased nodes (n = 68; p < 0.005). In patients who had involvement of both the abdominal and thoracic lymph nodes (n = 28), 5- and 10-year survivals were 13% and 13%, compared with 26% and 26% if metastases were confined to the abdomen (n = 37; p > 0.05). Grouping patients with diseased intrathoracic nodes together with patients with N2 abdominal nodes showed survivals of 14% at both 5 and 10 years. When tumors were staged as an esophageal carcinoma, classification of individual patients changed, as did the 5- and 10-year survivals. Five- and 10-year survivals were as follows: stage I (n = 8), 100% for both 5 and 10 years; stage II (n = 18), 68% for both 5 and 10 years; stage III (n = 27), 37% for both 5 and 10 years; and stage IV (n = 41), 10% for 5 years and 6% for 10 years. These data indicate that tumors of the esophagogastric junction tend to spread to both abdominal and thoracic nodes. However, reasonably good 5- and 10-year survivals can be obtained even in patients with nodal metastases in both areas. We suggest that N2 labeling be included for thoracic node metastases instead of the actual M+Ly label, because the N2 label better reflects the potential for curative surgery. Finally, staging tumors as gastric or esophageal carcinoma makes no significant difference in survival analysis, which raises the question whether these tumors behave more like esophageal carcinoma than gastric carcinoma.

Adenocarcinoma↗