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T Wiggers

Publications and source records attributed to T Wiggers.

At least 19 recordsLinked to original sources
PubMed1996

Surgery for local recurrence of rectal carcinoma.

PURPOSE: This study was designed to evaluate results, especially mortality and morbidity, of surgical resection with curative intent for patients with a local recurrence of rectal cancer, in combination with radiotherapy. METHODS: Consecutive medical records of 163 patients with local recurrence of rectal carcinoma after previous "curative" therapy for primary rectal cancer were reviewed. Although 35 patients had an exploratory laparotomy, only 27 had local recurrence amendable to resection (6 irresectable locoregional recurrences and 2 distant metastases found at laparotomy). Twenty-one patients received radiotherapy. There was no perioperative mortality. Median follow-up time was 42 (range, 22-92) months. RESULTS: Local recurrence occurred in 16 (59 percent) patients. Ten patients are alive, of whom nine have good local control. Estimated five-year survival (Kaplan-Meier) is 20 percent. Survival was significantly better in patients without a second recurrence, but radicality of the resection was not influential. Good local control could be obtained in 12 (44 percent) patients, and 1 patient is living with symptoms. CONCLUSIONS: In selected patients with local recurrence of rectal carcinoma, reoperation with irradiation may result in good palliation and possibly cure.

Aged↗
PubMed1996

Detection of liver metastases from colorectal carcinoma: is there a place for routine computed tomography arteriography?

BACKGROUND: A prospective evaluation of the liver by preoperative ultrasonography, conventional computed tomography (CT), and continuous CT angiography (CCTA) was performed in 60 patients with primary or secondary colorectal carcinoma. METHODS: The standards of reference were palpation of the liver and intraoperative ultrasonography. The imaging techniques were assessed independently of each other. RESULTS: In 37 patients 105 liver metastases were identified; 23 patients had no metastases. CCTA and a high sensitivity of 94% (99 lesions identified) in contrast to ultrasonography (48%) and conventional CT (52%). The superiority of CCTA was also manifest in lesions less than 1 cm in diameter. However, the high sensitivity was accompanied by a high false-positive rate, particularly because of variations in the perfusion of normal liver parenchyma. Overall, CCTA had the highest accuracy (74%) compared with ultrasonography and CT (both 57%). The data indicate that preoperative ultrasonography and conventional CT have low sensitivity in the detection of liver metastases. CONCLUSIONS: Although CCTA seems to be superior to other preoperative imaging techniques, the too low specificity will hamper its routine application in patients with hepatic metastases from colorectal carcinoma.

Angiography↗
PubMed1995

[10-year follow-up after surgery for colon cancer: no further mortality from cancer after 7 years].

OBJECTIVE: To evaluate the 10-year follow-up of a cohort of 141 patients operated between 1979 and 1981, and to analyse the prognostic significance of traditional tumour parameters, using a univariate and a multivariate analysis. DESIGN: Prospective descriptive study. SETTING: Department of Surgery, University Hospital Maastricht, the Netherlands. METHODS: In 1979 a database was established in which 141 consecutive patients with colorectal carcinoma were included. The 5-year and 10-year survival rates were determined and the values of the clinicopathological staging (deducted from the Dukes classification), CEA expression, tumour size, localisation of the tumour and age of the patient as tumour markers were assessed. RESULTS: The 5-year and 10-year survival rates were 30.5% and 15.6% respectively. The Dukes staging system appeared to be the most important prognostic factor for survival (p = 0.0004), but tumour size and shape, and central lymph node involvement were independent prognostic factors. Furthermore, no patients died as a result of colon tumour after 7 years of follow-up. CONCLUSIONS: The Dukes staging system is the most important prognostic factor for survival. The follow-up of patients treated for colon carcinoma can be stopped after seven years. Only polyp surveillance should be continued after this time.

Aged↗
PubMed1995

[Supportive care].

Explore the source record for details and available documents.

Continuity of Patient Care↗
PubMed1994

[Initial results of immediate reconstruction of the breast following mastectomy].

OBJECTIVE: Evaluation of the results of immediate reconstruction after mastectomy for breast cancer by means of a silicone implant. DESIGN: Retrospective analysis. SETTING: Department of Surgical Oncology of the Dr Daniël den Hoed Cancer Centre and Department of Surgery of the Zuiderziekenhuis, Rotterdam, the Netherlands. METHOD: From September 1990 till July 1993, 37 immediate reconstructions of the breast after mastectomy were performed in 35 patients by means of a silicone implant. Indications for the treatment, consequences for further oncological treatment, additional plastic surgery, and complications of the reconstruction were evaluated. RESULTS: The indications for mastectomy and immediate reconstruction were local recurrence after breast conservative treatment (6 operations), multifocal disease (8), extensive in situ carcinoma (8), non-radically removed tumour at lumpectomy (5), anticipated poor cosmetics after breast conservative treatment (6), prophylactic ablation of the breast (2), and patient preference (1). 5 patients received adjuvant systemic chemotherapy, which could be administered without delay, and without negative influence on the result of the breast reconstruction. Additional plastic surgical treatment consisting of reconstruction of the areolar complex and correction of the breast symmetry, was performed in 5 and 3 patients respectively. In 8 of the 37 reconstructions (22%) complications were encountered. The main complications were haematoma (2), infection (4), implant removal (3), capsular contracture (2), skin necrosis (2), and luxation of the implant (1). CONCLUSION: Immediate reconstruction after mastectomy is a valuable treatment modality in breast cancer.

Adult↗
PubMed1994

The pedicled omentoplasty, a simple and effective surgical technique to acquire a safe pelvic radiation field; theoretical and practical aspects.

A substantial number of patients need radiotherapy after surgery for pelvic malignancy. Approximately 15% of them will experience radiation enteritis. After omentoplasty, reduction of irradiated bowel volume may be obtained. We evaluated the pedicled omentoplasty during gynaecologic surgery as a technique to improve safe irradiation of the pelvic region.

Case-Control Studies↗
PubMed1994

Impending and actual pathological fractures in patients with bone metastases of the long bones. A retrospective study of 233 surgically treated fractures.

OBJECTIVE: Analysis of short-term and long-term complications after cemented osteosynthesis for pathological fractures. DESIGN: Retrospective study. SETTING: South Municipal Hospital and the Daniël den Hoed Cancer Centre, Rotterdam, The Netherlands. SUBJECTS: 199 patients consecutive surgically treated between 1978 to 1990 for 233 fractures (161 actual and 72 impending) caused by metastatic lesions of the femur, humerus and tibia. INTERVENTIONS: Local resection of the tumour was followed by endoprostheses (n = 52) and by internal plate osteosynthesis (n = 167); 14 fractures were treated with intramedullary nails. Bone cement was added in 211 cases (91%). MAIN OUTCOME MEASURES: Pain relief, mobilisation, complications. RESULTS: Pain relief was achieved in about 90%. 145 (76%) who were treated for fractures of the lower extremity were able to walk again. There were 13 local complications: 26 (11%) implanted devices failed (cumulative probability 40%, after 60 months). In 11 cases the fixation failed after 7 weeks. The failure rate was 16% in the subtrochanteric region treated with an angled blade (probability 70% after four years). The patients' survival rate was 55% after six months and 20% at two years. CONCLUSION: Despite the poor life expectancy, our results indicate that hemiarthroplasty or osteosynthesis with bone cement for treatment of pathological (impending) fractures is a safe way to restore limb function and to improve quality of life.

Adult↗
PubMed1994

Management of extended radionecrosis in the pelvic area with repeated surgical debridement and omental transposition.

Extended radionecrosis in the pelvic area is a disaster occurring in a minority of patients treated with radiotherapy. Extensive excisional procedures, including pelvic exenteration, have been recommended, but carry high morbidity and mortality rates. Alternative treatment strategies are needed to improve survival and increase the quality of life in these patients. We retrospectively analysed the charts of eight patients treated for radionecrosis in the pelvic area between 1985 and 1991. During this period deviatory procedures, repeated but limited debridement and the early incorporation of an omental flap in the ischemic area were used in an attempt to avoid exenteration, but effectively stop further progression of infection and necrosis. The patients underwent a median of five surgical interventions (range: 2 to 21) for 10 sites of radionecrosis. The total of 61 procedures consisted of debridement (29), omental pedicle grafting (6), deviation of urinary tract (3) or intestinal tract (4) and including procedures due to complications (21). They were hospitalized for a median duration of 95 days (range 43-155) divided over several admissions (median 3, range 2-8). One patient died of sepsis during treatment. Complete recovery was achieved in all surviving patients with a median of 12 months (range: 9 to 20 months) after initial surgery. Early surgery, the limited extent of the procedures and omental transposition were the main components of our approach. We conclude that this approach has an acceptable morbidity and mortality rate, while a relatively good quality of life is achieved.

Adult↗
PubMed1993

Endocrine cells in colorectal adenocarcinomas: incidence, hormone profile and prognostic relevance.

The occurrence of endocrine cells in 350 cases of colorectal adenocarcinoma was studied by immunohistochemistry for chromogranin A (CGA). The hormone profile of endocrine tumor cells, the correlation between endocrine differentiation and presence of other colorectal epithelial-cell lineages and the prognostic relevance of endocrine differentiation in colorectal cancer were investigated. CGA-positive tumor cells were found in 30% of cases, 21% showing moderate positivity and 9.0% extensive positivity. Of CGA-positive tumors, 70% additionally produced neurohormones, mainly indigenous to normal colorectal epithelium: 55% showed immunoreactivity for glucagon-like substances, 20% for serotonin and 10% for somatostatin, PYY and HCG. No immunoreactivity was found for various neurohormones not normally produced by colorectal endocrine cells. CGA-positive tumors tended to be more aggressive than CGA-negative tumors. Especially, tumors with extensive CGA positivity showed shorter survival, which was most apparent within Dukes' stage C. In multivariate analysis, extensive CGA positivity was an independent indicator of poor prognosis. CGA immunoreactivity significantly correlated with mucin production, but not with expression of secretory component (SC), a columnar-cell marker. Mucin production significantly correlated with SC expression. Tumors positive for CGA but not for mucin and/or SC showed the worst prognosis. SC expression was a relatively favorable feature, and mucin-producing tumors showed intermediate behavior.

Adenocarcinoma↗
PubMed1993

[Endometriosis of the rectum].

Intestinal endometriosis is a diagnostic and therapeutic problem. In case the rectal wall is involved the physical signs of the endometriosis may mimic rectal carcinoma. Suspicion of the correct diagnosis can be aroused by a thorough history that will uncover the periodicity of symptoms e.g. cyclic bleeding. We present two patients with rectal endometriosis externa who were eventually treated successfully by surgery. Treatment may consist of hormonal therapy, although surgery will be necessary sooner or later in the majority of patients.

Adult↗
PubMed1993

[Thyroid metastases as cause of thyroid swelling].

In the period 1983-1991 16 patients with metastases to the thyroid gland were selected with the aim to compare the treatment results with those reported in literature and eventually arrive at a recommendation on treatment. There were 11 women and 5 men with a mean age of 62 years at diagnosis. The type of the primary tumour varied widely without clear predominance of any histology. The interval between the diagnosis of the primary tumour and the appearance of the thyroid metastasis varied from 0 to 9 years. Three patients were treated with chemotherapy, 3 with radiotherapy, 6 by surgery, 2 with a combination of surgery and postoperative radiotherapy and 2 patients were not treated at all. The median overall survival after treatment was 9 months. All patients eventually showed evidence of disease somewhere in their body. The local control until death or the last follow up visit was complete in case of surgery or a combination of surgery and radiotherapy. Chemotherapy resulted in 2 partial remissions and 1 stable disease. If there is fast systemic progression of disease with evident metastasis elsewhere or a short disease-free period an expectant policy is advocated. In case of (threatening) airway obstruction, a solitary metastasis or a long disease-free period individualised treatment is indicated with the aim of lengthening the disease-free period.

Aged↗
PubMed1993

Surgical treatment or gastric drainage only for intestinal obstruction in patients with carcinoma of the ovary or peritoneal carcinomatosis of other origin.

The records of 38 patients with advanced carcinoma of the ovary and 21 patients with peritoneal carcinomatosis of other origin who were treated for relief of intestinal obstruction were retrospectively analyzed. An explorative laparotomy was performed upon 40 instances, whereas in 25 instances, a large bore draining tube gastrostomy was done primarily. Retrospectively, the 40 explorative laparotomies were performed in two separate groups of patients. The first group consisted of 15 patients without palpable masses or ascites and five patients with intestinal obstruction as the first sign of ovarian disease. Another group of 20 patients presented with clinically manifest ascites or palpable masses, or both. The patients in group 1 survived for a median time of 154 days (range of 29 to 1,086 days) without recurrent intervention for obstruction. The patients in group 2 died after a median time of 36 days (three to 151 days). The explorative laparotomy was successful in only one patient in group 2. A third group of 25 patients was deemed inoperable and primarily received a tube gastrostomy. Twenty-three patients presented with ascites or palpable masses, or both. They died after a median time of 33 days (eight to 163 days). Surgical therapy for relief of intestinal obstruction should only be considered in patients who do not present with manifest ascites or palpable masses and in patients with carcinoma of the ovary for whom effective chemotherapy is available. Percutaneous gastrostomy should be the method of choice for other patients.

Ascites↗
PubMed1992

Hepatic resections for colorectal metastases in The Netherlands. A multiinstitutional 10-year study.

BACKGROUND AND METHODS: The records of 118 patients who had hepatic resections for colorectal liver metastases were analyzed retrospectively. RESULTS: The patient group, from 15 institutions in The Netherlands, was found to have a 5-year actuarial survival rate of 21% and a 5-year actuarial disease-free survival rate of 19%. The postoperative mortality rate was 7.6%. In the remaining group, the morbidity rate was 34.7%. A number of factors were examined that were reported to be of prospective significance in other studies. In the multivariate proportional hazard model of Cox, the number of metastases (P = 0.001) and the amount of perioperative blood loss (P = 0.002) were related significantly to disease-free survival. A factor that may be considered a contraindication to resection is the presence of extrahepatic disease (whether nodal or visceral), even if resectable. CONCLUSIONS: Although the actual benefit of resection is limited, and it is associated with considerable morbidity, surgical therapy offers some patients a chance for cure. It is a valid expectation that improvement in techniques and a proper understanding of hepatic anatomy will improve the safety and efficacy of hepatic resections in the future. Future research should focus on defining better selection criteria and on study of the value of adjuvant treatment modalities.

Adult↗