Search PubMed⌕ Search

Biomedical subjects

U Metzger

Publications and source records attributed to U Metzger.

118 records · Page 7Linked to original sources
PubMed1977

[Bronchoplastic methods in the resection treatment of malignant bronchial tumors].

1548 patients who were hospitalized 1964--1975 for diagnosis and treatment of bronchogenic carcinoma, 779 underwent resection. 17 patients could be operated by lobectomy or bilobectomy and bronchial resection (sleeve resection). Postoperative complications were frequent (n = 8): 4 times bronchopleural fistula, 2 times empyema, once fatal pneumonia and once bronchial stenosis. The overalll mortality and the survival rates are comparable to those of patients with radical resections. Sleeve resection is therefore a suitable alternative to pneumonectomy in elderly patients with reduced pulmonary function, rarely indicated also by a favourable tumor size. Sleeve resection increases the resectability of malignant bronchogenic tumors by 2%. Methods to prevent or cure the postoperative complications consisted in the use of absorbable suture material and long lasting intrathoracic suction.

Adult↗
PubMed1977

[Operative mortality, mortality and late results in bronchial carcinoma].

457 patients with a bronchial carcinoma of the years 1947--1962 are compared with 126 patients of the years 1969--1970 and set up in comparison to the whole clinical material of the years 1960--1975. In the period between 1969 and 1970 radical resections were performed in 20% more patients than in the first period (1947--1962). Older patients were in the last period (1970--1974) more frequent. 8% of all patients in which lobectomy was performed and 5.5% of the patients in which pneumonectomy was performed were older than 70 years of age. Overall mortality has remained unchanged for exploratory thoracotomy (19%), palliative resection (17.5%) and "radical" resection (14%). For simple pneumonectomy the overall mortality went down from 19.2% (1960--1964) to 9.6% (1970-1974) and for simple lobectomy from 14.4% to 3.8%. The five-year survival rate after radical resections was 8% (first period 0%) and after simple resections 26% (26.2%). Patients with stage I epidermoid carcinoma had a five-year survival rate of 46%. Those with stage II (spread to ipsilateral hilar nodes) a five-year survival rate of 14.3% Patients with palliative resections and exploratory thoracotomy died within 16 months.

Aged↗
PubMedDate not supplied

Intraportal chemotherapy for colorectal hepatic metastases.

One-third of colorectal cancer patients suffer from liver metastases on initial diagnosis. Overt liver metastases appear to be the first site of relapse for 40% to 50% of the patients with operable disease. The fact that tumor cells can be discovered in the mesenteric blood during surgery may indicate that circulating tumor cells give rise to metastases. Experimental investigations have shown that metastatic tumors reaching a diameter of 5 to 7 mm are predominantly perfused by the arterial route, which explains the unsuccessful attempts to treat established liver metastases through the portal vein. However, because metastases in the liver presumably arise via blood flow through the portal vein, adjuvant intraportal chemotherapy might permit ready access of the drug to small liver deposits in a way that systemic chemotherapy might not. The interest in portal adjuvant cytotoxic liver infusion in radically resected colorectal cancer patients is based on an early publication by Taylor, who in 1979 reported on a significant reduction of the incidence of liver metastases in a group of patients randomly assigned to perioperative adjuvant portal infusion with 5-fluorouracil. Based on these results, several groups initiated prospective randomized trials comparing intraportal infusion of various regimens to surgery alone. Results of most of these trials have been published during the last few years. All but one demonstrate improved overall survival and disease-free survival and a reduction of the incidence of liver recurrences in the adjuvant-treated patient group. Ongoing meta-analyses of the randomized trial data may confirm this tendency soon.

Chemotherapy, Adjuvant↗
PubMedDate not supplied

Adjuvant therapy for colorectal carcinoma.

In Western industrialized countries, colorectal adenocarcinoma is the second most common solid malignant tumor. Despite radical surgery in 75% to 80% of all cases, about 50% of patients with colorectal carcinoma die of this tumor. The essential advances of the last years are the reduction in the surgical complication rate and postoperative mortality. Recent studies show that radiotherapy for rectal carcinoma and chemotherapy (5-Fluorouracil in combination with levamisole) for colon carcinoma as additional measures in certain subgroups can significantly improve results. However, such multimodality treatment concepts need adequate equipment and experience and should only be implemented, whenever possible, in controlled clinical trials.

Antineoplastic Combined Chemotherapy Protocols↗
PubMedDate not supplied

Hematological toxicity of adjuvant portal liver infusion with fluorouracil, mitomycin and heparin.

Adjuvant perioperative liver infusion chemotherapy with fluorouracil, mitomycin and heparin caused mild but significant myelosuppression in the first two postoperative weeks. This was associated with a slightly increased bleeding tendency. Mortality was not increased. Future trials might combine chemotherapy with hematopoietic growth factors in order to minimize myelosuppression.

Antineoplastic Agents↗
PubMedDate not supplied

Randomized multicenter trial of adjuvant intraportal chemotherapy for colorectal cancer (SAKK 40/81). An interim report.

A prospective, randomized trial of adjuvant portal infusion of 5-fluorouracil in combination with mitomycin C was conducted on 469 patients with operable colorectal cancer. A single postoperative course of the cytotoxic agents was compared with radical surgery alone. The actuarial 5-year survival (median follow-up 48 months) was 70 +/- 3% in the chemotherapy group and 57 +/- 4% in the control group (p = 0.10). The respective figures for disease-free survival were 62 +/- 4% and 53 +/- 4% (p = 0.09). Among the 195 cases with strict adherence to the protocol for adjuvant chemotherapy there were 59 recurrences and 44 deaths in the follow-up period, whereas in the 274 with no or incomplete chemotherapy there were 120 recurrences and 99 deaths (p less than 0.05). Perioperative adjuvant chemotherapy via portal infusion proved to be feasible in a multicenter setting. Follow-up will be continued, in order to provide definitive information on survival according to randomization.

Adenocarcinoma↗
PubMedDate not supplied

Adjuvant therapy in colorectal cancer.

While uncontrolled and retrospective studies suggest a treatment benefit for radiotherapy or chemotherapy when administered as adjuvant before or after surgical resection with a curative aim for colon cancer, prospective randomized clinicals trials failed to show any advantage and do not to date confirm the efficiency of the proposed adjuvant therapy. For rectal cancer, preoperative irradiation administered at the dose of 34.5 Gy and postoperative radiotherapy administered at the dose of 46 to 53 Gy markedly decreased the local recurrence rate, however, these treatments failed to improve the 5 year survival rate significantly. Recently the efficacy of a postoperative chemotherapy was observed in a randomized clinical trial. The administration of methyl-CCNU, Vincristine and 5-fluorouracil after surgical resection of rectal cancer improved both the disease-free survival and the survival rate. Another randomized study showed a benefit of combined post-operative radiotherapy and chemotherapy with methyl-CCNU and 5-FU. Advantages and disadvantages of preoperative irradiation treatment and postoperative irradiation treatment are discussed.

Antineoplastic Agents↗
PubMedDate not supplied

Adjuvant portal liver infusion with 5-fluorouracil and mitomycin in colorectal cancer. SAKK.

Between 1981 and 1987, 533 patients from 9 institutions were entered in a randomized trial to assess the value of adjuvant perioperative portal infusion with Fluorouracil and Mitomycin as compared to radical surgery alone. Analysis of 469 evaluable patients at a median follow-up of 5.8 years revealed 110 recurrences in the control and 94 recurrences in the infusion group. Estimated 5-year disease-free survival was 52% and 61% respectively (hazard ratio: 1:0.75; 95% confidence interval 0.57-0.99; p = 0.046). Overall survival was 59% in the control and 69% in the infusion group (p = 0.048). Adjuvant portal infusion did not influence the occurrence of liver metastases but reduced the overall recurrence rate.

Colorectal Neoplasms↗
PubMedDate not supplied

Early hematological toxicity of adjuvant perioperative intraportal and intravenous chemotherapy with fluorouracil, mitomycin and heparin in colorectal cancer. Swiss Group for Clinical Cancer Research.

BACKGROUND: From 1987 to 1993 the Swiss Group for Clinical Cancer Research (SAKK) performed a randomized phase III adjuvant trial in patients with colorectal adenocarcinoma with the objective of comparing intraportal versus intravenous perioperative chemotherapy. PATIENTS AND METHODS: Patients younger than 75 years had a curative en bloc resection of their cancer and were then randomized into three arms: 1. adjuvant perioperative portal liver infusion with fluorouracil, mitomycin and heparin, 2. adjuvant subclavian intravenous infusion with the same regimen and 3. no adjuvant treatment. The hematological toxicity was evaluated by hemoglobin determination and leucocyte and thrombocyte counting before and during ten days after surgery. RESULTS: Hemoglobin showed a median decrease of 22% in the control group. This decrease is aggravated significantly by 3% through the chemotherapy. Leucocytes showed a median decrease of 7% in the control group. Perioperative chemotherapy caused a significantly higher median drop; 23% when given into the liver through the portal vein and 34% when given systemically through a subclavian catheter. Thrombocytes revealed a median decrease of 25% in the control group. Chemotherapy was not associated with a significant additional drop. CONCLUSIONS: Adjuvant perioperative chemotherapy with fluorouracil, mitomycin and Heparin as given in this study is associated with a significant mild drop in hemoglobin and leucocytes during the first 10 postoperative days. If drug dose increases are planned in future trials the addition of hematopoietic growth factors might be considered.

Antineoplastic Combined Chemotherapy Protocols↗