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At least 271 records · Page 15Linked to original sources
PubMed1984

Survival following resection for second and third primary lung cancers.

The performance of sequential resections and the consideration of new lesions as second or third primary lung cancers remain controversial issues. Criteria to define these as new primary lesions depend upon a difference in histologic types, a prolonged interval between initial and second or third resections, and location in the contralateral lung or a different ipsilateral lobe. Ninety patients have undergone multiple resections for bronchogenic carcinoma from 1960 to December, 1983. There were 10 examples of synchronous lesions and the remaining 80 were metachronous with the longest interval between resections being 17 years, 4 months. The initial surgical procedure was pneumonectomy in 11, lobectomy in 43, sleeve lobectomy in eight, segmentectomy in 27, and carinal resection in one. At the second operation, the procedures were segmentectomy in 55, lobectomy in 11, completion lobectomy in six, and completion pneumonectomy in 15. Two patients had sternotomy with bilateral resections and one patient had a tracheal resection. At the third operation, the procedures were segmentectomy in seven, completion lobectomy in two, and completion pneumonectomy in two. In 20 patients undergoing the second procedure and three undergoing a third resection, a different cell type was identified. The perioperative mortality following the second operation was seven of 90 patients (8%) and there were no deaths in those patients undergoing three resections. The cumulative survival rate following second resection in 80 patients with metachronous tumors was 33% at 5 years and 20% at 10 years. These data support continued aggressive surgical approach to second and third primary lung cancers.

Adenocarcinoma↗
PubMed1995

[Resection of the posterior mediastinal gastric tube used in reconstruction after radical surgery for esophageal cancer--case reports].

Two patients are presented who underwent resection of a gastric tube placed in the posterior mediastinum during reconstruction following radical esophageal resection for esophageal cancer. The indications for gastric tube resection were bleeding from a peptic ulcer in one and gastric cancer in the other. Case 1: A 72-year-old man, who had undergone a thoracic esophagectomy 3.5 years prior to admission, presented with a chief complaint of hematemesis. The gastric tube was resected and replaced with an antethoracic, pedicled segment of left colon. Pathologic examination of the resected gastric tube revealed a penetrating peptic ulcer. Case 2: A 65-year-old man with esophageal cancer and early gastric cancer underwent thoracic esophagectomy with combined resection of the fundus and lesser curvature of the stomach. One year later, he was found to have a new early gastric cancer in the antrum. The distal portion of the gastric tube was resected and replaced with a pedicled jejunal graft. Of the 526 patients with esophageal cancer treated in our department from 1972 to 1993, peptic ulcers were evident in the gastric tube used to reconstruct the esophagus in only seven cases. The stomach was resected in only one of these patients. Similar patients requiring gastric tube resection have been reported. All six of these cases are reviewed. Cancer of the gastric tube developed in 3 of the 526 patients. Although 74 cases of gastric tube cancer have been reported in the Japanese literature, the patient presented here (case 2) is the first to undergo successful resection of the stomach from the posterior mediastinal position.

Aged↗
PubMed1995

[Is liver abscess still an indication for liver resection?].

AIM: The standard therapy for liver abscesses consists of percutaneous drainage. In certain cases a liver resection may be indicated. The indication for liver resection in six patients with liver abscess is analysed retrospectively. METHODS: Between 7.7.87-13.10.93 six patients (4 male, 2 fem.) in the age of 40-72 years (mean 59 yrs.) underwent liver resection for liver abscess at our institution. The patients suffered from symptoms of a progressive liver abscess formation: fever, hepatomegaly, loss of weight, jaundice and anorexia. Abscess localization was performed preoperatively by ultrasound and CT. Drainage attempts were unsuccessful in these patients, resections were carried out for suspicion of malignancy or during a laparotomy due to other reasons. RESULTS: Liver resections were left and right hemihepatectomy (1x each), left lateral resection (3x) and one wedge resection. Intraoperative blood transfusion requirements were not different from those of other indications for resection. Postoperative hospitalization lasted 12-33 days (mean 19 days). The postoperative course was uneventful, in one case a hematoma at the resection site required drainage. CONCLUSION: Resection for liver abscesses is indicated only in exceptional cases but allows for definite therapy.

Adult↗
PubMed1994

Resection for multiple metastatic liver tumors after portal embolization.

BACKGROUND: Five patients with bilateral multiple liver metastases (3 to 12 lesions) from colorectal cancer who underwent extensive liver resection after portal embolization are described. METHODS: Portal embolization of the right portal branch was performed 9 days to 8 months before hepatic resection. The location and number of metastases were determined by intraoperative ultrasonography at the time of liver resection to accomplish complete resection of the tumors. Extended right lobectomy was carried out in four patients, two of whom underwent additional wedge resection of nodules located in the left lateral segment. The other patient underwent right lobectomy associated with local resection of the tumor in the left lobe. RESULTS: The postoperative course in the five patients was uneventful, with no serious complication or liver dysfunction. Although one patient died of recurrence 28 months after liver resection, the remaining four patients were alive and free of cancer between 36 and 74 months after hepatectomy. CONCLUSIONS: The presence of bilateral multiple (four or more) metastatic liver lesions from colorectal cancer is not considered a contraindication for hepatic resection if thorough examination of the liver is performed with intraoperative ultrasonography and the surgical risk is minimal. Portal embolization appears effective for increasing the safety of hepatectomy for patients with small metastases who require major right-sided resection combined with wedge resection of the left lobe.

Adult↗
PubMed1993

[Is surgical therapy of locoregional recurrence of resected colorectal cancer effective?].

The role of surgery in the treatment of local recurrence of colorectal carcinoma is controversial. This study aims to analyse the value of surgical reintervention. From July 1982 to June 1991 157 patients were treated for local recurrence after "curative resection" of primary colorectal carcinoma in our institution. The mean age was 60.3 years. In 67 patients tumor recurred in the pelvis (45% distant metastases) and in 90 patients in the abdomen (39% distant metastases). Intraluminal recurrence was found in 55 patients (35%), extraluminal recurrence in 102 patients (65%). The mean interval between primary tumor resection and recurrence was 24 months. The resection rate was 73.9% (n = 116). R0-resection was achieved in 38% (n = 44). There was no significant difference in the R0-resection rate between pelvic and abdominal recurrences (33% vs. 41%). In contrast to that intraluminal tumors showed a significant difference in R0-resections when compared with extraluminal tumor recurrences (57% vs. 23%). In 34 patients (22%) only palliative surgery was performed, while in 7 patients (45%) no surgical intervention was possible at all. Multivisceral resections were necessary in 36% of pelvic and in 81% of abdominal recurrences. The postoperative complication rate was 58% (19% major complications), mortality was 3.4%. For R0-resection mean survival was 44.1 months, for R1-resection 16.5 months and for R2-resection 10.9 months. Survival in intraluminal recurrences was 42 months compared with 13.8 months in extraluminal tumors. Tumor location (abdominal/pelvic) had no influence on survival.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1987

Composite pelvic resection. An approach to advanced pelvic cancer.

The definition of resectability has changed in the management of advanced pelvic malignancy. Most tumors previously considered unresectable can be removed by a function-preserving composite resection of the pelvis. We have performed resection in 55 such patients. Most had posterior pelvic tumors (47 patients), had previously undergone irradiation, and required a combined sacral resection. Included were patients with recurrent or locally advanced rectal cancer (32 patients), epidermoid cancer of the anorectum (seven patients), and primary pelvic malignancies (eight patients). Most had good functional recovery. The five-year actuarial survival rate was 23% (five of 25 patients survived longer than 51 months) in the patients with resected rectal cancer and 14% (one of seven patients) in the patients with resected anorectal carcinoma. Five of eight patients with primary tumors survived longer than 48 months. Lateral pelvic resections were done for five tumors that involved the ileum or ischium, and anterior resection was done in three patients for malignancy that involved the symphysis and rami. Four of these patients were living three to six years after surgery. The overall mortality rate was 7% (four of 55 patients). Composite pelvic resections can provide good local control with preservation of limb function in most patients with primary or secondary tumors of the bony pelvis.

Adult↗
PubMed1993

Pancreas cancer resection outcome in American University centers in 1989-1990.

BACKGROUND: Series of patients with pancreas cancer from single high-volume institutions or surgeons have demonstrated improvements in morbidity and mortality of pancreatic resection in recent decades. The experience of these single institutions or surgeons may not, however, reflect the results achieved by a cross-section of surgeons or hospitals. This article examines the resection outcome for a large unselected group of university hospitals and surgeons. METHODS: Pancreas cancer resection morbidity and mortality were examined using a multi-institution data base of discharge coding data from 26 American university hospitals. The data were analyzed for relationships of morbidity and mortality with the type of resection, patient age, hospital volume, and individual surgeon case load. RESULTS: Two hundred twenty-three resections were performed in 1989-1990 (pancreaticoduodenectomy, 168 patients; total pancreatectomy, 11; distal pancreatectomy, 30; and islet tumor resection, 14). The mortality rate was 6% (13 of 223) with major complications in 21%. Patient age did not correlate with complications or death. The surgeon case load ranged from 1-15 cases (median, 1) over the 2-year period. The mortality rate did not correlate with the case load. Surgeons performing one to three resections had significantly more complications than those performing four or more resections (P = 0.011). CONCLUSIONS: Pancreas resection is performed by an unselected cross-section of surgeons in American university centers with acceptable morbidity and mortality rates.

Adenoma, Islet Cell↗
PubMed1995

Prognostic implications of the extent of surgical resection in patients with intracranial malignant gliomas.

BACKGROUND: The goal of treating patients with malignant gliomas by intracranial surgery has been to remove as much tumor as possible without causing new neurologic deficits. However, it is still debatable whether the degree of surgical resection correlates with survival times of patients with supratentorial gliomas. METHODS: One hundred and one patients with supratentorial malignant gliomas who underwent either a gross total resection, a subtotal resection, and/or a partial resection were examined. A correlation between their length of survival and the degree of surgical resection was determined. RESULTS: The survival rates of patients who underwent total resections were significantly higher than those of patients who underwent subtotal or partial resections (P < 0.01). However, there was no significant difference in the survival rates between the subtotal and partial resection groups. These results also were confirmed by independent variables, such as age, location of the tumors, and histologic subtypes, with the exceptions of temporal gliomas and those younger than 60 years. CONCLUSIONS: The favorable prognosis of patients with malignant gliomas depends upon the total resection of these tumors. These findings should be of help in designing preoperative surgical intervention strategies.

Adolescent↗
PubMed1989

Resectability of large focal liver lesions.

Despite modern imaging techniques evaluation of the resectability of large focal liver lesions is often difficult or impossible until the time of operation. Based on experience with 54 primary or secondary focal liver tumours, a simple morphological classification has been found to be reasonably predictive of resectability. All tumours were classified before operation using computed tomography, ultrasound and angiography; 38 patients underwent laparotomy. Dependent, 'hanging' tumours (n = 7) were resected in six cases, expansively growing 'pushing' tumours (n = 19) were resected in 18 cases, and infiltrating, 'invasive' tumours (n = 17) were not resected because of involvement with major vascular structures. Eleven small tumours (less than 5 cm) were not classifiable by this system. This simple classification may be a useful clinical concept in preoperative assessment of resectability of focal liver lesions. Hanging tumours should always be resected, and large expansile tumours are generally resectable despite their size. Invasive tumours can only be resected in exceptional cases.

Humans↗
PubMed1992

Anterior resection without a defunctioning colostomy: questions of safety.

The need to defunction the anastomosis at anterior resection remains controversial. As the policy in this unit has been not to perform a defunctioning colostomy during anterior resection, the outcome of a consecutive series of 114 anterior resections, all carried out without a covering colostomy, was studied. During the period February 1985 to September 1991, 21 abdominoperineal resections, six Hartmann's procedures and two resections with coloanal anastomosis were also performed. Within the anterior resection group six clinical leaks (5.3 per cent) occurred, all in the low anastomosis group (8 per cent leak rate) and all of which required an end colostomy. The perioperative mortality rate within the anterior resection group was 3.5 per cent; of the four deaths one was attributable to anastomotic dehiscence and sepsis and the others were due to unassociated medical conditions. The results demonstrate similar leakage and mortality rates to published studies where anterior resection is frequently performed with a defunctioning colostomy. These results indicate that the routine use of a defunctioning colostomy at anterior resection should now be questioned.

Adult↗
PubMed1992

Survival after hepatic resection for malignant tumours.

A retrospective analysis of 194 patients who underwent hepatic resection for primary or metastatic malignant disease from January 1962 to December 1988 was undertaken to determine variables that might aid the selection of patients for hepatic resection. Hepatic metastases were the indication for resection in 126 patients. The 5-year survival rate was 17 per cent. For patients with resected metastases from colorectal cancer (n = 104), the survival rate at 5 years was 18 per cent. The 5-year survival rate was 27 per cent when the resection margin was > 5 mm compared with 9 per cent when the margin was < or = 5 mm (P < 0.01). No patient with extrahepatic invasion, lymphatic spread, involvement of the resection margin or gross residual disease survived to 5 years, compared with a 23 per cent 5-year survival rate for patients undergoing curative resection (P < 0.02). The survival rate of patients with poorly differentiated primary tumours was nil at 3 years compared with a 20 per cent 5-year survival rate for patients with well or moderately differentiated tumours (P not significant). The site and Dukes' classification of the primary tumour, the sex and preoperative carcinoembryonic antigen level of the patient, and the number and size of hepatic metastases did not affect the prognosis. The 5-year survival rate for patients with hepatocellular carcinoma (n = 42) was 25 per cent. An improved survival rate was found for patients whose alpha-fetoprotein level was normal (37 per cent at 5 years) compared with those having a raised level (nil at 3 years) (P < 0.01). Involvement of the resection margin, extrahepatic spread and spread to regional lymph nodes were associated with an 8 per cent 5-year survival rate versus 44 per cent for curative resection (P < 0.005). The presence of cirrhosis, the presence of symptoms, and the multiplicity and size of the tumour did not affect the prognosis. The 5-year survival rate of 11 patients with hepatic sarcoma was 25 per cent. No patient with peripheral cholangiocarcinoma survived to 1 year in contrast to patients with hilar cholangiocarcinoma, all four of whom survived for more than 14 months.

Adenoma, Bile Duct↗
PubMed1994

Combined resection of the pancreas and portal vein for pancreatic cancer.

Between March 1976 and December 1992, 137 (57 per cent) of 239 patients with pancreatic duct cell cancer underwent resection; 79 (58 per cent) of the 137 had combined resection of the pancreas and portal vein. Sixty-three of the 79 patients underwent resection of the portal vein alone; six died (mortality rate 10 per cent). The mortality rate was the same as that in 58 patients with no resection of the portal vein. In the remaining 16 patients adjacent arteries were also resected, with seven deaths. Of patients with resection of the portal vein alone who underwent curative resection, four survived more than 5 years, accounting for nearly half of the nine 5-year survivors. Combined resection of the pancreas and portal vein is associated with both an increased resectability rate and improved long-term survival.

Adult↗
PubMed1981

Effect of major small bowel resection on dimethylhydrazine-induced bowel carcinogenesis.

We have investigated the effect of distal small bowel resection on chemically induced tumors of the gastrointestinal tract in Wistar/Furth (W/Fu) rats. Dimethylhydrazine (DMH) (20 mg/kg sc once weekly x 16) was commenced 3 months after rats underwent resection of the distal 30 cm of small bowel (one-third resection) or after sham small bowel resection (controls). Fifty weeks after the start of DMH administration, tumors were found in 15 of 25 animals who underwent small bowel resection compared to 9 of 31 animals in the control group (P less than 0.05). After small bowel resection, 8 of 15 tumors occurred at the site of anastomosis but no anastomotic tumors were seen after sham resection. In addition, tumors were larger and more invasive after small bowel resection. These data indicate that major small bowel resection potentiates DMH induced-intestinal carcinogenesis.

Adenocarcinoma↗
PubMed1994

Resection of hepatic metastases from colorectal carcinoma. The registry data.

When liver metastases from colorectal carcinoma are detected, the surgeon must decide whether or not the patient is a candidate for resection. Even though long-term survival after resection is far from optimal, the relegation of patients to nonresective treatment means denying them the only chance for cure currently available. Better understanding of liver anatomy and improvement in resection techniques have decreased the morbidity and mortality. The RHM and the GITSG reports have better defined the prognostic factors for resections of colorectal liver metastases and allowed for a better understanding of the indications for resection. During the last decades, liver resection has been extended to older patients, patients with multiple liver lesions, and patients with larger solitary metastases. At the same time, anatomic rather than wedge resections are more common, and it is preferable to perform the colon and liver resection at different stages. The end result has been a marked increase in the number of hepatic resections performed for colorectal liver metastases during the last two decades.

Colorectal Neoplasms↗
PubMedDate not supplied

Results of hepatic resection for hepatocellular carcinoma.

The results of 122 hepatic resections in 112 patients with hepatocellular carcinoma are described. The type of liver resection performed was selected according to the patient's liver function. Forty-nine patients underwent anatomic resections, including 1 trisegmentectomy, 5 lobectomies, 11 segmentectomies, and 32 subsegmentectomies; the remaining 63 patients had nonanatomic resections. The 1-, 2-, and 3-year survivals after liver resection for all patients, taking into account one operative and one hospital death (0.9% each), were 92.4%, 85.0%, and 78.9%, and disease-free survivals at 1, 2, and 3 years were 68.6%, 46.2%, and 32.6%, respectively. Twenty-one repeat hepatic resections (17.2% of the total of 122 resections) were performed with no hospital mortality. Cumulative survival from the time of repeat hepatectomy in these 21 patients was 84.2% and 56.3% at 1 and 2 years, respectively. Among the factors that may affect survival or disease-free survival, the absence of vascular invasion (p < 0.05) and intrahepatic metastases (p < 0.01) were significantly related to the disease-free survival time. A good outcome was obtained after liver resection in 112 patients with hepatocellular carcinoma through appropriate choice of the type of resection, careful follow-up, and a vigorous surgical approach for recurrence.

Adult↗
PubMed1989

Preoperative total parenteral nutrition for bowel resection in Crohn's disease.

To examine the effect of preoperative total parenteral nutrition (TPN) on patients with Crohn's disease undergoing bowel resection, an historical cohort was assembled of 103 patients resected between 1982 and 1984 by a single surgical team. Preoperative, perioperative, and postoperative variables were compared between patients receiving TPN and patients not receiving TPN. Analysis was stratified for three surgical procedures: segmental small bowel resection, ileocectomy, and segmental or total colectomy The effect of TPN was most pronounced in patients having small bowel surgery. For segmental small bowel resection, 12 of 17 patients had TPN, and these patients had 20.4 +/- 14.3 cm less bowel resected than did those in the non-TPN group, an effect not dependent on duration of TPN. For ileocectomy patients, 31 of 62 patients received TPN, and these patients had 11.2 +/- 4.2 cm less small bowel resected than the non-TPN group, an effect not dependent on the duration of TPN. For large bowel resection patients, 6 of 24 patients had TPN, and there was no difference in length of bowel resection, preoperative and perioperative variables, or recurrence. The total hospital stay was 13.5 +/- 2.6 days longer for those having TPN; 3.5 +/- 1.9 days of the longer stay was postoperative. In conclusion, TPN was associated with reduced length of small bowel resection at the expense of longer hospital stay.

Cecum↗
PubMedDate not supplied

Resection combined with intraoperative radiation therapy (IORT) for stage IV (TNM) gallbladder carcinoma.

From October 1976 to May, 1990, a total of 86 patients with stage IV (TNM) gallbladder cancer were treated at Tsukuba University Hospital. Twenty-seven of the 86 patients underwent tumor resection; 43 patients received palliative surgery. The remaining 16 were too advanced to have surgery. Of 27 patients who had tumor resection, 9 had resection alone, 17 had intraoperative radiation therapy (IORT) +/- postoperative external radiotherapy (ERT), and 1 had postoperative ERT. The procedures used were: extended right hepatic lobectomy plus hepaticobiliary resection (HBR) (n = 2), hepatic segmentectomy (SIVb, SV) plus HBR (n = 9), hepatic segmentectomy (SIV, V, VI) with HBR (n = 1), hepatic segmentectomy (SIV, V) plus HBR with pancreaticoduodenectomy (PD) (n = 3), PD plus HBR (n = 1), cholecystectomy with wedge resection of the gallbladder fossa plus HBR (n = 3), and cholecystectomy plus HBR (n = 3), and cholecystectomy (n = 4). Regional lymph node dissections were performed in every patient and 17 of 27 patients underwent additional resections of adjacent organs such as the stomach, duodenum, colon, and abdominal wall. A single dose of 20-30 Gy was delivered intraoperatively for 17 patients. A mean total dose of 36.4 Gy (1.8/fraction) was added to IORT for 10 patients. The three-year cumulative survival rate was 10.1% for resection plus IORT but 0% for resection alone. The longest survivor is alive and well at 3 years and 3 patients are alive 16, 13, and 4 months after tumor resection followed by IORT plus ERT.

Adenocarcinoma↗
PubMedDate not supplied

Duodenum-preserving resection of the head of the pancreas in chronic pancreatitis with inflammatory mass in the head.

In 141 patients with chronic pancreatitis and an inflammatory enlargement of the head of the pancreas, a duodenum-preserving resection of the head of the pancreas was performed within a 16-year period. The hospital mortality was 0.7%; the late mortality was 5%. Seventy-seven percent of the patients were completely free of abdominal pain; 67% returned to their former occupation. After a follow-up period of 3.6 years, glucose metabolism was unchanged in 81.7% of the patients, in 10.1% it deteriorated, and in 8.3% it improved permanently. In patients with severe chronic pancreatitis and an inflammatory mass in the head of the pancreas, a duodenum-preserving resection of the head of the pancreas is an alternative procedure to the Whipple operation. The surgical technique of the duodenum-preserving resection includes 2 major steps: first, subtotal resection of the head of the pancreas conserving the duodenum; second, restitution of the exocrine pancreatic secretory flow from the body and tail of the pancreas by using the first jejunal loop as an interposition. In comparison to the Whipple procedure, the duodenum-preserving resection of the head of the pancreas in chronic pancreatitis spares the patient a gastric resection, a duodenectomy, and a common bile duct resection. With respect to long-lasting pain relief and preservation of the endocrine function of the pancreas, duodenum-preserving resection of the head is a highly effective surgical procedure with a low early and late morbidity and mortality due to the limited surgical resection.

Chronic Disease↗