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Results for “Digestive System Neoplasms”

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PubMed2002

[The extensibility and retractility of surgical margins in digestive tract cancer].

OBJECTIVE: To study the extensibility and retractility of the surgical margins in digestive system neoplasms. METHODS: The length difference of the digestive tract was measured in vivo and in vitro under different conditions. Five cm of the stomach, small intestine and large bowel and 2 cm of the esophagus were measured as standard control length in vivo just before resection. The length was measured with a ruler under pull of 500 g and 1 000 g in vivo, in fresh status in vitro, and 10% formaldehyde fixed for 6 - 8 h, 12 - 24 h and 48 - 72 h. The extension or retraction ratio was calculated. The length difference was divided by the natural length in vivo. RESULTS: Seventeen cases of the esophagus, 18 cases of the stomach, 15 cases of the small intestine and 25 cases of the large bowel were measured under pull of 500 g and 1 000 g. The esophagus extended 16.5% and 30.5%, stomach 15.0% and 22.6%, small intestine 66.4% and 120.0%, large bowel 36.0% and 56.0% respectively. In natural status ex vivo, the esophagus retracted 44.5%, stomach 13.6%, small intestine 11.4% and large bowel 15.6% respectively; they continue to retract after 10% formaldehyde fixation until 12 - 24 h later. If the length of surgical margin of the fresh specimen ex vivo was x, the natural length of margin in vivo of the esophagus would be 1.80 x, stomach 1.16 x, small intestine 1.13 x, and large bowel 1.18 x. If formaldehyde fixation for 6 - 8 h, the natural length of surgical margin in vivo of the esophagus would be 1.82 x, stomach 1.41 x, small intestine 1.22 x, large bowel 1.55 x. If formaldehyde fixation for 12 - 24 h, the surgical margin length in vivo of the esophagus would be 2.22 x, stomach 1.43 x, small intestine 1.28 x, and large bowel 1.57 x. CONCLUSION: The length of surgical margin of digestive system cancers varied under different conditions, and the evaluation of surgical margin during surgery should be performed under natural status in vivo.

Adult↗
PubMed2004

Laparoscopy for malignancy: current status.

The acceptance of laparoscopy for the management of oncologic disease has been slow because of initial fears regarding the effect of this new approach on the interaction between the patient and the tumor. Since the initial attempts at laparoscopic resection, experience and technology have improved in parallel, facilitating improvements in this area. Laparoscopic oncologic surgery has a role in the management of oncologic patients at all stages of disease. Good evidence exists that laparoscopy has become an invaluable staging tool in many upper gastrointestinal cancers as well as lymphomas. The specter of port-site recurrence has loomed over the use of a laparoscopic approach for curative resections. However, it is clear from many reported trials that the initial prevalence of port-site metastases was more a technical issue rather than a problem with laparoscopy. Current large, multicenter trials will report the true outcomes of laparoscopic colon cancer surgery and its comparison with open surgery. It does appear that laparoscopic cancer surgery is feasible, safe, and oncologically sound. We fully believe that laparoscopic cancer surgery will play an increasingly major role in the management of gastrointestinal malignancies.

Clinical Trials as Topic↗
PubMedDate not supplied

Role of laparoscopy to evaluate candidates for complete cytoreduction in advanced stages of epithelial ovarian cancer.

The objective of this study was to evaluate the role of laparoscopy in selecting candidates for complete cytoreduction surgery in epithelial ovarian carcinoma. We performed an explorative laparoscopy in 15 women presenting with advanced ovarian carcinoma, and for whom the preoperative evaluation was considered unsatisfactory, to define the possibility of achieving a complete cytoreduction. We focused on three sites of carcinomatosis: bowel, liver pedicle, and right diaphragmatic dome. Laparoscopic evaluation was successful in all 15 patients. Four patients were considered to have unresectable carcinomatosis because of extensive involvement of the small bowel and therefore had no laparotomy. These women underwent neoadjuvant chemotherapy in the following 2 weeks. Eleven patients were considered to have resectable peritoneal carcinomatosis (PC). Ten women had no macroscopic residual tumor after surgery. A modified posterior exenteration was performed in five patients. The laparoscopic exploration had underestimated the liver pedicle involvement in two patients, but only one had an infracentimetric residual tumor after surgery. Laparoscopy is a reliable method of exploring PC in advanced-stage ovarian cancer. Laparoscopy may obviate the need for unnecessary laparotomy in many cases and may, therefore, contribute to a better quality of life for patients found to have unresectable disease.

Adenocarcinoma↗
PubMed2002

Extranodal lymphoplasmacytoid lymphoma: spectrum of disease.

Lymphoplasmacytoid lymphomas (LPL) are non-Hodgkin's lymphomas characterized by a proliferation of lymphoplasmacytoid cells or plasma cells with intracytoplasmic monoclonal Ig. The LPL are low-grade B-cell neoplasms close to B chronic lymphocytic leukemia with plasmacytoid differentiation. They show an indolent course, typically affect older men, and present as a disseminated disease with predominantly nodal involvement. Nevertheless, localized forms, some of them extranodal, have been described. The cases that best represent the range of radiographic findings on X-ray, CT, and MR imaging are presented.

Adult↗
PubMed2006

Single-photon emission computed tomography in the screening for postoperative pulmonary embolism.

The aim of the study was to evaluate the usefulness of serial lung perfusion scintigraphy prospectively using single-photon emission computed tomographic image (SPECT) in screening for pulmonary embolism (PE) after elective surgery for gastrointestinal malignancy. PE was examined pre- and postoperatively with SPECT. Diagnosis of PE was based on segmental perfusion defect visualization in at least two of three planes on a SPECT image compared with preoperative SPECT images. Final diagnosis was determined by detection of embolus with multidetector helical CT (MDCT). No perioperative anticoagulant was used. Thirty-four patients were enrolled. One patient was excluded because of thrombophilia. In preoperative scans, nonsegmental defects were detected in 11 and a segmental defect in 1 patient, who was then diagnosed as PE preoperatively. Among 21 patients with normal preoperative SPECT, 2 had nonsegmental and 5 had segmental defects postoperatively. Among 11 patients with nonsegmental preoperative SPECT, 7 had nonsegmental and 4 had segmental defects postoperatively. Postoperative segmental defects were differentiated by their shape only and there was no need to compare pre- and postoperative SPECT. MDCT confirmed four patients with PE among nine with segmental defects postoperatively. Our results of screening for PE by visualization at least two planes of SPECT images suggest that postoperative SPECT scan is suitable for the diagnosis of postoperative PE.

Aged↗
PubMed2004

A study of the lengthening and contractility of the surgical margins in digestive tract cancer.

BACKGROUND: The lengthening and the contractility of the digestive tract were studied. METHODS: The stretched length of specimens was measured under pull weights of 500 g and 1000 g; the contracted length was measured in natural status and in 10% formalin fixation in vitro. The lengthening or contractility rate was calculated as the length difference divided by the natural length in vivo. RESULTS: The esophagus lengthened 16.5% at 500 g and 30.5% at 1,000 g, stomach 15% and 22.6%, small intestine 66.4% and 120%, large intestine 36% and 56%. In natural status in vitro, the esophagus contracted 44.5%, stomach 13.6%, small intestine 11.4%, and large intestine 15.6%; they continued to contract 12 to 24 hours after formalin fixation. CONCLUSIONS: The lengthening and contractility of the digestive tract should be considered in evaluating the resection margin at surgery. The length of different conditions can be converted by the formula: Y = alphaX.

Adult↗
PubMed1984

[Postoperative hypophosphoremia in digestive surgery. Influence of the parenteral diet].

Twenty-seven non emaciated patients undergoing major visceral surgery were randomly divided into two different groups according to the postoperative parenteral diet (100% glucose versus 50% fat 50% glucose). All patients received the same anaesthetic protocol and, peroperatively, none received any glucose. In the postoperative phase, parenteral feeding was started on the day of operation (18.5-21.8 kcal X kg-1) and was continued for a minimum of four days (37-44 kcal X kg-1 X 24 h-1). All patients received intravenous insulin and phosphorus (0.15 mmol X kg-1 X 24 h-1). During five days, daily measurements of serum phosphate and glucose levels were made and nitrogen balance was studied. For all these parameters, there was no evidence of any significant difference between the two groups. A significant fall in plasma phosphate occurred in each group on the first postoperative day, was maximum on the second and lasted until the fourth. This fall was not influenced by parenteral diet. No patients in this study developed symptoms of phosphate depletion. The glucose levels increased significantly and the nitrogen sparing effect was similar in both groups. The mechanism of hypophosphataemia seemed to be an intracellular transfer under the influence of hyperglycaemia and high plasma insulin levels rather than an increase in urinary phosphate excretion. The advantage of using lipid solutions did not appear under the dietary conditions studied. Indeed a glucose supply greater than or equal to 3 mg X kg-1 X min-1 seemed to induce a maximum intracellular transfer of phosphorus. Because of this, phosphate supplementation and frequent measurement of serum phosphate are recommended for patients undergoing major visceral surgery and postoperative intravenous feeding.

Blood Glucose↗
PubMed2005

Endoscopic stenting versus surgical bypass in advanced malignant distal bile duct obstruction: cost-effectiveness analysis.

OBJECTIVE: Palliative treatment of obstructive jaundice from advanced tumour of the distal bile duct is controversial. The aim of this study was to compare the clinical outcomes and costs between endoscopic stent insertion and surgery. METHODS: The clinical data for 116 patients treated with either endoscopic plastic stenting (65 patients) or surgical bypass (51 patients) were reviewed and analysed. RESULTS: No significant difference was found between the two groups in terms of the length of hospital stay, survival time, cost, effectiveness, and early complications. However, late complications were significantly more common in the stenting group (p = 0.007). Jaundice recurred in 15 stented patients at a median time of 3 months due to stent blockage, and one surgical patient had recurrent jaundice from anastomosis stricture. Late gastric outlet obstruction occurred in one of 36 surgical patients who did not undergo prophylactic gastroenterostomy and one of 65 stented patients developed this complication. CONCLUSION: Both techniques are equally effective in biliary drainage, but stenting has a higher rate of recurrent jaundice. We recommend surgery for patients with low surgical risks and endoscopic stent in those with a short life expectancy or those unfit for surgery.

Adult↗
PubMed2001

Digestive neuroendocrine tumours: diagnosis and treatment in Italy. A survey by the Oncology Study Section of the Italian Society of Gastroenterology (SIGE).

BACKGROUND: New insights in the diagnosis and treatment of digestive neuroendocrine tumours have prompted a renewed interest in these rare and complex diseases. AIM: To establish how many new cases of digestive neuroendocrine tumours were diagnosed, and how they were treated, at gastroenterological centres across Italy during a two-year period (1997-1998). METHODS: The 12 centres taking part filled in a data collection form reporting type of tumour, methods of diagnosis and therapeutic strategies adopted in each case. Data were collected and analysed by the authors of the present report. RESULTS: Data refer to 98 patients, 22 with functioning and 76 with non-functioning digestive neuroendocrine tumours [50 carcinoids, 48 pancreatic endocrine tumour syndromes]. Primary tumours were localised in 96% (38% with metastases) of non-functioning and 81% (50% with metastases) of functioning tumours. These were surgically removed in >80% of patients in both groups. Somatostatin analogue treatment, with or without interferon, was administered in 35% of patients, while chemotherapy was used in 9% and 23% of functioning and non-functioning tumours, respectively. The imaging study always included a computed tomography scan (20% helical computed tomography). Magnetic resonance and somatostatin receptor scintigraphy were also performed, the former in 41% and 21% of the two (functioning and non-functioning tumour) groups, the latter in 45% and 30%. CONCLUSIONS: The number of functioning digestive neuroendocrine tumours reported was lower than expected. Surgery plays a major role in the treatment of these tumours in all centres. Overall, in only a small number of patients was a multidisciplinary approach applied.

Adolescent↗
PubMed2004

Cathepsin D expression levels in nongynecological solid tumors: clinical and therapeutic implications.

Cathepsin D is a lysosomal acid proteinase which is involved in the malignant progression of breast cancer and other gynecological tumors. Clinical investigations have shown that in breast cancer patients cathepsin D overexpression was significantly correlated with a shorter free-time disease and overall survival, whereas in patients with ovarian or endometrial cancer this phenomenon was associated with tumor aggressiveness and a degree of chemoresistance to various antitumor drugs such as anthracyclines, cis-platinum and vinca alkaloids. Therefore, a lot of research has been undertaken to evaluate the role and the prognostic value of cathepsin D also in other solid neoplasms. However, conflicting results have been generated from these studies. The discrepancies in these results may, in part, be explained with the different methodological approaches used in order to determine the levels of expression of the enzyme in tumor tissues and body fluids. Further investigations using well-standardized techniques may better define the clinical significance of cathepsin D expression in solid tumors. Nevertheless, evidence emerging from these studied indicates that this proteinase seems to facilitate early phases of tumor progression such as cell proliferation and local dissemination. These findings support the concept that cathepsin D may be a useful marker for identifying patients with highly malignant tumor phenotypes who may need more aggressive clinical treatment; this enzyme may also be considered as a potential target for a novel therapeutic approach in the treatment of solid neoplasms.

Antineoplastic Agents↗
PubMed2004

Consensus report on the use of somatostatin analogs for the management of neuroendocrine tumors of the gastroenteropancreatic system.

This consensus report gives a detailed description of the use of somatostatin analogs in the management of neuroendocrine tumors of the gastroenteropancreatic system. As background information we have outlined critical aspects of the pathology, the use of tumor markers, a definition of functional and non-functional digestive neuroendocrine tumors, different imaging modalities, surgical considerations, liver embolization and the use of cytotoxic drugs as well as interferon. Included in the report is an overview of somatostatin, somatostatin analogs and its receptor expression in different neuroendocrine tumors. It will also define the binding affinities of different somatostatin analogs to the five different subtypes of somatostatin receptor. We compare the efficacy of octreotide and lanreotide in reducing diarrhea and flushing. Side-effects are described and we provide practical information on somatostatin analog treatment.

Antineoplastic Agents, Hormonal↗