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PubMed1985

Specific active immunotherapy in patients with adenocarcinoma of the colon utilizing tumor-associated antigens (TAA). A phase I clinical trial.

Twenty-two patients received specific active immunotherapy (TAA vaccine once per month for 3 months), with the duration of follow-up, as of July 1984, ranging from 3 months to 36 months (median, 21 months). Of these, seven had Dukes B2, seven had Dukes C, and eight had Dukes D lesions. All received surgical resection, and those with Dukes D disease underwent resection of all metastases where possible, with six clinically disease-free at the time of initiation of therapy. The age range of the 22 patients was 40 to 73 years (median, 60 years); sex distribution was 12 males and 10 females. All patients were monitored by physical examination and by laboratory parameters including complete blood count, liver and renal function tests, blood chemistries, urinalysis, chest x-ray, carcinoembryonic antigen levels, migration inhibition assays, complete immune complexes, serum chemistries, helper and suppressor and total T-cell and B-cell assays, and TAA antibody levels. As measured by delayed cutaneous hypersensitivity skin test and by migration inhibition assays (MIA), a strong postimmunization response is developed approximately 5 months after vaccination is completed. There were no clinical or biochemical manifestations of any type of systemic toxicity including hepatic, renal, gastrointestinal, respiratory, or neurologic during the period of follow-up. All patients developed skin ulcers at the vaccination and required 4 to 5 months to heal. With this small number of patients in a Phase I trial, survival is indicative of the safety of the vaccine only: 82% of the patients are alive (mean survival, 21 months) thus far, and 59% of the patients are without evidence of disease (NED) (mean NED, 22 months). These studies, therefore, justify a Phase II-III trial in a larger number of patients and have provided selection of appropriate monitoring tests for the larger trial.

Adenocarcinoma↗
PubMed1990

Tumor cells in intraoperative pleural lavage. An indicator for the poor prognosis of bronchogenic carcinoma.

Fifty-nine patients with bronchogenic carcinoma and 21 patients with nonneoplastic lung diseases underwent intraoperative pleural lavage with 300-ml physiologic saline before (Lavage I) and after resection (Lavage II). The presence of tumor cells in the lavage fluid was established cytologically in 29 patients with bronchogenic carcinoma. Twenty-seven had positive findings in Lavage I and 23 of these also in Lavage II. Two patients had positive findings in Lavage II only. All controls were negative. In all 40% of patients with Stage I bronchogenic carcinoma had positive lavage results. The cumulative two-year survival rate of this group is 40%, which differs significantly (P less than 0.01) from the 97% survival rate of the patients with the same tumor stage whose lavage findings were negative. Detection of tumor cells in pleural cavity washings before resection proves that tumor cells have spread into the pleural cavity. Cytologic examination of an intraoperative pleural lavage should be done when assessing the tumor stage.

Adenocarcinoma↗
PubMed1991

Transurethral resection of the prostate and metastatic prostate cancer.

Demonstration of malignant cells in blood specimens collected during transurethral resection of the prostate (TURP) has implicated TURP in the dissemination of prostatic cancer. Of 153 patients who underwent radiation therapy for prostate cancer between January 1977 and June 1990 and were retrospectively analyzed, 93 were evaluable. Fifty-nine patients required TURP before radiation therapy for prostatic obstruction (BPH and/or cancer); the remaining 34 patients underwent radiation therapy after fine-needle aspiration biopsy. No statistically significant difference in failure rate could be detected between these groups, with a failure rate of 47% (28 of 59 patients) at a median follow-up time of 49 months (range, 8 to 146 months) in the TURP group versus a failure rate of 47% (16 of 34 patients) at a median follow-up time of 50 months (range, 3 to 122 months) in the group who underwent biopsy only (Fisher's exact test, P = 0.23). Within the confines of this retrospective study, it appeared that TURP did not enhance the development of metastatic disease.

Adenocarcinoma↗
PubMedDate not supplied

Management of adnexal masses: role and risk of laparoscopy.

Laparoscopic surgery has become the gold standard in the treatment of benign adnexal masses, whereas laparotomy remains the standard for the treatment of malignant tumors. The laparoscopic management of adnexal masses remains controversial because of the potential risks of cancer dissemination suggested by many case reports and national surveys. Experimental data show potential advantages and disadvantages for the laparoscopic treatment of gynecologic cancer. Since the risk of dissemination appears high when a large number of malignant cells are present, adnexal tumors with external growths and bulky lymph nodes may be considered contra-indications to CO(2) laparoscopy. Surgical diagnosis is the key to adequate management of adnexal masses. In our experience, laparoscopic diagnosis of malignancy is reliable after a careful pre-operative evaluation has been performed. Moreover, national surveys have revealed that despite suspicious laparoscopic findings, many malignant masses were considered benign at the outset. Using strict guidelines, laparoscopic diagnosis can be proposed for both non-suspicious and complex masses, thus avoiding many unnecessary laparotomies for benign masses suspicious at ultrasound. The more controversial limits of laparoscopic treatment are discussed. If a laparotomy was performed for all masses suspicious at surgery, 80% of the cases would be treated by laparoscopy. The role of laparoscopy for restaging and second-look operations for ovarian cancer requires further evaluation.

Adnexal Diseases↗
PubMed2005

Suppression of accelerated tumor growth in surgical wounds by celecoxib and indomethacin.

BACKGROUND: Tumor growth is accelerated in surgical wounds. However, few experiments seeking to prevent such accelerated tumor growth have been performed. METHODS: We created surgical wounds in three syngeneic mice for the implantation of three murine cancer cell lines, SCC VII, CT-26, and B16F10. The tumor growth in the wound group was compared with that in non-wound-control mice. Celecoxib or indomethacin was administered to the mice that had tumor implanted into the surgical wound to observe the tumor-suppressive effect. RESULTS: The surgical wounds promoted tumor growth with different degrees, depending on the type of tumor. Such an accelerated tumor growth did not seem to be affected by cyclooxygenase-2 expression of tumors per se, but its mechanism needs to be explained by further studies. Celecoxib and indomethacin had a significant inhibitory effect on the tumor growth in the surgical wound. This suppressive effect is most obvious when celecoxib is administered daily from 1 day before surgical wounding and tumor implantation. CONCLUSION: Our results can justify that the preventive use of celecoxib in patients in whom local recurrence by tumor contamination is predicted.

Animals↗
PubMedDate not supplied

Incisional or excisional neck-node biopsy before definitive radiotherapy, alone or followed by neck dissection.

An analysis of 508 patients (660 heminecks) with head and neck squamous cell carcinoma and clinically positive neck nodes who were treated with radiotherapy alone to the primary lesion (with or without a neck dissection) was conducted to determine if open neck-node biopsy before definitive treatment adversely affected the probability of control of neck disease, the risk of distant metastasis, or the cause-specific survival rate. The prognostic factors analyzed included biopsy status of the neck, N stage, neck treatment, node mobility, node location, T stage, primary site, and control of disease above the clavicles. Sixty-six patients who had undergone an open neck-node biopsy before definitive radiotherapy were compared with a control group of 442 patients who did not undergo a neck-node biopsy; no detrimental effect of the biopsy on neck control, distant metastasis, or cause-specific survival was demonstrated. We conclude that the potential adverse effect of violating the neck before definitive treatment cannot be demonstrated if radiotherapy is the next step in the patient's management.

Biopsy↗
PubMed2005

Surgery promotes implantation of disseminated tumor cells, but does not increase growth of tumor cell clusters.

INTRODUCTION: Local recurrence and peritoneal dissemination is common after intentionally curative resection of colorectal carcinoma. It is not yet clear which mechanisms stimulate post-operative intra-abdominal tumor development. Enhanced adhesion or growth of tumor cells and/or post-operative immuno suppression may influence tumor recurrence. AIMS OF THE STUDY: In the present study, we evaluated effects of local and remote surgery on intra-abdominal tumor development. MATERIALS AND METHODS: A standardized intra-abdominal trauma was inflicted by rubbing both uterus horns in laparotomy groups, while a dorsolateral thoracotomy was performed in thoracotomy groups (on day -1, 0, or +3). To induce tumor development rats were injected intra-peritoneally with the coloncarcinoma cell line CC531s on day 0 and evaluated after 21 days. RESULTS: Rats undergoing laparotomy and injection on day 0 showed significantly higher tumorload than control rats (195 +/- 20 vs. 47 +/- 29, P < 0.001). When a laparotomy was performed, the day before tumor inoculation even higher tumorload was seen (245 +/- 37 vs. 195 +/- 20, P < 0.01). Strikingly, performing a thoracotomy on the day before or on the same day as tumor inoculation resulted in enhanced tumorload compared to controls as well (135 +/- 84 vs. 47 +/- 29; P < 0.001 and 88 +/- 38 vs. 47 +/- 29; P < 0.02, respectively). Either laparotomy or thoracotomy 3 days after tumor cell inoculation did not affect growth of pre-existing tumor cell clusters. CONCLUSIONS: The (post) surgical intra-peritoneal microenvironment enhances successful implantation of spilled tumor cells, whereas growth of adhered tumor cell clusters is not affected. The inflammatory response as a result of remote surgery promotes successful tumor development as well.

Adenocarcinoma↗
PubMed1980

Anesthesia and surgery: a double-edged sword for the cancer patient.

All therapeutic modalities used in cancer patients are associated with immunosuppression. Anesthesia and surgery represent a double-edged sword. By removal of gross tumor in many patients a restoration of general immune responses can be documented. In addition, circulating antigen or antigen-antibody complexes which block tumor-specific immune responses can be abrogated by removal of bulk tumor. However, animal data indicates that certain anesthetic agents and major surgical procedures may enhance growth of micrometastatic tumor foci. One mechanism by which this occurs might be immunosuppression. The use of immunorestorative drugs in the perioperative period has been able to reverse this phenomenon in animal tumor models.

Anesthesia↗
PubMed1982

Common-sense untoward factors in lung cancer resection.

Four common-sense untoward factors (age over 60, pneumonectomy, microresidual disease, and postoperative empyema) were retrospectively evaluated in a consecutive series of 199 surgically apparently complete non-oat cell lung cancer resections. By single-factor analysis all factors showed a lower survival that was contingent for microresidual disease and age over 60. For stage I tumors the negative impact on survival was significant for all except empyema, and for stage II and III tumors only for empyema. Without confounding factors, microresidual disease and age over 60 were negative prognostic factors only for distant mortality, empyema a negative prognostic factor only for early mortality, and pneumonectomy a probable negative prognostic factor for both early and distinct mortality. It is concluded that the scientific method used confirmed the prognostic assessment of common sense for these four factors.

Age Factors↗
PubMed1987

Autotransplantation of colonic tumors into the colonic wall of the rat.

Colonic tumors were induced in Sprague-Dawley rats by weekly subcutaneous injections of 1,2 Dimethylhydrazine (DMH) for 4 months. The animals were thereafter laparotomized and a palpable tumor was transplanted into the same animal in a tumor-free area of the transverse colon. Autotransplanted tumors were considered those tumors growing in the wall of the transverse colon, covered by intact colonic mucosa. The frequency of autotransplanted tumors was 34%. The possibility that autotransplantation may also occur in humans by accident, during procedures to remove a colorectal adenocarcinoma, is discussed.

1,2-Dimethylhydrazine↗
PubMed1993

Inadvertent spread of cancer at surgery.

Surgical cure requires that a given cancer be removed without inadvertent spillage of cancer cells by technical error. Potential mishaps include pressing a ligature, while tying, against a protruding tumor and cutting into it; inserting a hemostat into the tumor area to gain control of an escaped short pancreaticoduodenal artery stump which has retracted; grasping a lymph node with forceps which invariably fragments it spilling any cancer cells it may contain; and injecting local anesthesia into or adjacent to a lesion for biopsy. If the lesion is a cutaneous melanoma or other cancer the resulting pressure may force cancer cells into the lymphatic or bloodstream. Other misadventures include touching that portion of a biopsy needle which has been in the tumor and doing an intraoperative biopsy which allows blood or tissue fluid to flow out the opening from the tumor. Sensitivity to such dangers appears essential to avoiding spillage of cancer cells and obtaining maximal benefit from surgery.

Biopsy, Needle↗
PubMed1994

Retroperitoneal dissemination of cervix cancer following surgical staging.

Retroperitoneal and cutaneous dissemination of cervical carcinoma occurred following an extraperitoneal surgical staging procedure. This type of event may be rare or merely underreported in surgical staging literature. Extraperitoneal and laparoscopic staging procedures that result in piecemeal removal of tissue should be studied for the incidence of this type of recurrence.

Female↗
PubMed1996

Incidence and effect on survival of abdominal wall metastases at trocar or puncture sites following laparoscopy or paracentesis in women with ovarian cancer.

The aim of this retrospective study was to examine the incidence and prognostic significance of abdominal wall metastases in patients with ovarian cancer present at the primary debulking at the entry sites of previous laparoscopy or paracentesis. The clinical records of 219 patients were studied. In 7 of 43 patients (16%) who had undergone laparoscopy and 3 of 30 patients (10%) who had undergone paracentesis previous to the primary debulking, an abdominal wall metastasis had developed at the entry sites. All metastases occurred in patients with FIGO stage IIIC-IV including ascites. Survival analysis using the Cox proportional hazards model showed that after adjustment for age, FIGO stage, histology, grade, ascites, and residual disease after primary debulking, the presence of abdominal wall metastases in the entry sites of previous laparoscopy or paracentesis was negatively, although not statistical significantly, correlated with survival (P = 0.14).

Abdominal Neoplasms↗