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PubMedDate not supplied

Factors influencing prognosis and indications for curative pancreatectomy for ductal adenocarcinoma of the head of the pancreas.

The factors influencing prognosis and the indications for curative resection by radical pancreatectomy were evaluated in 74 patients treated with pancreatectomy for ductal cell carcinoma of the head of the pancreas. The 5-yr survival rates for patients without lymph node metastasis, capsular invasion, portal system involvement, or retroperitoneal invasion were 21.2, 20.2, 25.5, and 19.6%, respectively; the 5-yr survival rate for patients with lymph node metastasis or capsular invasion was 5.3% and 6.4%, respectively, and the 2-yr survival rate for patients with portal system involvement or retroperitoneal invasion was 0%. The 5-yr survival rate for 32 patients treated with radical pancreatectomy was 33.4%, and the 3-yr survival rate for 42 patients treated with nonradical pancreatectomy was 0%. Our results suggest that, in patients with ductal adenocarcinoma of the pancreas without factors limiting prognosis, curative resection by radical pancreatectomy is feasible; however, in patients with positive factors, particularly portal system involvement or retroperitoneal invasion, a comprehensive therapeutic program combining extensive surgery, radiation, chemotherapy and/or immunotherapy is necessary to obtain better results.

Adult↗
PubMed1999

[Principles of curative resection of liver metastases].

For patients with liver metastases, surgery currently represents the only possibility for cure, with a mean 5-year survival rate of 25-35%. Due to refinement in operative and anesthetic techniques and improved critical care with decreased morbidity (< 25%) and mortality (< 5%), hepatic resection is a safe and efficient procedure. Surgery has repeatedly achieved long-term disease-free survival in 20-25% of patients. However, only 10-25% of patients with colorectal liver metastases can undergo potentially curative liver resection. Therefore, accurate staging plays a pivotal role in selecting patients who would benefit from surgery. For metastatic colorectal cancer, resection offers the only potential for cure. For symptomatic neuroendocrine tumors, hepatic resection offers long-term palliation in many cases and cure in some. The role of hepatic resection for noncolorectal and nonneuroendocrine metastases, however, is less well defined. Recurrence of hepatic metastases after seemingly curative resection is observed in about 40-60% of the cases. Only 20-35% of these recurrent metastases appear to be resectable, resulting in an overall 3-year survival rate of about 30%. The morbidity and mortality from repeat hepatectomy is similar to that of first hepatic resection. All results together demonstrate that resection and re-resection of liver metastases can provide long-term survival rates and can be beneficial in a carefully selected group of patients without extrahepatic disease.

Colorectal Neoplasms↗
PubMed2005

[Nonoperative ablation for liver metastases. Possibilities and limitations as a curative treatment].

Under the term "nonoperative ablation" are grouped a number of heterogeneous approaches for the treatment of liver metastases, including laser-induced thermotherapy (LITT), radio-frequency therapy (RF), and cryotherapy. In general these procedures had been intended only for palliative purposes. The establishment of clinically relevant lesion size and a lack of long-term survival data were regarded as main limitations to using them with curative intention. During the last years however, new application systems have demonstrated remarkable results in RF and LITT, and some clinical studies have shown long-term survival in selected patients comparable to that for hepatic resection. We review possibilities and limitations of nonoperative ablation procedures with curative intent, highlighting the histopathological bases of thermal ablation techniques and clinical aspects such as R0 ablation and long-term survival.

Animals↗
PubMed1998

Creating and curating a pediatric radiology digital library to make the internet a useful reference tool for the radiologist.

BACKGROUND: To practice pediatric radiology optimally, radiologists need convenient access to organized and authoritative pediatric radiology information. The Internet has the potential for offering such convenient access, but the majority of information on it is poorly organized and of questionable authority. OBJECTIVE: The goal of this project was to create and curate a pediatric radiology digital library that will make the Internet a useful reference tool for the radiologist at the point-of-care. MATERIALS AND METHODS: A pediatric radiology digital library containing organized and authoritative pediatric radiology information from the Internet was created and has three components : (1) PediatricRadiology.com (http://pediatricradiology.com)--a catalog of pediatric radiology Web sites; (2) The MetaTextbook of Pediatric Radiology (http://www. vh.org/Providers/TeachingFiles/MetatextbookPedRad/MetaTBP edRad.html)--a catalog of pediatric radiology teaching file cases on the Internet; and (3) Paediapedia (http://www.vh. org/Providers/TeachingFiles/PAP/PAPHome.html)--an imaging encyclopedia of pediatric disease. The pediatric radiology digital library is curated regularly. RESULTS: Over 7 months, 223,689 pages of information were read and 26,972 images were viewed in the pediatric radiology digital library by 69,866 individual users, with 20% of the users from outside the United States. CONCLUSION: Creating a pediatric radiology digital library that identifies and organizes authoritative pediatric radiology information and makes it conveniently available can allow radiologists to use the Internet productively as a reference tool.

Child↗
PubMed2005

Efficacy of adjuvant immunochemotherapy with polysaccharide K for patients with curatively resected colorectal cancer: a meta-analysis of centrally randomized controlled clinical trials.

The benefits of immunochemotherapy employing the biological response modifier polysaccharide K (PSK) for patients with curatively resected colorectal cancer was reassessed by means of a meta-analysis of data with center randomization from 1,094 patients enrolled in three clinical trials. In all three trials, patients were followed up for at least 5 years after surgery and enrollment of the last patient and outcomes for standard chemotherapy were compared with those for chemotherapy plus PSK. The endpoints were overall survival and disease-free survival; and intent-to-treat analysis was performed without patient exclusion. Data were analyzed using the weighted average of the individual log hazard ratios. The overall survival risk ratio for all eligible patients was 0.71 (95% confidence interval (CI) : 0.55-0.90; P=0.006), and the disease-free survival risk ratio was 0.72 (95% CI: 0.58-0.90; P=0.003). The results of this meta-analysis suggest that adjuvant immunochemotherapy with PSK can improve both survival and disease-free survival of patients with curatively resected colorectal cancer.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed2001

Is timing of death from tumor recurrence predictable after curative resection for gastric cancer?

It is still difficult to predict whether cancer in patients who undergo curative gastrectomy for gastric cancer will recur and when they will die of recurrence. This study clarified predictive factors related to timing of death from tumor recurrence. A multivariate analysis was used to assess the dependence of death on postoperative tumor recurrence and were the dependence of the timing of death on tumor recurrence. Patients were divided into two groups according to the timing of death: those who died of tumor recurrence less than 2 years after surgery and those who died more than 2 years after surgery. Depth of cancer invasion, regional lymph node metastasis, and tumor size were independently correlated with tumor recurrence after curative gastrectomy. Onlv the depth of cancer invasion independently correlated with the timing of death due to tumor recurrence. It might be possible to predict the timing of death from tumor recurrence by the depth of cancer invasion into the gastric wall.

Female↗
PubMed2003

Incidence and factors associated with recurrence patterns after intended curative surgery for gastric cancer.

Recurrence after curative resection for gastric cancer remains high. We examined its incidence and factors related to recurrence pattern, while trying to avoid the interaction of various factors. A total of 611 gastric cancer patients after resection for curative intent (1988-1995) were analyzed. The result showed that 245 patients had recurrence (40.1%). Cumulative recurrence rates were 53.5%, 80%, 89.0%, 94.7%, 96.3%, 98%, and 99.5% at 1, 2, 3, 4, 5, 6, and 7 years, respectively. Over half of patients with recurrence (123; 50.2%) had an initial single recurrence. Taking single and multiple recurrence together, most recurrences (213; 86.9%) were distant metastases, 110 recurrences (44.9%) were local relapses, and 78 recurrences (49.8%) were both local and distant. Among the distant metastases, 131 patients (53.5%) had peritoneal dissemination, 106 patients (43.3%) had hematogenous metastases, and 70 patients (28.6%) had distant lymphatic spread. Scirrhous-type stromal reaction, serosa invasion, and female gender were factors negatively related to peritoneal recurrence. Medullary-type stromal reaction and male gender showed a preference for locoregional recurrence, and expanding growth tumor commonly led to hematogenous metastasis. Patients who had paraaortic lymph node metastasis were at high risk of developing distant lymphatic recurrence. It is conceivable that the patterns of recurrence and the times to recurrence provide a biological basis for clinical monitoring of patients with the aim of modifying therapeutic modalities.

Adult↗
PubMed2004

Time to death and pattern of death in recurrence following curative resection of gastric carcinoma: analysis based on depth of invasion.

It is difficult to predict recurrence in patients who undergo curative gastrectomy for gastric carcinoma. If the timing and site of recurrence can be predicted, it becomes easier to detect recurrent disease. Records of 290 patients who died of tumor recurrence after curative gastrectomy for gastric carcinoma were retrospectively analyzed to determine whether the depth of carcinoma invasion is independently correlated with the time to death due to tumor recurrence. Additionally, the relation between the pattern of recurrence and the depth of invasion of the gastric wall was examined. Postoperative survival in patients with tumors with deep invasion was shorter than that of patients with tumors with shallow invasion. Depth of invasion was a predictor of survival on multivariate analysis. When carcinoma invaded into deeper layers, the incidence of peritoneal metastasis and local recurrence rose and that of hematogenous metastasis fell. In conclusion, the timing of death and the site of recurrence after gastrectomy for gastric carcinoma might be predicted by the depth of invasion of the gastric wall.

Aged↗
PubMed2005

Association of the primary tumor location with the site of tumor recurrence after curative resection of thoracic esophageal carcinoma.

The site of surgical failure in cases of thoracic esophageal cancer (TEC) may be affected by the vertical location of the cancer in this longitudinal organ, suggesting the need to select the mode of adjuvant therapy based on location. We classified 501 TECs (92% squamous cell carcinomas) that underwent curative surgery without preoperative treatment as 13% upper thoracic (Ut), 51% middle thoracic (Mt), and 36% lower thoracic (Lt) lesions. Recurrent disease was discovered in 180 (36%) of the patients during a postoperative survey, most frequently in the cervical nodes (19%), liver (18%), abdominal paraaortic nodes (17%), and upper mediastinal nodes (17%). Although postoperative survival rates were similar (5-year survival: Ut 51%, Mt 55%, Lt 54%), the tumor recurrence site was significantly affected by the TEC vertical location, with recurrence in the cervical and upper mediastinal nodes being most frequent for Ut and Mt cases and in the liver and abdominal paraaortic nodes for Lt cases. Insufficient surgical lymph node clearance could be assessed by the recurrence index (RI), defined as the frequency of metastasis at recurrence divided by that at surgery. The RI was significantly lower for the upper abdominal nodes (4%, 8/184) than the lower mediastinal nodes (15%, 19/123) or the upper mediastinal nodes (19%, 30/154). These findings indicated that regional tumor recurrence, corresponding to the surgical field, was more frequent in the Ut and Mt cases (53% and 51%) than the Lt cases (18%); and distant recurrence was more frequent in the Lt cases (62%) than in Ut or Mt cases (25% and 36%). Thus the vertical location of the thoracic esophageal cancer can be said to affected strongly the site of tumor recurrence after curative surgery. Regional radiotherapy might be expected to have an adjuvant effect on Ut/Mt tumors and systemic chemotherapy on Lt tumors.

Abdomen↗
PubMed2000

Improvement of operative mortality after curative resection for gastric cancer: population-based study.

It is not well known if the improvement in operative mortality after surgery for gastric cancer reported in hospital series can be extrapolated to the whole population. The aim of this study was to determine trends in operative mortality over a 20-year period in a nonselected community-based series of patients. A database of 648 patients with gastric cancer resected with curative intent between 1976 and 1995 in a region with a half-million population was divided into two periods: 1976-1983 and 1984-1995. Nonconditional logistic regression was performed to estimate the independent effects of the studied factors. Operative mortality was higher during the 1976-1983 period than during the 1984-1995 period (17.1% vs. 7.1%; p < 0.0001). When comparing the two study periods, operative mortality decreased dramatically from 26.2% to 10.0% in patients over age 70, from 31.8% to 7.9% after total gastrectomy, and from 30.7% to 6.3% after proximal esophagogastrectomy. Operative mortality after total gastrectomy was nearly the same as that after distal gastrectomy (7.9% vs 5.9%) during the second study period. During the first study period, operative mortality was independently associated with age at diagnosis, type of gastrectomy, and to a lesser degree stage at diagnosis; during the second study period, only age and stage at diagnosis were associated with the risk of operative mortality. This study indicates that in this well defined population operative mortality after curative resection for gastric cancer has decreased during the last 20 years. The results should encourage aggressive management of patients with gastric cancer, even in patients over 70 years of age.

Aged↗
PubMedDate not supplied

The role of preoperative TIPSS to facilitate curative gastric surgery.

The use of TIPSS to facilitate radical curative upper gastrointestinal surgery has not been reported. We describe a case in which curative gastric resection was performed for carcinoma of the stomach after a preoperative TIPSS and embolization of a large gastric varix in a patient with portal hypertension.

Adenocarcinoma↗
PubMed2002

p53 and DCC immunohistochemistry in curative rectal cancer surgery.

BACKGROUND AND AIMS: In rectal cancer altered expression of p53 or DCC may be indicative of poor patient prognosis. This study determined by immunohistochemistry the tumour status of p53 protein and DCC protein in patients with rectal cancer who had a curative resection and were followed-up prospectively and examined the correlation to clinical and pathology variables. PATIENTS AND METHODS: The study included 171 who had a curative resection for rectal cancer: 88 at Concord Hospital (CH) followed up for a mean of 11 years and 83 at Royal Prince Alfred Hospital (RPAH) followed up prospectively for a mean of 4.3 years. Specimens were assessed by immunohistochemical assay of p53 expression ( n=170) and of DCC expression ( n=168). RESULTS: p53 over-expression was demonstrated in 58% of CH tumours and 59% of RPAH tumours. Absence of normal DCC expression was demonstrated in 66% of CH tumours and 52% of RPAH tumours. On both separate and combined analysis of these groups there were no significant associations by univariate analysis between p53 expression or DCC expression or combinations of p53 and DCC expression and the pathology variables: extent of penetration through bowel wall, lymph node involvement, presence of venous invasion, and tumour differentiation. CONCLUSION: The immunohistochemical p53 and DCC status of rectal tumours was not associated with other clinical or pathology variables, nor predictive of outcome.

Cell Adhesion Molecules↗
PubMed2003

Non-curative surgery for colorectal cancer: critical appraisal of outcomes.

BACKGROUND AND AIMS: The value of surgery for patients with incurable colorectal cancer is controversial. This study evaluated outcomes in patients undergoing non-curative surgery for colorectal cancer and aimed to identify patients who would benefit from palliative surgery. PATIENTS AND METHODS: Demographics, tumour characteristics, operating details and outcomes were reviewed for 180 patients undergoing surgery for incurable colorectal cancer; palliative resection was performed in 150 cases. Seventeen patients died in the postoperative period. Risk factors for postoperative mortality and poor survival were analysed with univariate and multivariate analysis. RESULTS: Multivariate analysis showed that operative mortality was significantly higher in patients with non-resection surgery and in those with ascites. Median survival of patients with resection was significantly longer than in those without resection (30 vs. 17 weeks). Other independent factors that were significantly associated poor survival were the presence of ascites, presence of bilobar liver metastasis and absence of chemotherapy and/or radiation therapy. CONCLUSION: Non-curative surgery is associated with high mortality in patients without resection and in the presence of ascites. These two factors, together with the presence of bilobar liver metastasis and the absence of chemotherapy and/or radiation therapy, are associated with poor survival. In the presence of these factors the balance between the benefit and risk of surgery should be carefully considered before decision for operative treatment.

Adult↗
PubMed2006

Curative in situ ablation of colorectal liver metastases-experimental and clinical implementation.

INTRODUCTION: In situ ablation of colorectal liver metastases is frequently assessed for palliative treatment only. The establishment of clinically relevant lesion size and a lack of long-term survival data were regarded as main limitations to using them with curative intention. In contrast to surgical liver resection, whose oncological findings seem to have remained unchanged over the years, the in situ ablation methods have considerably changed technically and clinically in the last few years. OBJECTIVE: The aim of the paper was to point out experimental and clinical data underlining the impact of in situ ablation for potentially curative treatment of colorectal liver metastases. DISCUSSION: On the basis of experimental data, the aim of complete local tumor control (R0 ablation) can only be obtained if additional energy is applied after reaching the tumor-adapted maximal coagulation volume. Analogous to the oncological safety margin in surgical resection, we defined this decisive energy difference as the "energy safety margin" for in situ ablation. The energy safety margin is the energy that must be additionally applied after reaching the plateau in the energy/volume curve to achieve complete tumor coagulation. In addition to that, in situ ablation should be combined with temporary interruption of hepatic perfusion whenever possible to prevent intralesional recurrences. In this way, the thermoprotective mechanism of hepatic perfusion can be effectively eliminated. With restrictions, the survival data after ablation in specialized centers is comparable to surgical resection with concomitantly lower morbidity and mortality. Based on recent findings and with the corresponding expertise in the field of ablation and state-of-the-art equipment, ablation is, thus, an alternative to surgical resection. The combined application of surgical resection and ablation is also a suitable method for increasing the R0 rate and thus helps improve the prognosis of treated patients. In summary, it can be said that in situ ablation is a useful expansion of the therapeutic spectrum of liver metastases and can be applied as an alternative to or in combination with surgical resection.

Animals↗
PubMed1998

The appropriate use of colonoscopy in the curative management of colorectal cancer.

A total of 175 patients who underwent a curative resection for a colonic (n = 130) or a rectal cancer (n = 45) between 1986 and 1992 were entered into a routine colonoscopy program. Colonoscopies were performed 1 year after the operation, and then at 2-year intervals. The findings at colonoscopy, as well as those of preoperative colonoscopy (when performed), were recorded. Eleven anastomotic recurrences were diagnosed at an asymptomatic stage, at a mean follow-up of 14 months. All of them were identified in patients with a stage B or C primary rectosigmoid cancer. Eight patients underwent another potentially curative re-operation. Only perioperative colonoscopy (preoperative colonoscopy; first postoperative colonoscopy in patients for whom the preoperative procedure was incomplete or not performed) allowed diagnosis of second cancers (n = 7) and adenomatous polyps greater than 10 mm (n = 17). Further colonoscopies detected only polyps less than 10 mm. Positive examination rates for successive follow-up colonoscopies were 15, 20 and 23%, respectively; they were significantly higher in patients who had previously had adenomatous polyps than in patients who had not: 30% versus 6% (P < 0.025), 46% vs 5% (P < 0.005) and 38% vs 11% (P < 0.025), respectively. From these data, the following recommendations are made: (1) All colorectal cancer patients should have a total colonoscopy either before (whenever possible) or soon after operation; (2) Based on results of the perioperative colonoscopy, patients: should undergo their first follow-up colonoscopy only 3 yearly (presence of synchronous adenomatous polyps) or 5 yearly (absence of synchronous adenomatous polyps) after resection; (3) In patients with stage B or C primary rectosigmoid cancer, a surveillance of the suture line by rigid proctosigmoidoscopy should be added during the first 2 postoperative years: 6, 15 and 24 months after the operation.

Anastomosis, Surgical↗
PubMed2005

Correlation between the current TNM staging and long-term survival after curative D1 lymphadenectomy for stomach cancer.

BACKGROUND AND AIMS: This study aims to assess the tumour-related factors that influence long-term survival after curative gastrectomy with standard D1 lymphadenectomy for patients with stomach cancer. PATIENTS AND METHODS: Patients who had undergone curative gastrectomy for carcinoma of the stomach at North Shore Hospital between 1990 and 2000 were identified from theatre records and the hospital database. Medical records were reviewed and included tumour location, type of operation, in-hospital mortality, gross morphology of tumour, histological type, and Helicobacter status; pathology slides were reviewed, and tumours were staged according to the new TNM staging. Patients were followed-up for 2-11 years. Length of survival was obtained for each patient from medical records or from family doctors. RESULTS: R0 gastrectomy was performed on 70 patients; median survival was 23 months, and all patients with early gastric cancer are currently still alive. T stage, nodal stage and histological type correlated significantly with survival, but multivariate analysis showed that T stage is the most significant predictor. Five-year survival was 26%. Significant survival difference was seen between T2a and T2b. CONCLUSION: Histological subtype, lymph node metastases and depth of invasion are factors that affect survival of patients with gastric cancer; however, depth of invasion is more important than other variables. Tumour location and type of gastrectomy has no effect on survival. The latest TNM classification (sixth edition) gives a better prognostication than the previous classification.

Adenocarcinoma↗
PubMed2006

Predictors of long-term survival in node-positive gastric carcinoma patients with curative resection.

BACKGROUND AND AIMS: We analyzed the clinicopathologic features of node-positive gastric carcinoma patients who were long-term survivors (5 years or longer) and evaluated the predictive factors associated with long-term survival. PATIENTS AND METHODS: Of 554 node-positive gastric carcinoma patients with curative resection, 161 (29.1%) were long-term survivors, and 393 died of the disease before 5 years. RESULTS: The long-term survivor group had a recurrence rate of 16.1%, while the recurrence rate was 95.4% in the short-term survivor group (P < 0.05). The mean tumor size in the long-term survivors (4.5 cm) was significantly smaller than that in the short-term survivors (5.3 cm; P < 0.001). A depth of invasion greater than T3 was found more frequently in the short-term survivor group (88.1%) than in the long-term survivor group (70.1%; P < 0.001). Using Cox's proportional hazard regression model, the only factor found to be an independent, statistically significant prognostic parameter was tumor size (risk ratio, 0.301; 95% confidence interval, 0.10-0.88; P < 0.05). CONCLUSION: The tumor size emerged as the only independent, significant factor for the prediction of long-term survival in node-positive gastric carcinoma patients with curative resection.

Adult↗
PubMed2000

Tumor volume: a novel prognostic factor in patients who undergo curative resection for gastric cancer.

BACKGROUND AND AIMS: The present study evaluates the significance of tumor volume as a prognostic factor in gastric cancer. PATIENTS/METHODS: Tumor volume was measured from serial tissue sections of 101 patients who had undergone curative resection for solitary carcinoma of the stomach using a computer graphics analysis program. These patients were analyzed with respect to survival based on univariate and multivariate analyses of clinicopathological factors, including tumor volume, to determine an independent prognostic factor. RESULTS: Significant differences in survival were found with respect to depth of tumor invasion (P=0.001), status of lymph-node metastasis (P=0.018), tumor diameter (P=0.005), and tumor volume (P<0.0001) based on univariate analysis. However, multivariate analysis indicated only tumor volume as a valid factor in determining prognosis among the nine variables and was significantly associated with the prognosis (P=0.0005; relative risk 18.23; 95% confidence interval 3.52-94.37). CONCLUSION: The present findings indicate that tumor volume is an important prognostic factor in patients who undergo curative resection for gastric cancer and may be an alternative to conventional factors, thus providing a novel independent prognostic factor in gastric cancer.

Adult↗