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At least 865 records · Page 48Linked to original sources
PubMed2006

Altered small intestinal absorptive enzyme activities in leptin-deficient obese mice: influence of bowel resection.

BACKGROUND: Residual bowel increases absorption after massive small bowel resection. Leptin affects intestinal adaptation, carbohydrate, peptide, and lipid handling. Sucrase, peptidase, and acyl coenzyme A:monoacylglycerol acyltransferase (MGAT) are involved in carbohydrate, protein, and lipid absorption. We hypothesized that leptin-deficient obese mice would have altered absorptive enzymes compared with controls before and after small bowel resection. METHODS: Sucrase, peptidase (aminopeptidase N [ApN], dipeptidyl peptidase IV [DPPIV]), and MGAT activities were determined from lean control (C57BL/6J, n = 16) and leptin-deficient (Lep(ob), n = 16) mice small bowel before and after 50% resection. RESULTS: Ileal sucrase activity was greater in obese mice before and after resection. Jejunal ApN and DPPIV activities were lower for obese mice before resection; ileal ApN activity was unaltered after resection for both strains. Resection increased DPPIV activity in both strains. Jejunal MGAT in obese mice decreased postresection. In both strains, ileal MGAT activity decreased after resection, and obese mice had greater activity in remnant ileum. CONCLUSIONS: After small bowel resection, leptin-deficient mice have increased sucrase activity and diminished ileal ApN, DPPIV, and MGAT activity compared with controls. Therefore, we conclude that leptin deficiency alters intestinal enzyme activity in unresected animals and after small bowel resection. Altered handling of carbohydrate, protein, and lipid may contribute to obesity and diabetes in leptin-deficient mice.

Acyltransferases↗
PubMed2005

Extensive circumferential endoscopic mucosal resection with a new rigid esophagoscope: an animal study.

OBJECTIVE: Current endoscopic mucosal resection techniques are suboptimal for large circumferential mucosal resections intended to treat Barrett mucosa with multicentric foci of high-grade intraepithelial neoplasia or early adenocarcinomas. A rigid modified endoscope was developed for extended endoscopic mucosal resection in the esophagus. This pilot animal study investigated the feasibility of circumferential endoscopic mucosal resections of different lengths in the sheep esophagus. METHODS: Circumferential esophageal endoscopic mucosal resections of 2.2 cm (n = 6), 3.3 cm (n = 6), 4.4 cm (n = 7), and 5.5 cm (n = 5) were performed in 24 sheep. Circumferential resections consisted of two opposite hemicircumferential mucosectomies. Animals were followed up with endoscopic examinations at 1 week and then monthly to 6 months, or until complete re-epithelialization without stenosis eventually ensued. Strictures were treated with a single or repeated dilatations with Savary bougies. RESULTS: Circumferential resections 2.2 to 5.5 cm in length were successfully performed in 23 of 24 of the animals. One perforation occurred directly after mucosectomy. Accurate depth of resection through the submucosa was obtained in 85% of the specimens. Cicatricial stenosis was controlled in 95% by bougienage. CONCLUSION: Endoscopic mucosal resection performed with the rigid esophagoscope allowed extensive circumferential resections in a single session. There is thus potential to eradicate complete Barrett esophagus with high-grade intraepithelial neoplasia or early adenocarcinomas.

Animals↗
PubMed2005

Functional magnetic resonance imaging-guided resection of low-grade gliomas.

BACKGROUND: We sought to determine the safety and efficacy of using functional magnetic resonance imaging (fMRI) to guide the resection of low-grade gliomas (LGG). METHODS: From September 1997 to February 2003, fMRI was performed in 16 patients (age, 15-43 years) before an attempted surgical resection of LGG. Functional imaging was used to identify and coregister eloquent cortices pertinent to motor (10), speech (3), motor and speech (2), and short-term memory and speech (1) activation with respect to the tumor using a 1.5-T interventional MRI system. Intraoperatively acquired T(2)-weighted and turbo-fluid attenuated inversion recovery images were used to assess the completeness of surgical resection. RESULTS: Tumors included 10 oligodendrogliomas, 4 astrocytomas, 1 dysembryoplastic neuroepithelial tumor, and 1 pleomorphic xanthoastrocytoma. In every case, the preoperative brain activation study accurately determined the location of neurologic function. After surgery, one patient had a transient hemiparesis and another had a temporary apraxia. Ten patients had radiographically complete resections and 5 with oligodendrogliomas had incomplete resections because of the proximity of their tumors to functional areas. Only one patient with an astrocytoma in the motor strip received postoperative radiation therapy. To date, radiographic tumor progression has not been seen in any patient with either a partial or a complete resection with a median follow-up of 25 months (range, 12-87 months). CONCLUSIONS: Functional MRI was accurate for identifying areas of neurologic function before surgical resection of LGG. Patients with complete radiographic resections or with incompletely resected oligodendrogliomas can be safely followed radiographically after surgery. Radiation therapy was reserved for infiltrating astrocytomas that were not completely resectable.

Adolescent↗
PubMed2003

Resection of recurrent ovarian or fallopian tube carcinoma involving the liver.

OBJECTIVES: Patients who develop recurrent ovarian of fallopian tube carcinoma involving the liver often have disease refractory to chemotherapy and carry a poor prognosis. The impact of aggressive resection in this patient population is unclear. METHODS: From 1/1988 to 9/2001, 24 patients with recurrent ovarian or fallopian tube carcinoma who underwent complete gross resection or optimal debulking of their hepatic metastases and disease at other sites were identified from prospective databases at a single institution. RESULTS: The median age of patients was 53 years old, and the median interval between primary diagnosis and liver resection was 69 months. All patients had primary resection or cytoreduction and chemotherapy as part of their initial treatment. Subsequent hepatic resections included trisegmentectomy (2), lobectomy (2), segmentectomy (17), and wedge resection (3). Additional resection of disease outside the liver was performed in 18 patients (75%). Twenty-one patients (88%) had removal of all gross disease, and three patients (13%) had optimal tumor debulking to less than 1 cm. Eighteen patients recurred with sites of initial recurrence, including the abdomen and pelvis (14), spine/paraspinal region (2), lung (1), and liver (1). Overall median survival was 62 months after hepatic resection with a range of 6 to 94 months. Fourteen patients were alive at the time of last follow-up, and 10 had no evidence of disease. No significant prognostic factors for overall survival could be identified on univariate analysis. CONCLUSIONS: In highly selected patients with recurrent ovarian or fallopian tube carcinoma involving the liver, hepatic resection along with resection of other gross disease may lengthen survival and should be considered as a treatment option.

Adult↗
PubMed1996

Resection of malignant primary liver tumors.

BACKGROUND: Malignant primary liver tumors are an uncommon and challenging surgical problem. In spite of multimodality therapies, surgical resection remains the mainstay of treatment and the most likely chance for cure. We reviewed the 13-year resection experience of a single surgeon at our institution to evaluate the results. METHODS: A retrospective review from July 1982 to June 1995 was performed for patients presenting with a diagnosis of primary liver cancer. Those undergoing resection of their primary liver tumors form the basis of this report. RESULTS: One hundred eighty-four patients with a diagnosis of primary liver cancer were seen at our institution. Of these, 43 patients underwent 46 resections of their cancers by a single surgeon. There were 22 females (51%) and 21 males (49%). The average age was 61 years with a median age of 63 years (range, 19-85 years). Tumors resected included 27 hepatomas, 16 cholangiocellular carcinomas, 1 carcinoid tumor, 1 low grade mucinous cystadenocarcinoma, and 1 cystadenocarcinoma. Resections were as follows: 9 right trisegmentectomies, 8 right lobectomies, 1 left trisegmentectomy, 4 left lobectomies, 7 left lateral segmentectomies, and 17 partial lobectomies. Major complications occurred in 11 patients (26%). There were 3 deaths, for a 30-day perioperative death rate of 7%. Of the 43 patients, 13 had follow-up of less than 12 months and 30 had follow-up for more than 1 year. The mean survival of the 30 patients who had their tumors resected and were followed up for more than 1 year was 27.2 months and the median survival was 21 months. The median survival of patients not undergoing resection was less than 6 months. The 1-, 2-, 3-, and 5-year survival rates were 57%, 52%, 40%, and 33%, respectively. CONCLUSIONS: Primary liver cancer can be treated by resection with acceptable results. This remains the standard treatment of any liver cancer. Survival rates of patients after resection are much better than survival rates of patients who do not undergo surgery.

Adult↗
PubMed2003

Factors predictive of complete resection of operable esophageal cancer: a prospective study.

BACKGROUND: Esophagectomy remains a standard treatment for patients with resectable esophageal cancer, but the 5-year survival is only 20% to 25%. After complete resection survival is significantly longer than after incomplete resection with microscopic or macroscopic penetration. The purpose of this study was to prospectively identify the factors predictive of complete resection of operable esophageal cancers. METHODS: Betwen January 1995 and January 2002, 372 patients with esophageal cancer underwent surgery with curative intent. Complete resection was performed in 304 patients (81.7%), incomplete resection with microscopic penetration in 28 (7.5%), and incomplete resection with macroscopic penetration in 40 (10.8%). Univariate and multivariate analysis included 16 preoperative and operative factors. RESULTS: Factors predictive of complete resection were absence of any modification of the esophageal axis on the barium swallow (p = 0.019) and a partial or complete response to preoperative radiochemotherapy (p = 0.042). Three groups of patients were identified: group 1 had no deviation of the axis on the barium swallow (n = 253); group 2 had deviation of the axis on the barium swallow and partial or complete response to radiochemotherapy (n = 66); and group 3 had deviation of the axis on the barium swallow and no response to radiochemotherapy or no preoperative treatment (n = 53). Rates of complete resection were 90.1%, 74.2%, and 50.9%, and 5-year actuarial survivals were 46%, 37%, and 0%, respectively (p < 0.001). CONCLUSIONS: Complete resection of esophageal cancer is predictable. Deviation axis on the barium swallow and morphologic response to neoadjuvant radiochemotherapy are variables available for all patients at onset of therapeutic management.

Adenocarcinoma↗
PubMed2000

What is the optimal distal resection margin for esophageal carcinoma?

BACKGROUND: Whereas a proximal resection margin of 12 cm is recommended for complete resection of esophageal cancer, the extent of distal resection is unclear. METHODS: We examined distal resection margins in a consecutive series of patients who underwent esophagectomy for squamous cell carcinomas (n = 50), primary esophageal adenocarcinomas (n = 100), and adenocarcinomas of the cardia (n = 39), in whom all macroscopic tumor was judged to be completely resected. RESULTS: Microscopic tumor was found at a 3-cm distal resection margin for one multifocal squamous cell carcinoma. Positive distal resection margins were seen in 12% (12 of 100 patients) of primary esophageal adenocarcinomas (median, 2 cm versus 4 cm if negative; p = 0.002, Wilcoxon) and 28% (11 of 39 patients) of cardia adenocarcinomas (median, 1 cm versus 3 cm if negative; p = 0.02, Wilcoxon). Although pathologic stage was shown to be the only significant predictor of overall survival (Hazard ratio [HR] 1.8; 95% confidence interval 1.2 to 2.6; p = 0.007), there was a trend toward reduced postoperative survival for patients with histologically positive distal resection margins, in particular for patients with cardia adenocarcinomas (median, 15.4 months versus 5.7 months if negative; p = 0.0001). CONCLUSIONS: To achieve consistently negative distal resection margins, we recommend resection of at least 5 cm of macroscopically normal foregut below the distal margin of the primary tumor.

Adenocarcinoma↗
PubMed1998

Mechanisms underlying intestinal adaptation after massive intestinal resection in the rat.

BACKGROUND/PURPOSE: The regulatory events that control the adaptive response after massive intestinal resection are poorly understood. An improved understanding could lead to improved clinical therapies. This study tests the hypothesis that massive intestinal resection increases nutrient transport by upregulation of mRNA for the sodium glucose cotransporter (SGLT1). METHOD: Male Lewis rats (225 to 250 g) were studied. Control animals (Con, n = 6) underwent ileal transection 15 cm proximal to the cecum; resected animals (Res, n = 8) underwent resection of all bowel proximal to the terminal 15 cm of ileum. Animals were followed up for 14 days, pair fed, and weighed daily. At the time of death the terminal ileum was studied quantifying SGLT1 mRNA using reverse transcriptase-polymerase chain reaction (RT-PCR) normalized to B-actin, in vitro glucose transport in Ussing Chambers, and histology. RESULTS: All animals survived; animals that were transected regained preoperative weight by day 10, and underwent resection by day 14. Significant adaptation occurred with increases in villus height, (control jejunum 934 +/- 79; control ileum, 811 +/- 64 v resected ileum, 949 +/- 83 [P < .05]). Nutrient flux (J mucosal --> serosa; Jms) was increased in resected ileum (3-0 Methyl-D-Glucose flux: 0.71 +/- 0.2 v 0.56 +/- 0.04 in Con ileum [P < .05; units, micromol/cm2/hr of 3-0 Methyl-D-Glucose]). This was paralleled by an increase in expression of the SGLT1 gene in resected ileum, 104 +/- 14, versus Con ileum, 74 +/- 9 (P < .05; values normalized versus expression of B-actin). CONCLUSION: SGLT1 expression may be useful as a marker of the adaptive process after massive resection and potentially may be used as an endpoint of therapy after resection clinically.

Adaptation, Physiological↗
PubMed1999

Limited ileal resection in infancy: the long-term consequences.

BACKGROUND/PURPOSE: The longer-term sequelae of short bowel syndrome in infancy are reasonably well documented, but little is known about the long-term nutritional and metabolic effects of limited (less than 50 cm) ileal resection. This makes it difficult to formulate a rational follow-up policy in such children. METHODS: All children who underwent limited ileal resection for either necrotizing enterocolitis (NEC) or intussusception at our institution between 1984 and 1992 were invited to attend a detailed clinical, anthropometric, hematologic, and biochemical assessment, together with a biliary and renal ultrasound scan and measurement of bone mineral density. RESULTS: Twenty-four children (NEC, 17; intussusception, 7) of median age 7.4 years (range, 5.5 to 13.7 years) agreed to participate. Nine previously had undergone an isolated ileal resection, and 15 also had had variable lengths of colon removed. The length of resected ileum ranged from 3 to 44 cm, with a median of 10 cm. Seven control subjects in whom neonatal NEC developed but recovered without surgery were also evaluated. Median height, weight, and body mass index after ileal resection were between the 25th and 50th percentiles; no child was stunted or wasted. After ileal resection, one boy was found to have asymptomatic vitamin B12 deficiency, and three children had low plasma concentrations of vitamin A. Hematologic and biochemical parameters were otherwise normal apart from a few marginally low trace element levels in both subjects and controls. No renal calculi were detected, and bone mineral density measurements were normal in all except one child. Four children had cholelithiasis, all of whom had previously undergone limited ileal resection for NEC (two isolated, two ileocolic). Thus, the prevalence of cholelithasis after limited ileal resection for NEC was 24% at a median age of 7.0 years. CONCLUSIONS: Growth and nutritional status are well preserved after limited ileal resection in infancy. Limited ileal resection for NEC is associated with a subsequent high prevalence of cholelithiasis and a risk of vitamin B12 deficiency. These findings are important when planning strategies for long-term follow-up.

Bone Density↗
PubMed1989

The risk of distant metastases after transurethral resection of the prostate versus needle biopsy in patients with localized prostate cancer.

Although transurethral resection of the prostate provides an effective treatment for obstructive voiding symptoms associated with prostate cancer, there is growing concern about the possible role of transurethral resection in the dissemination of this malignancy. To determine the effect of transurethral resection on the rate of development of distant metastasis, we analyzed a large series of patients (379) treated at our institution with definitive radiotherapy for localized prostate cancer that was diagnosed by either needle biopsy or transurethral prostatic resection. In our series the presence of lymph node metastasis was documented by pelvic lymph node dissection in all patients. An initial univariate analysis suggested that patients diagnosed by transurethral resection had distant metastases significantly more rapidly than patients diagnosed by needle biopsy. However, transurethral resection usually was performed because of the presence of obstructive voiding symptoms and such patients were much more likely to have positive lymph node dissections than patients without obstructive voiding symptoms. A proportional hazards regression analysis showed that nodal status and the degree of obstructive voiding symptoms at diagnosis were independent and powerful predictors of the interval to distant metastases, along with stage and grade. The type of initial biopsy (transurethral prostatic resection versus needle biopsy) had no independent prognostic significance in this analysis. Among patients who had substantial obstructive voiding symptoms there was no significant difference in interval to distant metastases between the transurethral prostatic resection and needle biopsy groups. We conclude that the apparent adverse effect of transurethral prostatic resection results from the poor prognosis of tumors causing obstructive voiding symptoms rather than as a direct result of the resection itself.

Actuarial Analysis↗
PubMed2002

Radical resections for T4 lung cancer.

T4 lung cancers are a heterogeneous group of locally advanced lung cancers. Treatment is palliative for the majority of patients, ranging from supportive care to chemoradiotherapy. In certain patients, however, surgery is beneficial and may be curative. Patients with T4N0M0 cancers invading the distal trachea, carina, left atrium, aorta, superior vena cava, or vertebral bodies may be surgical candidates. Radical resections of these T4 lung cancers have potential for cure if no mediastinal lymph node metastases (N2 or N3) occur and if resection is complete. Increased postoperative mortality exists and extends beyond 30 days, as evidenced by a 30-day mortality of 8% and a 90-day mortality of 18%. Improved palliation (median survival of 19 months) and cure (31% five-year survival) are possible in patients who meet the criteria, who undergo radical resection, and who are followed by physicians in facilities with special interests in extended resections. The use of induction therapy and surgery in T4 patients may further increase survival and the number of T4 patients in whom radical resection is possible. Radical resections are contraindicated in patients with T4 lung cancers associated with malignant pleural effusions. Unfortunately, these patients have the worst prognosis. If surgical palliation is an option, only pulmonary resection with pleurectomy and not pleuropneumonectomy should be considered. In contrast, lung cancers with the best prognosis are those T4 tumors diagnosed because of a satellite tumor nodule within the same lobe. Because radical resections are usually not required, operative mortality is not increased. Five-year survival in patients with satellite intralobar tumor nodules without mediastinal nodal metastases is comparable to survival of highly selected T4N0M0 patients who undergo radical resection. These two extremes of T4 lung cancers, malignant pleural effusion and satellite intralobar tumor nodules, generally are not considered for or do not require radical resections. It is debatable that the definition of T4 should include these entities.

Humans↗
PubMed2004

The fate of the tumor remnant after less-than-complete acoustic neuroma resection.

OBJECTIVES: We sought to determine the recurrence rate after near-total and subtotal resection of acoustic neuroma. STUDY DESIGN, SETTING, AND PATIENTS: We conducted a retrospective chart review of a total of 79 patients: 50 with near-total resections (remnant < or =25 mm(2) and < or =2 mm thick) and 29 with subtotal resections (any larger remnant). Surgical approach included 5 middle fossa, 17 retrosigmoid, and 57 translabyrinthine. MAIN OUTCOME MEASURES: Recurrence was defined as documented tumor growth by serial imaging or the recommendation for further treatment after a single scan. No recurrence was defined as no visible tumor on imaging for a minimum follow-up time of 3 years or tumor remnants that remained unchanged on serial scans (mean, 5-year follow-up). RESULTS: Fifty-two patients were included in the study group. Recurrences were seen in 1 (3%) of 33 patients who had a near-total resection compared with 6 (32%) of 19 patients who had a subtotal resection. After adjustment for follow-up time and large tumor size, the odds ratio for recurrence was 12 times larger for subtotal than for near-total resections (P = 0.033). All recurrences were seen following the translabyrinthine approach in the mid-cerebellopontine angle. None were encountered in the internal auditory canal. The mean time interval from surgery to the detection of a recurrence was 3 years (range, 1 to 5 years). CONCLUSIONS: The recurrence rate when performing a near-total resection is low but is substantially higher with a subtotal resection. Recurrences can be detected within the first 5 postoperative years. We recommend near-total resection in any patient if needed to preserve neural integrity. Subtotal resection is best avoided whenever possible; however, adjunctive treatment with stereotactic radiotherapy may be considered.

Adult↗
PubMed2003

[Lobectomy versus limited resection to treat non-small cell lung cancer in stage I: a study of 78 cases].

OBJECTIVE: To compare mortality and loco-regional recurrence rates in patients treated surgically for stage I non-small cell lung cancer by either lobectomy or sublobar lung resection (pulmonary wedge) from 1994 to 1998. PATIENTS AND METHODS: Seventy-eight patients who underwent lung resection for stage I non-small cell lung cancer from January 1994 to December 1998 were reviewed retrospectively. Fifty patients underwent lobectomy and 28 limited resection (pulmonary wedge). We reviewed oncologic history, tumor histology, loco-regional recurrence and tumor-related mortality during the follow-up period. RESULTS: Histology, lobectomies: 36 (72%) squamous cell carcinomas, 12 (24%) adenocarcinomas and 2 (4%) large cell carcinomas. Histology, wedge resection: 12 (42.8%) squamous cell carcinomas and 16 (57.2%) adenocarcinomas. Staging, lobectomies: 15 Ia (30%) and 35 Ib (70%). Staging, wedge resections: 16 Ia (57.2%) and 12 Ib (42.8%). Loco-regional recurrence: lobectomies 9 (18%) and wedge resections 4 (14.3%) plus 1 remote metastasis (3.6%). Mortality during follow-up: lobectomies 8 (16%) and wedge resections 4 (14.3%). Accumulated survival rate (in months): lobectomies 62.38 and wedge resections 63.92. The rates of loco-regional recurrence and accumulated survival in the two groups were not significantly different. CONCLUSIONS: The rates of loco-regional recurrence and accumulated survival in this study agree with those from other retrospective studies. We found no statistically significant differences between patients undergoing lobectomy and those undergoing sublobar resection. Wedge resection is an appropriate technique for patients with stage I non-small cell lung cancer who can not tolerate lobectomy.

Carcinoma, Non-Small-Cell Lung↗
PubMed2003

Stereotactic radiosurgery provides equivalent tumor control to Simpson Grade 1 resection for patients with small- to medium-size meningiomas.

PURPOSE: To compare tumor control rates after surgical resection or stereotactic radiosurgery for patients with small- to medium-size intracranial meningiomas. MATERIALS AND METHODS: Between 1990 and 1997, 198 adult meningioma patients treated at our center underwent either surgical resection (n = 136) or radiosurgery (n = 62) as primary management for benign meningiomas <35 mm in average diameter. Tumor recurrence or progression rates were calculated by the Kaplan-Meier method according to an independent radiographic review. The mean follow-up was 64 months. RESULTS: The tumor resections were Simpson Grade 1 in 57 (42%), Grade 2 in 57 (42%), and Grade 3-4 in 22 (16%). The mean margin and maximal radiation dose at radiosurgery was 17.7 Gy and 34.9 Gy, respectively. Tumor recurrence/progression was more frequent in the surgical resection group (12%) than in the radiosurgical group (2%; p = 0.04). No statistically significant difference was detected in the 3- and 7-year actuarial progression-free survival (PFS) rate between patients with Simpson Grade 1 resections (100% and 96%, respectively) and patients who underwent radiosurgery (100% and 95%, respectively; p = 0.94). Radiosurgery provided a higher PFS rate compared with patients with Simpson Grade 2 (3- and 7-year PFS rate, 91% and 82%, respectively; p <0.05) and Grade 3-4 (3- and 7-year PFS rate, 68% and 34%, respectively; p <0.001) resections. Subsequent tumor treatments were more common after surgical resection (15% vs. 3%, p = 0.02). Complications occurred in 10% of patients after radiosurgery compared with 22% of patients after surgical resection (p = 0.06). CONCLUSIONS: The PFS rate after radiosurgery was equivalent to that after resection of a Simpson Grade 1 tumor and was superior to Grade 2 and 3-4 resections in our study. If long-term follow-up confirms the high tumor control rate and low morbidity of radiosurgery, this technique will likely become the preferred treatment for most patients with small- to moderate-size meningiomas without symptomatic mass effect.

Adult↗
PubMed1996

Surgical experience in treating T4 lung cancer: its resectability, morbidity, mortality and prognosis.

Extensive experience in the treatment of locally advanced lung cancers is rare. The aim of this study is to show the rationality and effectiveness of an aggressive surgical approach in T4 lung cancers. Between 1984 and 1994, 111 consecutive cases of T4 lung cancers were operated on. The patients included 91 males and 20 females, with mean ages of 61.8 years and 55.3 years, respectively. The cell types included 57 squamous cell carcinomas, 42 adenocarcinomas, and 12 miscellaneous malignancies. Fifty-three (47.7%) procedures were non-resectional. The remaining 58 (52.3%) procedures had various extents of pulmonary resection. These surgical procedures included 24 (21.6%) pulmonary resections with gross residual tumour (R2), nine (8.1%) pulmonary resections with microscopic residual tumour (R1), and 25 (22.5%) curative pulmonary resections without residual tumour (R0). Post-operative adjuvant therapy included radiotherapy ( > or = 3000 rads) in 53 patients (47.7%), and cisplatin-based chemotherapy in 15 patients (13.5%). The overall median survival time of these 111 patients was 9.1 months. The overall cumulative survival rates at 1, 2, 3 and 5 years were 38.0%, 20.4%, 15.3%, and 5.5%, respectively. There were 24 (21.6%) complications and eight (7.2%) hospital mortalities. Most of the pleural seedings were caused by adenocarcinomas, while most of the curatively resected tumours were squamous cell carcinomas. Our data demonstrate that: (1) Almost a quarter (22.5%) of T4 lung cancers could be curatively resected, and the cumulative 5-year survival rate was 23.4%; (2) squamous cell carcinoma had a higher curative resection rate (P = 0.0381), while adenocarcinoma showed higher possibility of pleural seeding (P = 0.0000); (3) the prognosis of T4 lung cancers did not relate to their nodal status (P = 0.7978), and cell type (P = 0.4169); (4) complete surgical resection provided the best rates for long-term survival (P = 0.0263); (5) the complication rate was higher in the resectional group (P = 0.0221); (6) post-operative irradiation did not lengthen survival times (P = 0.1720); and (7) post-operative chemotherapy did not improve survival (P = 0.1577). We conclude that surgery to T4 lung cancers should only be performed in highly selected patients due to their poor prognosis, and the associated high complication and mortality rates.

Adult↗
PubMed2001

Wedge resection of the bronchus: an alternative bronchoplastic technique for preservation of lung tissue.

OBJECTIVES: We present a modified wedge resection of the bronchus, as an alternative bronchoplastic technique for lung resection, in cases of patients with or without adequate pulmonary reserve to undergo a pneumonectomy, in order to preserve lung tissue. METHODS: Seventeen patients underwent a major lung resection with wedge resection of the bronchus for non-small cell lung cancer (NSCLC) in our department, from March 1995 to October 1999. A right-sided NSCLC were diagnosed in 17 males, with a mean age 62.5+/-6.6 (range 51-72) years. Further workup was free of metastatic disease. All patients underwent a right posterolateral thoracotomy, under general anesthesia with a double lumen endotracheal tube. Twelve right upper lobectomies, four right upper and middle lobectomies and one carinal resection were performed. The wedge resection of the bronchus carried out longitudinally, along the bronchial tree, and the bronchial defect was reapproximated transversely, in a single-layer, with interrupted non-absorbable suture. The frozen section of the distal margin of the resected bronchus was negative for malignancy in all patients. Extended mediastinal lymph node dissection followed each lung resection. RESULTS: The pathology report showed 12 squamous-cell carcinomas, three adenocarcinomas, one adenosquamous carcinoma and one neuroendocrine carcinoma. The differentiation of the carcinomas was well in two cases, moderate in ten and poor in five. The pTNM stage was IB in four patients (23.5%), IIA in one (5.9%), IIB in eight (47.1%) and IIIA in four (23.5%). The median disease-free distal margin of the bronchus was 5 mm (range 2-15 mm). The average postoperative hospital stay was 15 days (range 12-28 days). The morbidity and mortality rate was 11.8 and 5.9%, respectively. Postoperative follow-up was every 6 months. The average survival is 20.0+/-15.2 months (range 1-54 months). There are 12 patients alive, and their follow-up is negative for locoregional recurrence or distant metastasis. The survival study showed no significantly statistic relation to the histologic type, cancer differentiation, pTNM stage, and disease-free distal margin of resection larger or less than 0.5 cm (Kaplan-Meier study log rank method). CONCLUSIONS: The wedge resection of the bronchus as a bronchoplastic procedure is an easy, fast and safe technique of reparation of the bronchial tree. It presents not only a low rate of morbidity and mortality, but also a satisfactory survival.

Aged↗
PubMed2002

Resection of advanced thoracic malignancies requiring cardiopulmonary bypass.

OBJECTIVES: Patients with malignancies involving cardiac structures have limited therapeutic options and significant risk of mortality. The decision to offer radical palliative or curative resection must be made only after consideration of the substantial surgical risks. The purpose of this retrospective study was to determine the feasibility and benefits of resection with cardiopulmonary bypass (CPB) of metastatic or non-cardiac primary malignancies extending directly into or metastasizing to the heart in select patients. Our results were examined to assess the risks and benefits of such radical therapy. METHODS: We retrospectively reviewed patient charts and identified all patients with malignancies involving the cardiac chamber or great vessels (excluding renal carcinomas with caval extension) or with substantial cardiac compression who had undergone resection with CPB at The University of Texas M.D. Anderson Cancer Center between January 1995 and July 2000. We evaluated demographic data, symptomatology, tumor characteristics, and outcomes. RESULTS: Nineteen patients (six males and 13 females; median age of patients, 47 years; age range, 17-67 years) were included in the study. Eleven patients underwent surgery with curative intent, and eight underwent surgery with palliative intent. Seventeen patients had tumors that required CPB because their tumors directly involved the heart and/or great vessels (nine sarcomas, seven epithelial carcinomas, and one unclassified), and two patients (both with sarcomas) required CPB to relieve tumor tamponade. The technique included CPB (n=5), CPB with diastolic arrest (n=12), and CPB with hypothermic circulatory arrest (n=2). Five patients underwent concomitant pneumonectomy, and three underwent lobectomy. Two patients (11%) died in the hospital after resection with palliative intent. Of the 11 patients who underwent resection with curative intent, ten (91%) had complete resections. The median time in the intensive care unit was 5.3 days (range, 0-37 days) and the median length of hospital stay was 17.2 days (range, 0-107 days). Major complications occurred in 11 patients (58%); the most common major complications were pneumonia (n=7 patients), mediastinal hematoma (n=4 patients), and acute respiratory distress syndrome (n=2 patients). The median follow-up duration was 27 months. The overall 1- and 2-year survival rates were 65 and 45%, respectively. CONCLUSIONS: Extensive thoracic tumors involving cardiac structures can be resected with acceptable risk. When resection was performed with curative intent, excellent 1- and 2-year cumulative survival rates were achieved. Although resection with palliative intent was associated with greater mortality rates, some patients survived for 1 and 2 years. The use of CPB in selected patients with thoracic malignancies should be considered, especially when complete resection can be achieved.

Adolescent↗
PubMed2002

Indications and results of sleeve carinal resection.

OBJECTIVE: Carinal resection is the most complicated procedure in tracheobronchial surgery. The main aspects of the technique are still debated at the present time. We present our experience of 231 carinal resections with analysis of operative techniques, complications and long-term survival. METHODS: Since 1979 we have performed 231 carinal resections. Indications for surgery included lung cancer in 151 cases (65.4%), non-bronchogenic carcinoma in 45 (19.4%), main bronchus fistula with short stump in 25 (10.8%), stenosis of tuberculous and nonspecific etiology in nine (4%), and trauma in one case (0.4%). We have performed 156 right-sided resections (67.5%) and 75 left-sided (32.5%). In 162 cases carinal pneumonectomy was undertaken, carinal resection following pneumonectomy was performed in 28 cases, isolated resection of bronchial bifurcation was performed in 25 cases, and in 15 cases we combined lobectomy and resection of bifurcation. The length of resection extended from one to nine tracheal rings. The operative approach was lateral thoracotomy in 102 cases (44.2%), and sternotomy in 129 (55.8%). RESULTS: Thirty-seven patients died postoperatively (16%). Complications were observed in 82 patients (35.4%), dominated by anastomotic problems which occurred in 58 cases (25.1%). The most frequent causes of death were respiratory distress syndrome and anastomotic dehiscence (P < 0.05). Mortality and the incidence of complications were significantly correlated to length of resection, laryngeal nerves injury, and mode of intraoperative ventilation. CONCLUSIONS: The feasibility of carinal resection is limited by the patient's functional status and extension of tumor growth. Thorough selection of patients may improve immediate and long-term results.

Adult↗