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PubMed2002

Invasive pulmonary aspergillosis: effects of early resection in a neutropenic rat model.

OBJECTIVE: Invasive pulmonary aspergillosis is frequent in neutropenic patients. Usually localized in the beginning, the disease spreads and mortality is high despite antifungal treatment. The role of early adjuvant surgery is not clear. Surgery may help to confirm fungal disease, may control fungal disease locally and may prevent systemic spreading. This study examines effects of early resection on survival and dissemination in a rat model of localized invasive pulmonary aspergillosis. METHODS: Forty persistently neutropenic male albino rats were challenged with standardized conidial aspergillus inoculum injected into peripheral lung tissue of the right upper lobe under direct vision. Animals were divided into four groups. Twenty animals were treated with amphotericin B at 1 mg/kg per day beginning 48 h after inoculation, 20 animals were left untreated. In each group half the animals underwent early resection of localized invasive aspergillosis by lobectomy. Animals were checked daily and mortality was recorded up to 28 days after which surviving animals were sacrificed. RESULTS: Significantly higher survival was observed in resected animals in the non-Am B groups (survival: 10 +/- 19% without early resection and 50 +/- 32% with early resection; P = 0.044). However, early resection did not lead to improved survival in animals treated with amphotericin B (survival 70 +/- 29% without early resection and 50 +/- 32% with early resection; P = 0.316). CONCLUSIONS: In this rat model of localized invasive pulmonary aspergillosis effects of early resection on survival could be demonstrated only in animals not receiving amphotericin B treatment.

Amphotericin B↗
PubMed1999

Extended resections for lung cancer. How far is too far?

Pulmonary resection is the preferred treatment for patients with lung cancer. Half of all patients, however, have signs of unresectability at the time of diagnosis. Contraindication to pulmonary resection is based on cell type, the extent of the disease, and the patient's overall general medical condition. Invasion of the chest wall by bronchogenic carcinoma is not rare. The diagnostic importance of this findings, however, has been controversial. Early reports had regarded thoracic wall invasion as a uniformly ominous sign, while recent reports have been more optimistic, especially when lymph nodes were not metastatically involved. Chest wall resection should be preceeded by mediastinoscopy. If lymph nodes are negative, excision is generally performed en bloc with pulmonary resection. After the thorax is entered and the cancer is found to be invading the chest wall, wide resection of the chest wall with attached lung is performed. Generally, the line of resection should encompass the area of invasion by several centimeters. The lung with attached chest wall is then allowed to fall back into the pleural cavity, where the appropriate pulmonary resection is performed. If the chest wall defect is less than 5 cm in diameter, no reconstruction of the defect is required. If, however the defect is larger and structural, stability is required. The defect should be reconstructed with a prosthetic material, such as the various meshes, metals, or soft tissue patches, and reinforced with a muscle flap. If the wound is contaminated from an intrathoracic source, prosthetic material should be avoided and reconstruction with a muscle flap alone is preferred. Muscles commonly used include serratus anterior, pectoralis major, latissimus dorsi, and occasionaly, rectus abdominus. Because the omentum lacks structural stabilitly, it should be considered a back-up alternative procedure. Operative mortality is usually related to the extent of pulmonary resection rather than the extent of chest wall resection. Five-year survival approaches 50% for patients with T3N0M0 lesions. For patients with either N1 or N2 neoplasms, 5-year survial is less than 10%. Postoperative radiation therapy appears to have no effect on surival.

Adolescent↗
PubMed2002

Aggressive management of patients with extrahepatic and intrahepatic recurrences of hepatocellular carcinoma by combined resection and locoregional therapy.

BACKGROUND: Resection of hepatocellular carcinoma (HCC) is associated with a high incidence of recurrence. Aggressive management of recurrence is an important strategy in prolonging survival. This study evaluated the role of combined resection and locoregional therapy in the management of selected patients with extrahepatic and intrahepatic recurrences. STUDY DESIGN: From a prospective database of 399 patients with hepatectomy for HCC from 1989 to 1998, 63 patients were identified with extrahepatic and intrahepatic recurrences either concurrently or sequentially. Survival outcomes of patients who underwent resection of extrahepatic recurrence and re-resection or locoregional therapy for intrahepatic recurrence were evaluated. RESULTS: Ten patients underwent resection of solitary extrahepatic recurrence and locoregional therapy for intrahepatic recurrence. Transarterial chemoembolization was the main treatment modality for intrahepatic recurrence. Two of these patients also underwent re-resection of intrahepatic recurrence at the time of resection of extrahepatic metastasis. Median survival after recurrence of these 10 patients was 44.0 months (range 18.6 to 132.9 months), and the median overall survival from initial hepatectomy was 49.0 months (range 21.6 to 134.6 months). In contrast, median survival after recurrence of the remaining 53 patients with extrahepatic and intrahepatic recurrences treated by nonsurgical means (locoregional therapy, systemic chemotherapy, or hormonal therapy) was only 10.6 months (p = 0.002). CONCLUSIONS: Aggressive management with combined resection of isolated extrahepatic recurrence and re-resection or locoregional therapy for intrahepatic recurrence may offer longterm survival in selected patients who develop both intrahepatic and extrahepatic recurrences after hepatectomy for HCC.

Adult↗
PubMedDate not supplied

Effects of intestinal resection on enterocyte apoptosis.

Intestinal resection results in increased numbers of villus and crypt enterocytes. This adaptive response occurs secondary to increased crypt cell proliferation early after resection. Apoptosis also increases in both crypt and villus compartments early after resection. Our aim was to evaluate change in proliferation and apoptosis later during the adaptive period. Eighteen rabbits undergoing 50% proximal intestinal resection were killed 7, 14, or 21 days after resection. Intestine at the resection margin was evaluated before and after resection for morphometry, crypt cell production rate (CCPR), and in situ end labeling of DNA fragmentation. Apoptotic cells were identified by morphologic evaluation. Villus height (382 +/- 51 microm vs. 505 +/- 131 microm) and crypt depth (121 +/- 10 microm vs. 163 +/- 21 microm; P <0.05) were significantly increased at 21 days. CCPR was also increased compared to preoperative values (5.8 +/- 1.2 cells/hr vs. 8.6 +/- 0. 3, 7.9 +/- 0.3, and 8.3 +/- 1.6 cells/hr at 7, 14, and 21 days; P <0. 05). Apoptotic index (apoptotic cells per 100 cells) was significantly increased in cells at the tip of the villus at 21 days (32 +/- 7% vs. 19 +/- 7%; P <0.05) but not in the lateral villus or total villus. Total cells per villus (83 +/- 6 vs. 65 +/- 3) and apoptotic cells per villus (9.2 +/- 1.6 vs. 4.5 +/- 2.5; P <0.05) were also greater at 21 days. Mean DNA fragmentation scores were similar before and after resection. The crypt apoptotic index was increased only in the lateral crypt at 14 days. Total cells per crypt increased after resection, and the number of apoptotic cells per crypt was increased at 7 and 14 days (2.5 +/- 1.7 and 2.3 +/- 1. 1 vs. 0.6 +/- 0.6 days; P <0.05). Thus the following conclusions were reached: (1) Apoptosis of villus tip cells remains elevated late in postresection adaptation; (2) crypt cell apoptosis returns to preoperative levels during the time interval when crypt cell proliferation is still stimulated; and (3) apoptosis in the crypt and villus compartments appears to be regulated independently.

Adaptation, Physiological↗
PubMed1999

Transsphenoidal resection of pituitary adenomas in an intraoperative MRI unit.

BACKGROUND: Transsphenoidal resection is a well known surgical procedure used in the treatment of sellar and parasellar lesions. In certain cases, operative identification of the lesion and achieving a complete resection can be problematic. We describe a surgical image guidance method using an intraoperative MRI which provides definitive identification of a lesion and verification of a complete resection. MATERIAL AND METHODS: Five patients with pituitary macroadenomas underwent transsphenoidal resection of their tumors in the intraoperative MRI unit at the Brigham and Women's Hospital. This unit was developed as a collaboration between General Electric and BWH and is an open configuration 0.5 Tesla MR imager in which surgery can be performed with real time, intraoperative MR guidance. RESULTS: The transsphenoidal resections were performed in a standard fashion in this unit. Intraoperative imaging allowed accurate localization of the lesions, identification of pertinent surrounding structures, and the evaluation of the extent of each resection. In two patients, the resection would have been considered complete based on the surgical field of view alone but MR imaging allowed remaining tissue to be identified. Developing clot was seen in one patient after a fat graft had been placed. CONCLUSION: The intraoperative MR is a surgical modality by which transsphenoidal resection of pituitary macroadenomas can be performed using real-time image guidance. It allows definitive identification of the tumor and an immediate evaluation of whether resection is complete. It also can monitor the occurrence of intraoperative complications such as hemorrhage. This revolutionary device can be an important tool for the surgical management of pituitary tumors.

Adenoma↗
PubMed1999

Factors affecting outcome following proximal and distal intestinal resection in the dog: an examination of the relative roles of mucosal adaptation, motility, luminal factors, and enteric peptides.

In the clinical setting, resection of the ileum results in an inferior functional outcome compared to jejunal resection. This may be related to a greater adaptive capacity of the ileum, intrinsic structural and functional differences, or regional differences in motor and hormonal function. Our aim was to evaluate the relative contributions of these factors to functional outcome after resection of the proximal or distal intestine. Twenty-four dogs underwent either intestinal transection or 50% resection of the proximal or distal intestine. Studies (nutritional status, absorption, adaptation, motility, peptide levels) were performed every four weeks until the animals were killed at 12 weeks. Caloric intake was similar in all four groups. Weight loss was greater and more sustained after distal resection (DR). Serum cholesterol levels decreased significantly only in the DR group. While stool weight and moisture were similar, the DR animals had persistent, significant steatorrhea. Intraluminal anaerobic bacteria and SCFA concentrations were significantly greater in the ileum but were not influenced by resection. Intestinal remnant length increased to a greater extent after proximal resection (PR), but circumference increased to a similar extent after both resections. Villus height and crypt depth increased significantly only after PR. MMC frequency was similar in all four groups. In the DR animals 26% of migrating motor complexes (MMCs) originated within the remnant. The jejunal remnant of these animals had a dominance of cluster activity similar to the intact distal ileum. Following PR, the postprandial motilin response was decreased. After DR, there were transient increases in neurotensin and PYY. Of the various factors evaluated, mucosal adaptation and the intestinal motor response appear most likely to explain the inferior nutritional and absorptive outcome associated with resection of the distal small intestine.

Adaptation, Physiological↗
PubMed1998

Prediction of resectability of pancreatic malignancy by computed tomography.

BACKGROUND: The accuracy of computed tomography (CT) in predicting resectability of pancreatic malignancy has been questioned recently and alternative methods have been recommended. METHODS: To determine the accuracy of CT for predicting resectability and its influence on survival, a standard protocol for performing CT and reporting the results was developed and then compared retrospectively with the ability of one surgeon to perform a resection during 1989-1994. Postoperative survival was determined. RESULTS: Of 88 consecutive patients 35 (40 per cent) had CT-resectable disease and 53 (60 per cent) had CT-irresectable disease. Twenty-one patients were excluded because of advanced disease or poor performance status. Of the remaining 67 patients, 47 (70 per cent) had pancreatic ductal adenocarcinoma and 20 (30 per cent) had ampullary adenocarcinoma, of whom 32 had a resection, 32 had a palliative bypass and three had only a staging laparoscopy. The sensitivity and specificity for computed tomographic prediction of resectability were 72 and 80 per cent respectively. The positive predictive value was 77 per cent and the negative predictive value 76 per cent. There were seven false-positive and nine false-negative findings. Survival was more dependent on whether or not resection was performed than on computed tomographic predictability of resection. CONCLUSION: CT was reasonably accurate in predicting resectability but cannot be relied on entirely, requiring an improvement in staging methods for pancreatic malignancy.

Adenocarcinoma↗
PubMed1998

An 8-year experience of hepatic resection: indications and outcome.

BACKGROUND: Most reports highlighting decreasing operative morbidity and mortality rates following hepatic resection have focused on the management of metastatic disease. Information on the full range of hepatic disease is lacking. METHODS: The indications for hepatic resection in a specialist hepatobiliary unit have been reviewed and the operative morbidity and mortality rates assessed. RESULTS: Among 129 patients undergoing 133 hepatic resections between October 1988 and September 1996, the principal indication for resection was hepatic malignancy (102 resections), metastatic in 66 cases. Other indications included contiguous tumour (n = 20), primary tumour (n = 16) and benign disease (n = 31). Some 116 procedures were classical anatomical resections. Blood transfusion was required in 40 per cent of cases but major morbidity occurred in 20 per cent. There were six deaths following surgery, five of which were due to hepatic failure and followed resection for malignancy or trauma. The 3-year survival rate in patients resected for colorectal metastases was 65 per cent. CONCLUSION: This experience has demonstrated an increasing role for hepatic resection in a wide variety of hepatobiliary pathologies. Despite the low postoperative mortality rate, the significant risk of complications in the postoperative period serves to emphasize the need for careful selection of patients for such surgery, which should be undertaken in specialist centres.

Adult↗
PubMed1999

Liver metastases after curative resection in patients with distal bile duct cancer.

BACKGROUND: Curative resection cannot ensure long-term survival for patients with distal bile duct cancer. The aim of this study was to determine the most frequent mode of recurrence after curative resection and to analyse its risk factors. METHODS: Clinical details for 64 consecutive patients with distal bile duct cancer who underwent surgical resection between 1980 and 1997 were reviewed. Modes of recurrence and clinicopathological findings were analysed based on the residual tumour (R) classification. RESULTS: The overall actuarial 5-year survival rate was 32 per cent. Of 42 patients undergoing R0 resection 10 were alive at 5 years, of 17 having R1 resection one was alive at 5 years, and none of the five patients having R2 resection survived for 5 years (R0 versus R1, P = 0.02). In the R0 group, the incidence of liver recurrence (14 of 42 patients) was similar to that in the R1 resection group (six of 17), although there were fewer lymph node and peritoneal recurrences than in patients who had R1 resection (P < 0.05). The high-risk factor for liver metastasis was microscopic vascular involvement. Important factors for survival were lymph node metastasis, microscopic vascular involvement and age. In addition, microscopic vascular involvement was the only independent factor for survival in the R0 group. CONCLUSION: R0 resection provided significant survival benefit but had no effect on liver recurrence. Therefore, new agents or strategies to prevent liver metastasis are necessary for improvement of survival.

Adult↗
PubMed1999

Treatment of gallbladder cancer by radical resection.

BACKGROUND: The use of radical resection for gallbladder cancer is controversial. This study evaluated results of resection for gallbladder cancer and analysed prognostic factors. METHODS: A retrospective review of 135 patients who underwent surgical resection for gallbladder cancer between 1976 and 1998 was performed. Of these, 123 patients underwent radical resection and the remaining 12 had palliative resection. The resections included 32 hepatopancreatoduodenectomies and 57 with adjuvant radiotherapy. Twelve prognostic factors were analysed. A subset of 96 patients with stage IV disease was analysed separately with respect to residual tumour level and adjuvant radiotherapy. RESULTS: Surgical resection was associated with a 5-year survival rate of 36 per cent, with a mean follow-up time of 870 days. Twenty-two patients have survived more than 5 years including three with stage IV disease. Overall operative morbidity and mortality rates were 13 and 4 per cent respectively. The 5-year survival rate decreased with disease stage: 100, 78, 69 and 11 per cent for stages I (n = 13), II (n = 19), III (n = 7) and IV (n = 96) respectively. Performance status, jaundice, histopathological type and grade, primary tumour, lymph node, distant metastasis, stage grouping, residual tumour level and adjuvant radiotherapy were significant prognostic factors. CONCLUSION: With careful patient selection, radical resection for gallbladder cancer improves the prognosis with acceptable operative mortality and morbidity rates, even for stage IV disease, provided that complete gross tumour resection is combined with radiotherapy.

Adult↗
PubMed2002

Morphometric and biomechanical remodelling in the intestine after small bowel resection in the rat.

The short-bowel syndrome is a clinical condition caused by intestinal resection. As intestinal adaptation occurs after resection, it can be used as a model for studying morphometric and biomechanical remodelling in the small intestine and to get a better understanding of the pathophysiology of the short-bowel syndrome. The resected rats had a 67% resection of jejunum and ileum. Control animals underwent no operation (nonoperated controls) or an ileal transection with subsequent end-to-end anastomosis (sham-resected controls). The animals were followed for up to 4 weeks after the operation. Changes in biomechanical properties were studied in terms of residual strain (the internal strain remaining when all external loads are removed), opening angle and stress--strain relations referenced to the zero-stress state (the cut-open state where external and internal stresses are released). The resected animals gained less weight than the controls. The intestinal length and diameter increased more in the resected groups than the control groups (P < 0.05), resulting in a larger absorptive surface. Resection induced profound gross morphometric changes and histological alterations characterized by proliferative increases in the tissue layers. The opening angle, along with residual strain at the mucosal and serosal surface, increased in the remnant small intestine (P < 0.05). All changes increased as function of postoperative time and were most prominent in the remnant ileum. However, the stress-strain relationship remained unchanged. In conclusion, this study demonstrated that resection of the majority of the small bowel results in significant remodelling in structural and residual strain properties in the remnant small intestine. The remodelling seems to be guided by the need for a greater absorptive surface area rather than for a change in the stress-strain properties.

Adaptation, Physiological↗
PubMed2001

Surgical therapy for adenocarcinoma of the cardia: modalities of recurrence and extension of resection.

In order to define the optimal extent of resection for cancer of the cardia, we considered 116 patients operated upon with five different surgical techniques. The procedures were: transabdominal total gastrectomy associated with distal esophagectomy in 38 patients; transabdominal total gastrectomy and left thoracotomic esophageal resection at the inferior pulmonary vein level in 26 patients; transabdominal total gastrectomy and right thoracotomic esophageal resection at the azygos vein level in 27 patients; transabdominal total gastrectomy and transhiatal lower third esophagectomy in 18 patients; transhiatal total esophagectomy and upper third gastrectomy with cervical esophago-gastroplasty in seven patients. Grading, staging, neoplastic lymphangitis, satellite intramural metastases, infiltration of the resection margin, site of recurrence, and survival were analyzed. N+ was the single independent prognostic factor for survival. A poorly differentiated grading was related to T (P = 0.0009), N (P = 0.001), satellite growth (P = 0.05), and infiltration of the resection margin (P = 0.0001). Recurrence was local in 26% and distant in 74% of patients. The modalities of recurrence were not related to the aggressiveness parameters and the surgical technique. Infiltration of the esophageal resection margin was related to the type of operation (P = 0.005) and survival (P = 0.02), but it was not related to the site of recurrence. Transabdominal total gastrectomy and the right thoracotomic esophageal resection procedure achieved free margins and control of the lymph nodal metastatic spread. Transabdominal total gastrectomy and right thoracotomic esophageal resection at the azygos vein level provides a radical oncologic resection, particularly in poorly differentiated tumors. However, surgery alone cannot cure the majority of adenocarcinomas of the cardia.

Adenocarcinoma↗
PubMed2002

Resecting large numbers of hepatic colorectal metastases.

BACKGROUND: Despite the widespread use of surgical resection as a treatment for hepatic colorectal metastases, the value of resecting more than three metastases remains controversial. It was the objective of this study to determine if resection of larger numbers of metastases affects patient survival. METHOD: The survival of 123 consecutive patients who underwent curative hepatic resection for colorectal metastases between 1989 and 1999 by a single surgeon was analysed retrospectively. Kaplan-Meier survival statistics and Cox regression were used to determine the factors that affected survival, and logistic regression was used to determine the factors that affected the risk of recurrence of hepatic disease. RESULTS: The median survival rate for the whole group of patients was 38 months, with 1, 3 and 5 year survival rates of 88%, 53% and 31% respectively. The survival rate of patients undergoing resection of four to seven metastases (n=22; 5 year survival=39%) was not significantly different to that of patients undergoing resection of one to three metastases (n=91; 5 year survival=30%), P=0.9. Age, sex, primary cancer site, hepatic disease distribution, resection margins and adjuvant hepatic arterial chemotherapy (HAC) did not affect survival. Local invasion of the hepatic metastases (relative risk (RR)=2.9; P=0.001) and hepatic disease recurrence (RR=2.1; P =0.007) were the only factors that independently affected survival. Local invasion of the hepatic metastasis was the only factor associated with an increased risk of hepatic recurrence (RR=2.8; P=0.03). Adjuvant HAC did not affect the risk of hepatic recurrence (RR=1.5, P=0.4). CONCLUSION: Although there are no randomized trials that quantify any survival benefit from resection of liver metastases, the comparison of our results with well documented historical evidence indicates that surgical resection of up to seven colorectal liver metastases can result in a significant survival benefit.

Adult↗
PubMed2003

Rectal resection with low anastomosis: functional outcome.

OBJECTIVE: Function after anterior, low anterior and intersphincteric resection for rectal cancer was studied. METHOD: Of 139 patients 122 responded to a standardized questionnaire (Cleveland Clinic Continence Score) 108 +/- 46 weeks postoperatively and 70 underwent anorectal manometry at 26 +/- 15 weeks. RESULTS: The postoperative continence score was dependent on the procedure (anterior resection 4.1 +/- 4.6, low anterior resection 6.9 +/- 5.6, intersphincteric resection 11.5 +/- 5.2; P < 0.0001). It was poorer after radiochemotherapy (9.0 vs. 5.7; P = 0.030), but after colonic pouch reconstruction there was no significant difference between low anterior resection (5.6 vs. 7.3) and intersphincteric resection (10.0 vs. 12.5). Mean and maximal resting pressures were significantly reduced after intersphincteric resection (24 +/- 9 and 40 +/- 13 mmHg, respectively, P < 0.001) and further reduced by radiochemotherapy. Squeeze pressure was unaffected by the operative procedures and radiochemotherapy. Maximum tolerable volume and rectal compliance were reduced, after both low anterior and intersphincteric resection. Statistical correlation between continence score and maximal resting pressure (P = 0.014), mean resting pressure (P = 0.002), urge volume (P = 0.037), and neorectal compliance (P = 0.0018) reached significance. Satisfaction with the functional outcome was expressed by 71% of patients. CONCLUSION: After rectal resection the degree of impaired continence depended on the operative procedure and the form of reestablishment of intestinal continuity. Radiochemotherapy affected the outcome adversely. Despite reduced function, overall patient satisfaction was high.

Adenocarcinoma↗
PubMed2003

The incidence and causes of permanent stoma after anterior resection.

AIMS: Defunctioning stomas are used following anterior resection to guard against the serious consequences of anastomotic leak such as pelvic sepsis and generalized peritonitis. This study aims to determine what proportion of patients undergoing anterior resection have a defunctioning stoma, how many of these patients do not have their stoma closed, and the reasons for this. METHODS: All patients undergoing a resection for rectal cancer in our institution in a five year period (January 1995 to December 1999) are included in the study. Anterior resection was performed on 154 patients, divided into 76 anterior resections (AR) and 78 low anterior resections (defined as the anastomosis within 6 cm of the anal verge). The data from these patients were analysed retrospectively. RESULTS: Of the total of 154 patients undergoing anterior resection, 59 (38%) were defunctioned, divided into 33 with loop ileostomy and 26 with loop colostomy. Five of these patients had not had their stoma closed at a median follow up of four years (range 1.5-6.5 years). The reasons for non closure were anastomotic stricture (2), metastatic disease (2), and patient choice (1). When comparing AR and LAR, 16% of patients had a defunctioning stoma after AR, compared with 60% after LAR (P < 0.01). CONCLUSION: Anterior resection is being performed for very low rectal tumours in order to avoid a permanent stoma. However we have found that 8% of patients who are defunctioned with a stoma at anterior resection will not have their stoma closed, and conclude that patients should be warned of this pre-operatively.

Aged↗
PubMed2002

Indications and results of resection for hepatocellular carcinoma.

AIM: In this retrospective series we evaluate our experience in surgical treatment of HCC and examine early and long-term results of 46 hepatic resections. METHODS: Eighty-eight patients with HCC have been observed at our Department. Fifty patients (57%) have been operated, but only 46 (92%) could be resected; 43 patients (93.5%) carried liver cirrhosis. We performed 28 non-anatomical resections (60.8%) and 18 anatomical resections (39.2%). Tumour clearance at resection margin of at least 1cm was considered for a curative resections. RESULTS: Overall mortality and morbidity were 8.7 and 30.4% respectively. These rates significantly decreased in the last years: from 1995 to 2000 no hospital mortality has been recorded. Hospital mortality among non-anatomical and anatomical resection subgroups was 3.5 and 16.6% respectively (P<0.02). After a median f.u. of 41 months, 19 patients (45.2%) had recurrences: it was intrahepatic in 16 (84.4%). We observed a 3-, 5- and 10-years actuarial survival rate 62, 51.1 and 22.5% respectively. Long term survival significantly differed between non-anatomical and anatomical resections, with 5-year and 10-year values of 61.1 and 34.3% vs 37.7 and 18.8% respectively (P=0.0224). CONCLUSIONS: Early results after hepatic resection for HCC can be improved by using a limited surgical approach. Long-term results are still unsatisfactory, because of the high recurrence rate that is not influenced by different surgical approaches.

Adolescent↗
PubMed2001

The effect of cisplatin dose and surgical resection in children with malignant germ cell tumors at the sacrococcygeal region: a pediatric intergroup trial (POG 9049/CCG 8882).

PURPOSE: This study was designed to evaluate (1) the efficacy of standard or high-dose cisplatin with etoposide and bleomycin and (2) the role of surgical resection in infants and children with malignant germ cell tumors of the sacrococcygeal region (SCT). METHODS: Seventy-four of 317 children presenting to Pediatric Oncology Group (POG)/Children's Cancer Group (CCG) institutions from 1990 through 1996 with malignant germ cell tumors had malignant SCT. There were 62 girls and 12 boys with a median age of 21 months (range, 3 days to 37 months) and median serum alpha-fetoprotein of 35,500 ng/mL. Twelve had undergone resection of a benign SCT as a newborn. Forty-four (59%) had evidence of metastatic disease at time of diagnosis. Presentation by type (Altman classification) was I, 0; II, 2; III, 30; and IV, 42. The initial procedure was biopsy in 45 and resection in 29. Patients were assigned randomly to receive 4 cycles of chemotherapy with etoposide (E) and bleomycin (B) and either high-dose cisplatin (200 mg/m(2) per cycle; HDP) or standard dose cisplatin (100 mg/m(2) per cycle; P). After completion of chemotherapy, 42 of 45 initially treated with biopsy underwent resection. RESULTS: Overall 4-year survival rate is 90% (SE = 4%) and 4-year event-free survival (EFS) is 84% (SE = 6%). Event-free survival data for subgroups of interest are as follows: 4-yr EFS% (SE) P Values Mets (44) 88 (6).48 No Mets (30) 80 (8) HDP EB (37) 89 (6).21 P EB (37) 78 (7) Initial Resection (29) 90 (7).50 Delayed Resection (42) 83 (7) Complete Resection (49) 90 (5).19 CR/PR Partial Resection (22) 77 (10) Biopsy Only (3) 33 (27).005 (3 way) CONCLUSIONS: (1) The current survival rate of malignant sacrococcygeal tumors is excellent even with metastases. (2) Delayed surgical resection is not associated with an adverse outcome. (3) In this subset the treatment comparison was inconclusive however, followed the trend in the overall study of more than 300 children in which the high-dose cisplatin group had superior EFS (P<.05).

Antineoplastic Combined Chemotherapy Protocols↗
PubMed2003

[Resection of bronchial carcinoma combined with lung volume reduction].

Lung volume reduction (LVRO) combined with simultaneous resection of bronchial carcinoma ignores the well known principles of functional operability. In case of 6 patients with LVRO and resection of the lung because of a non-small-cell lung cancer (NSCLC) stage I (4 x), stage II (1 x) and stage IIIa (1 x) located in the emphysematous lung parenchyma lobectomy was done four times and extraanatomical resection twice. Because of a gangrene the resection of middle lobe was necessary in case of one patient. There were no other perioperative complications. 6 months after the operation 5 patients noticed decreased dyspnea. The survival rate after 2 years was 66 %, after 3 years 34 %. 1 patient is still alive after 56 months. Cause of death was in every case progress of tumour. Due to the principles of oncologic surgery lung resection will be functional tolerated if the cancer is located in the area of bullous lung destruction; in singular cases lung resection will improve the cardiorespiratory status at least temporary. In case of extraanatomic or segmental resections there is a low rate of morbidity and lethality but a high incidence of recurrence of carcinoma. The short- and medium- term functional results seem to be encouraging. Limiting factor for carrying out extensive resections is the tumour infiltration of non emphysematous lung parenchyma. There is no doubt that simultaneous resection will be reserved for a group of highly selected patients.

Aged↗