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PubMed1988

[Reconstruction of the pelvic ring based on classification following resection of bone tumors].

Bone tumors in the pelvis (28 cases), which had been treated surgically were classified into types I to V and their subtypes A and B, according to the location and range of tumor resection, and were assessed with regard to both the method of reconstruction used and restoration of function. Type I-A, -B (6 cases) did not require any reconstruction of the pelvic ring. However, with type I -B, some difficulty was experienced in maintaining balance upon sitting for a long period. Type II (3 cases) included cases of resection of the anterior part of the pelvis, resulting in loss of ring continuity, but reconstruction was not necessary. In type III -A, the acetabulum excluding the hip joint (1 case) was resected and arthrodesis of the ilium and the femoral head performed. In type III -B the acetabulum with the hip joint was resected (2 cases) followed by replacement of the pelvis and hip joint with an artificial prosthesis. Type N included cases (5) of partial (-A) or total (-B) sacroiliac resection, both of which needed massive bone grafting to reconstruct the pelvic ring. Type V (7 cases) required partial (A) or total (B), resection of the sacrum dynamic reconstruction by spinal instrumentation and massive bone grafting. Among 13 cases of primary malignant bone tumors for which tumor resection was performed, 3 cases recurred. This classification was useful for comparing the surgical modalities of tumor resection, reconstruction and their functional results. Our method of total sacral resection was also introduced.

Adolescent↗
PubMed1987

The role of resection in the treatment of pulmonary metastases from Ewing's sarcoma.

We have investigated the role of resection in the treatment of patients with isolated pulmonary metastases from Ewing's sarcoma. In a retrospective review, 19 patients with the diagnosis of Ewing's sarcoma treated at the National Cancer Institute from 1965 to 1985 who underwent chest exploration for resection of pulmonary nodules were evaluated. Ten patients (53%) were made disease free by resection of pulmonary metastases, six patients (32%) were found to have unresectable disease, and three patients (16%) were found to have benign pulmonary disease. The actuarial 5 year survival rate of the 10 patients successfully made disease free by resection was 15%, and the median survival of this group was 28 months. In contrast, the median survival of the six patients not made disease free was 12 months, and no patient with residual disease was alive 22 months after thoracotomy (p2 = 0.0047). There were no postoperative deaths and only three minor postoperative complications for 25 operative procedures. Various prognostic variables were analyzed to determine their influence on postmetastasectomy survival. There was no difference in postmetastasectomy survival between patients who underwent resection of synchronous versus metachronous pulmonary metastases (p2 = 0.90). Patients who underwent resection of fewer than four malignant nodules had a significantly longer postmetastasectomy disease-free survival (p2 = 0.0019) and overall survival (p2 = 0.06) than those undergoing resection of four or more nodules. Patients who underwent resection of metastases that developed during chemotherapy had a significantly shorter postmetastasectomy survival that those who underwent resection of metastases that developed after chemotherapy (p2 = 0.0295). Our data show that selected patients with Ewing's sarcoma metastatic to the lungs may benefit from an aggressive surgical approach. Also, a significant proportion of these patients will have benign pulmonary disease and can thus avoid additional intensive systemic therapy.

Adolescent↗
PubMed1980

Comparison of lobectomy and wedge resection for carcinoma of the lung.

To evaluate comparatively lobectomy and wedge resection for carcinoma of the lung, we reviewed retrospectively 1,000 consecutive cases of lung cancer at a Veterans Administration Hospital. Of these cases, 252 were operable; 199 were resectable. Thirty-three patients underwent resection of their lesion as primary treatment. The indications for wedge resection were (1) insufficient pulmonary reserve, (2) resectable cerebral metastasis, (3) frozen-section results reportedly benign. One hundred twelve patients underwent standard lobectomy procedures. Of these patients, 40 were comparable to those patients undergoing wedge resection on the basis of age, histopathological examination, tumor size and location, and the presence of metastatic disease. One, 2, and 5 year survival rates were 85%, 58%, and 26%, respectively, for wedge resection and 75%, 55%, and 25%, respectively, for lobectomy. The operative mortality rate was 0% for wedge resection and 5% for lobectomy. These results indicate that for the patient with a peripheral lung carcinoma and no evidence of metastatic disease a wedge resection offers comparable survival rates with minimal risk of death.

Adenocarcinoma↗
PubMed1982

Hepatic resection for secondary neoplasms.

Despite recent advances in chemotherapy, patients with hepatic metastases treated nonsurgically continue to have a dismal survival rate. Using our experience with surgical resection of pulmonary metastases as a model, we have adopted an aggressive surgical approach to secondary hepatic neoplasms. Hepatic resection for metastatic disease in 64 patients undergoing 75 celiotomies resulted in a cumulative survival rate of 45% at 2 years and 34% at 5 years. Operative procedures included 37 wedge resections, 20 segmentectomies, 16 lobectomies, and 2 total hepatectomies in preparation for liver allograft transplantation. The operative mortality rate (less than 30 days) was significant (20%). The most favorable prognosis was associated with Wilms tumor (4 patients) and colorectal carcinomas (29), the 2-year survivals being 80% and 67%, respectively. Long-term survivors include patients with Wilms (17 and 14 years), leiomyosarcoma (12 years), and colorectal (11 and 10 years) primary tumors. Thirty patients with synchronous resections of the primary tumor and the hepatic resections had 2- and 5-year survival rates of 29% and 26%, whereas 34 patients with metachronous resections had survival rates of 64% and 30%. Eighteen patients underwent resections of multiple hepatic metastases with a survival rate essentially no worse than that of patients with isolated metastases, but careful case selection may have played an important role in the outcome. The extent of hepatic resection was primarily dictated by location and number of metastases. More extensive resections were not associated with a higher long-term survival rate but did have a higher operative mortality. We conclude that an aggressive surgical approach in the treatment of metastatic disease confined to the liver offers a chance for long-term survival and significant palliation in selected patients whose primary tumor is controlled.

Actuarial Analysis↗
PubMed1978

Colonic interposition between the jejunum and ileum after massive small bowel resection in rats.

Most patients who undergo massive small bowel resection develop the "short bowel syndrome", which usually resolves as intestinal adaptation takes place. Some, in whom adaptation appears to be inadequate, remain severely incapacitated, and attempts have been made to improve absorption using a variety of surgical maneuvers. Successes have been recorded, but the procedures (of which reversal of a segment of small intestine to prolong the intestinal transit time has been most frequently used) are unpredictable and may actually be harmful. This study was designed to evaluate the theory that, because of the slow pattern of peristaltic activity inherent in the colon, the intestinal transit time could be safely and predictably prolonged after massive small bowel resection by transposing a segment of colon to between the jejunal and ileal remnants in an iso-peristaltic direction. The following procedures were performed, using 56 rats: (1) Resection of 80% or 90% of the small intestine. (2) Small bowel resection (80% or 90%) and iso-peristaltic jejuno-ileal colonic interposition. (3) Bowel anastomoses without resection. Intestinal function was subsequently evaluated by studying the following: (1) body weight; (2) blood count; (3) intestinal transit time (by contrast radiography); (4) intestinal absorption of sodium iodide, albumin, triolein and Vitamin B12 (using radioisotopic methods); (5) intestinal morphology. Colonic interposition did not have any significant effect following 80% small bowel resection. After 90% resection, colonic interposition increased the intestinal transit time significantly (p less than 0.001) without mortality or serious morbidity, and did not cause intestinal obstruction or prevent intestinal adaptation. Body weight and intestinal absorption were not increased significantly, but the study was too short to exclude an eventual beneficial effect in terms of body weight. It was concluded that iso-peristaltic colonic interposition is a safe and reliable method of prolonging the intestinal transit time after massive small bowel resection in the rat, thereby increasing the efficiency of absorption within the existing absorption capacity. The procedure has been found to be beneficial in dogs, and for reasons discussed, should be equally effective in man. Adjunctive surgery is not recommended at the time of resection in man, but should be considered if absorption remains severely impaired.

Animals↗
PubMedDate not supplied

[Variations in post-small bowel resection gastric acid hypersecretion and hyper-gastrinemia after vagotomy and antrectomy. Experimental study in rat (author's transl)].

Resection of the small bowel provokes gastric acid hypersecretion and hyper-gastrinemia. Various studies have been conducted to assess the effects of vagotomy and antrectomy on post-resection gastric hyperacidity, both on basal levels and those after stimulation with histamine and pentagastrin. Similar studies involved hypergastrinemia levels. A total of 100 Sprague-Dawley rats were divided into 6 groups : controls (C). massive small bowel resection (R), vagotomy plus pyloroplasty (VP). antrectomy (A), vagotomy plus pyloroplasty and bowel resection (VPR), and antrectomy plus bowel resection (AR). - It was demonstrated that vagotomy is the most effective method for reducing gastric acid hypersecretion after small bowel resection. Antrectomy provokes diminution of gastric acid secretion in animals without bowel resections, but neither this nor gastrinemia levels are significantly altered in operated animals. Synergistic action of the mechanisms provoking post-resection and post-vagotomy hyper-gastrinemia is observed when they occur in the same group of animals, the incidence being higher than that observed after vagotomy or resection alone. Gastrinemia levels increased after VPR or reduced after AR cannot be differentially transposed to gastric secretion in these two groups of animals, demonstrating that, under these conditions, blood gastrin levels are not the principal factor involved in gastric secretion control.

Animals↗
PubMed1994

Comparison of resectable and unresectable periampullary carcinomas.

Two hundred and fifty-eight patients with pathologically proved periampullary carcinomas who underwent surgical treatment between the years 1965 and 1992 were evaluated. Comparison was carried out between the resectable and unresectable groups. Carcinoma of the pancreatic head occurred in less than one-half (47 percent) of the patients, and only 23 percent were resectable. In contrast, carcinoma of the ampulla of Vater had a similar rate of occurrence, but a much higher resectable rate (86 percent). Thus, carcinoma of the pancreatic head was the minor group (19 percent) in the resectable patients we studied. The main clinical presentations and durations of symptoms before diagnosis did not differ in the resectable and unresectable groups, so it was impossible to predict the resectability by symptoms. Incidences of diabetes mellitus and diarrhea increased twofold in the unresectable group. Preoperative biopsy was difficult to perform for those with carcinoma of the pancreatic head. Comparing pancreatoduodenectomy and palliative operation, pancreatoduodenectomy resulted in a higher complication rate (43 versus 13 percent), a higher surgical mortality rate (17 versus 9 percent) and a longer hospitalization period (31 versus 20 days), but there was no statistical difference in the median survival time between the resectable and unresectable carcinomas of the pancreatic head (seven and one-half versus five months). Most of the patients (81 percent in the resectable group and 70 percent in the unresectable group) we studied died of cachexia with tumor recurrence. Although the advantage of pancreatoduodenectomy for resectable carcinoma of the pancreatic head was questioned, we still recommend this procedure for all periampullary carcinomas to avoid depriving the occasional patients with pancreatic carcinomas of long term survival and forfeiting the chance of cure for some misdiagnosed patients with other more favorable periampullary carcinomas.

Age Factors↗
PubMed1994

Repeated hepatic resection for recurrent hepatocellular carcinoma in eighteen cases.

BACKGROUND: Although intrahepatic recurrence after hepatic resection for hepatocellular carcinoma is the most significant cause of death, very few reports are available for hepatic re-resection as a radical treatment for recurrence. METHODS: Eighteen patients who underwent repeated hepatic resections for hepatocellular carcinoma were evaluated. Most of the patients regularly received measurement of alpha-fetoprotein level once a month and examination by ultrasonography and/or computed tomography scanning once every 3 to 4 months. RESULTS: No operative deaths occurred. The alpha-fetoprotein levels of 9 of the 18 patients were within the normal range. Most patients underwent limited hepatic resection to maintain the remaining hepatic function. The 1-, 3-, and 5-year cumulative survival rates after repeated resection were 88%, 37%, and 37%, respectively. The 3-, 5-, and 7-year survival rates after the first resection were 88%, 68%, and 45%, respectively. These showed no significant difference from the survival rates of patients with no recurrences after hepatic resection. CONCLUSIONS: Careful follow-up examinations after hepatic resection are needed for early detection of recurrences, and efforts should be made for repeated hepatic resection, which leads to satisfactory outcome.

Adult↗
PubMed1995

Carcinoma of the pancreas: critical analysis of costs, results of resections, and the need for standardized reporting.

BACKGROUND: The incidence of carcinoma of the pancreas is increasing in Western societies at great cost. Pancreatic resections have been performed for 60 years and there are hundreds of papers written on the subject, but there is no agreement on the efficacy of resections. Authors have reported on different groups and subsets of patients and have used different statistical methods. Most authors are unable to report a single five-year survivor; others claim a five-year survival rate of 30 to 55 percent. STUDY DESIGN: I have standardized and compared the results reported in 340 papers that deal with survival rates and where there is apparently adequate confirmation of disease. RESULTS: Survivors who have been resected may be reported up to six times even from different countries, whereas survivors who were not resected are frequently overlooked. Actuarial statistical methods exaggerate results when data are lost. After corrections for repetitions, approximately 300 survivors were found, of whom 10 percent had not undergone resection, of the estimated 80,000 patients reported. The overall survival rate was less than 0.4 percent. The best overall survival rate in surgical studies reported in detail is only 3.6 percent and for a nonsurgical study it was 1.7 percent. The average excess cost for each resection was at least $150,000. With only one in 30 patients who underwent resection living for five years, the cumulative cost per "successful" resection was therefore approximately $4.5 million. CONCLUSIONS: Pancreatic resections have had minimal impact on survival rates in patients with carcinoma and are wasteful of resources.

Adenocarcinoma↗
PubMed1994

[Effectiveness of regular after-care in R0-resected rectal carcinoma].

Regular follow-up programs after radical resections of rectal carcinoma have been introduced in numerous hospitals. The main goal of a regular follow-up program is the early diagnosis of tumor recurrence in the asymptomatic stage to allow further radical resection. We evaluated the efficiency (quote of further resections of asymptomatic tumor recurrences) of regular follow-up after resection of 288 rectal carcinomas. 88 patients developed recurrent disease (47 primary locoregional recurrence, 27 distant metastasis, 14 locoregional and distant recurrence). Only 31 patients were asymptomatic at the time of recurrence (metastasis 55.6%, locoregional recurrence 31.9%, local and distant recurrence 7.1%; p < 0.05). In 31 patients (13 asymptomatic, 18 symptomatic) further R0-resection was possible. Locoregional recurrences were resected more often following anterior resection than after abdominal perineal resection. With 13 radical resections of asymptomatic recurrence the efficiency of regular follow-up was only 4.5%. Therefore efficiency alone does not justify regular follow-up examinations. Follow-up still makes sense for psychosocial support, diagnosis of metachronous colonic carcinoma, treatment of postoperative complications and critical evaluation of the results of surgery. Furthermore the follow up data can be used to plan adjuvant therapy studies.

Aftercare↗
PubMed1993

[Effects of different methods of tooth resection in suckling piglets].

Epizootic examinations were made on 796 newborn piglets to test the consequences of the resection of a piglet's canine and lateral incisor teeth on its first day of life. As a comparative examination the resection was carried out with side-cutter pliers or with the teeth grinder PIGMATIC 110. A third group of piglets was not treated. Histological, radiographic and bacteriological examinations were made of 10 piglets--in each case with piglets with the resection with side-cutter pliers or with the teeth grinder. 48% of ground teeth reacted with an inflammation of the pulp. The clipping of the crown of teeth with side-cutter pliers caused pulpitis in 92% of the teeth. Inflammation of the gingiva could almost only be seen around clipped teeth. Splinters only occurred with teeth which had been clipped with side-cutter pliers. Gingivitis and pulpitis extended along the splinters to the bottom of the root. Bites among the litter mates were more frequent in the group of piglets whose teeth had not been treated than in the group of piglets with resected teeth. Compared to the grinding or the clipping of needle teeth, bites to the sow's udder were much more frequent if the resection had been omitted. During the whole period of examination the mortality of piglets was at its lowest in the group of piglets with clipped teeth. The development of grinding instruments for the resection of needle teeth presents a method which reduces the negative consequences of the conventional resection with side-cutter pliers and shows clearly the advantages of resection. In terms of animal welfare, teeth resection is an amputation and therefore every case requires veterinary justification.

Animals↗
PubMedDate not supplied

Circumferential block resection to reduce myopia.

BACKGROUND: The surgical treatment of excessive myopia following penetrating keratoplasty has been largely ignored. Oversized corneal grafts can induce myopia and the Troutman wedge (block) resection has been used to correct astigmatism by removing tissue in a single corneal semimeridian. This study explores the use of block resections in opposing semimeridians to reduce myopia caused by a steep cornea. METHODS: Six eyes received three different operations. One eye received 60-degree block resections in semimeridians located 90 degrees (procedure 1), two eyes received 0.5-millimeter semicircumferential (180 degrees) block resections (procedure 2), and three eyes underwent 0.5-millimeter 360-degree circumferential block resections (procedure 3). All patients were followed for at least 1 year. RESULTS: Procedure 1 (two 60-degree block resections) developed approximately 2.75 D of myopic correction at 1 year. The average reduction of spherical equivalent was 4.50 D for procedure 2 (one 180-degree block resection) and 10.50 D for procedure 3 (one 360-degree block resection) at 1 year. Although all eyes regained best spectacle-corrected visual acuity, the postoperative course was prolonged by irregular astigmatism. CONCLUSIONS: Circumferential and semicircumferential block resections can reduce myopia after penetrating keratoplasty and in naturally-occurring myopia, but the postoperative course can be prolonged, especially because of irregular astigmatism. Early removal of sutures results in regression of myopic correction.

Adult↗
PubMed1977

[Liver damage after resection of the stomach: evaluation of 215 cases (author's transl)].

Only 11% out of 215 patients with resection of the stomach had a normal liver if the term of the resection was not longer ago than 30 years. Contrarily the deposition of fat became less frequent with increasing distance from the operation term while deposition of iron (siderin) was demonstrable nearly equaly in all groups. Age and sex did not influence the behaviour of the liver after resection of the stomach. The information value by blood transaminase activity (GOT/GPT) decreases with the distance of time from the resection term. Alcoholics (n = 20) had less shares of post resection liver harms than non-alcoholics. Thus alcohol seems to be not a bigger risk for resectioned as for people with normal stomach. Repeated liver biopsies after different intervals of time pointed out that a change for the worse happened more often with increasing distance to the resection term. Therefore resected patients should be examined regularly, including liver biopsy, as to discover in time a growing up liver damage. After resection of the stomach discovered liver diseases refer to a damage caused by that stomach disease which induced the operation.

Adult↗
PubMed1995

Liver segmentectomy as anatomically precise resections. An experimental study in sheep.

OBJECTIVE: To assess a new technique of anatomically precise hepatic segmental resection and to compare the degree of precision and biochemical profiles with results after traditional segmental resection and a sham operation. DESIGN: Experimental study. SETTING: University hospital, Germany. MATERIAL: 50 sheep (10 each had segments II, III, and IV removed by the new technique, and 10 each were studied in the traditional resection and sham operated groups). INTERVENTIONS: Operative ultrasonography and injection of methylene blue to identify segmental boundaries. In traditional operations boundaries were identified only from knowledge of the surface structure of the liver. MAIN OUTCOME MEASURES: Degree of precision, duration of operation, blood loss, mortality, transaminase activities and liver function tests. RESULTS: Anatomically precise segmentectomies were achieved in 6/9 (67%) for segment II, 6/9 (67%) for segment III, and 4/8 (50%) for segment IV. Using the traditional technique (segment III only) there was only 1/10 anatomically precise resections, together with 5 perisegmentectomies and 4 incomplete resections (p < 0.02). The operations for anatomically precise resection lasted significantly longer, but resection time was similar. Blood loss, survival, and transaminase activities were similar for the two groups, but the margin of necrosis at the cut edge was significantly less in anatomically precise resections. CONCLUSION: Anatomically precise hepatic resections are technically feasible with the use of intraoperative ultrasonography and selective staining of the segment(s) to be removed with methylene blue. Although it takes longer, there are no detrimental consequences compared with the considerably less accurate traditional technique.

Animals↗
PubMed1995

[Endoscopic mucosectomy for resection of early gastric cancer and precancerous lesions].

The authors collected 14 cases of early gastric cancer located in the mucosa and precancerous lesions which were resected with endoscopic mucosectomy. These lesions were as follows: 6 cases were early cancer (IIc type: 4 cases; IIa type: 2 cases); 3 cases were severe dysplasia; 5 cases were adenoma, Yamada I type. The size of all the lesions was less than 20mm. Four cases of early gastric cancer were resected completely. Two cases were resected incompletely, but radical gastrectomy was performed one month after endoscopic mucosectomy. All the three cases of severe dysplasia had complete resection. But two of them received resection twice. Five cases of adenoma were also resected completely. The criteria of complete endoscopic resection were those reported in the Japanese literature. All cases have been followed up for 4-41 months; endoscopic and histological studies showed that there were no residual and recurrent cancer cells. The complete resection rate was 85.7% (12/14). The results suggest that endoscopic mucosectomy can be applied to the patients with early gastric cancer located in the mucosa and precancerous lesions less than 20mm in size, which can be resected completely. This method is safe, entails less complications and is especially suitable for the old and weak patients.

Adenoma↗
PubMed1996

Resection of benign hepatic lesions with selective use of total vascular isolation.

BACKGROUND: The main morbidity associated with hepatic resection is related to excessive blood loss. Total vascular isolation (TVI) may be used to minimize blood loss in difficult hepatic resection cases. STUDY DESIGN: We reviewed our criteria for use of TVI and our experience in 43 patients who underwent hepatic resection for benign lesions between January 1990 and January 1995. Total vascular isolation was used in 23 patients; 20 resections were performed without TVI. RESULTS: We found TVI particularly useful for resection of highly vascular lesions, and lesions located centrally or adjacent to major vessels. The use of TVI reduced blood loss in difficult hepatic resections; transfusion requirements for these patients were similar to requirements for the resection of peripheral lesions. Fewer complications directly related to hepatic resection were encountered in the TVI group. CONCLUSIONS: Appropriate use of TVI will improve results after difficult hepatic resections and allow maximal sparing of normal hepatic tissue when operating on benign lesions.

Adolescent↗
PubMed1996

[Possibilities and limitations of curative resections in cancers of the pancreas].

Univariate and multivariate analysis was used to assess the potential and limitations of curative resection in cancer of the pancreas. From 1971 to 1993, we operated 466 patients with cancer of the pancreas, using tumor resection in 192 cases. Among these, 40% required resection of the vessels or neighboring organs allowing RO resection in 85% of the patients. The most valuable prognostic factor was curative resection, followed by tumor grading and tumor size. Non-curative tumor resection did not improve survival over exploratory laparotomy or palliative anastomoses. Operative mortality after resection was lower than for procedures leaving the tumor in situ. Extended resection with vessel resection had no effect unless combined with local curative ablation, but cannot be indicated in cases with synchronous metastases or invasion of the neighboring organs. Preoperative explorations do not provide a precise indication of extension in cancer of the pancreas which can only be evaluated in an open procedure by an experienced surgeon.

Adenocarcinoma↗
PubMed1996

[Surgical therapy and prognosis of not curatively resectable rectum carcinoma. Results of a multicenter study of the Colorectal Carcinoma Study Group].

The prospective multicenter observation study of the SGCRC found in 1121 rectal carcinomas a resection rate of 94.2% with 79.1% curative resections (R0), 3.1% R1 resections and 11.7% R2 resections. The reasons for non-curative resections were multimorbidity preventing tumor resection, distant metastasis or locally advanced primary tumors. The prognosis following non curative surgery for rectum carcinoma depends on resectability, synchrone distant metastases and R classification (according to UICC). Additional therapy (chemo- and radiotherapy) may improve short time survival after non-curative resections in presence of distant metastases. After non-resective surgery local tumor destruction (laser, kryotherapy) is possibly an useful additional therapy. The indications for multimodal therapies are discussed and the development of uniform therapeutical strategies is required.

Adult↗