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At least 127 records · Page 7Linked to original sources
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↗
PubMedDate not supplied

[The limits of saving the extremity--amputation versus resection].

On the basis of the extensive data contained in the Vienna Bone Tumor Register, i.e. 839 primary malignant bone tumors, as well as of 554 cases treated at the Orthopedic Department of the University of Vienna Medical School, a comparison between the methods of surgery applied at pelvis and extremities during the past two decades can be drawn. Resectional therapy had been performed in twice as much patients as amputation therapy, and barely 20%, mostly with multiple metastases, had been merely treated with palliative surgery or were just biopsied and underwent chemo- and radiotherapy. An analysis of amputations and resections, subdivided into pelvis and sacrum resections, resectional reconstructions and resectional reimplantations at the extremities, shows approximately the same low incidence of local recurrences in the groups amputation versus resection, but a significantly higher involvement of pelvis and sacrum resections as well as no local recurrences in the group of 48 resectional reimplantations. As regards the oncologic radicality of surgical margins, in cases of resections, as compared to amputations, about twice as much inadequate operations had to be accepted, though. The fact that the local recurrences did not increase to the same degree, but were approximately equilibrated, seems to be due to the new chemotherapeutic treatment which had been initiated at the same time as the frequent application of resectional therapy. The conservation of extremities contains twice as high a risk of inadequate operation, but it is, in cases of effective chemotherapy, comparable with the former results of amputations, as regards local recurrences.(ABSTRACT TRUNCATED AT 250 WORDS)

Amputation, Surgical↗
PubMed1989

Concomitant abdominal aortic aneurysm and colorectal carcinoma: priority of resection.

Seventeen patients (15 men and two women) underwent operation for concomitant abdominal aortic aneurysm (AAA) and colorectal carcinoma (Ca) during a recent 12-year period. Ages ranged from 59 to 89 years (median 75.2 years). Diameter of the AAA ranged from 3.5 to 9.5 cm (median 5.5 cm). The Ca was staged by the Astler-Coller modification of Dukes' classification as B1 in three patients, B2 in eight, C2 in three, D in two, and unclassified in one. Personal preference, presence of symptoms, and extent of malignant involvement determined preference of resection. The Ca was eventually resected in 16 patients and the AAA in nine. Thirteen patients underwent resection of the Ca first, two the AAA first, and two concomitantly. Eight patients (47%) underwent resection of both the AAA and Ca, eight underwent resection of the Ca only, and one underwent resection of the AAA only. There were three deaths in 24 operations. Follow-up ranged from 5 weeks to 8 years (median 1 1/2 years). Only five patients (29.4%) were long-term survivors without evidence of recurrent Ca and all occurred in the eight patients (62.5%) who had undergone resection of both the Ca and AAA. Three late deaths occurred as a result of complications from the unresected AAA in the eight patients who had undergone resection of the Ca only (37.5%). We conclude that if the Ca is not symptomatic and localized the AAA should be resected first. However, both lesions need to be resected eventually for long-term survival.

Aged↗
PubMed1985

Resection of rabbit ileum: effect on brush border membrane enzyme markers and lipids.

Alterations in transport function have been described 6 weeks after surgical resection of 50% of the distal small intestine. Previous studies demonstrated a modest increase in the jejunal uptake of medium chain length fatty acids following resection, while the uptake of many other lipids (cholesterol, bile acids, fatty alcohols, short and long chain length fatty acids) appears to be unaffected. Marked changes in the kinetic constants for the carrier-mediated uptake of four sugars and leucine were observed following resection, but the changes in transport were not associated with changes in the mucosal surface area. This study was undertaken to examine the possible adaptive mechanisms that occur with ileal resection in the rabbit. A 29% increase in the wet weight of jejunal mucosal scrapings and a 53% increase in jejunal brush border membrane (BBM) protein was observed following resection. The jejunal BBM sucrase (S) was unchanged following ileal resection, but alkaline phosphatase (AP) total activities were increased in the resected rabbits. This resulted in a 45% increase in the ratio of AP/S with resection. The lipid composition (total free fatty acids, total bile acids, total cholesterol, total phospholipids, individual phospholipids, and the ratio of total phospholipids/total cholesterol) of BBM was similar in control and resected rabbits. This suggests that quantitative rather than qualitative changes in the membrane composition may be responsible for the transport changes observed in resected animals.

Animals↗
PubMed1991

[Influence of 50% proximal or distal small bowel resection on gut hormone release after test meal loading in dogs].

The effect of proximal and distal small bowel resection on gut hormone release after test meal loading in dogs was studied. Ten beagle dogs were subjected to 50% proximal or distal small bowel resection, and test meal loading was performed after one night fasting to examine gut hormone release. Fasting levels of plasma gastrin were not changed after both proximal and distal resection, but response to test meal was increased at 18 weeks of postoperative period in 50% proximal resection. Postprandial release of plasma GIP was significantly decreased in both proximal and distal resection compared with preoperative period. Postprandial release of enteroglucagon was increased at 4 and 8 weeks in proximal resection. In distal resection, it was increased at 4 weeks but returned to preoperative levels at 8 weeks. Villus height of middle part of the intestine was increased in both proximal and distal resection, and significant change was observed in the duodenal mucosa of proximal resection at 4 weeks. These findings suggest that part of the resection of small bowel influences gut hormone release, and these may play an important role in intestinal adaptation.

Adaptation, Physiological↗
PubMed1988

[Endoscopic resection with local injection of hypertonic saline epinephrine for the treatment of early gastric cancer].

We have developed a new method of endoscopic resection of early gastric carcinomas and other tumors. Characteristics of the new method are summarized as follows. 1. In order to prevent bleeding after endoscopic resection of the tumors, local injection of hypertonic saline epine phrine (HSE) solution was applied to the lesion. Even a depressed lesion like II c type early gastric carcinoma was artificially protruded by local injection of HSE solution. 2. Instead of a single fiberscope, double fiberscopes were employed simultaneously for endoscopic resection of the lesion. 3. Prior to resection of the lesion by high frequency current snare method, incision of the mucosa along the marking line around the lesion performed, enabling the area to be resected precisely. 4. Because tissue damage is mild, resected materials removed are suitable for pathological study. Endoscopic resection was performed on a total of 113 cases in early gastric carcinomas; 103 cases among them (91.2%) were curative resections. Ten cases of the rest underwent surgical gastrectomy for the endoscopic non-curative resections. Rate of five-year survival in 103 cases was 85.2%. Endoscopic resection by our method seems to be effective for the treatment of early gastric carcinomas in any lymph node metastasis and in patients at high surgical risk.

Epinephrine↗
PubMed1976

Role of fat maldigestion in pathogenesis of steatorrhea in ileal resection. Fat digestion after two sequential test meals with and without cholestyramine.

To clarify the role of fat maldigestion in the pathogenesis of steatorrhea in patients with ileal resection the total and aqueous phase concentrations of bile acid and fatty acid were characterized in 8 such patients (5 patients with small ileal resection, bile acid diarrhea, and steatorrhea less than 20 g per day; 3 patients with large ileal resection, fatty acid diarrhea, and steatorrhea greater than 20 g per day) as well as 4 healthy control subjects after a morning and an afternoon liquid test meal. The study was then repeated with cholestyramine, 4 g being administered before each meal to induce fat maldigestion. After a conventional test meal, patients with large resections and severe steatorrhea had significantly lower aqueous phase concentrations of bile acids (and fatty acids) than patients with smaller resections or control subjects, explained in part by intraluminal precipitation of about one-half of the bile acids during digestion. When cholestyramine was administered before the meal, aqueous phase bile acid concentrations decreased in all patients, including the normal control subjects; the degree of fat maldigestion induced in the patients with small resections (and the control subjects) became similar to that present after the conventional test meal in the patients with large resections. Because steatorrhea increased little in the patients with small resections when cholestyramine was administered continuously, the data suggest that fat maldigestion per se does not induce severe fat malabsorption in patients with sufficient anatomical reserve, because such patients can absorb fat efficiently by utilizing the distal small intestine. In patients with large ileal resections, severe steatorrhea is explained in part by the combination of fat maldigestion and decreased surface area. It is also speculated that the steatorrhea occurring in patients with small resections and relatively normal fat digestion during two test meals may be explained by impaired fat digestion which occurs during the final meal of the day, which is often the largest meal.

Adult↗
PubMed1987

Composite pelvic resection. An approach to advanced pelvic cancer.

The definition of resectability has changed in the management of advanced pelvic malignancy. Most tumors previously considered unresectable can be removed by a function-preserving composite resection of the pelvis. We have performed resection in 55 such patients. Most had posterior pelvic tumors (47 patients), had previously undergone irradiation, and required a combined sacral resection. Included were patients with recurrent or locally advanced rectal cancer (32 patients), epidermoid cancer of the anorectum (seven patients), and primary pelvic malignancies (eight patients). Most had good functional recovery. The five-year actuarial survival rate was 23% (five of 25 patients survived longer than 51 months) in the patients with resected rectal cancer and 14% (one of seven patients) in the patients with resected anorectal carcinoma. Five of eight patients with primary tumors survived longer than 48 months. Lateral pelvic resections were done for five tumors that involved the ileum or ischium, and anterior resection was done in three patients for malignancy that involved the symphysis and rami. Four of these patients were living three to six years after surgery. The overall mortality rate was 7% (four of 55 patients). Composite pelvic resections can provide good local control with preservation of limb function in most patients with primary or secondary tumors of the bony pelvis.

Adult↗
PubMed1989

Resectability of large focal liver lesions.

Despite modern imaging techniques evaluation of the resectability of large focal liver lesions is often difficult or impossible until the time of operation. Based on experience with 54 primary or secondary focal liver tumours, a simple morphological classification has been found to be reasonably predictive of resectability. All tumours were classified before operation using computed tomography, ultrasound and angiography; 38 patients underwent laparotomy. Dependent, 'hanging' tumours (n = 7) were resected in six cases, expansively growing 'pushing' tumours (n = 19) were resected in 18 cases, and infiltrating, 'invasive' tumours (n = 17) were not resected because of involvement with major vascular structures. Eleven small tumours (less than 5 cm) were not classifiable by this system. This simple classification may be a useful clinical concept in preoperative assessment of resectability of focal liver lesions. Hanging tumours should always be resected, and large expansile tumours are generally resectable despite their size. Invasive tumours can only be resected in exceptional cases.

Humans↗
PubMed1992

Anterior resection without a defunctioning colostomy: questions of safety.

The need to defunction the anastomosis at anterior resection remains controversial. As the policy in this unit has been not to perform a defunctioning colostomy during anterior resection, the outcome of a consecutive series of 114 anterior resections, all carried out without a covering colostomy, was studied. During the period February 1985 to September 1991, 21 abdominoperineal resections, six Hartmann's procedures and two resections with coloanal anastomosis were also performed. Within the anterior resection group six clinical leaks (5.3 per cent) occurred, all in the low anastomosis group (8 per cent leak rate) and all of which required an end colostomy. The perioperative mortality rate within the anterior resection group was 3.5 per cent; of the four deaths one was attributable to anastomotic dehiscence and sepsis and the others were due to unassociated medical conditions. The results demonstrate similar leakage and mortality rates to published studies where anterior resection is frequently performed with a defunctioning colostomy. These results indicate that the routine use of a defunctioning colostomy at anterior resection should now be questioned.

Adult↗
PubMed1992

Survival after hepatic resection for malignant tumours.

A retrospective analysis of 194 patients who underwent hepatic resection for primary or metastatic malignant disease from January 1962 to December 1988 was undertaken to determine variables that might aid the selection of patients for hepatic resection. Hepatic metastases were the indication for resection in 126 patients. The 5-year survival rate was 17 per cent. For patients with resected metastases from colorectal cancer (n = 104), the survival rate at 5 years was 18 per cent. The 5-year survival rate was 27 per cent when the resection margin was > 5 mm compared with 9 per cent when the margin was < or = 5 mm (P < 0.01). No patient with extrahepatic invasion, lymphatic spread, involvement of the resection margin or gross residual disease survived to 5 years, compared with a 23 per cent 5-year survival rate for patients undergoing curative resection (P < 0.02). The survival rate of patients with poorly differentiated primary tumours was nil at 3 years compared with a 20 per cent 5-year survival rate for patients with well or moderately differentiated tumours (P not significant). The site and Dukes' classification of the primary tumour, the sex and preoperative carcinoembryonic antigen level of the patient, and the number and size of hepatic metastases did not affect the prognosis. The 5-year survival rate for patients with hepatocellular carcinoma (n = 42) was 25 per cent. An improved survival rate was found for patients whose alpha-fetoprotein level was normal (37 per cent at 5 years) compared with those having a raised level (nil at 3 years) (P < 0.01). Involvement of the resection margin, extrahepatic spread and spread to regional lymph nodes were associated with an 8 per cent 5-year survival rate versus 44 per cent for curative resection (P < 0.005). The presence of cirrhosis, the presence of symptoms, and the multiplicity and size of the tumour did not affect the prognosis. The 5-year survival rate of 11 patients with hepatic sarcoma was 25 per cent. No patient with peripheral cholangiocarcinoma survived to 1 year in contrast to patients with hilar cholangiocarcinoma, all four of whom survived for more than 14 months.

Adenoma, Bile Duct↗
PubMed1989

Preoperative total parenteral nutrition for bowel resection in Crohn's disease.

To examine the effect of preoperative total parenteral nutrition (TPN) on patients with Crohn's disease undergoing bowel resection, an historical cohort was assembled of 103 patients resected between 1982 and 1984 by a single surgical team. Preoperative, perioperative, and postoperative variables were compared between patients receiving TPN and patients not receiving TPN. Analysis was stratified for three surgical procedures: segmental small bowel resection, ileocectomy, and segmental or total colectomy The effect of TPN was most pronounced in patients having small bowel surgery. For segmental small bowel resection, 12 of 17 patients had TPN, and these patients had 20.4 +/- 14.3 cm less bowel resected than did those in the non-TPN group, an effect not dependent on duration of TPN. For ileocectomy patients, 31 of 62 patients received TPN, and these patients had 11.2 +/- 4.2 cm less small bowel resected than the non-TPN group, an effect not dependent on the duration of TPN. For large bowel resection patients, 6 of 24 patients had TPN, and there was no difference in length of bowel resection, preoperative and perioperative variables, or recurrence. The total hospital stay was 13.5 +/- 2.6 days longer for those having TPN; 3.5 +/- 1.9 days of the longer stay was postoperative. In conclusion, TPN was associated with reduced length of small bowel resection at the expense of longer hospital stay.

Cecum↗
PubMedDate not supplied

Resection combined with intraoperative radiation therapy (IORT) for stage IV (TNM) gallbladder carcinoma.

From October 1976 to May, 1990, a total of 86 patients with stage IV (TNM) gallbladder cancer were treated at Tsukuba University Hospital. Twenty-seven of the 86 patients underwent tumor resection; 43 patients received palliative surgery. The remaining 16 were too advanced to have surgery. Of 27 patients who had tumor resection, 9 had resection alone, 17 had intraoperative radiation therapy (IORT) +/- postoperative external radiotherapy (ERT), and 1 had postoperative ERT. The procedures used were: extended right hepatic lobectomy plus hepaticobiliary resection (HBR) (n = 2), hepatic segmentectomy (SIVb, SV) plus HBR (n = 9), hepatic segmentectomy (SIV, V, VI) with HBR (n = 1), hepatic segmentectomy (SIV, V) plus HBR with pancreaticoduodenectomy (PD) (n = 3), PD plus HBR (n = 1), cholecystectomy with wedge resection of the gallbladder fossa plus HBR (n = 3), and cholecystectomy plus HBR (n = 3), and cholecystectomy (n = 4). Regional lymph node dissections were performed in every patient and 17 of 27 patients underwent additional resections of adjacent organs such as the stomach, duodenum, colon, and abdominal wall. A single dose of 20-30 Gy was delivered intraoperatively for 17 patients. A mean total dose of 36.4 Gy (1.8/fraction) was added to IORT for 10 patients. The three-year cumulative survival rate was 10.1% for resection plus IORT but 0% for resection alone. The longest survivor is alive and well at 3 years and 3 patients are alive 16, 13, and 4 months after tumor resection followed by IORT plus ERT.

Adenocarcinoma↗
PubMedDate not supplied

Duodenum-preserving resection of the head of the pancreas in chronic pancreatitis with inflammatory mass in the head.

In 141 patients with chronic pancreatitis and an inflammatory enlargement of the head of the pancreas, a duodenum-preserving resection of the head of the pancreas was performed within a 16-year period. The hospital mortality was 0.7%; the late mortality was 5%. Seventy-seven percent of the patients were completely free of abdominal pain; 67% returned to their former occupation. After a follow-up period of 3.6 years, glucose metabolism was unchanged in 81.7% of the patients, in 10.1% it deteriorated, and in 8.3% it improved permanently. In patients with severe chronic pancreatitis and an inflammatory mass in the head of the pancreas, a duodenum-preserving resection of the head of the pancreas is an alternative procedure to the Whipple operation. The surgical technique of the duodenum-preserving resection includes 2 major steps: first, subtotal resection of the head of the pancreas conserving the duodenum; second, restitution of the exocrine pancreatic secretory flow from the body and tail of the pancreas by using the first jejunal loop as an interposition. In comparison to the Whipple procedure, the duodenum-preserving resection of the head of the pancreas in chronic pancreatitis spares the patient a gastric resection, a duodenectomy, and a common bile duct resection. With respect to long-lasting pain relief and preservation of the endocrine function of the pancreas, duodenum-preserving resection of the head is a highly effective surgical procedure with a low early and late morbidity and mortality due to the limited surgical resection.

Chronic Disease↗
PubMed1988

The prognostic significance of resection of primary tumor in gastric and colorectal cancer patients with synchronous liver metastasis.

The significance of primary tumor resection in gastric and colorectal cancer patients with liver metastasis (H(+)) was evaluated in terms of operative mortality and survival rate by dividing the materials [293 gastric cancer and 80 colorectal cancer patients (53 colon and 27 rectum) with synchronous liver metastasis] into the following groups: Firstly, with or without peritoneal dissemination (P), secondly, with or without resection of the primary tumor and thirdly, with or without postoperative adjuvant chemotherapy. The following results were obtained: (1) The direct operative death rate of primary tumor resection, excluding death from other causes, showed an absence of statistically significant differences between the P0H(+) and P(+)H(+) gastric and colorectal cancer patients. (2) There was no significance in the prognosis between the primary tumor resection + postoperative chemotherapy group and the non-resectable group in the P(+)H(+) gastric and colorectal cancer patients, revealing no prognostic value of the primary tumor. (3) In the P0H(+) gastric and colorectal cancer patients, the primary tumor resection + postoperative chemotherapy group was significantly more favorable in prognosis than was the primary tumor resection alone group or the non-resectable group, showing the value of primary tumor resection.

Adult↗
PubMedDate not supplied

Increased resectability of locally advanced pancreatic and periampullary carcinoma with neoadjuvant chemoradiotherapy.

A prospective neoadjuvant trial utilizing chemotherapy (CTX) and radiotherapy (XRT) prior to pancreatectomy was established to determine the feasibility of resection after aggressive pretreatment and its effect on survival. Fifteen patients with pancreatic cancer (14 head, 1 body) and 1 patient with duodenal cancer, (with paraaortic adenopathy), were subjected to combination treatment with infusional 5-FU, bolus injection of mitomycin-C, and XRT (4 patients were treated off the protocol). Patients were restaged 3 wk after XRT, and those deemed resectable underwent a pancreatic resection. Three patients did not undergo exploration after the neoadjuvant therapy, although two of these were deemed resectable by CT scan. The remaining 13 patients underwent exploration and 10 underwent resection. Three did not undergo resection because of extrapancreatic disease, although their primary tumors were resectable. One patient had no residual tumor in the specimen. The others had residual tumor with evidence of necrosis and hyalinization, but all margins were free of tumor. There were two perioperative deaths from sepsis. Of the remaining patients who underwent resection, one died of a myocardial infarction at 9 mo. One patient died with recurrent disease at 19 mo. The remaining patients are alive 40, 32, 11, 11, 10, and 4 mo since diagnosis and are currently free of disease. Aggressive neoadjuvant chemoradiotherapy can be performed safely, allows successful resection, and may yield long-term survival or curve.

Adenocarcinoma↗
PubMed1987

Sexual function after resection for rectal cancer.

Major rectal operation, that is, abdominoperineal or anterior resection, for cancer frequently damages the autonomic pelvic nerve supply with resultant sexual dysfunction. The anatomic characteristics and function of the autonomic nervous system in the pelvis has been reviewed. Sexual function after rectal excision for cancer was studied in 25 male patients who were less than 60 years of age and exhibited normal sexual activity preoperatively. Of nine patients who had abdominoperineal resection, four were impotent and two reported no ejaculation with normal potency postoperatively. Of 4 patients who had high anterior resection, only 1 reported no ejaculation, whereas of 12 patients with low anterior resection, 4 were impotent and 3 reported no ejaculation. A higher incidence of sexual dysfunction was noted after abdominoperineal resection compared with after anterior resection (66 percent and 50 percent, respectively). However, the incidence after low and very low anterior resection was comparable with that after abdominoperineal resection (58 percent and 66 percent, respectively). Advanced patient age and very low resection were the two main factors effecting sexual dysfunction after major rectal operation. Although we believe that careful operative technique might reduce the incidence of sexual disturbances attributable to sympathetic fiber damage, avoidance of parasympathetic damage during operation cannot be accomplished because the most likely site of injury, namely the periprostatic plexus, is usually within the operative field, the exception being cases in which the tumor is small, thus allowing preservation of the rectoprostatic fascia.

Autonomic Nervous System↗
PubMed1992

Indocyanine green clearance as a predictor of successful hepatic resection in cirrhotic patients.

Twenty-two cirrhotic patients who underwent hepatic resection from July 1989 to March 1991 at Vancouver General Hospital were analyzed prospectively in order to determine whether there was any preoperative evaluation of liver function that would help identify those patients who would not survive hepatic resection. Patients were analyzed on the basis of age, type of resection, and a variety of so-called standard liver function tests. In addition, all patients were evaluated preoperatively with an indocyanine green (ICG) clearance test, a relatively new test that we attempted to evaluate in terms of its role in hepatic resection in cirrhotic patients. Parametric statistical evaluation used included Student's t-test and multivariate regression, as well as discriminate analysis. The nonparametric evaluation used was the Wilcoxon rank sum test. Overall, the 30-day mortality rate was 18%, with those patients who did not survive resection having a significantly lower ICG clearance than those who underwent successful resection (p less than 0.0001). No other liver function test was useful in determining the outcome of resection. Similarly, neither age nor type of resection appeared to influence outcome. Use of discriminate analysis (p = 0.0029) allowed the identification of a cutoff point for ICG clearance below which hepatic resection should not be attempted.

Hepatectomy↗