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PubMedDate not supplied

[Colorectal liver metastases resected with safe margin achieved by tissuelink monopolar floating ball].

BACKGROUND: Nowadays many technological devices are present in hepatic surgery to permit safer liver resections. Main purpose is decrease the intraoperative blood loss. The aim of this study is to analyze our initial experience in hepatic resections for liver metastasis using the new water-cooled, high-density, monopolar device, the Tissuelink Monopolar Floating Ball and Dissecting Sealer (Tissuelink Medical, Inc., Dover, NH). MATERIALS AND METHODS: We analyzed patients who underwent hepatic surgery for metastases from colorectal cancer between January 2003 and December 2004. Sex, age, type of surgical procedure, duration of the surgical procedure, blood loss, use of vascular clamping of the liver, length of hospital stay, morbidity, and mortality were analyzed. RESULTS: Three liver resection, one segmentectomy and two limited resections were performed with the use of these new devices. In one case the devices was used to increase safe free margin of hepatic resection. Average blood loss was 150 ml (range, 50 to 300 ml). No mortality or morbidity were recorder. CONCLUSIONS: In conclusion, this new device permits a bloodless liver resection avoiding vascular clamping. In plus the effect of radiofrequency waves can be useful to enlarge free resection border in patients submitted to hepatic resection without macroscopically safe margins. Prospective randomized studies are needed in order to establish the effective usefulness.

Aged↗
PubMed2006

[Resection for lung cancer invading the superior vena cava].

OBJECTIVE: To analyze the feasibility and the value of resection for lung cancer invading the superior vena cava (SVC). METHODS: Between 1988 and 2005 the data of 31 patients who underwent resection were analyzed retrospectively. The reconstruction was done using simple suture, pericardial patch or prosthetic replacement. Postoperative morbidity, long-term survival were examined using the Kaplan-Meier method (Log rank test) and the COX model for survival. RESULTS: Seventeen squamous cell carcinomas, 8 adenocarcinomas, and 6 undifferentiated small cell carcinomas were resected. There were 13 partial SVC resection, the reconstruction was done using a simple running in 5 patients, and a pericardial patch in 8 patients. Eighteen patients underwent complete resection of SVC with prosthetic replacement. The time of clamping the SVC system was from 8 to 35 minutes for complete resection patients, while the time was from 3 to 15 minutes for partial resection patients. One patient didn't clamp the SVC. Postoperative morbidity and mortality were 48% and 0%, respectively. One, 3 and 5-year survival rates were 61%, 33% and 21%, respectively, with median survival at 31 months. Survival rate of patients with N2 disease was obviously lower than those with localized (N0/N1) nodal disease (chi2 = 14.3, P = 0.000), the median survival was 42 and 13 months respectively. There were no significant effects on overall survival with pathologic features and surgery methods. Survival rate of patients with induction chemotherapy before operation or intraoperative chemotherapy was higher than those received direct surgery (chi2 = 5.0, P = 0.025), the median survival was 39 and 14 months respectively. CONCLUSIONS: The resection of the SVC for involvement by lung cancer can be performed in selected patients, especially for those with localized (N0/N1) nodal disease. Induction chemotherapy should be performed.

Adult↗
PubMed2006

[Functional outcome following shoulder tumor resection and reconstruction].

OBJECTIVE: To analyze the long-term limb sparing outcomes of various reconstructive procedures and complications associated with extensive excision in bone tumours of the shoulder girdle. METHODS: Shoulder reconstruction following resection of bone tumors of the shoulder girdle was reviewed retrospectively for 32 patients at the Wesley Hospital or Princess Alexandra Hospital. The reconstructions were including arthrodesis (8 cases), allograft-prosthetic composite (7 cases), spacer (6 cases), no bone reconstruction (5 cases), prosthesis (3 cases), vascular fibular graft (2 cases) and allograft (1 case). RESULTS: The average duration of follow-up was 81 months for the 23 patients who were still alive at the time of the latest follow-up examination. Functional results were related to the type of resection and the method of shoulder reconstruction. After intra-articular resection of the proximal humerus with loss of the abductor mechanism, arthrodesis resulted in 87% functional score and more strength was found after reconstruction with prosthesis or allograft-prosthetic composite. Allograft-prosthetic composite had better function (Score 79%) than prosthesis alone after intra-articular resection of the humerus because reconstruction of the deltoid and the rotator cuff could be performed without increased prevalence of complication related to the allograft. After extra-articular resection of the glenoid cavity and the proximal humerus with abductor mechanism, reconstruction with a functional spacer frequently resulted in superior subluxation of the implant and only fair function (Score 66%) of the shoulder. With two teen-aged patients, a free fibular graft inserted after intra-articular resection of the proximal humerus led to fair function (Score 73%), to be followed by secondary arthrodesis when growth was complete. CONCLUSIONS: Indications for the method of reconstruction depend on type of resection, age, gender, occupation, the expected functional level and restriction of activity. After resection of the abductor mechanism, arthrodesis results in more strength and is the preferred option for the young active demanding patients. If the abductor mechanism is preserved, allograft-prosthetic composite gives good results.

Adolescent↗
PubMed2006

[Resection and reconstruction for tumors of iliac bone].

OBJECTIVE: To discuss the resection of tumors, reconstruction of defects. METHODS: Sixty-one patients with tumors in ileum were treated surgically in People's Hospital from July 1998 to July 2004. The series comprised 38 males and 23 females with an average age of 43 years old (range from 12 to 78 years old). According to Enneking staging system, 36 cases had lesions in region I, 17 cases in region I and II, and 8 cases in region I and IV. After tumor resected, posterior fixation system of spine was applied to reconstruct the integrality of pelvic ring in series of region I cases. The four pedicle screws were implanted in the lumbar and sacrum superiorly, pubis and ischium inferiorly. For children patients, bone graft or bone cement and Steinmann's pins internal fixation was applied to reconstruct the pelvis. RESULTS: Among all the 61 cases, 48 cases followed up from 16 months to 6 years. Thirty-three cases were survived and had no local recurrence or metastasis. Fifteen cases were dead. Oncology result: local recurrence were found in 19.4% patients with region I resection (7/36), the resection level was close to acetabulum (in order to reserve the acetabulum), and it might be the reason of recurrence. 35.3% of patients (6/17) with region I and II resection had local recurrence, the recurrence maybe related to residual tumor after curettage. 50.0% of the patients (4/8) with region I and IV resection had local recurrence, the tumor residual in sacrum might be the reason of recurrence. Functional result: all of the 36 cases received region I resection regained normal walking function. The hip joint function was normal in 17 cases received tumor curettage, bone cement or hip joint replacement. CONCLUSIONS: The posterior fixation system of spine can be used to reconstruct the integrality of pelvic ring after resection of iliac tumors. Simple reconstruction is more favorable for child patients. Allograft or self-ileum can be implanted in the space of sacral wing and residual ileum, and the bone graft is fixed with compressional screw.

Acetabulum↗
PubMedDate not supplied

Decreased interstitial cells of Cajal in the neorectum after anterior resection of the rectum.

BACKGROUND/AIMS: Patients who have undergone anterior resection for rectal carcinoma often complain of anorectal and defecatory dysfunction postoperatively. The aim of this study was to examine the expression of interstitial cells of Cajal (ICCs) in the sigmoid colon used for constructing the neorectum after anterior resection of the rectum. METHODOLOGY: As the neorectum group, we assessed 12 patients with local and anastomotic recurrence or new neoplasm in the neorectum after anterior resection of the rectum. The control group consisted of 16 patients who underwent sigmoid colon resection for sigmoid colon carcinoma. All resected specimens were investigated with immunohistochemical staining, using c-kit antibody for ICCs. The correlation between the number of ICCs and defecatory symptoms was assessed for the neorectum. RESULTS: The total number of ICCs significantly decreased in the neorectum group as compared to the control group. In particular, a significant difference was noted between the two groups as to the number of ICCs found between the layers of the myenteric plexus in histological studies, as well as in the circular and longitudinal muscles. There was no correlation between the number of ICCs and the time interval from the initial anterior resection to the resection of the neorectum, nor was there any relationship between the number of ICCs and defecatory symptoms. CONCLUSIONS: The expression of ICCs in the neorectum was reduced in the early stages after anterior resection of the rectum. Expression of ICCs in the neorectum did not recover to preoperative levels over time.

Adult↗
PubMed2006

A single-centre experience of 40 laparoscopic liver resections.

OBJECTIVE: To review results of laparoscopic liver resections, particularly in those patients with hepatic malignancy and recurrent pyogenic cholangitis. DESIGN: Retrospective analysis. SETTING: Minimal access surgery training centre, Hong Kong. PATIENTS: Patients with pathologies located at anterio-inferio-lateral segments (Couinaud segments 2, 3, 4b, 5, 6) for laparoscopic resection were recruited during the period 1998 to 2005. Patients were excluded from review if they had: pathologies at central locations and the superior and posterior segments (4a, 7, 8), large tumours (>5 cm in diameter), and those close to major vasculature or the liver hilum. RESULTS: During the study period, we attempted 40 such laparoscopic liver resections, excluding marsupialisations and resections for simple liver cysts. There were 20 female and 20 male patients, with a mean age of 57 (standard deviation, 13; range, 29-81) years. All but one underwent a successful laparoscopic operation. Pathology included hepatocellular carcinoma (n=17), recurrent pyogenic cholangitis (n=14), colorectal liver metastasis (n=4), benign liver tumour (n=4), and intrahepatic cholangiocarcinoma (n=1). All except four were hand-assisted laparoscopic liver resections. The mean operating time was 169 (range, 60-290) minutes and mean blood loss amounted to 270 mL (range, 0-1000 mL). Complications occurred in eight (20%) patients, which included six wound infections, one postoperative bile leak, and two incisional hernias. There was no operative or hospital mortality. For hepatocellular carcinoma, clear resection (>10 mm) was achieved in all except five patients, and the 1-year and 2-year survival rates were 86% and 59% respectively. Favourable results were also obtained for resections in patients with recurrent pyogenic cholangitis; after a mean (standard deviation) follow-up of 29 (23) months, only one was readmitted (for cholangitis). CONCLUSION: In appropriately selected patients, laparoscopic liver resection is feasible and safe, and achieves acceptable survival among individuals with hepatic malignancy and very favourable long-term outcomes in those with recurrent pyogenic cholangitis undergoing hand-assisted laparoscopic segmentectomy.

Adult↗
PubMed2007

[Endoscopic resection for early gastric cancers by EMR/ESD].

The key issue in the field of therapeutic endoscopy in recent years is the development of a new therapeutic strategy for early gastric cancers using endoscopic submucosal dissection (ESD) technique. ESD was developed to overcome the problem of remnant or recurrent tumors after incomplete resection by conventional endscopic mucosal resection (EMR). Ever since after the emergence of ESD, indication criteria for endoscopic resection of early gastric cancers were extended through expansion of both theoretical and technical conditions. Complete en bloc resection rates were 96.7% and 62.6% in the ESD group and the EMR group, respectively, in our institution. ESD is a highly effective technique enabling us to resect much larger and difficult lesions, which cannot be resected by conventional EMR techniques. However, it involves a much higher complication rate and requires much higher skills. A small lesion less than 20 mm located in a good position can be resected completely, without any difficulties using conventional EMR techniques. Therefore, we must consider the approach to treatment, when conducting an endoscopic resection,it terms of the situation and skills of the endoscopist.

Digestive System Surgical Procedures↗
PubMed1991

Surgical indication and significance of portal vein resection in biliary and pancreatic cancer.

Tumor and vascular resection was carried out in 27 patients with biliary and pancreatic cancer. Vascular resection included resection and reconstruction of the both the portal vein and hepatic artery in two of the patients. Portal vein resection only was carried out in 23 patients, and resection of the side wall and plasty of the portal vein was carried out in the other two patients. The technical limit of portal vein resection without graft was 4 cm in the hepatic hilus and 7 cm after total pancreatectomy or pancreatoduodenectomy without grafts. On temporary occlusion of the portal vein between resection and reconstruction, simple occlusion was sufficient if it occurred within 30 minutes. In occlusion of more than 30 minutes, simultaneous occlusion of the superior mesenteric artery is better to prevent congestion of the intestine. If occlusion of more than 60 minutes is anticipated, a bypass between the superior mesenteric vein and the femoral vein with Anthron tube is recommended. The postoperative course was uneventful in 20 of the 27 patients. Two patients died within 1 month after surgery. The mortality rate for this aggressive surgery was 8.4%. Minor complications such as hydrothorax, small bile leakage, and localized abscess were observed but soon subsided in five patients. Fourteen of 27 patients survived or are alive after more than 1 year, and 9 of 14 patients survived or are alive after 2 years. Forty-seven percent of the patients who had no lymph node metastasis or peritumor lymph node metastasis without cancerous invasion of the portal vein intima survived more than 2 years. The longest length of survival of a patient with nonfunctioning islet cell carcinoma of the pancreatic head was 5 years 9 months. The longest surviving patient with ductal cell carcinoma of the pancreas is still living after 4 years. This approach is recommended in certain patients with vascular involvement but without lymph node metastasis or those patients with only peritumor lymph node involvement. Frozen section of mesenteric and paraaortic nodes should be standard practice before this aggressive resection.

Adult↗
PubMed1991

[Controlled study of cremaster resection in Shouldice repair of primary inguinal hernia].

237 Shouldice operations with resection of the cremaster muscle from the Department of Surgery of the RWT University of Aachen were compared with 153 Shouldice repairs without resection of the cremaster muscle from the Department of Surgery of the Elizabeth Hospital in Essen. The aim of this prospective controlled trial was to determine the value of the resection of the cremaster muscle in Shouldice's hernia repair. A comparable follow-up of 12 to 26 months in both groups revealed no significant differences in early-postoperative complications. In the group without resection of the cremaster muscle the incidence of chronic inguinal pain was reduced. However, avoidance of the cremaster resection is not advisable because it leads to atypical indirect recurrences and totally higher recurrence rate (2.6%), so four indirect recurrent hernias were diagnosed. In the group with resection of the cremaster muscle no indirect recurrent hernia was detected, only one direct recurrent hernia was documentated. The significantly elevated rate of recurrent hernias (p less than 0.05) and the occurrence of atypical indirect recurrent hernias in the group without resection of the cremaster muscle demonstrates the important influence on the technique of repair. Based on our results the resection of the cremaster muscle is an essential part of Shouldice's hernia repair.

Adult↗
PubMed1991

Limited resection for Stage I lung cancer.

We have reviewed our experience of limited resections for Stage I lung cancer for the years 1971-88. Sixty-one cases of sublobar resection (wedge or segmental) were compared with 411 lobar resections (lobectomies or bilobectomies), performed over the same period. Operative mortality was 0% in the limited resection group and 3% (12/411) in the control group. Cancer recurrence was detected respectively in 36% and 38% of patients, and actuarial survival at 5 years was 55% versus 49% overall. Sublobar resection had a slightly better outcome than lobar resection in pathological T1 (5-year survival of 73% vs 55%) but a worse outcome in pT2 (35% vs 46%); however, none of the differences was statistically significant. In 28 patients with pre-existing cardiac or pulmonary co-morbidity, limited resection yielded the same 5-year survival as lobectomy (53% vs 51%) with no peri-operative deaths (0 vs 5%). Although derived from a retrospective analysis, these data offer a further confirmation that limited resection combined with adequate nodal staging is a reliable and effective technique for early stage lung cancer management.

Aged↗
PubMed1991

[T4 advanced lung cancer: results of surgical treatment and indications of surgical resection].

A total of 1,289 patients with primary lung cancer were surgically treated at our hospital from January 1953 to December 1985. Surgical treatment for T4 lung cancer was studied in 93 patients who had pulmonary resections. The relationships between histologic type, stage, method of resection, curability, nodal involvement, pleural involvement, site of invasion, pleural metastasis, pleural effusion, combination therapy, and the survival rate were analyzed. The survival rate of 93 patients with T4 lung cancer was 17% at 3 years and 7% at 5 years. Three-year survival rate of 39 patients with adenocarcinoma, 34 patients with squamous cell carcinoma, and 9 patients with large cell carcinoma was 7%, 23%, and 14%, respectively. Two-year survival rate of 6 patients with small cell carcinoma was 17%. Four-year survival rate of 14 patients who had complete resection was 33%. On the other hand, four-year survival rate of 77 patients who had incomplete resection was 7%. Three-year survival rate of 6 patients with N0 disease, and 19 patients with N1 disease, 46 patients with N2 disease, and 22 patients with NX disease was 40%, 39%, 0%, and 15%, respectively. Two patients, who had partial resection of the left atrium because carcinoma made an invasion upon it, had survived more than 5 years. All patients with esophageal invasion or tracheal invasion had died within a year. Indications of surgical resection for patients with T4 lung cancer should be limited to patients with N0 and N1 disease. Radical pulmonary resection can be performed in patients who are expected to have complete resection.

Adult↗
PubMed1991

[The value of differentiated transurethral resection in primary superficial bladder cancer].

In a prospective study the efficacy of transurethral resection (n = 60) and differentiated resection (n = 66) in primary superficial bladder cancers was evaluated for persistent tumors and recurrences. At the control examination after 8 weeks an persistent tumor was found in 18.3% of cases after simple resection and in 9.1% after differentiated resection. The frequency of recurrences after a follow-up period of 3 years was 40% after simple resection and 27% after differentiated resection. The necessity of a third resection for complete removal of the tumor was shown in 12.1% following differentiated resection. Understaging or undergrading was detected in 3% with this method.

Aged↗
PubMed1990

Repeat hepatic resections for colorectal metastases.

We identified 106 patients who had undergone complete resection of isolated colorectal hepatic metastases. Nine of these patients subsequently underwent repeat liver resections for isolated hepatic recurrences. The median follow-up for these patients was 21 months. One postoperative death was related to the second hepatectomy. At the time of last follow-up, five patients were alive and free of recurrent disease at 9, 19, 31, 50, and 67 months after their second hepatic resection. The remaining three patients were alive, but disease had recurred 11 months after resection in the first patient, 12 months after resection in the second, and 18 months after resection in the third. Among these three patients, two had solitary pulmonary nodules, which were resected, and one had unresectable liver disease. Our experience and a review of the literature suggest that repeat hepatic resection for isolated colorectal metastases can result in long-term survival in selected patients.

Colonic Neoplasms↗
PubMed1990

Electrolyte transport in rat colon: comparative effects of intestinal resections and bypass.

In the present study the influence of different types of intestinal resection (50% distal and 50% proximal small bowel resection) and bypass (50% jejunoileal bypass) upon water and electrolyte (Na and K) colonic transport was examined. Four weeks after resections and bypasses no significant changes in wet and dry tissue weights, serum sodium and potassium values were found in comparison to sham-operated controls. In vivo net absorption of sodium, measured in micromoles of 22Na+ which disappeared from the medium during a determined period (15, 30, 45 and 60 min), in sham-operated animals, showed a gradual increase with the increase in the perfusion time, rising from 144 +/- 20 mumol at 15 min of perfusion to 425 +/- 28 mumol at 60 min. One month after the resection, Na absorption, expressed as total absorption and as micromoles per square centimeter, was not significantly modified in animals distally and proximally resected, but did significantly increase in bypassed rats with respect to sham-operated animals. When the results were calculated taking into account the tissue wet weight, the values of the resected rats continued to show no modifications; however, there was a compensation in the bypassed rats. These data demonstrate that the increase in the absorptive capacity of the colon in bypassed rats is due to morphological changes, which could originate from the trophic influence of enteroglucagon or from the effect of the secretions which flowed directly into the colon from the blind loop, an action which does not occur in resected rats. The effects of resection and bypass upon K+ colonic secretion showed no significant differences among the groups studied.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1990

[Clinical studies on reconstruction procedure of total layer chest wall resection].

The results of clinical studies on 16 reconstruction procedure after total layer chest wall resection in 14 cases of malignant tumor of the chest wall were reported. The 14 cases consisted of two cases with recurrent primary chest wall tumor, two cases of primary breast cancer, seven cases of recurrent breast cancer, and others. The reconstruction procedure after total layer chest wall resection was conducted using only various myocutaneous flaps (eight cases using latissimus dorsi of the resected side, three cases using the abdominitis of the resected side, three cases using latissimus dorsi of the non-resected side, and two cases using a pectoralis major myocutaneous flap of the non-resected side). reconstruction only using a myocutaneous flap proved to be satisfactory for preventing early stage postoperative respiratory distress and maintaining the stability of the chest wall and respiratory function during prolonged observation. Namely, use of myocutaneous flap is the best approach of reconstruction the chest wall after total layer chest wall resection. We confirmed that reconstruction with latissimus dorsi myocutaneous free flap of the non-resected side with microvascular anastomosis of thoracodorsal vessels was useful for posterior chest wall tumors invading the latissimus dorsi muscle. Also, our results demonstrated the insertion of an omental flap under the myocutaneous flap was useful for cases with secondary chest wall infection or vascular damage caused by preoperative high dose irradiation.

Adult↗
PubMed1990

Quality of life and functional results following different types of resection for gastric carcinoma.

In order to evaluate quality of life and functional results following surgery for gastric cancer we studied 89 patients with no evidence of disease at a minimum of 12 months postoperatively. Patients were treated with total gastrectomy and jejunal pouch reconstruction according to Hunt-Lawrence-Rodino (n = 59), distal gastric resection (n = 21) or proximal gastric resection (n = 9). No significant differences were found between total gastrectomy or distal gastric resection with respect to dumping or heartburn, while patients with proximal gastric resection suffered from both. The latter group of patients reported both reduced feelings of hunger and appetite, resulting in a reduced nutritional status. Similar differences were observed when patients were assessed for quality of life; feeling well, feeling ill and capacity to work were all reduced in patients with proximal gastric resection, and their scores were lower when scoring systems according to Visick, Karnofsky, Spitzer and Troidl were applied. Psychological-rating scales measuring complaints and distress confirmed the superiority of total gastrectomy with pouch reconstruction or distal gastrectomy compared to proximal gastric resection. We conclude that in terms of postoperative quality of life, distal gastric resection has no advantage over total gastrectomy with pouch reconstruction. Proximal gastric resection incurs bothersome sequelae and should, therefore, be avoided.

Aged↗
PubMedDate not supplied

[Role of abdominoperineal resection in the surgical treatment of cancer of the rectum].

The respective indications for abdomino-perineal amputation and colorectal resection are being debated, especially in the treatment of mid-rectal cancer. We report a series of 242 patients operated on for cancer of the rectum, including 200 who underwent tumor resection, which aimed to be curative in 162 cases. In the choice of intervention we took into account the possibility of keeping a distal margin of security of at least 2 cm when carrying out the resection. The size of the tumor, its staging and degree of differentiation did not influence our choice. Operative mortality was 9.8% for amputations and 5.3% for resection; deaths occurring in patients over 65 years and in only two cases for specific reasons. Local recurrence developed in 16.3% of amputations and in 12.5% of resections. For the mid-rectum these percentages were respectively 20 and 10.7%, though this difference may partially be explained by a greater number of patients with Dukes stage C, among the patients undergoing amputation. Five year survival was 56.8% for amputation and 63.2% for resection. We therefore feel that abdomino-perineal amputation does not produce a better tumor clearance than resection, and that it should currently only be proposed in cases where a resection with a satisfactory margin of security cannot be ensured.

Follow-Up Studies↗
PubMed1989

Hepatic resection for secondary tumours.

The role of liver resection for secondary tumours is reviewed, with particular reference to secondary disease from primary colorectal cancer. While there are no controlled trials producing direct evidence of improved survival following resection, figures on five year survivors without resection are anecdotal. Numerous series now report five year survival of up to 50% following resection, instances of five year survival without resection are now fallen to around 5% in most major series. Factors which adversely affect survival after resection seem to be poor tumour clearance, number of metastases and possibly Dukes' C primary tumours. Other factors, including the extent of resection and size of the tumour, may affect perioperative morbidity and mortality but should not influence long-term survival. Resectional treatment is rapidly gaining an established position in the treatment of colorectal secondaries, and may be considered also for some non-colorectal lesions, particularly endocrine tumours.

Colorectal Neoplasms↗