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PubMed1989

The role of combined composite resection and irradiation in the management of carcinoma of the oral cavity and oropharynx.

Squamous cell carcinoma of the oral cavity and oropharynx can invade the mandible requiring an "en bloc" or composite resection. With this procedure alone, reported local control rates for advanced stage tumors have been suboptimal suggesting the need for adjuvant therapy. The treatment records of 35 patients were reviewed who were treated with composite resection alone, composite resection plus radiotherapy, or composite resection as a salvage procedure for a primary treatment failure. Combined irradiation and composite resection resulted in a higher local control than patients receiving composite resection alone (72% vs. 43%). There was no difference in complication rates between these two treatment groups. Composite resection as a salvage procedure resulted in local control in 38% of patients through this was associated with a 64% rate of complications. This data and a review of the literature suggest that tumors of the oral cavity and oropharynx with extension to the mandible requiring composite resection probably represent a category of tumors with a high risk of local recurrence and may benefit from adjuvant irradiation.

Aged↗
PubMed1986

The role of adjuvant therapy after resection of T1 N1 M0 and T2 N1 M0 non-small cell lung cancer.

Thirty-four consecutive patients with non-small cell lung cancer plus N1 nodal metastases (eight with T1 N1 M0 and 26 with T2 N1 M0) were retrospectively reviewed. Nineteen had adenocarcinoma, 11 had squamous disease, and four had large cell carcinoma. Eleven patients had surgical resection alone (32.3%), with a median survival of 13 months. Seven patients (20.6%) had resection followed by radiation therapy, with a median survival of 19.2 months. Sixteen patients (47.1%) had resection followed by radiation therapy and chemotherapy, consisting of cyclophosphamide, doxorubicin, methotrexate, and procarbazine. Median survival for the latter group was 45.5 months, significantly greater than for those treated with resection alone (p less than 0.005). We did not observe any relationship between survival and age, cell type, number or location of diseased hilar nodes, distance of tumor from the resected bronchial margin, tumor size, the presence or absence of visceral pleural involvement, or the type of resection performed. Resection in combination with adjuvant radiation therapy and chemotherapy offers improved median survival over resection alone in patients with T1 N1 M0 and T2 N1 M0 non-small cell lung cancer.

Adenocarcinoma↗
PubMed1988

Thymoma: results with complete resection and adjuvant postoperative irradiation in 141 consecutive patients.

A series of 141 patients with thymoma was studied with regard to the way in which complete resection followed by postoperative radiation therapy influenced prognosis according to the stage and histologic type of thymoma. Postoperative radiation therapy (30 Gy in 3 weeks to 50 Gy in 6 weeks) was performed in 73.1% of the patients. Thirty-five of 48 patients with thymoma invading the surrounding tissues (stage III) underwent complete resection, with survival rates of 100% at 5 years and 94.7% at 10 and 15 years. The prognosis in these patients was comparable with those in 45 patients with no invasion (stage I) and in 33 patients with capsular invasion (stage III), all of whom underwent complete resection. Complete resection was done in 18 of 26 patients with epithelial cell thymoma, and there were no deaths by tumor until 15 years after the operation. There were no statistically significant differences in the survival rates of patients undergoing complete resection according to cell type (33 of 36 patients with lymphocyte predominant type and 61 of 77 patients with mixed cell type). The survival rate in six patients with epithelial cell type who underwent subtotal resection was not significantly different from that of 12 patients who underwent biopsy alone. Our findings indicate that complete resection of thymoma followed by postoperative radiation therapy results in a "benign" postoperative course, regardless of the stage and histologic type. Therefore, an aggressive surgical approach, such as resection of the superior vena caval system followed by reconstruction with a ringed polytetrafluoroethylene graft and/or complete pleuropneumonectomy, is justified for advanced thymoma, although the long-term results of such extended operations are still unclear.

Adolescent↗
PubMed1987

[Mechanism of deafferentation pain--experimental research using spinal root resection model].

In rats, autotomy of the digits following dorsal root resection has been observed by many researchers and is considered as an animal model of deafferentation pain. Using C5-Th 1 root resection model of rats, we investigated the role of the ventral roots and pain experience given before deafferentation in the development of autotomy. Male Sprague-Dawley rats of eight weeks old, weighing about 200 g, were used. Animals were divided into two major groups; dorsal root resection group and total (both ventral and dorsal) root resection group. Each group was further divided into several sub-groups, according to the use of formalin injection, before or after surgery, and to the side of formalin injection, the forearm of the affected (root resection) side or unaffected side or of both sides. In pre-injection groups, 0.1 ml of 5% formalin was given subcutaneously on the forearm one hour before surgery. In the postinjection groups, formalin was given within one hour after surgery. Dorsal root resection group without formalin injection was used as control. Under anesthesia with intraperitoneal injection of nembutal, left C 5-Th 1 dorsal root resection was performed by C 4-Th 1 laminectomy and left C5-Th 1 total root resection by opening of the corresponding vertebral foramen. After surgery, we checked neurological findings, systemic condition and local changes of all the extremities everyday during the first week and once a week thereafter for at least three months. In control groups, autotomy was not observed at all during the observation period of three months.(ABSTRACT TRUNCATED AT 250 WORDS)

Afferent Pathways↗
PubMed1987

Sequential endocardial resection for the surgical treatment of refractory ventricular tachycardia.

The optimal surgical therapy for refractory ventricular tachycardia is controversial. The usual operation involves induction of tachycardia and endocardial mapping during normothermic cardiopulmonary bypass, followed by systemic hypothermia, aortic cross-clamping, and resection of the identified site of origin of the tachycardia. Our initial experience with this technique in 20 patients (mean age 60 years, mean ejection fraction 29%, mean number of failed antiarrhythmic drugs three) resulted in five (25%) surgical deaths, three caused by ventricular tachycardia and two by respiratory or heart failure. Electrophysiologic study showed that 11 of 15 survivors were free from ventricular tachycardia after operation, for a success rate in the survivors of 73%. Most failures occurred in patients with multiple tachycardia morphologies that were not eradicated by initial resection. Thereafter, the technique of sequential endocardial resection was used. After completion of endocardial mapping, directed normothermic endocardial resection is performed; more attempts to induce ventricular tachycardia are made and followed by further mapping and resection until tachycardia can no longer be induced. Fifty patients (mean age 59 years, mean ejection fraction 33%, mean number of failed antiarrhythmic drugs three) were treated by this method, with a mean of two resections per patient (range one to six). Mean perfusion time in the sequential resection group (101 +/- 28 minutes) was not significantly different from that of the earlier patients (101 +/- 40 minutes). There were four (8%) surgical deaths, one caused by persistent arrhythmia and three caused by respiratory or heart failure. Electrophysiologic study after operation showed that 40 of 46 survivors (87%) were free of ventricular tachycardia. Symptoms in the six with inducible tachycardia on postoperative electrophysiologic study were well controlled with medication. These data suggest that sequential endocardial resection guided by intraoperative mapping is a highly effective operative approach for patients with ventricular tachycardia.

Cardiac Pacing, Artificial↗
PubMed1985

[Assessment of ability to withstand lung resections and post-operative survival in patients with respiratory disorders and bronchogenic carcinoma].

Of 1192 lung resections in patients with bronchogenic carcinoma since 1952, the early post-operative mortality averaged 3.9%, whereas during the last ten years, it was 2.6% of 730 lung resections, including 159 (22%) pneumonectomies, 76 (10%) bilobectomies, 492 (67%) single lobectomies and 3 (0.4%) partial lung resections. In the latter, 352 (48.2%) and 75 (10%) had airway obstructive failure of FEV1.0 less than 70% and 55%, respectively, and, 56 (7.7%) and 9 (1%) represented preoperative hypoxia of PaO2 less than 70 torr and 60 torr, respectively. The ratios of pneumonectomies in these, being similar to those with better lung functions, the perioperative mortality was also similar. Our previously reported indices preoperatively to prove ability to withstand curative lung resections, being supported by these data, we attempted in a certain limited group of patients, extendingly to clear patients with critically poor predicted pulmonary vascular reserve pf 710-930 dyne . cm-5 . sec/m2 for lung resections, resulting in six elevenths of over one year survival. One must extend benefit of lung resection to patients with coexistence of bronchogenic carcinoma and respiratory disorder apparently severe enough to preclude resection surgery by critical assessment of the predicted pulmonary vascular reserve after lung resection.

Aged↗
PubMed1980

Gastric malignancy: resection for palliation.

One hundred and forty-four patients with gastric malignancy (98% adenocarcinoma) underwent curative resection (CR, 69 patients), palliative resection (PR, 55), or gastrojejunostomy (GJ, 20) between 1957 and 1978. Allocation to the CR or PR groups was according to the surgeon's intraoperative assessment. The extent of resection, mortality, complications, and postoperative ability to eat were reviewed in all patients. Palliation of preoperative symptoms, duration of palliation, and survival were recorded in 105 of 112 discharged and followed patients. GJ was accompanied by a 25% operative mortality rate and a 20% incidence of gastrointestinal complications. PR and CR partial or subtotal gastrectomy were associated with 15% and 21% mortality and 22% and 29% gastrointestinal complication rates, respectively. PR and CR total or proximal gastrectomy with esophagectomy were accompanied by 27% and 33% mortality and 33% and 48% gastrointestinal complications. These comparative values are not significantly different. Two thirds of all patients were able to resume a normal diet postoperatively. After GJ 80% of survivors obtained relief of preoperative symptoms for a mean interval of 5.9 months; none was alive at 1 year. After PR 88% of survivors experienced relief of symptoms for a significantly longer interval of 14.6 months (P < 0.01); 16% were alive at 2 years and 7% at 3 years. After CR 68% of survivors obtained satisfactory palliation of symptoms for a significantly longer interval of 47.6 months (P < 0.025); 47% were alive at 2 years and 38% were alive at 3 years, a significant (P < 0.01) improvement over the other two groups. Gastrojejunostomy provides less palliation of significantly shorter duration when compared to resection, without reduction of postoperative gastrointestinal complications or operative mortality. Curative resection significantly improves 3-year survival without increasing mortality, although gastrointestinal complications are more common with extended resection and esophageal anastomosis. Extension of resection in an attempt to cure is worthwhile because it prolongs survival, although with some risk of increased complications. Otherwise, resection of the major lesion is preferable to bypass in order to improve and prolong palliation.

Adenocarcinoma↗
PubMed1984

Sequential electrocoagulation and resection for carcinoma of the rectum.

Sequential electrocoagulation followed by resection of carcinoma of the rectum provides better survival results than have been previously obtained. More than 200 patients have been treated by this combined approach during the past ten years. The over-all five year survival rate is 67 per cent. The preferred method of treatment is sequential electrocoagulation followed by low anterior resection. When this procedure was done, 55 of the 65 patients have survived a minimum of five years. If abdominoperineal resection is necessary, the over-all survival rate is 61 per cent. The specific advantages of sequential electrocoagulation and resection are several. This procedure is safe and relatively easy to do. Electrocoagulation may be done at the time of initial biopsy as part of the preoperative evaluation. The usual interval between electrocoagulation and resection is three to five days. This may be longer in selected instances. Preoperative electrocoagulation of carcinoma of the rectum helps to prevent local recurrence on anastomoses and in the perineum. Local recurrence occurred in only 5 per cent of the patients. Electrocoagulation destroys rectal tumor cells in an area in which vascular isolation technique and wide resection of the mesentery are not possible. The efficacy of electrocoagulation in destroying tumor cells is confirmed by pathologic study of our clinical material. Combining electrocoagulation with resection may extend the limits of low anterior resection for favorable lesions allowing use of sphincter-saving procedures with less likelihood of local recurrence. Electrocoagulation, radiation therapy and surgical treatment are not mutually exclusive treatment methods. Rather, we view these modalities as complimentary in offering the potential for additive benefits.

Adult↗
PubMed1984

[Metachronous bilateral pulmonary resection for primary bronchogenic carcinoma].

A metachronous bilateral pulmonary resection was executed on 11 cases of primary bronchogenic carcinoma. Of the 11 cases of secondary tumors, 5 were double primaries and 6 were metastatic foci. Except for 1 wedge resection, radical lobectomy was done for the first resection of the 11 cases. Modes for the second resections were lobectomy in 2, segmentectomy in 3, and wedge resection in 6. At the second operation, 2 cases underwent a complete regional lymphnode dissection but in the other 9 cases lymph node dissection was incomplete. Tumor infiltration was proven on the margin of surgical specimen for 2 cases. There was a necessity of ventilatory support for 3 cases after the operation but there were no surgical deaths. Of the 6 cases of recurrent diseases that underwent second resection, 1 case died of respiratory insufficiency a year after operation. The 5 remaining cases are living from 1 to 4 years. Of the 5 double primaries, 1 case died of respiratory insufficiency 7 months after operation and 1 case died of metastatic disease 10 months after operation. One case died of an accident 3 years 6 months after the operation. For the remaining 2 cases, one is living for 1 year and 6 months, the other for 3 years and 4 months following resection. The demand for second resection in primary bronchogenic carcinoma is increasing from year to year.

Carcinoma, Bronchogenic↗
PubMed1983

Modern thirty-day operative mortality for surgical resections in lung cancer.

Modern postoperative mortality rates for resectional operations for lung cancer are not readily available. In recent publications estimating the risk factors for surgical resection, mortality rates of 10% to 15% for pneumonectomy and 5% to 7% for lobectomy are frequently quoted. In order to determine modern operative mortality rates (up to 30 days postoperatively), the Lung Cancer Study Group (LCSG) analyzed the surgical mortality rates of the various participating centers during the years 1979 to 1981. A total of 2,200 resections for lung cancer were available for analysis. Of the 2,220 resections performed, 1,058 were lobectomies, 569 were pneumonectomies, and 143 were lesser resections (segmental or wedge). Eighty-one postoperative deaths occurred from among the 2,220 resections (3.7%). The mortality rate for pneumonectomy was 6.2% and for lobectomy, 2.9%. Lesser resections carried a 1.4% mortality rate, not statistically different from lobectomy. In patients under the age of 60 years, the mortality rate was 1.3%, 60 to 69 years, 4.1%, and over 70 years, 7.1%, all significantly different (p less than 0.01). The postoperative mortality rate for patients 70 years or older was 7.1% (pneumonectomy 5.9% and lobectomy 7.3%). It is obvious that greater care was taken in selection among the older pneumonectomy patients. The striking similarity of postoperative mortality rates for resectional operations for lung cancer among the various centers of the LCSG and among the various institutions within these centers suggest that these data are a reasonably accurate analysis of modern surgical mortality rates in the treatment of lung cancer.

Aged↗
PubMed1983

[Surgical resection of hepatic metastases of cancers of the colon and rectum].

Surgical resection of metastatic colorectal carcinoma remains controversial. Few patients are eligible for resection since out of 2,725 patients operated upon for colonic or rectal adenocarcinomas in 11 years, 14 p. 100 had liver metastases and only 0.9 p. 100 could be resected. Twenty-nine patients who have undergone partial liver resections for metastatic colorectal carcinomas are reported. The primary neoplasms were Duke's class B(8), Dukes' C (12) or extended to another organ (5). Local extension was unknown in 4 cases. Eight metastases were unique and measured less than 5 cm; seven, although unique, measured more than 5 cm. Fourteen patients had multiple but unilateral hepatic deposits. Twenty major resections and 9 wedge liver resections were performed. One patient died (3.4 p. 100). Average hospital stay was 19 days. Pain was relieved by surgery in 10/11 patients. In 19 patients follow-up exceeds one year: six underwent the resection of a unique and small liver metastasis: one died after 3 and a half years and two are doing well 4 and 10 years after surgery. Thirteen patients underwent major liver resections for large or multiple liver deposits: 9 lived less than one year and 4 are alive after 16, 19, 26 and 60 months respectively. All patients with a follow-up of less than one year are alive. The low operative mortality, the efficacy in relieving pain, and the prolonged survival which can be obtained in some cases justify an aggressive surgical approach to colorectal liver metastases.

Adult↗
PubMed1982

Proliferative and morphological adaptation of the intestine to experimental resection.

The proliferative and morphological adaptation of the residual intestine following resection is briefly reviewed. Within days after a partial intestinal resection, the number of crypt cells increases. There is a proportional increase in the number of proliferative cells, thus there is no change in the growth fraction. Villus height and morphological complexity increases, particularly in the ileum. The thickness of the muscularis mucosae increases, most likely through an increase in cellularity. The size of the adaptive response is dependent on the amount of tissue removed. The possibility of an adaptive change in the number and proliferative characteristics of rat intestinal stem cells was investigated using the microcolony assay (38). Regenerative foci of mucosal epithelium were quantitated as a function of 137Cs gamma ray irradiation in control or 30 days after a 60% resection of the combined jejunum and ileum. Hydroxyurea, (HU), an S phase cytotoxic agent was given to one group of control and one group of resected rats five minutes before a single dose of radiation. HU had little effect on control jejunum or ileum, however, HU reduced the clonogenic cell survival by over tenfold in resected animals which implies a post-resection change in the intestinal stem cell age distribution. The radiation dose-survival curve of clonogenic cells was shifted to the right after resection compared to control values. These results suggest that an increase in intestinal stem cell number and a shift in the proliferative characteristics (from slowly to rapidly cycling) occur as an adaptive response to intestinal resection.

Adaptation, Physiological↗
PubMed1982

[Limited resection in partial surgery for carcinoma of the larynx. Prognostic consequences and therapeutic implications].

Limited resection in partial surgery for carcinoma of the larynx leads to discussion of three surgical attitudes: total surgical resection as a matter of principle, additional treatment by radiotherapy, or waiting, with the need for strict surveillance. The present study reports the results of this latter attitude adopted in 23 cases out of 24 of limited resection in a group involving 119 partial laryngectomies (vertical or horizontal) consisting of: 57 cordectomies, 20 hemilaryngectomies, 42 supraglottal laryngectomies. Results of analysis show that there was no recurrence and patients were well with a 3 year follow-up in 19 cases of limited resection out of 24. Overall survival following limited resection was identical to that seen after satisfactory resection, but there was a marked difference with insufficient resection (X2 significant) Following partial laryngeal surgery involving a limit resection, it is felt to be legitimate to temporise as long as the patient can be seen regularly. Such an approach would not seem to modify the overall survival in these patients.

Adult↗
PubMed1980

[Definition and classification of the late complications after gastric resection].

In literature reports dealing with assessment of the long-term results after gastric resection a great diversity exists in terms of clinical definition, denominations, and classification of the late post-resection complications. This gave sufficient reason to the author to carry out personal researches into 126 patients with expressed late complications subsequent to gastric resection with a view to elucidate the type aad incidence of these complications, their etiopathogenesis, clinical peculiarities, possibilities of diagnosis and differential diagnosis and treatment problems, and on the basis of the results obtained to work out a personal classification scheme of post-resection complications which would be utilized both in connection with the diagnosing and treatment of these complications, and in assessment of the long-term results of gastric resection. In the suggested classification are included pathological syndromes representing true post-resection complications and never recorded without resection of the stomach; they run a prolonged course, and exert a permanent effect on the clinical condition and working ability of the operated patients, they are characterized by a typical symptom constellation on the basis of which it is possible to diagnose and differentiate them, and are conditioned by a variety of pathogenetic mechanisms demanding different treatment policy. The pathogenetic and clinical characteristic of the syndromes included in the classification (e.g. dumping syndrome, afferent loop syndrome, digestive insufficiency syndrome, hypoglycemic syndrome, and ulcerous recurrences after gastric resection)are briefly outlined.

Gastrectomy↗
PubMed1995

[Acute colonic ileus caused by left-sided colorectal cancer. A randomized trial of emergency ostomy versus resection].

Staged resection (group T) versus acute resection (group R) for curative purpose was compared in a randomized study of 121 patients presenting with signs of left-sided obstructive colorectal tumours during emergency surgery from 1978 to 1993. Patients with distant spread were excluded. Transversostomy was done in 58 and resection without immediate anastomosis in 56. Duration of emergency surgery was shorter, blood transfusions fever and wound infections less frequent in T compared to R, but postoperative mortality was similar (eight patients in each group). The diagnosis of tumour was wrong in 11 patients in T and six in R. The proportion of patients surviving the second stage curative resection in T without a permanent colostomy (32/35) was higher than after acute resection (36/50) in spite of six patients having anastomotic surgery (Coloshield) at the time of acute resection in R. Days spent in hospital were less in R. Overall recurrence rates and survival rates were similar in T and R. In conclusion, no major advantage besides shorter hospital stay could be demonstrated by acute resection without simultaneous anastomosis compared to the traditional 3-stage procedure, which on the other hand carried a much smaller risk of a permanent colostomy. The latter should therefore serve as a control in a prospective evaluation of emergency resection with simultaneous anastomosis.

Adult↗
PubMed1995

[Risk and follow-up after multi-visceral resections including the left side of the pancreas].

Aim of this study was to analyze the operative risk of multivisceral resection including the left side of the pancreas. Between September 1 th, 1985 and May 31 th, 1994 18 multivisceral resections including the left side of the pancreas and 8 left-sided pancreatic resections were performed at the University Hospital for General and Abdominal Surgery, Mainz. Postoperatively 5 of the 18 patients with multivisceral resections and 3 of the 8 patients with left-sided pancreatic resections developed minor complications (wound infections, pneumonia). One insufficiency of an esophagojejunostomy was seen. One patient died after gastrectomy and left-sided pancreatic resection due to a pneumonia. In this case the operation was performed after substitution of 22 red cell packs under emergency conditions because of an infiltration of the splenic artery by a lymphoma of the stomach. The best prognosis had patients with neuroendocrine tumors. These results show that in case of an elective operation the risk of multi-visceral resections including the left side of the pancreas is comparable to that of left-sided pancreatic resections alone.

Adrenalectomy↗
PubMed1995

[Extended partial Kausch-Whipple duodenopancreatectomy by resection of tumor infiltrated vascular segments].

AIM: Vessel infiltration of the portal vein is often considered as contraindication for pancreas resection for carcinoma. In this retrospective analysis we investigated if an extended Whipple's procedure including vessel resection submits the patient to a significantly higher risk. PATIENTS AND METHODS: From August 1985 until February 1994 179 Whipple's procedures were carried out, in 74 cases for carcinoma of the pancreatic head. In this group 26 patients were classified as stage I (35.2%), 5 as stage II (6.7%), 38 as stage III (51.4%) and one patient as stage IV. In 18 cases a segment of the portal vein was resected, in 16 cases reconstructed by end-to-end anastomosis and in two cases by implantation of a GoreTex prosthesis. No special anticoagulation was applied. RESULTS: There were no anastomosis-related complications such as hemorrhage, thrombosis or stenosis. The lethality rate was 1.4% (1/74), insufficiencies at the pancreas and bile duct anastomosis occurred in 0% and 1.4% (1/74), resp. Patients with segmental vessel resection in stage III had a mean survival of 9 months and by 3 years there was no survivor compared to 11.7 months and 17% survival after 4 years in stage III without vessel resection. CONCLUSION: By performing vessel resection more pancreas tumors than earlier are resectable without increased risk. Since the results of oncologic alternative treatment modalities are still poor pancreas resection represents at present the best option for the patient.

Adult↗
PubMed1995

Prostatic histology in secondary transurethral resection of the prostate.

Human benign prostatic hyperplasia consists of 3 major components, stromal and glandular tissue, and glandular lumen. To our knowledge morphometric analysis of prostatic tissue from patients who have undergone a secondary transurethral resection of the prostate has never been reported. Quantification of these histological components might aid in selecting treatment for patients with recurrent urinary symptoms following transurethral resection of the prostate. Transurethral resection specimens from 13 consecutive patients who had undergone prostatectomy twice were stained by the Masson trichrome method. Quantitative morphometric analysis was performed using computer image analyzing software. The mean total area was 15.9%, 15.4% and 68.7% for glandular lumen, and glandular and stromal areas, respectively, in the initial transurethral resection specimens and 13.3%, 14.1% and 72.6%, respectively, for secondary transurethral resection of the prostate. There was no significant difference among the 3 morphometric components in the 2 prostatectomy specimens with respect to percent area, within subject variability and skewness (all p values > or = 0.38). Our study confirms previous findings that the majority of initial transurethral resection specimens are predominantly stroma. Furthermore, our study indicates that the percent distributions between initial and secondary transurethral resection of the prostate with respect to the 3 major histological components are not different, suggesting that the stromal, glandular and glandular lumen content of an initial transurethral resection specimen is representative of the recurrent prostatic tissue.

Aged↗