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PubMed1995

Hepatic resection for colorectal liver metastases.

The lack of other effective treatment for colorectal liver metastases makes hepatic resection a primary treatment consideration. Between January 1980 and December 1990, 26 selected patients with liver colorectal metastases who underwent hepatic resection were reviewed. The age, sex, site of primary lesion, histological grade, lymph node involvement, location, size, and number of hepatic metastases, type of hepatic resection, and preoperative CEA blood levels were documented. Complete removal with histologically negative resection margins were accomplished in 24 patients. The extent of resection performed was hepatic lobectomy in 12 patients. Segmentectomy in eight patients, and wedge resection in four patients. The 5-year survival rate was 30.5 per cent. Patients with metachronous metastases showed a better survival rate than those with synchronous lesions--46.6% versus 13.6% respectively (P = 0.08). None of the other factors studied showed a significant effect on survival. All patients were followed from the time of hepatic resection to the time of this study or death. During a median follow-up of 30.9 months, 20 patients developed recurrence of their disease (60 per cent in the liver). There was no perioperative mortality. Morbidity arose in 66.6 per cent of patients, with a majority of the complications being minor. We conclude that hepatic resection can be performed safely enough to be recommended in selected patients.

Adult↗
PubMedDate not supplied

Multi-visceral resection for locally advanced gastric cancer.

Fifty-three of sixty-four patients who underwent gastrectomy for gastric carcinoma presented with advanced gastric cancer. 8 patients underwent palliative gastrectomy. In 17 patients gastrectomy and lymphadenectomy was performed. In 28 patients with locally advanced gastric carcinoma, extended resection was performed. Patients who underwent splenectomy were only included if tumorous adherence to the spleen was present. Hospital mortality and morbidity were 3.6% and 25% in extended resection and 5.9% and 18% in gastrectomy and lymphadenectomy alone. R0 resection was performed in 26/28 and in 16/17 patients, respectively. In R0 (complete) resections the mean one and two-year-survival rates were 64% and 44% in extended resection, and 67% and 47% in gastrectomy and lymphadenectomy. In patients (11) with residual tumour (R1/R2) mean one and two-year-survival rates were 27% and 0%, respectively. If complete resection (R0) is achieved, extended resection for locally advanced gastric carcinoma provides survival time, which is comparable, stage for stage, with survival rates observed after R0 resection for cancer limited to the stomach.

Aged↗
PubMed1995

A technique for the use of cryosurgery to assist hepatic resection.

BACKGROUND: Wedge or other nonanatomic hepatic resections, performed in an attempt to spare functional parenchyma, often are not accomplished with clear resection margins and may be complicated by hemorrhage from the depth of the resection. STUDY DESIGN: The current study describes a technique of cryoassisted hepatic resection that allows for controlled resection with well-defined margins. The early experience in managing 16 tumors in 13 patients is reported. RESULTS: A cryoprobe is inserted into the tumor and freezing performed to a predetermined resection margin using ultrasound control. The ice ball, so formed, is then maintained and excised. The management of these 13 patients was associated with one intraoperative and two postoperative complications, including a death of a patient with cirrhosis who had infected ascites and died as a result of hepatic failure. CONCLUSIONS: Cryoassisted hepatic resection seems to be safe and allows resection with good tumor clearance and maximal preservation of functional parenchyma.

Cryosurgery↗
PubMed1994

Preventable causes of bowel resection in Zaria, Nigeria: a report of 93 cases.

This report presents a summary of 93 bowel resections which were considered to be for preventable causes and performed during 5 years (1984-1988) in our Hospital in Zaria. These resections constituted 57% of the total bowel resections performed in that period and were responsible for an annual resection rate of 19 "avoidable" bowel resections. The resections included 48 for strangulated external groin hernia with gangrene of the bowel or doubtful viability, typhoid perforation eleven, vehicular trauma ten, anastomotic dehiscence eight and other non-neoplastic causes of faecal fistula eight. Multiple special forms of preventable causes of bowel resection accounted for 8 resections. These were foreign body impacted in the ileum 1, incisional hernia 1, large irreducible scrotal hernia in a recently gangrenous scrotum 1, irreducible rectal prolapse 2, paracolostomy abscess 1, bowel necrosis from residual pelvic abscess 1 and from multiple intra-abdominal abscesses one.

Adolescent↗
PubMed1994

[Low anterior resection versus rectum amputation for treatment of rectal cancer].

In the controversy whether abdominoperineal resection of sphinctersaving resection is more radical for the treatment of lower rectal cancer, 77 consecutive patients with rectal cancer were retrospectively analysed. All resections were curative. 40 patients underwent a low resection and 37 patients an abdomino-perineal resection. Both groups were comparable with regard to age, sex and especially tumor-stage. The crude 5-year survival-rates were 52.5% in the resection group and 54.1% in the amputation group, respectively. The patients with a carcinoma located within 5-10 cm from the anal verge were of special interest. The crude 5-year survival-rates in these special subgroups were 61.9% for the sphinctersaving procedure and 61.5% for the amputation group, respectively. We conclude that the choice of surgical procedure does not influence the prognosis in rectal cancer, in particular, sphinctersaving resection does not worsen the prognosis. Therefore, whenever technically possible, the sphincter-saving resection should be chosen to cure rectal cancer.

Aged↗
PubMed1994

Liver metastases from colorectal carcinoma: incidence, resectability, and survival results.

We studied 328 cases of colorectal carcinoma (stages I-IV) seen at our hospital during a 19-year period. We found that 15% of these had liver metastasis (LM) at initial diagnosis, and 14% developed LM after resection of their primary cancers. Among the 73 patients with LM, the lesion was confined to the liver (LM only) in 40 patients. Using our criteria of "resectability" of LM, 45% with LM only had resectable LM lesions, but only 15% (six patients) actually had hepatic resections. We had no operative death nor major complication. Five of the six patients with LM resected lived 3 years or longer, but none of the other 34 patients with LM only (either non-resectable or resectable but not operated on) lived more than 35 months. Although our series is relatively small, our data are consistent with results coming from other national and institutional studies. The controversies and issues relating to resection of colorectal liver metastasis are discussed.

Aged↗
PubMed1993

Anterior transcervical-thoracic approach for radical resection of lung tumors invading the thoracic inlet.

We describe an original anterior transcervical-thoracic approach required for a safe exposure and radical resection of non-small-cell lung cancer that has invaded the cervical structures of the thoracic inlet. Through a large L-shaped anterior cervical incision, after the removal of the internal half of the clavicle, the following steps may be performed: (1) dissection or resection of the subclavian vein; (2) section of the anterior scalenus muscle and resection of the cervical portion of the phrenic nerve, if invaded; (3) exposure of the subclavian and vertebral arteries; (4) dissection of the brachial plexus up to the spinal foramen; (5) section of invaded ribs; and (6) en bloc removal of chest wall and lung tumor, either directly or through an extension of the cervical incision into the deltopectoral groove. An additional posterior thoracotomy may be required for resection of the chest wall below the second rib. Between 1980 and 1991, 29 patients underwent radical en bloc resection of the inlet tumor, chest wall (ribs 1 and 2), and underlying lung, either through the anterior transcervical approach alone (n = 9) or with an additional posterior thoracotomy (n = 20). The inferior root of the brachial plexus, either alone (n = 11) or with the phrenic nerve (n = 4), was involved and resected in 15 patients (52%). Twelve patients (41%) had a vascular involvement that included the subclavian artery alone (n = 3); subclavian artery and subclavian vein (n = 3); subclavian artery, subclavian vein, and vertebral artery (n = 2); subclavian artery and vertebral artery (n = 1); subclavian vein alone (n = 1); vertebral artery alone (n = 1), or subclavian artery and vertebral artery (n = 1). The subclavian artery was revascularized either with a prosthetic replacement (n = 7) or an end-to-end anastomosis (n = 2), and the median graft patency was 18.5 months (range, 6 to more than 73 months); only 1 patient had postradiotherapy graft occlusion in the revascularized artery 6 months after operation. We performed 14 wedge resections, 14 lobectomies, and 1 pneumonectomy. There were no operative or hospital deaths. Postoperative radiotherapy (median, 56 Gy) was given to 25 (86%) patients, either alone (n = 14) or in combination with adjuvant systemic chemotherapy (n = 11). With a median follow-up time of 2.5 years, overall 2- and 5-year survivals were 50% and 31%, respectively. This transcervical-thoracic approach affords a safe exposure and radical resection of non-small-cell lung cancer involving the thoracic inlet and results in encouraging long-term survival.

Adult↗
PubMedDate not supplied

[Enteral resection in the nursing rabbit (an experimental study)].

The response to enteral resection in human newborns and nursing babies depends on the site and magnitude of the resection: usually these patients have a satisfactory recovery although long term supportive measures are required in order to prevent nutritional and digestive complications. This study assessed the post-surgical response of six groups of nursing rabbits with 0, 40, 50, 60, 75 and 90% selective resection of the small intestine. A greater number of surgical complications was observed in those cases with more manipulation and greater resection. Villi hypertrophic was found at the distal extremes of the enteral remnants only with 40% jejunal resection and 75 and 90% jejunum-ileum resections. None of the groups showed growth interruption. Only in rabbits with resections greater than 60% a significant decrease in weight was found. Forty and sixty percent enteral resections, mainly proximal and distal respectively, did not yield weight or length deficits as compared with the control group.

Animals↗
PubMed1996

Small-bowel resection for metastatic melanoma.

OBJECTIVE: To determine whether complete resection of small-bowel metastases from melanoma improves patient survival. DESIGN: A computer-aided chart review. SETTING: Hospitals associated with McGill University. PATIENTS: Twenty patients (17 men, 3 women), identified from 1524 patients with melanoma, who underwent surgery to the small bowel for metastases. Patient age and clinical presentation, tumour site and stage were recorded. INTERVENTION: Exploratory laparotomy with complete or partial resection of involved small bowel. MAIN OUTCOME MEASURES: Operative morbidity, mortality and length of survival related to the extent of small-bowel resection. RESULTS: Eleven patients had complete resection, 8 patients had partial resection and 1 patient had a palliative bypass only. Long-term survival (ranging from 2 to 10 years) was 36% in those who had complete resection and 0% in those who had partial resection; operative morbidity and mortality were 20% and 15% respectively. CONCLUSION: Complete resection of small-bowel metastases in patients with metastatic melanoma can result in long-term survival.

Adult↗
PubMedDate not supplied

Regional vascular resection using catheter bypass procedure for pancreatic cancer.

BACKGROUND/AIMS: To elucidate the indications for extended operation including main vessel resection in pancreatic cancer surgery, a clinical study was performed. The safety and clinical significance of portal vein resection in pancreatic cancer surgery have not yet been obtained in a large series. MATERIALS AND METHODS: Over a period of more than 10 years, 134 of 212 (63%) patients with pancreatic carcinoma underwent resection by extensive radical surgery. Portal vein resection was performed in 104 of 134 (78%) resected cases using catheter bypass procedure. The postoperative survival was investigated and a clinicopathological study was conducted. RESULTS: Operative death within 30 days after operation was observed in 11 of 134 (8%) resected cases. Postoperative survival rate correlated with the grade of portal vein invasion, which was diagnosed by preoperative or intraoperative portography. Survival for more than two years after operation was seen in cases of negative invasion on the margins of the resected specimens group even when portal system vein wall invasion was observed. CONCLUSION: Portal vein resection is performed safely using bypass procedure of the portal vein and is recommended to obtain a tumor-free surgical margin.

Catheterization, Peripheral↗
PubMed1996

Postoperative hypercoagulable state followed by hyperfibrinolysis related to wound healing after hepatic resection.

BACKGROUND: Coagulative disorders may result from a breakdown in the balance between coagulation and fibrinolysis. It is important to assess the relative physiologic states of coagulation and fibrinolysis related to operation. STUDY DESIGN: A prospective study of 16 patients who underwent hepatic resection was performed. Coagulative and fibrinolytic activities were examined for comparison with those of patients having total thoracoesophagectomy or colorectal resection. In addition, mice underwent hepatic resection, and histologic analysis was conducted to detect local fibrinolysis. RESULTS: In patients who underwent hepatic resection, circulating levels of thrombin-antithrombin III complex were significantly elevated during operation, whereas the levels of plasmin-alpha 2-plasmin inhibitor complex, fibrin-fibrinogen degradation products, and D-dimer were slightly elevated. After operation, the values of thrombin-antithrombin III complex decreased but plasmin-alpha 2-plasmin inhibitor complex peaked on the third postoperative day and both fibrin-fibrinogen degradation products and D-dimer increased again to reach maximum levels on postoperative day 7. Immediately after operation, the ratio of thrombin-antithrombin III complex to plasmin-alpha 2-plasmin inhibitor complex was significantly greater and the ratio of tissue-type plasminogen activator to plasminogen activator inhibitor-1 was significantly lower in patients who underwent hepatic resection than comparable ratios in patients who underwent colorectal resection. In the murine model, fibrin-like products with immunostaining of plasminogen activator inhibitor-1 were broadly deposited at the edge of the residual liver on postoperative day 5, then disappeared by postoperative day 14. CONCLUSIONS: These findings indicate that immediately after operation the stress of hepatic resection led to extensive hypercoagulation and hypofibrinolytic activity, as compared with colorectal resection, and suggest that fibrinolysis without hypercoagulation in the late postoperative period might be caused by local fibrinolysis in the healing wound.

Aged↗
PubMed1996

[Prognostic factors of resected pulmonary metastases of osteogenic sarcoma].

From December 1979 to December 1994, 22 patients with osteogenic sarcoma underwent a total of 34 thoracotomies for resection of pulmonary metastases in our department. We did a retrospective study to identify prognostic factors. The tumor doubling time (TDT) calculated for 21 patients before the first (if multiple) resection was not correlated with days of survival after resection of the primary tumor, nor was it correlated with days of survival after the first (if multiple) resection of the pulmonary metastatic tumors. Of the nine patients who underwent at least two thoracotomies, the TDT calculated from X-ray films taken before the second (or later) thoracotomy was significantly shorter than the TDT calculated before the preceding thoracotomy (p < 0.05). The disease-free interval (DFI) after resection of the primary tumor was correlated with the days of survival after that resection (p < 0.001) and also with survival after resection of the pulmonary metastatic tumors (p < 0.01). This DFI of patients who survived at least 2 years from the date of the resection of the primary tumor was significantly longer than in patients who survived less than 2 years from that date (p < 0.05). The most significant prognostic factor was this DFI. The cumulative survival rate was 42.4% at three years and 33.9% at five years, with an operative mortality of 0%.

Adolescent↗
PubMed1996

Bowel resection and neurotensin treatment. Histochemical study of neurotensin-like and somatostatin-like immunoreactivities and receptors.

The influence of a bowel-trophic neurotensin (NT) treatment (13 days, 300 micrograms/kg/every 12 hrs.) on neurotensin-like immunopositive structures (neurons, fibres and epithelial-N-cells) and the neurotensin receptors (NTr) in the residual bowel after resection (90% small bowel or 75% colon) in the rat was studied using histochemical methods. Somatostatin-like (ST) immunopositive structures (neurons, fibres and epithelial-D-cells) and somatostatin receptors (STr) were also studied, comparatively. The results displayed a general increase of N-cells (11-17%) but not of D-cells, and a higher degree of variability section-to-section in the NT and ST immunopositive nervous structures (without increased density) after both resections, both with or without NT treatment. Receptors did not change after the small bowel resection but the colon resection and/or the NT treatment produced variations in the NT binding (from -24.3 to +16.85) in different intestinal regions. In a general sense, the variations among 1) the controls, 2) the resected animals, and 3) the resected and NT-treated animals, were of less extent (< or = 24%) than previously supposed for explaining the trophic effect of NT. Our results: a) confirm the autonomy, injury-resistance and tendency to maintain the physiological features of the bowel in very diverse situations; b) open new questions on both, the neurotensinergic changes after bowel resection and the mechanisms of the trophic effect of NT treatment, and c) suggest that, when neurotensin was applied as a trophic treatment in the cases of the need of a bowel resection, no important neurotensinergic or somatostatinergic side effects should be expected in the remaining bowel. However, the higher degree of variability section-to-section after surgery in the nervous structures was not modified by the NT treatment. This fact, and the different response of various intestinal regions to the NT treatment, suggest that functional problems in the remaining bowel could be maintained despite the growth of the mucosa induced by the NT treatment.

Animals↗
PubMed1997

Lung resection for recurrence after pneumonectomy for metastases.

Resection of pulmonary recurrences after pneumonectomy for metastases is exceptional. Nevertheless in carefully selected patients surgery on the residual lung might be successfully performed. From January 1987 to February 1996, 5 patients underwent metastasectomy on single lung after pneumonectomy performed for the same metastatic disease. There were 3 male and 2 female with a mean age of 38 years at the time of surgery on single lung. All patients had a FEV1 > 40%. One patient (n degree 1) had 2 consecutive operations (wedge resections) on the right lower lobe followed 17 months later by right inferior lobectomy for metastases of soft tissue sarcoma. Three patients had only an operation on the residual lung (patient n degree 2 had 2 wedge resections for carcinoma; patient n degree 3 had 7 wedge resections for carcinoma; patient n degree 4 had 6 wedge resections for osteogenic sarcoma). The last patient (n degree 5) had 2 wedge resections on the right upper lobe and a large wedge resection on the right lower lobe for metastases of malignant corticosurrenaloma using a cardiopulmonary femoro-femoral by-pass without cardiac arrest. She postoperatively developed a right lower lobe venous infarction treated subsequently with a completion right lower lobectomy. She died in the postoperative course from cardiorespiratory insufficiency. The other patients had an uneventful postoperative course. Two patients (n degree 2 and n degree 4) died of their disease 14 and 12 months respectively after the surgery on the residual lung; by contrast 2 patients (40%) (n degree 1 and n degree 3) are still alive without recurrences 36 and 27 months after the last resection. In selected patients aggressive surgery for metastases on the residual lung can be successfully performed but the benefits in terms of long-term disease-free survival remain to be determined.

Adult↗
PubMedDate not supplied

Quality-of-life after curative surgery for gastric cancer: a comparison between total gastrectomy and subtotal gastric resection.

BACKGROUND/AIMS: Quality-of-Life has become an increasingly important factor for long term survivors after surgery for gastric cancer. Quality-of Life also includes social and psychological aspects. Many gastric carcinomas are located in the distal two thirds of the stomach. In these cases, a subtotal gastric resection may be adequate if a proximal safety margin of 5 cm in intestinal type tumors according to Laurén and 10 cm in diffuse type cancers respectively can be achieved. On the other hand total gastrectomy "de principe" has been advocated for all gastric malignancies because of high local recurrence rates after subtotal resection. The aim of the present study was to assess the Quality-of-Life in long term survivors after resection for gastric cancer comparing subtotal gastric resection with total gastrectomy. METHODOLOGY: One hundred ninety-five patients were examined with the Gastrointestinal Quality-of-Life-Index (GLQI). Hard clinical data such as postoperative weight loss, frequency of daily meals and bowel emptying were evaluated. One hundred five patients were submitted for total gastrectomy and in 90 patients a subtotal gastric resection was performed. None of the patients had clinical, radiological or endoscopic evidence of recurrence. RESULTS: After subtotal gastric resection, patients achieved statistically significant better scores concerning disease/therapy-related symptoms, physical functions resulting in a better overall score (p < 0.02). Following subtotal resection, patients had a significantly lower weight loss compared to patients after total gastrectomy (p < 0.02), a smaller number of daily meals (p < 0.001) and a lower frequency of bowel emptying/day (p = 0.031). There was no statistically significant difference in emotional status or social activities showing a similar acceptance of disease and therapy in both groups. CONCLUSIONS: In those cases where an adequate proximal safety margin can be achieved by a subtotal gastric resection, this procedure is preferable to a total gastrectomy. However preservation of the gastric stump should never be allowed to compromise oncological radicality.

Adult↗
PubMedDate not supplied

The effect of extend of caval resection in the treatment of inferior vena cava leiomyosarcoma.

BACKGROUND: A wide and complete surgical resection is the principle modality of therapy in the management of retroperitoneal sarcomas. It is current opinion that, also for inferior vena cava (IVC) leiomyosarcomas, an extended resection of either retroperitoneal tissue and vena cava should be performed. The aim of the study was to investigate the influence of the venous extent of resection on local recurrence and longterm outcome. METHODS: Up to August 1994, 218 patients were enrolled into The International Registry of Inferior Vena Cava (IVC) Leiomyosarcomas. For the purpose of this study we considered 120 patients who underwent a radical resection of the IVC tumor (i.e. removal of all gross disease with microscopic tumor-free margins and no evidence of distant metastases). Resection included an IVC rim in 53 patients and an IVC segment in 67. RESULTS: There were 3 (2.5%) early postoperative deaths and 7 (5.8%) major complications. Postoperative deep venous thrombosis of the lower limbs was diagnosed in 21 (17.5%) patients and was treated by anticoagulant therapy and/or elastic stocking without long-term sequelae. Overall, tumor recurrence was observed in 67 (57.3%) patients at a mean follow-up of 32 +/- 4 months. Seven, 13 and 4 patients who underwent caval wall resection and 9, 29 and 5 patients submitted to a caval segmental resection had either local recurrences, distant metastases or local and distant metastases (p = NS). Survival rates of the two groups were 55% and 37% at 5-year and 42% and 23% at 10-year, respectively (p = NS). CONCLUSION: An extended venous resection in IVC leiomyosarcoma does not influence local recurrence rate nor long-term outcome.

Adolescent↗
PubMed1998

Delayed hepatic resection for ruptured hepatocellular carcinoma.

BACKGROUND: Although transcatheter arterial embolization is advocated as initial therapy for ruptured hepatocellular carcinoma (HCC), hepatic resection is necessary for cure. The effectiveness of delayed hepatic resection for ruptured HCC was determined. METHODS: The records of 10 patients who underwent delayed hepatic resection for ruptured HCC were reviewed. RESULTS: All patients were men, and the mean age was 63 years. For hemostasis, transcatheter arterial embolization was performed in three patients, whereas in the other patients bleeding stopped without special procedures. Mean interval from rupture to hepatic resection was 74 days. Liver function test results before hepatic resection were almost normal. Trisegmentectomy in one and bisegmentectomy in four patients were performed, whereas minor hepatic resection was performed for four extrahepatic HCCs. There were no operative or hospital deaths. Four patients had cirrhosis. The mean tumor diameter was 7.5 cm. Of seven patients with recurrence, two with dissemination had tumors that ruptured on the inferior aspect of the liver. The 1- and 3-year survival rates were 77% and 48%, respectively. CONCLUSIONS: Because delayed hepatic resection for ruptured HCC was safe and compared similarly with that for other patients who underwent resection for HCC, it should be used. However, when HCC ruptures in an inferior location, recurrence of tumor as dissemination is likely.

Adult↗
PubMed1998

[Study on the duration of pyuria after transurethral resection of prostate].

A retrospective study was conducted on the duration of pyuria after transurethral resection of the prostate (TURP) and the factors affecting the duration in 273 patients, who were diagnosed as having benign prostatic hyperplasia (BPH) with postoperative resolution of pyuria among those who underwent TURP over the last ten years at our clinic. In the 273 patients, the mean (+/- SD) weight of the resected prostate was 13.2 +/- 10.2 g (range : 1-52 g), the mean operating time was 74.3 +/- 29.8 min (25-215 min), the duration of pyuria was 110.6 +/- 38.3 days (23-273 days), and the resected weight to operating time ratio was 0.172 +/- 0.093 g/min (0.018-0.500 g/min). There was a significant correlation between the duration of pyuria and the patient's age, resected weight, operating time, or resected weight/operating time ratio, resected weight being the most important factor. The surgeon, the postoperative antibiotics used, and the preoperative existence of pyuria did not have any significant effect on the duration of postoperative pyuria. Investigation after stratification by the resected weight in 10 g increments suggested that a shorter operating time was important to reduce the duration of postoperative pyuria, particularly in BPH patients with a resected weight of 20-29 g.

Age Factors↗