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PubMed1991

Hepatic resections for colorectal metastases: the Italian multicenter experience.

In 1989 there were 151,000 new cases of colorectal carcinoma in the United States. Approximately 50% of these patients will be at risk of developing liver metastases together with other sites of recurrence. However, the liver will be the main site of relapse in only 14,000 patients with colorectal cancer. Approximately 25% of patients with colorectal carcinoma have technically resectable hepatic metastases at the time of operation for primary lesion, and an additional 8-25% will develop metachronous hepatic metastases after primary resection. Recent reported experiences with surgical treatment of metastatic colorectal cancer in the liver seem to indicate that hepatic resection has become more acceptable, safe and effective therapy, and offers today when technically possible, the best prospect of survival in a conspicuous number of patients. For these reasons, although a prospective randomized trial has not been done comparing resection with nonresection, resection seems to give the best hope for cure and actually is the treatment of choice for selected patients. In fact in these patients is reported a significant prolongation of survival compared with those patients with unresectable liver metastases treated only with adjuvant therapy in the form of chemotherapy or radiation therapy. Median survival of resected patients with hepatic metastases has been reported to range from 6-12 months, and for patients with single metastases is reported to range from 4.5-6.2 months to 11 and 21 months. The benefits of surgical therapy have been emphasized by different experience, with a 5-year overall survival rate ranging from 20-40%. In a recent multicenter survey a 33% 5-year survival rate was demonstrated in 859 patients resected for hepatic metastases.

Adenocarcinoma↗
PubMed1992

Hepatic resection following systemic chemotherapy for metastatic colorectal carcinoma.

Increasingly effective systemic chemotherapy has improved responses in patients with previously unresectable colorectal hepatic metastases. In the future, response to chemotherapy may define a new population of patients that may benefit from hepatic resection. A retrospective review to determine the safety and effectiveness of potentially curative hepatic resection of metastatic colorectal carcinoma after systemic chemotherapy identified 11 such patients with resections between July 1987 and October 1991. Five patients had unresectable disease confined to the liver, two had hepatic and limited extrahepatic metastases, two had hepatic recurrences after previous hepatic metastasectomy, and two had initially resectable liver metastases. These patients were resected after a mean of 8 months of systemic chemotherapy. Complications, usually minor, occurred in five patients (45%). There were no deaths. Three patients are disease free at 15, 18, and 31 months (mean 21) after hepatic resection. Eight patients have recurred with a median time to recurrence of 8 months. Five patients have subsequently died of recurrent disease. This study suggests that hepatic resection following systemic chemotherapy can be performed safely and may benefit selected patients.

Aged↗
PubMed1993

Extent of hepatic resection as a prognostic factor for small, solitary hepatocellular carcinomas.

The prognostic factors for solitary hepatocellular carcinomas with a maximum tumor diameter of < or = 3 cm were investigated in 59 of 231 patients who underwent curative hepatic resections at the Department of Surgery II, Nagoya University Hospital between January 1981 and December 1991. The 3- and 5-year survival rates of these 59 patients were 61% and 41%, respectively. As prognostic factors, tumor maximum diameter, vascular invasion, capsule formation, cell differentiation, tumor localization, hepatic functional reserve, extent of hepatic resection, and macroscopic surgical margin were selected in this study. Of the patients with a tumor size > 1.5 cm, those who underwent major hepatic resections (hepatic lobectomy or segmentectomy) tended to have better survival than patients who received minor hepatic resections (hepatic subsegmentectomy or limited resection). Although most patients with a tumor size < or = 1.5 cm underwent minor hepatic resections, they had a good survival rate. According to Cox's multivariate analysis, the extent of hepatic resection was significantly correlated with long-term prognosis of patients with a solitary hepatocellular carcinoma < or = 3 cm in diameter, but the macroscopic surgical margin was not. Cell differentiation, vascular invasion, capsule formation, and tumor localization were all correlated with the long survival. These results suggest that the selection of an adequate operative procedure is an important factor for the long-term prognosis of patients with small, solitary hepatocellular carcinomas.

Adult↗
PubMed1993

Prediction of outcome in "resectable" esophageal carcinoma.

A retrospective review was performed of 51 patients with esophageal carcinoma, deemed "resectable" by preoperative workup (e.g., CT scan, barium swallow), who presented to Hahnemann University Hospital between 1980 and 1991. This represented 21.8% of the total number of patients (234) with esophageal cancer who presented during that time period. At exploration, only 21 of the 51 patients (41%, or 9% overall) were truly resectable; 59% had more extensive disease than was appreciated preoperatively and that precluded resection for cure. Of the 21 patients resected for cure, 24% were alive at two years and only 5% were alive at 3 years. Neither age, gender, tumor type nor location in the esophagus significantly affected overall survival. Furthermore, none of these parameters, taken as independent variables, were able to predict true resectability at the time of operation. We conclude that preoperative assessment of resectability, even in those patients who appear to be good candidates for cure, remains imprecise at best. Given an operative mortality rate of 6-8% (in most series) and an overall 3- to 5-year survival rate of less than 10% (even in patients thought to have had curative resections), we reinforce the fact that meticulous patient selection and multimodality management strategies remain the keys to making any impact on this disease.

Adenocarcinoma↗
PubMed1990

Intraoperative phototherapy (PDT) and surgical resection in a mouse neuroblastoma model.

This study evaluates the effect of intraoperative photodynamic therapy (PDT) using the multiline argon laser (488-514 nm) or the argon-dye laser (630 nm) combined with surgical resection compared with surgical resection alone in reducing the incidence of C1300 neuroblastoma recurrence in mice. In the control groups, surgical resection alone resulted in 86% +/- 12% tumor recurrence. Surgical resection and intraoperative lasing without photosensitizer resulted in 75% +/- 27% tumor recurrence with the argon-dye laser and 55% +/- 18% recurrence with the multiline argon laser. In the treatment groups, surgical resection and intraoperative PDT at 630 nm resulted in 56% +/- 19% tumor recurrence whereas surgical resection and intraoperative PDT at 488-514 nm resulted in 21% +/- 7% tumor recurrence. The cause for the decrease in local recurrence in the control group using the multiline argon laser is unknown, but could it be due in part to hyperthermic effects. Intraoperative PDT was an effective adjunct to surgical resection in preventing local recurrence in this tumor model.

Animals↗
PubMed2001

Is the decision for colorectal resection justified by histopathologic findings: a prospective study of 100 patients with advanced ovarian cancer.

OBJECTIVE: We compare the indication for colorectal resection in patients with advanced ovarian cancer with histopathologic findings. We describe the effect on pelvic control and morbidity associated with surgery. METHODS: Between February 1995 and March 2001, 100 patients with FIGO stage IIIc ovarian cancer underwent pelvic en bloc resection with excision of the rectosigmoid colon as part of primary or secondary cytoreductive surgery. Decision for resection was made by the surgeon when tumor involvement of the cul-de-sac was suspected. Rectosigmoid infiltration was histopathologically defined as infiltration of the serosa or deeper. RESULTS: In 73 of 100 patients (73%) tumor involvement of the rectum was confirmed histopathologically: infiltration of the serosa in 28 (28%) patients, infiltration of the muscularis in 31 (31%) patients, and infiltration of the mucosa in 14 (14%) patients; in 27 (27%) patients no infiltration was found. Histopathologically confirmed pelvic R0 resection was achieved in 85 (85%) patients. In 11 (11%) patients the pelvic resection margins were tumor-involved and in four (4%) patients visible parametric tumor remained in situ. Pelvic recurrence occurred in 4 (4.7%) of 85 optimally debulked patients compared with 9 (60%) of 15 patients with suboptimal pelvic resection status (P < 0.05). End colostomy could be prevented in 94 (94%) of 100 patients. CONCLUSION: Pelvic en bloc surgery with rectosigmoid resection was justified by histopathologic outcome since deperitonealization with preservation of the rectosigmoid would have left tumor in situ in 73% of patients with suspected cul-de-sac involvement.

Adult↗
PubMed1996

Smooth muscle contractility after intestinal resection.

Intestinal resection is followed by structural and functional adaptation of the remnant, including motor adaptation. Since changes also occur in intestinal smooth muscle, our aim was to determine whether changes in motor function are related to changes in smooth muscle contractility. Eighteen dogs underwent transection alone (GPI, n=6), 50% distal resection (GP II, n = 6) and 50% distal resection with jejunocolostomy (GP III, n = 6). Histologic measurements and length-tension studies with response to carbachol were made at 12 weeks. Longitudinal muscle (LM) length tended to increase in the resected animals but not significantly (174 +/- 23 and 180 +/- 23 vs 156 +/- 16 cm, GP II, GP III, and GP I, respectively). Circular muscle (CM) length was similar in all three groups (8.2 +/- 0.9 and 7.9 +/- 0.6 vs 7.5 +/- 0.6 cm). Both CM and LM tended to be thicker in the resected groups (CM: 660 +/- 163 and 733 +/- 139 vs 569 +/- 199 micron; LM: 213 +/- 77 and 246 +/- 76 vs 220 +/- 104 micron, GP II, GP III, and GP I, respectively, NS). Length-tension relationships for both CM and LM were similar in all three groups. The length (Lo) at which maximal active tension (To) was achieved was 130-140% initially in both LM and CM. Passive tension at Lo and the response to cholinergic stimulation were similar in all three groups. There were no significant differences in absolute active and total tension generated or force/cm2. The carbachol dose responses were similar with the maximal active tension occurring at 10(-4) M carbachol. The ED50 was greater in CM than in LM (P < 0.05 for transection animals). The ED50 was lower after resection and bypass (P < 0.05 GP III vs Gp I). There were no significant differences in in vitro smooth muscle length tension relationships or the response to cholinergic stimuli of jejunum 12 weeks after resection with or without bypass of the ICJ. Thus, any changes in motor adaptation during this period are related to earlier transient effects or other factors.

Adaptation, Physiological↗
PubMed1987

Long-distance resection of the trachea with primary anastomosis in small children.

While tracheal resection with primary anastomosis has been accepted as the therapy of choice for tracheal stenoses in adults since the 1960s, only 26 case reports are available on continuity resections of the trachea in children. The advantages of continuity resection include the one-stage procedure and the preservation of the natural wall structures. Anastomosis should be accomplished with pericartilaginous sutures and absorbable suture material. The increased tension on anastomoses inserted following resection of long tracheal segments does not necessarily have a negative influence on wound healing. The case histories of three small children are given in this report: they all underwent tracheal continuity resections involving four or five rings because of postintubation stenoses. The results of resection after up to 5 years' follow-up are very good, so that this method can be recommended in preference to the reconstructive tracheoplasty in children, which takes longer. If the cricoid cartilage is also involved a combination of tracheal resection and cricoid resection/dilatation is recommended.

Cricoid Cartilage↗
PubMed1994

Extended bile duct resection--a new oncological approach to the treatment of central bile duct carcinomas? Description of method and early results.

Since the results of surgical resection and transplantation in the treatment of central bile duct carcinomas have been poor and neither radiotherapy nor chemotherapy has shown promising results, a new attempt to achieve curative resection has been made to combine liver transplantation with the Kausch-Whipple operation. With this operation the complete biliary system can be resected without touching the region of the hepatoduodenal ligament. Our intention is to avoid tumor cell spread by this "no-touch technique." Tumor cell spread is very likely to occur with the commonly used technique of close dissection near the centrally located carcinoma. In the seven patients operated on so far, we observed that the combination of total hepatectomy, partial duodenopancreatectomy and liver transplantation can be performed with fewer postoperative problems than "cluster transplantation" and probably has the same oncological benefit in terms of more radical resections at least for central biliary carcinomas. Theoretically, the radicalness of the resection should be greater than with liver transplantation or bile duct resection alone. Whether this concept helps to achieve better results in surgical treatment of early Klatskin tumors can only be evaluated after a longer follow-up. So far, six of seven patients have survived the operation without great problems and have been discharged from the hospital. The quality of life after this procedure seems to be better than with total pancreatic resection or even with replacement of the pancreas.

Adult↗
PubMed1993

[Extended resection of liver metastases in colorectal cancer].

Over a 10-year period, 166 patients underwent liver resection with curative intent for colorectal secondaries. These included 23 (13.8%) with metastases invading to adjacent organs. Diaphragm (n = 9), major omentum (n = 5), portal vein/inferior vena cava (n = 3), gallbladder/extrahepatic biliary system (n = 3), right adrenal gland (n = 2), and lymph nodes of the hepatoduodenal ligament (n = 1) were resected en bloc together with the metastases. Operative mortality was 4.3% (1/23 patients). Intraoperative findings and the pathologist's report led to the performance of R0 resection in 14 patients, and microscopic residual disease after R1 resection was found in 7 patients; in 2 cases macroscopically visible tumour had to be left behind. Median survival for all patients was 14 months and was significantly less favourable than in patients who had undergone resection of metastases confined to the liver (P = 0.011, long-rank test). The median recurrence-free interval was 6.8 months (P = 0.11). Obviously, patients who had undergone R0 resection and whose CEA serum levels returned to normal after operation benefited the most, and among these a median survival of 17 months was recorded. It is concluded that in patients with liver metastases from colorectal cancer, invasion of the metastases to adjacent organs has significant implications for the prognosis, even if the metastases are resected. It is important to detect this situation preoperatively, to avoid subjecting patients to a treatment that offers little benefit.

Adult↗
PubMed1995

[Multivariate analysis of prognostic factors after resection of ductal pancreatic carcinomas].

At Hanover Medical School 466 patients were operated for ductal pancreatic cancer from 1971 to 1993. In 192 cases the pancreatic tumor could be resected, which amounts to a resection rate of 41%. These patients were subjected to uni- und multivariate factorial analysis in order to evaluate factors of significant prognostic value. Extended pancreatic resection because of vascular involvement or invasion of adjacent organs was performed in 40% (n = 77) of the cases. A curative R0 resection was possible in 85% of patients. The operative lethality dropped with time and from 1985 to 1993 was 3.5%. Patient survival at 5 years was 13.4% with a median survival time of 10.9 months. According to the univariate analysis the prognosis deteriorated with increasing tumor size and lymphatic and hematogenic metastases. There was a significant correlation between tumor stage according to the UICC and prognosis. The prognosis after resection was also significantly influenced by the residual tumor state and tumor grading. Extended pancreatic resections, however, had no significant prognostic impact. The multivariate analysis showed that only three factors were of independent significant relevance: residual tumor state, tumor size and tumor grade. The presence or absence of lymphatic and hematogenic metastases had no independent prognostic significance after resection of ductal pancreatic carcinomas.

Adult↗
PubMedDate not supplied

Survival after resection of gastric cancer and prognostic relevance of systematic lymph node dissection: twenty years experience in Taiwan.

A retrospective study of 954 resectable gastric cancers in a single institute of Taiwan from 1971 to 1990 was performed to evaluate improvements in gastric cancer surgery. The patients were divided into four time periods representing an overall experience of progressive implementation of aggressive resection and increased extent of systematic lymph node dissection. The clinicopathologic data and survival rates were statistically compared and the significance of the extent of resection on survival analyzed. A significant increase in the proportion of upper one-third tumors (from 14.8% to 20.4%) and a decrease in the incidence of intestinal type (73.6% to 41.5%) was found within the overall period. The proportion of patients with early gastric cancer increased from 11.5% to 19.4%. Patients who underwent total gastrectomy and combined visceral resection increased from 13.7% to 27.4% and 19.8% to 41.1%, respectively. An increase of both total dissected lymph node number and the incidence of detected lymph node metastases in early gastric cancer were associated with more extensive lymphadenectomy. An improved 5-year survival rate following aggressive resection was found for all stages except stage IV and T4 lesions, and the surgical mortality decreased from 5.5% to 2.0%. Patients with earlier stage lesions benefited more from radical resection, especially those with stage II and T2 lesions. Systematic lymph node dissection increased the 5-year survival of patients by about 10% for stage III or T3 lesions but not for patients with stage IV or T4 lesions. Multivariate analysis confirmed the significance of the improved technique of lymphadenectomy on the prognosis of gastric cancer following resection in Taiwan.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMedDate not supplied

En bloc resection for extensive hepatocellular carcinoma: is it advisable?

When the adjacent organ is partially invaded by a hepatocellular carcinoma (HCC), whether to go on an aggressive resection is a difficult but challenging problem. To investigate the worth of en bloc resections, a retrospective controlled study was conducted. During a 9-year period, nine patients (seven men, two women: group I) who had HCC with invasions to extrahepatic adjacent organs had undergone en bloc resections. The adjacent organs included diaphragm (eight cases), adrenal gland (two cases), abdominal wall (one case), and spleen (one case). The patients selected for en bloc resections were those with a solitary tumor without evidence of vascular invasion or intravascular tumor thrombi, daughter nodule(s), or distant metastasis. The evidence was based on preoperative evaluation by ultrasonography, computed tomography, arteriography, and intraoperative ultrasonography. Eighteen matched patients with HCC but no involvement of neighboring organs were selected as controls (14 men, 4 women: group II). Though patients of group I had wider invasion of HCC and more extensive resection, their surgical morbidity, mortality, hospital mortality, disease-free interval, and survival time were similar to those of group II, who had more limited HCC and resections. Eighteen months after operation, the HCC recurrence rate was 44% and 41% in groups I and II, respectively, and the percent survivals were 71% and 63%, respectively. We suggest that in cases of large HCC with local invasion to neighboring organs, aggressive en bloc resection is recommended after appropriate patient selection.

Carcinoma, Hepatocellular↗
PubMed1981

Treatment of bone and soft tissue malignant tumours of the extremities by radical resection. A preliminary report of 12 cases.

Radical local resection is undoubtedly the method of choice in treating malignant bone and soft tissue tumours in the extremities, provided there is no local recurrence after radical resection. This is even truer today when the chemotherapy of osteosarcoma has achieved encouraging advances in preventing lung metastasis. The diagnostic methods for the evaluation of the tumour infiltration are at a more complete stage, and operative reconstruction techniques have als made rapid progress. Radical local resection is especially suitable for sarcomata of the extremities which are at an early stage, with less infiltrative low-grade malignancy. Amputation is better when the tumour grows rapidly and is large, if the soft tissue is widely infiltrated, if the patient is from 20 to 30 years old, and especially if the tumour is located in the upper tibia where it is difficult to carry out local resection. In this article, we report and discuss the definition, necessity, and possibility of radical local resection as well as the method of surgical reconstruction and our results. The results and prognosis for radical resection of giant-cell sarcoma, chondrosarcoma, and fibrosarcoma are rather good. Three of five cases of osteosarcoma died of lung metastasis one year after surgery. Therefore, improving the results in local resection of osteosarcoma calls for further investigation.

Adolescent↗
PubMed1982

Zinc absorption following massive small-bowel resection in the rat.

Zinc absorption was evaluated six weeks after massive small-bowel resection in rats. Forty rats were divided into four groups. Ten were subjected to proximal small-bowel resection, 10 to distal resection, and 20 served as pair-fed controls. Intestinal perfusion studies were performed using a recirculation technique. Twenty ml of a solution containing 10 microgram/ml of zinc as zinc sulfate, isotonic sodium chloride, and polyethylene glycol 5 g/liter was perfused for 2 hr through 10 cm of remaining bowel in resected animals and comparable segments in control animals. Zinc uptake was determined and expressed per 0.1 g mucosal dry weight. In control animals, zinc absorption was greatest in the ileum. Animals undergoing distal bowel resection had a compensatory increase in zinc absorption in the proximal small intestine. However, animals undergoing proximal resection did not demonstrate an increase in zinc absorption in the distal bowel. The proximal small intestine appears capable of increasing its capacity for zinc absorption in the response to distal small-bowel resection.

Animals↗
PubMed1996

Surgical resection of brain metastases from lung cancer.

The role of surgical resection for brain metastases is evolving. The most common primary for brain metastases is lung; in the US in 1992, for example, there were nearly 40,000 deaths with symptomatic brain metastases from lung cancer. We reviewed a series of 25 consecutive patients with non small cell lung cancer (NSCLC) undergoing open resection of one or more symptomatic brain metastases to consider the role of open resection. Twenty-three of the 28 resected lesions were 3 cm or greater in diameter; 19 were solid and nine cystic. Surgical adjuncts included (where indicated): stereotactic biopsy, cyst drainage, and craniotomy; intra-operative ultrasound; and intra-operative evoked potential mapping of the sensorimotor area. Six patients underwent thoracotomy for resection of the lung primary (in all but one case, prior to craniotomy). Except for two patients who had whole brain radiation therapy (WBXRT) prior to referral to Neurosurgery, all patients underwent WBXRT (30 to 60 Gy) postoperatively. The mean survival from date of craniotomy was 13.1 months, with two patients still alive at ten and seventeen months post-craniotomy. Survival comparisons which were significantly different included (1) lung surgery versus no lung surgery (25.7 months versus 9.1 months, P < 0.001), and (2) metachronous presentation of the lung primary and brain metastasis versus synchronous presentation (17.6 months versus 9.5 months, P = 0.025). Survival comparisons which were not significantly different included single versus multiple metastases, complete versus incomplete resection, adenocarcinoma versus large or squamous or cell histology, supratentorial versus infratentorial location, solid versus cystic metastasis, and age < or = 60 years versus > 60 years. These results, when compared with the literature on brain metastases, suggest that aggressive resection of symptomatic metastases from lung cancer (even if multiple) can improve functional survival over conservative management, and that small, asymptomatic lesions are well-controlled by WBXRT. They also confirm the previous finding that surgical treatment of both the lung primary and the brain metastases may afford the greatest period of functional survival for these patients.

Adult↗
PubMed1993

Resection of relevant nerve roots in surgery of spinal neurinomas without persisting neurological deficit.

In 42 patients with a spinal neurinoma or neurofibroma, resection of the affected nerve root was necessary in 24 cases for complete removal of the tumour. In 10 of these the resected nerve root was relevant for upper or lower limb function. Of this subgroup of 10 patients with a resection of a relevant motor root, only 4 showed an initial slight impairment of motor function, which was followed by complete recovery in two cases by the time of discharge from hospital. A persisting relevant motor impairment was not observed in any case. Recommendations given in the literature for the resection of spinal neurinomas vary from radical resection to strict microsurgical resection with preservation of as much of the nerve root as possible. This report together with the publication of Kim et al. suggests, that radical resection is possible without neurological deficit, if microsurgical preservation of unaffected nerve fibres is impossible or if the risk of recurrence is judged to be unduly high.

Adult↗
PubMedDate not supplied

Radical and nonradical hepatic resection for alveolar echinococcosis: report of 18 cases.

The authors report their experience with 18 patients who underwent liver resection for alveolar echinococcosis of the liver from June, 1982 to January, 1989. Preparation for surgery included transhepatic biliary external-internal drainage in order to alleviate jaundice in 8 cases and catheterization of infected necrotic cavities in 7 cases. Resection was radical in 9 patients who underwent either right lobectomy (5 cases) or right trisegmentectomy (4 cases) with "en bloc" extension to the bifurcation of the hepatic ducts in 3 cases. Resection was nonradical in another group of 9 patients who had either atypical right hepatectomy (6 cases) or atypical left hepatectomy (3 cases). All patients were submitted to a periodic follow-up. The 9 patients treated by radical resection are alive and symptom-free and appear to be disease-free at radiologic imaging, except for 1 patient who had a small area of parasitic recurrence on computed tomography scan 4 years after operation. Among the 9 patients treated by palliative resection, 3 patients died during the follow-up period, the cause of the death having been related to the disease in 2 cases and nonrelated in 1 case. The 6 surviving patients had no noticeable growth of the parasitic mass during the period of follow-up. When feasible, radical liver resection is the best form of therapy. When massive parasitic invasion of both lobes of the liver and the porta hepatis and vena cava precludes radical hepatectomy, palliative resection associated with percutaneous procedures has to be considered before embarking on orthotopic liver transplantation.

Adult↗