摘要:

AbstractIntraoperative radiotherapy (IORT) is being used with increasing frequency in many institutions in the United States but little is known about the surgical complication rates. The Radiation Therapy Oncology Group initiated three prospective studies in IORT in 1986 and we report here the experience in advanced malignancies of the stomach, pancreas, and rectum. The incidence and nature of major surgical complications were reviewed and presented with their implications in regard to future IORT trials. Two hundred twenty‐seven patients were entered on three studies by 20 participating institutions between 1985 and 1989. One hundred twenty‐nine patients received IORT while 98 patients were found to have too advanced disease to be benefited by IORT and underwent palliative surgical procedures only. IORT doses ranged from 12–22 Gy and bowel anastomoses were not irradiated. Wound infection in the IORT group was 6% vs. 2% in the non‐IORT patients but this was not significant at theP= 0.05 level. Other complications included anastomotic leak (n = 5), operative bleeding (n = 10), pancreatitis (n = 2), and were not statistically different in the IORT and non‐IORT groups. The mortality rate for the IORT and non‐IORT groups combined was 1.8%. This large multi‐institutional experience in patients with advanced malignancy demonstrates that patients receiving IORT do not have a higher surgical complication rate than those not receiving IORT. Long‐term survival data await the implementation of Phase III trials in advanced intra‐abdominal malignancy. © 19

ISSN:0022-4790    

DOI:10.1002/jso.2930500402

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1992

数据来源: WILEY

摘要:

AbstractReconstruction of the hip joint by a saddle prosthesis after excision of a malignant pelvic tumor is a relatively new method, which thus far has been mainly used for revision of infected hip arthroplasties. One patient with a metastatic cystosarcoma phyllodes and one patient with a chondrosarcoma of the pelvis were treated by local resection and reconstruction with a saddle prosthesis. Although the patient with the metastatic cystosarcoma phyllodes died 9 months after surgery due to metastatic disease, both patients had early recovery, with no difference in leg length and obtained early painless complete weight bearing with satisfactory functional result. These two case reports clearly illustrate the usefulness of the saddle prostheses in limb saving surgery for malignant tumors of the pelvis. © 1992 Wiley‐Liss, I

ISSN:0022-4790    

DOI:10.1002/jso.2930500403

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1992

数据来源: WILEY

摘要:

AbstractIn the period 1980–1991, 78 patients with advanced nonseminomatous testicular cancer underwent retroperitoneal lymphadenectomy for post‐chemotherapy residual masses<2 cm. To decrease the frequency of “dry ejaculation” in these patients with no or limited residual disease, the extent of dissection was reduced during the period, with bilateral dissections (49 cases, 1980–1986) being initially replaced by unilateral procedures (19 cases, 1983–1990) and subsequently by nerve‐sparing techniques (10 cases, 1990–1991). As expected, a higher total number of lymph nodes was found in the retroperitoneal specimens after bilateral (44 (13–100)) than after unilateral (21 (7–35)) and nerve‐sparing (18 (7–60)) procedures. The number of lymph nodes with pathological changes was low, with 3 (1–16) after bilateral, 2 (1–9) after unilateral, and 2 (1–4) after nerve‐sparing operations. Histological examination revealed only necrosis/fibrosis in 65% of the patients, elements of mature teratoma in 28%, and remnants of viable malignant tumor in 6%. There were no major postoperative complications. “Dry ejaculation” was reported by 84% of the patients with bilateral operations, but was generally avoided after the unilateral (16%) and nerve‐sparing (nil) procedures. After a mean follow‐up of 83 (5–138) months, 6 patients have developed a recurrence, only one of them primarily in the retroperitoneal space. It is concluded that in patients with minimal residual retroperitoneal tumor, postchemotherapy lymphadenectomy using a unilateral or nerve‐sparing technique seems to offer an effective therapeutic alternative with acceptable postoperative morbidity and pr

ISSN:0022-4790    

DOI:10.1002/jso.2930500404

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1992

数据来源: WILEY

摘要:

AbstractPostoperative atrial fibrillation (AF) is a recognized complication of cancer surgery. The purpose of this study was to define preoperative risk factors for AF, and to evaluate the clinical significance of the arrhythmia. We reviewed the medical records of 43 patients with postoperative AF admitted to the surgical intensive care unit (SICU). All patients were older than 60 years, 79% had a history of cigarette smoking, and 44% had hypertension. AF occurred an average of 2.8 days following surgery, and lasted an average of 2.1 days. No significant complications developed, and there were no long‐term sequelae. This study suggests that, in cancer patients, postoperative AF is a disease of elderly patients. In addition the arrhythmia appears to be a relatively transient and benign phenomenon. Prolonged monitoring in an intensive care setting may not be necessary for asymptomatic, hemodynamically stable patients. © 1992 Wiley‐Liss,

ISSN:0022-4790    

DOI:10.1002/jso.2930500405

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1992

数据来源: WILEY

摘要:

AbstractWe retrospectively examined by flow cytometry the DNA ploidy pattern in tissue blocks from 25 primary colon adenocarcinomas and their lymph node and liver metastases. Intratumoral heterogeneity was present in 22% of primary tumors and 21% of metastatic liver deposits. Intertumoral heterogeneity, measured between the primary tumor and its lymph node and liver metastases, was 0% and 20%, respectively. Of 24 patients who underwent successful resection of their liver metastases, 8 neoplasms had uniformly diploid DNA content, while 16 tumors had aneuploid DNA pattern in either the primary tumor, the metastases, or both. Five‐year survival was better in the diploid group (38% vs. 7%,P= 0.10 by log rank analysis). Three of eight patients in the diploid group remain free of disease, while all 16 patients with aneuploid cell populations have died of recurrent disease. © 1992 Wiley‐Liss,

ISSN:0022-4790    

DOI:10.1002/jso.2930500406

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1992

数据来源: WILEY

ISSN:0022-4790    

DOI:10.1002/jso.2930500407

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1992

数据来源: WILEY

摘要:

AbstractIn a study of 18 patients diagnosed with vulvar malignant melanoma between 1975 and 1991, the effect of clinical and pathologic variables on the survival was evaluated. The overall 5‐year survival rate was 28.6%. In 14 cases the tumor was retrospectively microstaged with use of Breslow depth and Chung levels. International Federation of Gynecology and Obstetrics (FIGO) stage and Breslow depth did not correlate well with survival. Positivity of groin lymph nodes at initial surgery was associated with an insignificant worsening in survival. An inverse correlation, although statistically not significant, was demonstrated between advancing Chung levels and survival. It is concluded that since the data with respect to microstaging of vulvar malignant melanoma is, as yet, still limited, great caution should be used in electing less aggressive surgery than radical vulvectomy and bilateral groin lymphadenectomy for patients with early‐microstage localized disease. © 1992 Wiley‐Lis

ISSN:0022-4790    

DOI:10.1002/jso.2930500408

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1992

数据来源: WILEY

摘要:

AbstractIn this study, we compared the relapse‐free and overall survival of 83 patients who underwent mastectomy with immediate reconstruction (MIBR) using a musculocutaneous flap with or without silicone implant with those of 153 patients with breast cancer who underwent mastectomy without immediate reconstruction. In univariate analysis, the overall and/or relapse‐free survival of reconstructed patients with four or more positive axillary lymph nodes or those with menopausal status were significantly inferior compared with those of nonreconstructed patients. In multivariate analysis, however, the immediate breast reconstruction did not appear to have a significant adverse influence on all patients, and on the subgroups stratified by menopausal status or axillary lymph node metastases. Therefore, it was concluded that MIBR using a musculocutaneous flap did not compromise the survival of patients with breast cancer. © 1992 Wiley‐Lis

ISSN:0022-4790    

DOI:10.1002/jso.2930500409

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1992

数据来源: WILEY

摘要:

AbstractThe utility of fine needle aspiration (FNA) and physical examination for selecting patients with palpable thyroid nodules for surgery was evaluated in 795 consecutive cases. Surgery was performed in 216 patients based upon the cytological diagnosis and clinical criteria. Excluding 42 patients who were lost to follow‐up, the remaining 537 were regularly followed up (range, 2–10 years). Cytological findings were classified as malignant, histologic control recommended (suspicious), follicular tumor, benign, and unsatisfactory. Thirty‐six aspiration biopsies were positive for malignancy and the diagnosis was confirmed histologically in 34 of them. In 65 patients with final histological diagnosis of malignancy, cytology was positive in 34, suspicious in 20, benign in 3 cases, and unsatisfactory in 8. All patients with cytological diagnosis of follicular tumor had a benign lesion at histology. There were two false positive and three false negative cytological results among the 216 histologically confirmed cases. Excluding unsatisfactory specimen sensitivity, specificity and the predictive value for a positive and a negative result were respectively 95%, 97.5%, 94.5%, and 97%. We conclude that FNA is a very reliable diagnostic test in the evaluation of thyroid nodules and is the best guidance in addition to clinical criteria for selecting patients to be submitted to surgery. © 1992 Wiley‐L

ISSN:0022-4790    

DOI:10.1002/jso.2930500410

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1992

数据来源: WILEY

摘要:

AbstractTwenty‐nine patients with advanced refractory breast cancer were treated with cisplatin 20 mg/m2/d and VP‐16 100 mg/d for 5 days every 3–4 weeks. Ten patients received mitomycin C 10 mg/m2every 6 weeks additionally. Partial response was obtained in 10 of 26 evaluable patients (38%). The response rates for the group treated with and without mitomycin C were 40% and 37.5%, respectively. Median response duration was 5.5 months in partial responders. Median survival was 9.5 months for partial responders and 2 months for the rest of the patients. Cisplatin and VP‐16 combination can be considered as a salvage treatment in heavily pretreated patients with advanced breast cancer. © 1992 Wiley

ISSN:0022-4790    

DOI:10.1002/jso.2930500411

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1992

数据来源: WILEY