ISSN:0012-3706    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

PURPOSE:Perianal Bowen's disease is an uncommon squamous‐cell carcinomain situusually treated by surgical excision. There are controversies concerning surgical margin extent, because the disease is likely to recur in nonexcised skin areas of the anal and perianal skin. The aims of this study were 1) to determine the recurrence rate after different surgical treatments and 2) to determine if molecular markers might have a prognostic role in perianal Bowen's disease.METHOD:Retrospective chart review from 1972 to 1993 of 47 patients with perianal Bowen's disease was undertaken. Follow‐up was obtained by office visits and/or phone questionnaire. Immunohistochemical analysis for p53 protein and Ki‐67 nuclear antigen was conducted on fixed tissue specimens.RESULTS:Twenty‐six patients were treated by wide local excision with microscopic clearance of resection margins, 15 by local excision with only macroscopic clearance of resection margins, 5 by CO2laser vaporization, and 1 by abdominoperineal resection because of fecal incontinence. Median follow‐up for the entire population was 104 (range, 16‐273) months. The incidence of local recurrence was 23.1 percent (6/26) after wide local excision, 53.3 percent (8/15) after local excision, and 80 percent (4/5) after CO2‐laser vaporization. Recurrence rate estimated by Kaplan‐Meier analysis is statistically different (P=0.002) between radically treated patients (wide local excision/abdominoperineal resection;n=27) and patients undergoing conservative treatment (local excision/laser vaporization;n=20). Among patients with recurrence, the median time until recurrence was 38.5 (range, 3‐89) months and 41.5 (range, 4‐111) months after conservative and radical treatment, respectively. Nine of 20 (45 percent) patients in the conservative group and none of the 27 patients in the radical group had multiple episodes of recurrence (P<0.001). In addition, 3 of 20 and 0 of 27 patients in the respective groups developed an invasive cancer (P=0.034). Positive staining for p53 protein was observed in 12 (33.3 percent) of the 36 tissue specimens available for immunohistochemical analysis. Recurrence occurred in 9 of 24 (37.5 percent) patients negative for p53 and in 6 of 12 (50 percent) patients with positive p53 expression (P=not significant). Ki‐67 antigen‐graded expression from 1+ to 4+ did not reveal any correlation with incidence of recurrence. Recurrence rate did not differ by p53 and Ki‐67 results, either in the overall group of 36 patients or stratified by surgical treatment groups.CONCLUSION:Wide local excision for perianal Bowen's disease leads to a significantly lower recurrence rate than local excision or laser therapy. Follow‐up longer than five years is recommended because of the risk of late recurrence. p53 protein and Ki‐67 antigen immunohistologic expression may not have a prognostic role in perianal Bowen's disease.

ISSN:0012-3706    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

BACKGROUND:The etiology and significance of port site recurrence occurring after laparoscopic‐assisted resection for colorectal cancers will not be determined until controlled clinical trials determine if it is a predictor of out‐come. Indirect evidence in support of transcoelomic spread of viable cancer cells to port sites during resection can be postulated by the presence of free cells on the fresh surface of colorectal specimens during primary resection.PURPOSE:The study contained herein was undertaken to determine the incidence of free surface colorectal cancer cells by cytology during elective open resection and to correlate their presence with clinicopathologic variables.METHODS:Fresh clamped and ligated consecutive colorectal cancer specimens were assessed in the operating room during primary resection for the presence of free colorectal cancer cells during an 18 month period at one institution. Clinicopathologic variables were assessed prospectively and blinded to cytology results. Interobserver reliability of cytologists was excellent (unweighted kappa, 0.93).RESULTS:Overall, 15 of 103 (14.6 percent) colorectal cancers had positive cytology for cancer cells on the peritoneal or perirectal surface of the bowel. T3 and T4 tumors, the size or site of the tumor, lymph node status, mucinous characteristic, degree of differentiation, and the presence of vascular or neural invasion did not reach statistical significance as predictors of positive cytology in this study sample. The operative procedure performed was a statistically significant predictor of positive cytology. More than 50 percent of lymph nodes involved (28 percent), poorly differentiated tumors (28 percent), and the presence of liver metastases (22 percent) demonstrated a higher incidence of positive cytology, but this did not reach significant levels because of the limited power of the study sample for subgroup analysis.DISCUSSION:The presence of free surface colorectal cancer cells gives only indirect support to the transcoelomic route to port site recurrence. The significance and true incidence will only be determined by prospective database analysis and randomized, controlled trials.

ISSN:0012-3706    

出版商:OVID    

年代:1997

数据来源: OVID

ISSN:0012-3706    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

PURPOSE:Synchronous or metachronous ovarian metastases are common along the natural course of colorectal carcinoma. We attempted to prospectively assess the prognostic impact of simultaneous bilateral oophorectomy in postmenopausal women undergoing curative resection for colorectal cancer.METHODS:Between 1980 and 1990, simultaneous bilateral oophorectomy was proposed in each postmenopausal woman referred to our institution for treatment of colorectal cancer. A subset of 92 patients underwent a curative resection. Therefore, two groups were designed for comparison of the procedure. Group I included 41 patients who accepted surgical castration, and Group II consisted of the 51 remaining patients who refused. Prospective analysis of all patients was performed. Results were assessed with a follow‐up of 60 months after surgery, with 97.9 percent completion. Local recurrence and liver metastases rates were compared by the chisquared test. Survival in each group was calculated by the Kaplan‐Meier method and compared by the log‐rank test.RESULTS:One patient (1/41; 2.4 percent) had ovarian metastases detected on the operative specimen. Local recurrence or liver metastases rates were not affected by oophorectomy (P=0.73;P=0.25). Five‐year actuarial survival rates were not significantly different whether patients had oophorectomy (81.6 percent) or not (87.9 percent;P=0.62).CONCLUSIONS:Our results suggest that microscopic synchronous ovarian metastasis is rare at the time of curative resection of a colorectal carcinoma in postmenopausal women. Because simultaneous bilateral oophorectomy does not modify prognosis, this procedure seems to be unwarranted.

ISSN:0012-3706    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

PURPOSE:We investigated the effectiveness of hyperthermia added to preoperative radiation and chemotherapy for the treatment of rectal carcinoma.METHODS:Forty‐one patients receiving preoperative radiation were divided into two groups, Group A (20 patients; receiving radiation, hyperthermia, and chemotherapy) and Group B (21 patients, receiving no hyperthermia). Total dose of radiation was 40.5 Gy. Hyperthermia was administered using 8 MHz of radiofrequency. Rectal temperature reached 42‡C. A total dose of 3,400 mg of 5‐fluorouracil given by suppository was used as the chemotherapeutic agent. Effect of the preoperative treatment was assessed by tumor reduction on barium enema, histologic findings of the resected specimens, area measurement of the residual cancer tissue, and by silverstaining nucleolar organizer region (AgNOR) score.RESULTS:Tumor reduction on barium enema was significantly greater in Group A than in Group B (P< 0.01). Excluding two cases of mucinous carcinoma because a large acellular mucinous accumulation added materially to the cancerous area, the ratio of residual cancer area to total lesion size in Group A was significantly smaller than in Group B (P< 0.05). AgNOR score of the resected tumor tended to be smaller in Group A than in Group B.CONCLUSION:Addition of hyperthermia resulted in a greater degree of tumor necrosis and was considered to be useful as a preoperative treatment for rectal carcinoma.

ISSN:0012-3706    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

&NA;In managing advanced low rectal adenocarcinomas in medically fit patients, surgical resection offers the best palliation. Tenesmus, bleeding per rectum, sacral pain, and sciatic pain are common complaints, which are not relieved by radiotherapy or fulguration. The most appropriate resection, however, remains controversial. Abdominoperineal resection is faster and simpler to perform but leaves behind a perineal wound with associated complications. Hartmann's procedure requires adequate mobilization below the tumor and may be technically more demanding but avoids a perineal wound. Therefore, an analysis of outcome in patients treated by Hartmann's procedurevs.abdominoperineal resection was made.METHOD:Fifty‐four symptomatic patients with advanced rectal adenocarcinoma arising within a median of 5 (range, 4‐8) cm from the anal verge treated between June 1989 and October 1995 were studied. Twenty‐eight patients (17 males; mean age, 67.6±10.3 years) had Hartmann's procedure, and 26 patients (12 females; mean age, 68.8±8.3 years) were treated by abdominoperineal resection. Mean follow‐up was 23.5 months (±17.5) and 18.6 months (±12.9) in Hartmann's procedure and abdominoperineal groups, respectively.RESULTS:Mean operative time was 138.4±26.7 minutes for Hartmann's procedure group and 124.6±27.1 minutes for the abdominoperineal resection group (P>0.05; not significant). Postoperatively, Hartmann's procedure group started oral intake at a mean of 2.3 days, and stomas were functioning at a mean of 3.1 days compared with 2.6 days for oral intake and 3 days for stoma functioning in the abdominoperineal resection group. Hartmann's procedure group was ambulant after a mean of 2.4 daysvs.a mean of 3.2 days in the abdominoperineal resection group. Postoperative abdominal wound infection occurred in 18 and 19 percent, respectively, in Hartmann's procedure and abdominoperineal resection groups. Forty‐six percent of patients had perineal wound sepsis, and 38 percent had perineal wound pain in the abdominoperineal resection group. These complications were absent in Hartmann's procedure group. Postoperative stay was similar in both groups.CONCLUSION:We conclude that Hartmann's procedure offers superior palliation compared with abdominoperineal resection because it provides good symptomatic control without any perineal wound complications and pain.

ISSN:0012-3706    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

PURPOSE:This study was undertaken to compare local application of a glyceryl trinitrate ointment with lateral internal sphincterotomy for the treatment of chronic fissure‐in‐ano.PATIENTS AND METHODS:A sample of 24 consecutive patients with chronic anal fissure was randomly allocated to treatment with sphincterotomy or local glyceryl trinitrate. Patients were followed‐up for a median of 22 months.RESULTS:All 12 patients healed following sphincterotomy; 10 of 12 healed with local glyceryl trinitrate (P=0.239). There were no recurrences or side‐effects in either group.CONCLUSIONS:Local application of glyceryl trinitrate can avoid surgery in more than 80 percent of patients with chronic anal fissure.

ISSN:0012-3706    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

PURPOSE:Transformation of fast‐twitching skeletal muscles to slow‐twitching, slowly fatigable muscles have become of clinical interest in the recent past. Transposition and transformation of the gracilis muscle to use it as a substitute for a resected or defected anal sphincter (graciloplasty) has been reported as achieving promising results in the treatment of fecal incontinence caused by sphincter defects or following abdominoperineal anorectal excision for cancer.METHOD:This experimental study used a canine model and the sartorius muscle to evaluate the functional efficiency of two different configurations of the muscle loop to compare the presently applied transformation program (8 weeks) with a shorter (5 weeks) protocol. In six beagle dogs, both sartorius muscles were wrapped around two stomas, either in an alpha fashion or in the so‐called split‐sling technique. Muscle transformation was achieved by controlled neuromuscular stimulation either during eight (Program A) or five weeks (Program B). After completion of the transformation period, the function of the muscle slings was evaluated by manometry, and histomorphologic evaluation of the sartorius muscles was performed.RESULTS:It was shown that muscle transformation led to a slowly fatigable muscle that made it possible to perform continuos (tetanic) contraction, regardless of the configuration or the duration of the transformation. Median pressures created by these muscles also did not differ significantly. In accordance with these functional findings, the histologic evaluation showed the typical, significant increase of Type I fibers in both muscle slings and following both transformation protocols. Although the decrease of fast‐twitching Type II fibers was more pronounced following the conventional (8 weeks) program, this finding did not influence the functional results.CONCLUSIONS:Results of our experiment indicate the possibility for using a shorter transformation protocol for transformation of the gracilis muscle during graciloplasty in the clinical setting. Furthermore, the efficacy and safety of the modified (split‐sling) wrap technique was demonstrated.

ISSN:0012-3706    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

PURPOSE:This study was designed to compare esophageal and anorectal function parameters in patients with systemic sclerosis and to define the role of anorectal manometry in the diagnosis of gastrointestinal involvement of systemic sclerosis.PATIENTS AND METHODS:Twenty‐six consecutive patients (22 females) with systemic sclerosis originally referred for assessment of esophageal function were evaluated by esophageal and anorectal manometry. Anorectal function parameters were compared between patients with normal and those with disturbed esophageal function.RESULTS:A total of 17 of 26 patients (65 percent) had severe esophageal dysfunction with aperistalsis of the lower two‐thirds of the esophagus, whereas 9 patients (35 percent) had normal esophageal manometry. Only three patients (11.5 percent) suffered from occasional fecal incontinence. Anorectal function parameters (resting pressure, maximum squeeze pressure, perception threshold) were not significantly different between patients with normal and those with disturbed esophageal motility. Rectoanal inhibitory reflex was excitable in nearly 90 percent of patients.CONCLUSION:In an unselected group of patients with systemic sclerosis, fecal incontinence and abnormal anorectal function are rather rare findings. Anorectal manometry cannot differentiate between patients with and without gastrointestinal involvement of systemic sclerosis.

ISSN:0012-3706    

出版商:OVID    

年代:1997

数据来源: OVID