摘要:

&NA;The median survival of all patients with hepatic metastases from colorectal cancer referred to the Sidney Farber Cancer Institute during a five‐year period was 12.5 months. Two major factors influenced survival. The first was extent of disease at presentation. The second was the histologic grade of the cancer. The median survival of patients presenting with the least disease, characterized by less than four liver nodules visible on liver scan (n=38), normal liver size on physical examination (n=60), normal liver function test results (n=30), and normal performance status (n=91), was between 18 and 24 months, regardless of treatment. The median survival of those few patients (n=13) who had objective responses to a variety of treatments, most of whom also had minimal disease at presentation, was also 24 months. Patients whose tumors were poorly differentiated or who had abnormal performance status or weight loss of greater than 10 per cent at presentation survived only six months (median). Those with four or more liver nodules, hepatomegaly (greater than 16‐cm vertical span on physical examination), or abnormal liver function test results, survived ten, eight, and 12 months (median), respectively. It is concluded that a significant group of patients survived longer than would have been predicted by earlier literature surveys after the diagnosis of colorectal cancer metastatic to the liver. It is suggested that future therapeutic trials, using survival as a measure of response of patients with liver metastases from colorectal cancer, must be prospectively controlled before selection factors can be differentiated from significant therapy effect.

ISSN:0012-3706    

出版商:OVID    

年代:1982

数据来源: OVID

ISSN:0012-3706    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

&NA;The etiology of cancer of the large bowel is in large part environmental. Both epidemiologic and experimental studies suggest that the environmental factor is dietary, specifically associated with a diet high in fat and low in fiber. Prevention is possible by altering these dietary factors, but the degree of change needed to accomplish it would be too drastic to be acceptable. However, the inclusion of certain additives in a diet only slightly modified with respect to the fat‐fiber content may circumvent this problem. We have evidence that the addition of small amounts of representatives of three classes of cancer inhibitors (retinoids, plant steroids, and selenite) reduces intestinal cancer formation in rats by 50 per cent. This suggests that a diet with modest changes in the fat‐fiber content plus the addition of certain inhibitors may be effective in reducing the incidence of cancer of the large bowel.

ISSN:0012-3706    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

&NA;Methods of prognostic stratification for patients with rectal cancer currently rely solely on the extent of tumor penetration in the surgically excised rectum. Thus stratification according to prognostic factors can be performed only after treatment has been carried out and can play no role in pretherapeutic treatment decisions or in the design of trials of preoperative adjuvant treatment. To devise a method of clinical prognostic staging that could be applied to all patients with rectal cancer, regardless of therapy, the medical records were examined of an inception cohort of 282 patients treated by surgical and nonsurgical methods at three Toronto hospitals during the years 1968 to 1974. Six groups of clinical variables were identified that independently influenced prognosis: the presence or absence of metastatic disease, whether the rectal tumor was fixed or mobile, an annular rectal tumor, and the systemic symptoms of weight loss, anorexia, or weakness, and anemia. A composite method was developed for clinical prognostic staging from these variables and it was found that it created substantial gradients in survival. In patients treated by surgery, for whom comparisons of clinical staging with conventional anatomic staging were possible, clinical staging was as effective a method of prognostic staging as was anatomic staging. Furthermore, the prognostic impact of clinical staging persisted after adjustment for the effects of anatomic staging. This method of clinical prognostic staging should prove useful in making therapeutic decisions and in the design and analysis of clinical trials of alternative treatment for patients with rectal cancer.

ISSN:0012-3706    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

&NA;A 48‐year‐old man with Gardner's syndrome, who had abdominoperineal resection for rectal carcinoma in 1962, was found to have an ulcerating growth of the duodenum, and pancreaticoduodenectomy was performed in 1979. Histologic examination by complete step‐serial sectioning disclosed a well‐differentiated adenocarcinoma with adenomatous remnants, a large adenoma with focal carcinoma, 256 adenomas of the duodenum, and 91 adenomas of the gastric antrum. The world medical literature was reviewed, and 29 cases of periampullary carcinoma and 12 cases of gastric carcinoma complicating familial polyposis coli or Gardner's syndrome were analyzed.

ISSN:0012-3706    

出版商:OVID    

年代:1982

数据来源: OVID

ISSN:0012-3706    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

&NA;A retrospective analysis was undertaken of 51 patients with primary anal canal carcinoma who were treated by radiation therapy, with surgery being reserved for those with residual carcinoma. The five‐year uncorrected survival rate was 59 per cent, and the corrected survival rate was 71 per cent. The primary tumor was controlled by radiation alone in 29 of 51 patients (57 per cent) and by subsequent radical surgery in eight of ten patients. Abnormal lymph nodes were controlled by radiation alone in eight of 11 patients. Only three of 29 patients required surgery for complications associated with radiation in the absence of persistent tumor. Seventy‐seven per cent (23 of 30) of long‐term survivors did not require colostomy and retained anal continence. It is concluded that modern radiation therapy techniques are well tolerated and are an effective method of treating carcinoma of the anal canal.

ISSN:0012-3706    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

&NA;A randomized controlled trial aimed at comparing the individual efficacy of cephalothin, cefoxitin, and metronidazole in the prevention of postoperative wound infection was performed among 74 colorectal surgical patients. Of 28 patients on cephalothin, seven (25 per cent) developed a postoperative infection, but among 23 patients in each of the other two groups, only one (4 per cent) in each group became infected. These results confirm the primary importance of anaerobes in the causation of postoperative sepsis after colorectal surgery.

ISSN:0012-3706    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

&NA;The combination of blunt pelvic and perineal injuries is relatively uncommon but carries with it a high morbidity and mortality. A colostomy with distal wash‐out plays a significant role in the prophylaxis of septic complications, even in the absence of recognizable colorectal trauma. Among 14 patients with this type of injury, there were six deaths (42 per cent). Three patients died initially because of hemorrhage, and three late deaths were due to sepsis. Two of these patients had no colostomy, and one had a diversion without wash‐out. The indications for proximal diversion should be broadened to include an expanded view of the perincum, herein presented.

ISSN:0012-3706    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

&NA;Twenty‐five patients had major operations for regional enteritis between 1969 and 1981. Of these, 12 patients required subsequent major procedures for recurrent disease. This group consisted of three men and nine women who were operated upon a total of 32 times. Their average age at onset of disease was 27.4 years, compared with 40 years for those patients who were operated upon only once. The reoperated group had an average of 3.5 nonoperative hospital admissions, while, patients in the group with one operation were hospitalized 1.8 times for disease during the period studied. Identification of operated patients who will required reoperation would improve counseling of these patients. Earlier age of onset and more frequent nonoperative admissions seem to be associated with need for reoperation. Extent and type of primary resection seem to be of less predictive value.

ISSN:0012-3706    

出版商:OVID    

年代:1982

数据来源: OVID