摘要:

PURPOSE:The study contained herein was undertaken to evaluate the accuracy of radiolabeled human monoclonal antibody, 88BV59H21‐2V67‐66 (88BV59 or HumaSPECT®‐Tc), in predicting disease resectability in presurgical subjects with recurrent, metastatic, or occult colorectal carcinoma.METHODS:A total of 219 patients with disease visualized on computed tomographic scan (recurrent or metastatic disease) or with negative or equivocal computed tomographic scan and rising carcinoembryonic antigen serum levels (occult group) received technetium Tc 99m‐labeled 88BV59 intravenously. Planar and single photon emission computed tomographic images were obtained 14 to 20 hours postinfusion, before surgery. The ability of computed tomographic and HumaSPECT®‐Tc imaging to define the extent of disease and to predict resectability was evaluated based on surgical and histopathologic results.RESULTS:In patients with recurrent or metastatic disease (170 evaluable patients), the accuracy of predicting non‐resectability of disease was significantly greater (P<0.001) for HumaSPECT®‐Tc than for computed tomography (60vs.29 percent). Computed tomography understaged 41 percent of patients believed to have resectable disease compared with 27 percent for HumaSPECT®‐Tc (P<0.001). In occult disease patients (29 computed tomographic and 28 HumaSPECT®‐Tc evaluable patients), the overall accuracy of predicting resectability/nonresectability was 68 percent for HumaSPECT®‐Tc compared with 24 percent for computed tomography. Administration of HumaSPECT®‐Tc had no effect on monoclonal antibody‐basedin vitrodiagnostic assays. Only a single patient demonstrated an anti‐antibody response (90 ng/ml) at nine weeks postinfusion.CONCLUSION:HumaSPECT®‐Tc was more accurate than computed tomography in determining disease resectability in patients with metastatic, recurrent, or occult cancer. The addition of HumaSPECT®‐Tc imaging can play a significant role in patient management decisions.

ISSN:0012-3706    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

PURPOSE:Laparoscopic colorectal surgery for cancer is currently under discussion. Results of large, randomized studies will not be available for a number of years yet. This study analyses the results of such resections in consecutive patients operated on by unselected surgeons.METHODS:A prospective, observational, multicenter study was initiated on August 1, 1995, in the German‐speaking countries of Europe. One year after initiation of the study, findings are presented with respect to the quality of oncologic resections.RESULTS:Of 500 operations, 231 (46 percent) were performed for cancer, 167 (33 percent) with a curative intent. The most common curative resections were as follows: 63 anterior rectum resections (38 percent), 51 sigmoid resections (30 percent), and 27 abdominoperineal resections (16 percent). Segmental resections were performed in 20 patients (12 percent). Intraoperative tumor spillage was reported in 2 percent. Mean number of lymph nodes harvested was 13 (confidence interval, 5‐95 percent; range, 11.5‐14.6) and positive lymph nodes harvested was 2.2 (confidence interval, 5‐95 percent; range, 0.9‐3.4). Significant differences were noted between participating centers in terms of number of lymph nodes resected (P<0.0001). Distal and proximal resection margins were tumorfree in every case. Lateral margins were tumor‐free when examined. In the case of 63 curative anterior resections, the mean distal resection margin was 39 (confidence interval, 5‐95 percent; range, 33‐45) mm, and in 8 of these resections, it was less than 20 mm. Mean blood loss was 344 (confidence interval, 5‐95 percent; 292‐396) ml, and 21 percent of patients received blood transfusions.CONCLUSIONS:These data document that the average quality of laparoscopic colorectal procedures for cancer is satisfactory but differs among surgeons.

ISSN:0012-3706    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

PURPOSE:Traumatic manipulation of cancer specimens during laparoscopic colectomy may increase exfoliation of malignant cells into the peritoneal cavity, causing an early occurrence of peritoneal carcinomatosis or port‐sites recurrence. Because of this concern, the routine use of intraperitoneal chemotherapy after laparoscopic colectomy for cancer was suggested recently. We assessed if laparoscopicvs.conventional surgery increases exfoliated malignant cells in the peritoneal cavity during resection of colorectal cancer.METHODS:In a prospective, randomized fashion, 38 colorectal cancer patients undergoing an elective, curative operation were assigned to either a conventional or laparoscopic procedure between June 1996 and May 1997. In either group (n=19), after the abdominal cavity was entered, saline was instilled into the peritoneal cavity, and the fluid was collected (Specimen 1). During surgery, all irrigating fluids were collected (Specimen 2). Both specimens were assessed for malignancy using four techniques: filtration process (ThinPrep®), smear, cell block, and immunochemistry using Ber‐EP4. The change in the amount of tumor cells in both specimens was compared between surgical groups. A pilot study was performed to validate the proposed cytologic method.RESULTS:In the pilot study of 20 consecutive patients with colorectal cancer, postresectional peritoneal cytology was positive in six patients, including two Stage II (T3,N0,M0) patients. The pilot study also validated that our semiquantitative scoring system can be reliably used to assess the amount of free peritoneal cancer cells. In the main study, 16 right colectomies, 3 extended right colectomies, 17 proctosigmoidectomies, and 1 left colectomy were performed. The T and N stages were T1 (n=13), T2 (n=5), T3 (n=8), T4 (n=11); N0 (n=22), N1 (n=8), N2 (n=7). Malignant cells were not detected in any Specimens 1 or, more importantly, in Specimens 2 in either surgical group.CONCLUSION:When performed according to strict oncologic surgical principles, laparoscopic techniques in curative colorectal cancer surgery did not have an increased risk of intraperitoneal cancer cell spillage, compared with conventional techniques. We hope that these results can decrease some of the concerns about tumors cell spillage and seeding during laparoscopy.

ISSN:0012-3706    

出版商:OVID    

年代:1998

数据来源: OVID

ISSN:0012-3706    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

PURPOSE:This study examines the prognostic significance of circumferential margin involvement by tumor in resected specimens after potentially curative rectal cancer surgery.METHODS:During an eight‐year period, all patients with rectal cancer were prospectively audited. For tumors of the middle and lower thirds of the rectum, a total mesorectal excision was performed; for tumors of the upper third, mesorectal excision proceeded at least 5 cm distal to the primary tumor. Resected specimens were subjected to careful histologic assessment, and patients undergoing curative procedures were entered into a surveillance program to detect both local and distant recurrence.RESULTS:Of 218 patients in the cohort, 9 had no resection, 14 underwent local excision, 1 had pre‐operative radiotherapy, and 42 patients (20 percent) had palliative resections and were excluded from further analysis. This left 152 patients having a curative resection, of whom 20 (13 percent) had tumor within 1 mm of the circumferential margin. After follow‐up until death or a median period of 41 months, recurrent disease was seen in 24 percent of patients with a negative margin and 50 percent with a positive margin. Both disease‐free survival and mortality were significantly related to margin involvement (log‐rank,P=0.01 andP=0.005, respectively). Local recurrence, however, was not significantly different in the two groups (11 and 15 percent, respectively; log‐rank,P=0.38).CONCLUSIONS:When a mesorectal excision is performed, circumferential margin involvement is more an indicator of advanced disease than inadequate local surgery. Patients with an involved margin may die from distant disease before local recurrence becomes apparent.

ISSN:0012-3706    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

PURPOSE:In surgery for rectal cancer, it is unclear whether the inferior mesenteric artery should be ligated at a high or low position. The study contained herein was undertaken to clarify the indications for high ligation of the inferior mesenteric artery.METHODS:Subjects included 198 patients with rectal cancer who underwent resection with high ligation of the inferior mesenteric artery. Nodal metastases were examined by the clearing method.RESULTS:The incidence of metastases to the lymph nodes surrounding the origin of the inferior mesenteric artery (root nodes) was 8.6 percent. Inferior mesenteric artery root nodal metastases occurred more frequently with pT3 and pT4 cancer. The five‐year survival rate in patients with inferior mesenteric artery root nodal metastases was 38.5 percent; this rate was significantly lower than in those without inferior mesenteric artery root nodal metastases (73.4 percent).CONCLUSIONS:Although the five‐year survival rate in patients with inferior mesenteric artery root nodal metastases was lower than in those without metastases, inferior mesenteric artery root nodal dissection should be performed after high ligation of the inferior mesenteric artery for patients with pT3 and pT4 cancers.

ISSN:0012-3706    

出版商:OVID    

年代:1998

数据来源: OVID

ISSN:0012-3706    

出版商:OVID    

年代:1998

数据来源: OVID

ISSN:0012-3706    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

PURPOSE:Anorectal fistulas are commonly associated with Crohn's disease. Carcinoma arising in an anal fistula in the absence of Crohn's disease occurs rarely. Carcinoma arising in an anorectal fistula of Crohn's disease is likewise rare and is the subject of this article.METHODS:We have seen eight cases in seven patients. Four of these were squamous carcinoma and three were adenocarcinoma. Details of these seven patients are presented.RESULTS:Two deaths in the four patients with squamous carcinoma and one in the two patients with adenocarcinoma with adequate follow‐up suggest a poorer prognosis in both types of malignancy than when these lesions occur without Crohn's disease.CONCLUSION:Carcinoma does arise in the midst of the anorectal fistulas and abscesses of Crohn's disease. Carcinoma arising in a Crohn's disease fistula can be very difficult to diagnose. Examination may be limited by pain, stricture, or induration of the perianal and perineal tissues. Examination under anesthesia can also overlook the lesion. Diagnostic examination under anesthesia yields increases with biopsies or curettage of the fistulous tracts.

ISSN:0012-3706    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

OBJECTIVE:The study contained herein was undertaken to describe the minilaparotomy approach to tumors of the right colon.METHOD:Clinical data were prospectively registered from 47 patients who were undergoing resection of the right colonviaminilaparotomy.RESULTS:Bowel function returned after two days and passage of stools after four days. Pain medication was necessary only during the first three postoperative days. Major complications were few, and no postoperative deaths occurred. Tumors 10 cm or smaller could be handled by minilaparotomy, and the technique allowed a relevant number of lymph nodes to be removed. No local recurrences were detected during the early postoperative period.CONCLUSION:The minilaparotomy approach to tumors of the right colon seems to be an attractive alternative to conventional colon surgery.

ISSN:0012-3706    

出版商:OVID    

年代:1998

数据来源: OVID