ISSN:8756-0437    

DOI:10.1002/ssu.2980100302

出版商:John Wiley&Sons, Inc.    

年代:1994

数据来源: WILEY

摘要:

AbstractIn all but one of seven recent epidemiologic case‐control and cohort studies directly examining the association between aspirin and colorectal cancer and polyps, regular aspirin use reduced the risk of these diseases by about half. Although these studies show a biologically plausible relationship between aspirin and colorectal cancer, information regarding dose and duration and risk change after discontinuation of aspirin is limited and contradictory. Additionally, selection bias, recall bias, and confounding cannot be completed discounted. The one randomized trial of aspirin and placebo showed that aspirin at a dose adequate for preventing myocardial infarction (325 mg every other day) did not reduce colorectal cancer incidence during five years of randomized treatment and follow‐up. Further studies need to determine the biologic effects of aspirin, the minimum dose required, and whether other factors, such as age, illnesses, and reasons for aspirin use, modify or confound colorectal cancer development. © 1994 Wiley‐Lis

ISSN:8756-0437    

DOI:10.1002/ssu.2980100303

出版商:John Wiley&Sons, Inc.    

年代:1994

数据来源: WILEY

摘要:

AbstractStudies of risk factors for colonic adenomatous polyps have been reported in greater numbers in 1993 than in all previous years combined. This explosion in interest in polyps has not arisen because polyps themselves cause serious illness. They are in the vast majority of cases asymptomatic. However, adenomas have become the surrogate for colon cancer in a number of phase III dietary intervention trials. These trials were undertaken at a time when very little was known of adenoma risk factors. Data accumulated in the past 18 months in general demonstrate a similarity in risk factors for cancer and polyp. Since it has also been recently established that polypectomy diminishes colon cancer risk, the adenomatous polyp has been established as an ethical and convenient surrogate for cancer of the colon. Prevention of colorectal cancer is the goal of all the above studies, and it is hoped that the dietary intervention trials currently under way will generate the data that will make prevention possible. © 1994 Wiley‐Liss, I

ISSN:8756-0437    

DOI:10.1002/ssu.2980100304

出版商:John Wiley&Sons, Inc.    

年代:1994

数据来源: WILEY

摘要:

AbstractThe clinician treating colorectal cancer (CRC) should be able to predict which patients will live and which will die from their tumor. Many prognostic variables, significant in retrospective analyses, are never formally used in staging. The resultant imperfection of clinical predictions of survival are probably directly related to the relative inaccuracy of the staging system, a system inevitably dependent entirely on pathologic criteria. Potentially valuable clinical variables, sometimes associated with better or worse outcome despite the pathologic stage of disease, could improve the accuracy of prediction. Evolution to better clinico‐pathologic staging systems would also help to better stratify patients in prospective randomized trials of new adjuvant therapeutic modalities. © 1994 Wiley‐Liss,

ISSN:8756-0437    

DOI:10.1002/ssu.2980100305

出版商:John Wiley&Sons, Inc.    

年代:1994

数据来源: WILEY

摘要:

AbstractHospital‐based malnutrition is prevalent, especially among patients with gastrointestinal malignancy. Colorectal cancers produce malnutrition through impairment of gastrointestinal function and the liberation of cytokines. Malnourished patients who undergo operation have an increased likelihood of perioperative morbidity and mortality. The performance of a nutritional assessment will aid in the recognition of such patients and provide a risk assessment profile. Preoperative parenteral nutrition is a major expense and delays surgical intervention. Studies to document the efficacy of preoperative parenteral nutrition suffer from design flaws and small sample sizes. Studies that exclusively address patients with cancer of the colon and rectum are absent; therefore results must be extrapolated from the existing literature. Cumulative evidence suggests that a 7‐10 day period of parenteral nutrition repletion in the severely malnourished patient will diminish the incidence of postoperative septic complications and mortality. The preoperative treatment of lesser degrees of malnutrition remain controversial. Once the decision has been made to institute preoperative parenteral alimentation, attention to the details of protein requirements and caloric needs should be stressed. The endpoint of therapy is poorly defined. The role of glutamine, arginine, omega‐3 fatty acids, and growth hormone in the preoperative repletion process provide an exciting arena for future research. © 1994 Wiley‐L

ISSN:8756-0437    

DOI:10.1002/ssu.2980100306

出版商:John Wiley&Sons, Inc.    

年代:1994

数据来源: WILEY

摘要:

AbstractThe last 2 decades the immunomodulatory effect of blood transfusions has been investigated intensively. The effect of blood transfusions on the prognosis of colorectal cancer patients is reviewed in this paper. We made an evaluation of the material from animal and from clinical studies present in the literature. The results from clinical randomized trials dealing with this subject, which have been published recently, are discussed as well. © 1994 Wiley‐Liss, I

ISSN:8756-0437    

DOI:10.1002/ssu.2980100307

出版商:John Wiley&Sons, Inc.    

年代:1994

数据来源: WILEY

摘要:

AbstractSurgery is the primary mode of therapy for colorectal cancer. Advances beyond exteriorization began to appear at the end of the nineteenth century. The antibiotic era brought on more advances. Dogma abounds with respect to the technical aspects of surgery for colon and rectal cancer and few randomized, prospective trials have been done to evaluate the importance of these techniques. Firmly established are the techniques of resection of lymphatic drainage of tumors, en bloc resection of invaded structures, and obtaining at least 2 cm margins of rectal cancers. Radical lymph node dissection, luminal ligation, oophorec‐tomy, and the “No‐Touch Technique” are discussed. Despite the paucity of irrefutable scientific data to support many of the described surgical techniques, differences in outcome between surgeons suggest that technique is important. There is great need for randomized, prospective trials to evaluate the multitude of techniques described for the surgical treatment of colorectal cancer. © 1994 Wiley

ISSN:8756-0437    

DOI:10.1002/ssu.2980100308

出版商:John Wiley&Sons, Inc.    

年代:1994

数据来源: WILEY

摘要:

AbstractSince the beginning of the century, different surgical procedures have been employed to create new anal sphincters for a continent perineal colostomy after abdominal perineal anorectal resection for cancer.After a detailed review of all the currently employed surgical procedures, the authors present their experience with 15 cases treated by transposition of the gracilis muscles to the perineum.More than 50% of the operated patients had good functional results with complete continence for solid stools and sufficient control of the stimulus. Poor results are related to surgical complications or unexpected postsurgical diseases and cancer recurrence or metastases. This surgical procedure seems to be an interesting possibility for selected patients in the case of a permanent abdominal incontinent colostomy after the Miles operation. © 1994 Wiley‐Liss, I

ISSN:8756-0437    

DOI:10.1002/ssu.2980100309

出版商:John Wiley&Sons, Inc.    

年代:1994

数据来源: WILEY

摘要:

AbstractPatients' benefit from follow‐up examinations after curative surgery for colorectal cancer is unproven in spite of numerous different programs' having been designed for that purpose. Unfortunately, no final results from prospective randomized studies have been published yet and no ideal marker for recurrent cancer is available to identify patients in whom new curative treatment may be possible. So far, screening for metachronous neoplasia with intervals of several years may influence survival, whereas benefit from detecting recurrent colorectal cancer may be claimed only by using historical or other inappropriate controls. The tradition of follow‐up is expensive and prospective evidence for any cost benefit is needed to justify continuous use of our limited resources in this area of patient care. © 1994 Wiley‐Lis

ISSN:8756-0437    

DOI:10.1002/ssu.2980100310

出版商:John Wiley&Sons, Inc.    

年代:1994

数据来源: WILEY

摘要:

AbstractCauses of death were evaluated among 350 deceased patients with familial adenomatous polyposis (FAP) recorded in the Italian Polyposis Registry: 78.1% were due to colorectal cancer, 9.5% to extracolonic cancer (more than half of the upper gastrointestinal tract), 3.6% to desmoid tumors, and 8.8% to other causes. The age at diagnosis among 604 patients was studied in relation to presence of symptoms at presentation and presence of colonic cancer at surgery. In asymptomatic patients younger than 30 years the risk of colonic cancer was 3.3% and in symtomatic patients older than 40 it was 80%. A life‐table analysis showed that postsurgical survival among patients without cancer at colectomy was 68% after 30 years, whereas that of patients with cancer was 41% after 10 years. The alternative prophylactic treatments of total colectomy with ileorectal anastomosis versus total proctocolectomy (IRA vs. IAA) were compared in terms of postsurgical survival. Both treatments showed a survival of 83% after 10 years. The risk of cancer in the rectal stump after IRA was 14.5% after 15 years and 25.2% after 25 years; the corresponding risks of dying from it were 4.3% and 9.3%, respectively. © 1994 Wiley‐Liss,

ISSN:8756-0437    

DOI:10.1002/ssu.2980100311

出版商:John Wiley&Sons, Inc.    

年代:1994

数据来源: WILEY