ISSN:8756-0437    

DOI:10.1002/ssu.2980070302

出版商:John Wiley&Sons, Inc.    

年代:1991

数据来源: WILEY

摘要:

AbstractImproved survival rates for patients with colorectal cancer may depend on early detection of metachronous colon lesions and early detection of distant disease. Frequent serial CEA determinations and history and physical examination are the two most useful techniques for diagnosing early recurrent disease. Colonoscopy rarely detects early recurrent disease but is useful in finding metachronous colon lesions. Other radiographic and hematologic examinations have an extremely low yield and should be used to localize and stage disease discovered by other means. Simplified follow‐up can be expected to minimize early detection of recurrent and metachronous lesions yet offers minimal patient risk and expens

ISSN:8756-0437    

DOI:10.1002/ssu.2980070303

出版商:John Wiley&Sons, Inc.    

年代:1991

数据来源: WILEY

摘要:

AbstractThe evaluation of a patient with a suspected colorectal malignancy is well defined; however, the preoperative work‐up of a patient who is a candidate for second‐look surgery is controversial and based less on scientific evidence than on empiric or anecdotal grounds. The preoperative assessment of these patients can be divided into two phases. Phase I consists of a thorough history, physical examination, and routine laboratory tests as the most logical and traditional starting point. Phase II consists of specific tests aimed at evaluating the extent of the recurrence and the resectability of the tumor. Of the various modalities available, the enhanced computerized tomogram is currently the method most likely to provide significant information prior to carcinoembryonic antigen (CEA) directed second‐look surgery. The results of the preoperative evaluation together with a thorough understanding of the natural history of the disease will offer a clear perspective as to the most likely ou

ISSN:8756-0437    

DOI:10.1002/ssu.2980070304

出版商:John Wiley&Sons, Inc.    

年代:1991

数据来源: WILEY

摘要:

AbstractTechnical advances in imaging are barely keeping pace with the need for detailed pre‐operative imaging in second‐look surgery. Although the majority of intra‐abdominal recurrence can be detected at surgery, pre‐operative knowledge of possible sites of involvement will provide more efficient use of operative time. Dynamic incremental bolus CT is the modality of choice when evaluating these patients, even though magnetic resonance imaging is approaching, and may exceed, computed tomography in utility in the abdomen. Monoclonal antibody radioimmunoscintigraphy is useful for extra‐abdominal sites of recurrence. Further technical advancement is needed to make it useful in th

ISSN:8756-0437    

DOI:10.1002/ssu.2980070305

出版商:John Wiley&Sons, Inc.    

年代:1991

数据来源: WILEY

摘要:

AbstractSurgical removal of recurrent metastatic colon and rectal cancer has provided many individuals with disease‐free and treatment‐free long‐term survival of 5 or more years. Surgical removal of metastatic tumor from both lobes of the liver can be done with limited mortality and minimal complications when lesions are small and discovered early. Second‐look operations should be performed when a persistently rising carcinoembryonic antigen is observed in the period after colorectal cancer resection, even when all other tests are negative. Repeat operations may be beneficial when all detectable disease was removed at the previous op

ISSN:8756-0437    

DOI:10.1002/ssu.2980070306

出版商:John Wiley&Sons, Inc.    

年代:1991

数据来源: WILEY

摘要:

AbstractThe benefit of an aggressive surgical approach in selective patients with recurrent colorectal cancer has been demonstrated by several investigators. The disease‐free 5 year survival is 30%, and in carefully selected series it is as high as 46%. These procedures can be performed safely with minimal morbidity and mortality by surgeons who are experienced in the techniques of radical surgery. It is important and should be our focus to try to identify those patients who will benefit the most from an aggressive surgical approach, by better definition of the biology of the tumor through tumor differentiation and DNA and oncogene analysi

ISSN:8756-0437    

DOI:10.1002/ssu.2980070307

出版商:John Wiley&Sons, Inc.    

年代:1991

数据来源: WILEY

摘要:

AbstractMetastasis of colorectal cancer to the lung is a frequent occurrence. Resection of pulmonary metastasis provides the only effective treatment. The initial detection of disease is usually with a chest radiograph. A CAT scan determines the number of lesions, resectability and other metastatic disease. Candidates for surgical excision are those patients with completely resectable singular, multiple, and bilateral metastasis, and those with metachronous liver lesions excised for cure. Exposure of unilateral disease is via a thoracotomy and of bilateral disease via a sternotomy. Metastatic lesions are removed by wedge resection with conservation of lung tissue. Postoperative recovery is usually rapid with low morbidity and mortality. Long‐term success for these resections remains controversia

ISSN:8756-0437    

DOI:10.1002/ssu.2980070308

出版商:John Wiley&Sons, Inc.    

年代:1991

数据来源: WILEY

摘要:

AbstractCarcinoembryonic antigen has been demonstrated to be a valuable clinical aid in the management of patients with colorectal carcinoma. Its elevation in the serum prior to evidence of clinical recurrence in up to 80% of patients highlights its utility. CEA has also been found to be elevated in the serum of patients with other epithelial malignancies, but these have not been as well studied as has colorectal carcinomaIn patients with breast cancer CEA elevations may be found in 40–73% of patients presenting with disease in stages I‐IV. In addition, 80% of patients will have a CEA elevation 3–10 months prior to clinical symptoms of recurrenceSeventy‐seven percent of patients with bronchogenic lung cancer will have an elevated preoperative value. However, cigarette smoking also causes an increase in the CEA assay level and, thus, differentiation between benign and malignant conditions is more difficult. In small cell carcinoma of the lung, CEA assay levels above 10 ng/ml correlate highly with metastatic disease, while values less than 2.5 ng/ml correlate with localized diseasePancreatic and gastric malignancies demonstrate CEA level elevations in just over 50% of cases. But these, however, have not been clinically usefulEpithelial neoplasms of the female reproductive tract (cervix, uterus, and ovary) also produce CEA in 47–75% of cases and may correlate with stage of disease at diagnosis and level of cellular differentiationCEA assay levels are elevated in a variety of tumors and correlate with tumor stage, degree of differentiation, and effectiveness of therapy; they may also be the earliest marker of r

ISSN:8756-0437    

DOI:10.1002/ssu.2980070309

出版商:John Wiley&Sons, Inc.    

年代:1991

数据来源: WILEY

摘要:

AbstractRadioimmunoguided surgery (RIGS®) is a technique employed to locate tumor deposits with the aid of intravenously injected, tumor‐specific, radiolabeled monoclonal antibodies and a small gamma detecting device. The gamma detecting probe (GDP) is a small, portable unit which has the capacity to be used intraoperatively to survey the entire peritoneal surface for increased radioactivity indicative of targeted tumor tissue during abdominal exploration for colorectal cancer. Trials in humans have demonstrated the ability of this system to locate clinically nonpalpable tumor deposits in patients undergoing carcinoembryonic antigen second‐look laparotomies. This feature may be of value in improving the definition of tumor location and extent as well as allowing a more thorough resection of tumor‐bearing tissue to be performed and hopefully improving overall patient su

ISSN:8756-0437    

DOI:10.1002/ssu.2980070310

出版商:John Wiley&Sons, Inc.    

年代:1991

数据来源: WILEY

摘要:

AbstractSecond‐look surgery for recurrent colorectal carcinoma has been advocated for over four decades. Routine follow‐up procedures gave way to clinically directed or carcinoembryonic (CEA)‐directed procedures in the mid‐1970's. In this paper, we review the results of second‐look surgery for recurrent colorectal carcinoma and ask the question, “Is it worthwhile?” Excluding surgery for symptomatic patients, we conclude that second‐look surgery should only be performed for recurrent colorectal carcinoma with the intent of rendering the patient disease‐free. Without effective systemic therapy, “palliative” or “debulking” procedures probably do not increase survival. The most likely candidates for such a curative approach with second‐look surgery are those with isolated liver, pulmonary, and, less frequ

ISSN:8756-0437    

DOI:10.1002/ssu.2980070311

出版商:John Wiley&Sons, Inc.    

年代:1991

数据来源: WILEY