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Biomedical subjects

Brendan J Moran

Publications and source records attributed to Brendan J Moran.

8 recordsLinked to original sources
PubMed2007

Early results of surgery in 123 patients with pseudomyxoma peritonei from a perforated appendiceal neoplasm.

PURPOSE: Epithelial appendiceal tumors are uncommon but can present as an emergency simulating appendicitis, or unexpectedly at laparotomy, laparoscopy, or on cross-sectional imaging. Occult rupture with features of pseudomyxoma peritonei may be encountered. We report the operative findings, pathologic assessment, and early outcomes in 123 consecutive patients with a perforated appendiceal neoplasm presenting as pseudomyxoma peritonei. METHODS: From March 1994 to March 2004, 292 patients were referred to a peritoneal malignancy surgical treatment center. Complete tumor removal (cytoreduction) was attempted in selected patients and, if achieved, surgery was combined with intraoperative, intraperitoneal mitomycin C (10 mg/m(2)). RESULTS: In total, 123 patients (52 males; 41 percent) underwent laparotomy for a perforated appendiceal malignancy presenting as pseudomyxoma peritonei. The median age was 52 (range 30-77) years. Complete cytoreduction was achieved in 83 of 123 patients (67 percent), major palliative resection in 34 patients (28 percent), and 6 patients (5 percent) were inoperable. Postoperative mortality was 6 of 123 patients (5 percent). Kaplan-Meier analysis of the 83 patients who had complete tumor removal predicted 75 percent disease-free survival at five years. CONCLUSIONS: A perforated appendiceal epithelial tumor most frequently presents as pseudomyxoma peritonei. This treatment strategy, involving surgery and intraperitoneal chemotherapy, can result in good outcomes in this rare and otherwise fatal disease.

Adult↗
PubMed2006

Establishment of a peritoneal malignancy treatment centre in the United Kingdom.

The development, funding and early treatment outcomes of a centre for the assessment and management of a rare tumour is outlined. Central government funding, as obtained from the National Health Service in this instance, is optimal to allow service development and outcome assessment. The initiation and development of a new specialized service is probably best approached by focusing on a condition that is rare, with a reasonable number of cases and good outcomes. This report reviews an experience focusing on "pseudomyxoma peritonei of appendiceal origin" with an estimated annual incidence of one per million per year. The experience of a colorectal unit in structuring a national centre is reviewed in an attempt to document the development, funding and resources required to initiate and maintain a unit. The surgical skill, with its associated learning curve, and some early results of treatment are presented with the hope that such an experience may be of help to others.

Cancer Care Facilities↗
PubMed2004

Total mesorectal excision results in low local recurrence rates in lymph node-positive rectal cancer.

PURPOSE: Most series report lymph node involvement as the main predictor for local recurrence. The principal lymphatic drainage of the rectum is to nodes in the mesorectum and then nodes along the superior rectal and inferior mesenteric arteries. If total mesorectal excision provides adequate block dissection of the lymphatics of the rectum, good local control with low rates of local recurrence should be achieved even in node-positive disease. METHODS: Prospective data on all rectal cancers have been collected since 1978; 170 patients with Dukes C rectal cancer have undergone anterior resection and total mesorectal excision. We did not perform any internal iliac node dissections. Follow-up data were analyzed for local recurrence and distant recurrence. RESULTS: The local recurrence rate was 2 percent for Dukes A cases, 4 percent for Dukes B, and 7.5 percent for Dukes C ( P = 0.0127). The systemic recurrence rate was 8 percent for Dukes A, 18 percent for Dukes B, and 37 percent for Dukes C ( P = 0.0001). CONCLUSIONS: If surgical priority is given to the difficult task of excision of the whole mesorectum, anterior resection with total mesorectal excision in node-positive rectal cancer, local recurrence rates of < 10 percent can be achieved.

Adenocarcinoma↗
PubMed2004

Rectal cancer in the elderly: patients' perception of bowel control after restorative surgery.

OBJECTIVE: The risk of incontinence is perceived as a relative contraindication to a sphincter-saving procedure in elderly patients with rectal cancer. To investigate this, we reviewed functional results one year after restorative surgery in patients older than aged 75 years. METHODS: A total of 186 patients older than aged 75 years were diagnosed with rectal cancer during the study period. In 19 patients, no surgery was undertaken, and another 3 patients had a defunctioning stoma only. A local excision was performed in six patients. Of the remaining 158 having a major resection, 133 patients (84 percent) had a restorative anterior resection. The one-year, follow-up records of these patients were studied with particular reference to the patients' perception of bowel function and continence. RESULTS: At one year, 99 patients who had had an anterior resection were alive. In 92 patients, a stoma had been closed or avoided altogether, and these patients formed the study group. Significant problems with bowel function or continence were denied by 78 of 92 patients (85 percent). One patient had already reported severe difficulties and been given a definitive stoma for incontinence. The remaining 14 percent, although experiencing some problems with continence, did not consider the situation serious enough to contemplate a stoma. CONCLUSIONS: An elderly patient undergoing anterior resection for rectal cancer has a reasonable expectation of acceptable continence. Age alone should not be a contraindication to a restorative resection.

Aged↗
PubMed2003

The etiology, clinical presentation, and management of pseudomyxoma peritonei.

PMP is a rare condition, which, although of "borderline malignancy," is invariably fatal. Difficulties exist with the definition of PMP. It has been broadly applied to include a heterogenous group of pathologic lesions that present clinically with "jelly belly" due to mucinous ascites. The relatively few reports in the literature commonly use different pathologic definitions, and there is no consensus on the point of separation between PMP and carcinomatosis secondary to a mucinous adenocarcinoma. Sugarbaker has suggested "the term pseudomyxoma peritonei syndrome be strictly applied to a pathologically and prognostically homogenous group of cases characterized by histologically benign peritoneal tumors that are frequently associated with an appendiceal mucinous adenoma." This definition excludes all cases with mucinous adenocarcinoma. The optimal treatment is undoubtedly complete tumor excision, by complex surgical peritonectomy procedures, taking on average 10 hours. Surgery is usually combined with intraperitoneal, and now intraoperative heated chemotherapy. These techniques have a high morbidity and mortality. The rarity of the condition, together with the risks associated with definitive treatment, suggests that such treatment ought to be centralized in a few centers, covering a large population. The search continues for safer, less aggressive treatments, but is hampered by a lack of hard evidence and the absence of experimental animal or human models to evaluate emerging strategies.

Adult↗
PubMed2003

Initiation of a program in peritoneal surface malignancy.

The initiation of a Program in Peritoneal Malignancy is a long and complex process. The novelty, technically demanding nature and steep learning curve that characterize this treatment strategy calls for a carefully planned, systematic, controlled, and informed introduction is an institution, for which an Institutional Review Board approved protocol is suggested. Commitment of a surgical team and institution, education of other physician, nurses, and ancillary personnel involved in the procedure, safety precaution for patients and health care workers, and proper patient selection are important requirements for initiating the program. This manuscript provides a guide for implementation of this treatment strategy with a minimum of untoward events, reduced apprehension of medical and nursing colleagues, and a maximum benefit for patients.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed2002

Published evidence favors the use of suprapubic catheters in pelvic colorectal surgery.

INTRODUCTION: Bladder catheterization is routine during pelvic colorectal surgery, and transurethral catheterization is the norm. However, in gynecologic surgery suprapubic catheters are commonly used and are reported to be superior to urethral catheters. METHODS: A review of published studies comparing urethral and suprapubic catheters in patients undergoing colorectal surgery is presented. Level one evidence from randomized, controlled trials is sparse. Five randomized, controlled trials, most with small numbers, have been published comparing urinary tract infection, urinary retention, duration of catheterization, pain and discomfort, and patient preference. RESULTS: Urinary tract infections were increased in the urethral group in three of the five articles. There were no differences between the two techniques with respect to urinary retention, but all studies commented on the ease with which this complication could be assessed and managed in the suprapubic group. There did not seem to be any difference in duration of catheterization. The suprapubic group experienced less pain and discomfort than the urethral group, and the suprapubic catheter was preferred by those patients who had experienced both. CONCLUSION: The results reported favor suprapubic over urethral catheterization in that urinary tract infections are reduced, particularly in females, and the ability to attempt normal voiding is facilitated, particularly in males.

Colon↗