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C P Karakousis

Publications and source records attributed to C P Karakousis.

At least 19 recordsLinked to original sources
PubMed1995

Retroperitoneal sarcomas and their management.

BACKGROUND: Retroperitoneal sarcomas historically have presented difficulties in their management due to a high rate of unresectability. OBJECTIVE: To determine prognostic parameters, resectability, and survival of these patients in a more recent period. DESIGN: Retrospective review, with a mean follow-up of 47 months. SETTING: Tertiary care cancer institute. PATIENTS: The charts of 90 consecutive patients with retroperitoneal sarcomas treated in the period from 1977 to 1995. No patient referred with a localized retroperitoneal sarcoma was excluded from this review. RESULTS: The resectability rate was 100% for the primary tumors (n = 57) and 88% for the tumors initially presenting as local recurrence (n = 33). The 5-year survival rate was 63% (66% for patients with primary tumors and 57% for those with local recurrence). The 10-year survival rate was 46% (57% for patients with primary tumors and 26% for those referred with local recurrence). The local recurrence rate was 25% for primary tumors and 39% for tumors initially presented as local recurrence (overall rate, 30%); it was 56% after local excision and 16% after wide or radical resection (P < .001). The 5- and 10-year survival rates were 72% and 61%, respectively, for those with wide resection and 55% and 23%, respectively, for those with local excision (P = .01). CONCLUSIONS: With modern surgical techniques, the overall resectability rate of retroperitoneal sarcomas is 96%. The ensuing survival, affected significantly by the histologic grade, approaches that for the extremity sarcomas.

Adult↗
PubMed1995

Primary soft tissue sarcoma of the extremities in adults.

The modern literature on adult extremity sarcoma implies that adjuvant therapy (usually irradiation) is mandatory for adequate local control, at least in patients with high-grade tumours undergoing limb-sparing procedures. In 152 primary extremity soft tissue sarcomas, wide or radical resection was employed (116 patients) including amputation in nine patients (6 per cent), or local excision followed by adjuvant postoperative radiation therapy (36). Local recurrence alone occurred in 5 per cent of patients, and in combination with distant metastases in 9 per cent. The total rate of local recurrence was 10 per cent after wide resection (with or without chemotherapy) and 25 per cent after conservative resection and radiotherapy (with or without chemotherapy). Limb sparing was possible in 94 per cent of patients. The majority (76 per cent) had surgical resection alone as local treatment with satisfactory results. Wide resection, when feasible, provides acceptable local control and may be preferable to local excision plus radiation therapy.

Adolescent↗
PubMed1995

Liver metastases from soft tissue sarcomas.

Twenty-three patients with liver metastases from soft tissue sarcoma were reviewed. Patients with metastases to the liver first had poorer survival than those who developed spread to other sites first (P = .0035). The median time from diagnosis of the primary tumor to diagnosis of liver metastases was 14 months; the median time from diagnosis of liver metastases to death was 7 months. The median survival from diagnosis for four patients who underwent liver resection was 54 months compared to 20 months for those who did not undergo resection (NS). Soft tissue sarcomas rarely metastasize to the liver; when this occurs it is usually late in the course of the disease and after it has spread to other sites. The opportunity for successful liver resection is infrequent but may prolong survival.

Adolescent↗
PubMed1995

Malignant melanoma of the anorectal region.

The charts of 15 patients with malignant melanoma of the anorectal region treated at Roswell Park Cancer Institute in the period 1975-1991 were reviewed. All the lesions except one developed at the pectinate line, in the area of transitional mucosa. Two of the patients at the time of initial presentation had distant metastases. Of the remaining 13, 8 were treated with abdominoperineal resection (APR) and 5 with local excision (LE). The incidence of local recurrence was 50% in the LE group and 22% in the APR group. Patients treated with APR had a 25%, 5-year survival rate compared with 0% for those treated with LE, although one of the latter group died 55 months following LE due to unrelated causes without recurrence. The median survival of those with LE was 15.7 months and of those with APR 13.7 months.

Adult↗
PubMed1995

Prognostic parameters in localised melanoma: gender versus anatomical location.

Extremity location and female gender are both considered favourable prognostic parameters in primary melanoma, but since they cluster in the same group of patients, the question remains as to whether they are both independent variables. Multivariate analysis of 695 patients with primary, localised melanoma was used. The effects of gender and anatomical location were compared directly by sequentially controlling one factor while the other remained free. Following multivariate analysis, significant prognostic factors related to survival were the thickness of the primary lesion (P < 0.0001), the age of the patient at diagnosis (P < 0.0001), the gender of the patient (P = 0.0008) and the anatomical location of the primary lesion (P = 0.005). Thicker lesions, patients older than 50 years, males, and trunk, head and neck locations had poorer prognoses. There was a significant difference in survival according to gender within each location, extremity (P = 0.002) or trunk, head and neck (P = 0.0004); however, there was no significant difference in survival according to anatomical location within each gender, male (P = 0.11) or female (P = 0.29). The thickness of the primary lesion, the age of the patient at diagnosis, the gender and the anatomical location of the melanoma are all significant prognostic parameters in localised melanoma. Gender appears to have a more pronounced effect on survival than anatomical location.

Adolescent↗
PubMed1995

Survival of patients with stage IA malignant melanoma.

There is ongoing clinical research on prognostic parameters relevant to stage IA melanoma. The object is to identify those factors associated with an increased risk of recurrence. The charts of 197 patients first treated at our Institute between 1980 and 1992 along with 62 patients referred for follow-up or treatment of recurrent disease, all having been initially diagnosed with stage IA disease, were reviewed. Only one patient (0.5%) of those first treated at our Institute manifested recurrence and this was a local recurrence. No statistically significant differences were found between patients who relapsed and those who did not with regard to lesion thickness, level of invasion, evidence of ulceration, location of the primary lesion, gender, or age. Generally, stage IA melanomas have excellent prognosis. However, there are patients who experience recurrent and metastatic disease. At the present time, there are no reliable indicators available for use in predicting which patients are at risk.

Adolescent↗
PubMed1995

Gastrointestinal metastases from malignant melanoma.

Between 1980 and 1992, 68 patients with clinical indications of involvement of the gastrointestinal (GI) tract with metastatic melanoma were treated at Roswell Park Cancer Institute. Presenting symptoms were anaemia, abdominal pain, nausea and vomiting. Sites commonly involved were the small bowel (75%), the large intestine (25%), and the stomach (16%). Twenty-one patients were considered unsuitable for surgery; their median survival after diagnosis of GI metastases was 2.9 months. Forty-seven patients underwent abdominal surgery; effective palliation was achieved in most of them. Complete resection of GI metastases was accomplished in 47% of patients. The median survival after operation was 27.6 months for patients with complete resection of GI metastasis and no other disease, 5.1 months for patients with resection of involved GI tract and other metastases present, and 1.9 months for patients who had a by-pass procedure only. The 5-year survival for patients with complete resection of GI metastases and no other evidence of disease was 28.3%. The other groups had only 1-year survivors. Surgical intervention is justified on the basis of these findings, and extended palliation can be achieved in patients with complete resection of metastatic disease.

Adolescent↗
PubMed1995

[Surgical therapy of soft tissue sarcoma. I. General principles and resections of the trunk].

Resection, preferably wide resection is the primary treatment modality for localized (primary or locally recurrent) soft tissue sarcomas. Sarcomas of the chest or abdominal wall usually do not present great difficulty in their resection. When a mesh is used in the abdominal wall care should be exercised that there will be no direct contact between bowel loops and the mesh by using tissue interposition since otherwise the rate of bowel fistulization due to erosion by the mesh is considerable. Although the average rate of resectability in published reports in the United States for retroperitoneal sarcomas is 53%, with the incisions and techniques described below this rate is 95%.

Abdominal Neoplasms↗
PubMed1995

Use of a mesh for musculoaponeurotic defects of the abdominal wall in cancer surgery and the risk of bowel fistulas.

BACKGROUND: Enterocutaneous fistulas resulting from mesh reconstruction of full-thickness musculoaponeurotic abdominal defects in benign conditions is a relatively infrequent, but serious complication. STUDY DESIGN: In the period 1977 to 1986, 26 patients with abdominal wall defects due to ablative surgery for carcinoma had repair with prosthetic material without any special effort to interpose tissue between bowel loops and the mesh. In the period 1986 to 1992, 30 patients with similar defects had tissue interposition between the bowel loops and the mesh (four patients had a free peritoneal patch). In an experimental study, 11 rabbits had an abdominal wall defect repaired with mesh alone, and 14 other rabbits had the abdominal wall defect repaired with the mesh plus a free peritoneal patch sutured underneath. RESULTS: In the first group of patients, six (23 percent) of 26 had enterocutaneous fistulas develop, in the second group zero (zero percent) of 30 had a fistula develop (p = 0.007). In the experimental study, the first group (ten of 11 rabbits) had dense adhesions develop between bowel loops and the mesh. In the second group, none of the 14 rabbits had adhesions develop (p < 0.0001). CONCLUSIONS: In full-thickness abdominal wall defects, omentum, muscle flap, or a peritoneal patch sewn under a mesh prevent fistula formation.

Abdominal Muscles↗
PubMed1995

Partial and complete internal hemipelvectomy: complications and long-term follow-up.

BACKGROUND: The complications and long-term follow-up results of internal hemipelvectomy are not well documented. STUDY DESIGN: We reviewed 32 internal hemipelvectomies performed between 1976 and 1994. RESULTS: The pathologic diagnoses were soft tissue sarcoma in 15 cases, bone tumor in 14 cases, melanoma in two cases, and carcinoma in one of the cases. In 24 cases, the intent of surgery was curative; in 22 cases, the procedure was modified. Average blood loss was 3.2 L; the procedure took on average 7.5 hours. Complications included skin flap necrosis in four cases, infection in 15 cases, and various other complications in five cases. Three mortalities (9 percent) occurred. Thirty-four percent of the patients ambulated without any assistance, 59 percent ambulated with crutches, while 7 percent remained wheel-chair bound. The survival rate after resection for cure was 45 percent at ten years compared with 29 percent at two years for palliative resections. CONCLUSIONS: Internal hemipelvectomy is a complex procedure that is functionally and cosmetically superior to external hemipelvectomy and, when done with curative intent, results in considerable long-term survival rates.

Bone Neoplasms↗
PubMed1995

An institutional review of sarcomas of the large and small intestine.

BACKGROUND: This study was done to review the institutional experience with the treatment of sarcoma of the small or large intestine. STUDY DESIGN: Thirty-nine patients admitted between the years 1959 and 1987, with a diagnosis of sarcoma of the small or large bowel form the basis of this review. RESULTS: At referral, 74 percent of the patients presented with peritoneal sarcomatosis. Only six patients underwent complete resection. The overall five-year survival rate was 20 percent. Patients with low grade tumors had median and five-year survival rates of 33.3 months and 44 percent, respectively, while patients with high grade tumors had median and five-year survival rates of 22.4 months and zero percent, respectively, p = 0.01. Patients undergoing complete resection had a median survival period of 33.3 months, while patients receiving less than complete resection had a median survival period of 15.4 months, p = 0.003. Factors found to be significant by multifactorial analysis included tumor size, grade, stage at presentation, and invasion of adjacent organs. CONCLUSIONS: Sarcoma of the small and large bowel is an uncommon entity. Survival rates are relatively poor. Aggressive surgical intervention is the mainstay of therapy.

Adult↗
PubMed1994

Desmoid tumors in patients with familial adenomatous polyposis.

BACKGROUND: Sporadic desmoid tumors occur mainly in the abdominal wall and in extraabdominal sites. Desmoid tumors in patients with familial adenomatous polyposis (FAP) usually occur in the abdominal wall and in the bowel mesentery. Surgical resection of desmoids in patients with FAP has been controversial. METHODS: A retrospective review of patients with FAP and desmoid tumors treated from 1950 to 1991 was performed. Patients were evaluated for gender, age, site of desmoid tumors, treatment, recurrence, and survival. RESULTS: Twenty-one of 24 patients underwent 60 surgical procedures related to the desmoid tumors. Seven of nine patients who underwent potentially curative surgery had recurrences; three were reresected. Major morbidity after palliative or curative surgery was 47%. Five patients were alive with no evidence of disease at a median of 198 months, 10 patients were alive with disease at a median of 102 months, and 5 patients died with disease at a median of 31 months after diagnosis. CONCLUSIONS: Desmoid tumors are common in patients with FAP. Unresectability and recurrence are more common than cure. Palliative and curative resections have a high morbidity. Surgery should be reserved for those patients with symptomatic mesenteric desmoids.

Abdominal Neoplasms↗
PubMed1994

Groin dissection in malignant melanoma.

A total of 205 patients who underwent groin dissection for malignant melanoma were reviewed to document complications and survival rates. Wound complications included skin-edge necrosis in 8 per cent, wound infection in 16 per cent, lymphocele in 5 per cent and lymphorrhoea in 11 per cent. Lymphoedema of the operated leg below the knee was noted in 40 per cent, but all patients had localized oedema of the anteromedial thigh. The 5-year overall and disease-free survival rates were 43 and 35 per cent respectively when only the inguinal nodes were involved; they were 34 and 21 per cent with involvement of both the inguinal and deep nodes. The 10-year survival rate for these two groups was 39 and 25 per cent respectively, which suggests that a thorough, complete dissection of the deep nodes is worth-while when the inguinal nodes are palpably positive.

Adult↗
PubMed1994

Band 11q13 is nonrandomly rearranged in hibernomas.

Cytogenetic study of a short-term culture from a hibernoma, a very rare benign proliferation of the brown fat, demonstrated a four-break translocation t(5;7;11;17)(p14;q11.23;q13.1-13.3;p11.2) as the sole abnormality in all analyzed cells. Complex translocation involving band 11q13 have also been detected in the two other published cases of hibernoma. The consistent finding of 11q13 rearrangements appears to distinguish hibernoma from other benign adipose tissue tumors cytogenetically and suggests that 11q13 changes may play an important role in hibernoma pathogenesis.

Adipose Tissue, Brown↗
PubMed1994

Adrenal adenocarcinoma: a review of 53 cases.

PROBLEM: Fifty-three patients (30 men, 23 women) with histologically proven adrenal carcinoma were reviewed. Nineteen (36%) had endocrine manifestations from functioning tumors. Arteriography was positive in 95% (19/20), CT scan in 94% (17/18), and ultrasound in 92% (12/13). Seventy-six percent of the patients, at the time of diagnosis, were stage III and IV. Most common metastatic sites were the liver, lymph nodes, bone, and lungs. Local recurrence developed in 39% of cases (15/38). METHOD: Forty-one patients underwent an operation. Complete surgical removal of all gross tumor was achieved in 24 patients. RESULT: The overall median survival time was 8 months, and the estimated 5-year survival rate 19%. There were significant differences in survival between the various stages (P = 0.01) and between the group of patients who underwent complete excision of the tumor and those with incomplete resection (P = 0.002). CONCLUSIONS: Complete surgical excision offers the best prospect for long-term survival in localized adrenal carcinoma.

Adrenal Cortex Neoplasms↗
PubMed1994

Eccrine porocarcinoma.

Eccrine porocarcinoma, a malignancy of the eccrine sweat glands, is extremely rare. Our report and a review of the literature (70 cases) emphasize the features of this tumor. Age at time of treatment ranged from 19 to 94 years (mean 67 years). Duration of the lesion ranged from two months to 50 years; 31 (44%) had the lesion present > or = 5 years. Forty-four patients (62%) had tumors located on the extremities, 13 (19%) on the head and neck region and 12 (17%) on the trunk. All patients whose race is known were white. Primary treatment should consist of wide local excision and regional lymphadenectomy, if clinically indicated. Although there is a significant risk of cutaneous, regional lymph node, or visceral metastases, the value of elective or therapeutic regional lymphadenectomy is unknown, as is the role of adjunctive therapy.

Acrospiroma↗
PubMed1994

Regional chemotherapy in the canine liver.

Using a fluorometric assay, mean drug levels of Adriamycin were significantly higher in the normal canine liver following bolus injection of this drug via the hepatic artery or portal vein as compared to hepatic tissue levels following systemic intravenous administration (P < 0.001). However, the variations in tissue levels observed after hepatic artery (+/- 16.8 mcg/gm tissue) or portal vein (+/- 21.1 mcg/gm) infusion were significantly wider than those observed after systemic (+/- 1.3 mcg/gm) administration (P = 0.03). Using C14-labeled drugs, regional infusion of Adriamycin through the hepatic artery or portal vein resulted in significantly higher mean drug levels in the liver than after systemic intravenous administration, but the difference was more pronounced with bolus infusion of the drug than 1-hour infusion. 5-FU bolus or 1-hour infusion in the hepatic artery resulted in significantly higher mean drug levels in the liver compared to peripheral intravenous administration, but this was not so with the 3-hour infusion. The above experiments confirm previous studies that regional chemotherapy results in higher drug levels in the regional tissues compared to systemic administration. They also: (1) demonstrate the spotty drug distribution in the regional tissues after regional administration, a potentially correctable problem, and (2) suggest that the advantage of intra-arterial infusion may be more pronounced within a certain range of infusion times.

Animals↗