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J Meirion Thomas

Publications and source records attributed to J Meirion Thomas.

5 recordsLinked to original sources
PubMed2003

Amputation for soft-tissue sarcoma.

Soft-tissue sarcomas are a group of rare malignant tumours, many of which arise in the limbs. Most are treated with a combination of wide local excision and radiotherapy, but a small number--including proximal, large, high-grade, or recurrent tumours, or those involving major neurovascular structures--necessitate major amputation including forequarter or hindquarter amputation. These uncommon operations should remain in the surgical armamentarium for carefully selected patients. Those being considered for amputation should be referred to a tertiary sarcoma unit for examination of all other options, such as limb-salvage surgery, tumour downstaging with chemotherapy or radiotherapy (perhaps with subsequent limb-salvage surgery), or novel techniques such as isolated limb perfusion. Only after careful assessment should amputation be carried out. Outcomes after major amputation are highly variable, but such procedures can confer useful palliation to patients with distressing symptoms (pain, bleeding, fungation), long-term disease-free survival with reasonable function in carefully selected patients, and cure in some.

Amputation, Surgical↗
PubMed2003

Portsite recurrence after laparoscopy for staging of retroperitoneal sarcoma.

A 40-year-old woman underwent diagnostic and staging laparoscopy for a 12 cm retroperitoneal tumor, during which large-core biopsy was performed, which revealed an intermediate-grade leiomyosarcoma. Subsequent open resection (with en bloc resection of pancreatic tail and left kidney) was performed in a specialist unit. Complete tumor clearance was obtained with negative microscopic margins. Nine months later a laparoscopic portsite recurrence was detected clinically and confirmed histologically at resection. Laparoscopy is an unnecessary and inappropriate investigation in retroperitoneal soft-tissue sarcoma.

Adult↗
PubMed2003

Malignant gastrointestinal stromal tumor: distribution, imaging features, and pattern of metastatic spread.

PURPOSE: To investigate and describe the anatomic distribution, imaging features, and pattern of metastatic spread of malignant gastrointestinal stromal tumors (GISTs). MATERIALS AND METHODS: The medical records of all patients at our institution with a histologic diagnosis of GIST were reviewed. Two radiologists with knowledge of the diagnosis reviewed the radiologic findings by means of consensus. Sixty-seven patients underwent computed tomography, and scans of the primary tumor were available in 38 patients. RESULTS: One hundred sixteen patients with malignant GISTs were identified (76 men and 40 women; mean age, 54.6 years +/- 13.5 [SD]). The primary tumor locations in descending order of frequency were the small bowel (n = 49), stomach (n = 43), colon (n = 7), rectum (n = 6), other (n = 3), and not specified (n = 8). Mean primary tumor size was 13 cm +/- 6. Tumors were typically well defined (31 of 36 [86%]), with a heterogeneous rim of soft tissue with lower signal intensity than that of the contrast material-enhanced liver. Central fluid attenuation was seen in 24 of 36 (67%) patients. Metastases were seen in 23 of 38 (61%) patients at presentation and in 53 of 61 (87%) patients during follow-up. Spread was usually to the liver or peritoneum. Visceral obstruction rarely occurred, even in the presence of extensive peritoneal metastatic disease. Ascites was an unusual finding. CONCLUSION: Malignant GISTs are typically large, well-circumscribed, heterogeneous, centrally necrotic tumors that arise in the wall of the small bowel or stomach. They rarely obstruct viscera, despite their large size and propensity to metastasize to the liver and peritoneum.

Adult↗
PubMed1998

Multimodality treatment in the control of deep musculoaponeurotic fibromatosis.

BACKGROUND: Deep musculoaponeurotic fibromatoses are rare soft tissue neoplasms with a propensity for local recurrence. METHODS: A retrospective analysis was carried out of the factors contributing to local disease control in 75 patients treated between 1963 and 1993. RESULTS: Multivariate analysis identified the type of surgical excision (P < 0.001) and involvement of pathological resection margins (P < 0.02) as significant factors contributing to local recurrence. After a median follow up of 47 months (range 24 months to 29 years) 31 (49 per cent) of the 63 patients who had an 'adequate' surgical resection developed local recurrence. The median time before development of local recurrence was 83.4 (range 8-129) months in patients with clear pathological resection margins. This was significantly shortened to 13.1 (range 2-35) months in those with positive margins (P < 0.001). CONCLUSION: Adequate surgical extirpation is the most important determinant in local disease control. Treatment of local recurrence ranged from observation during periods of disease stabilization to multimodality treatment for aggressive disease.

Adult↗