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PubMed2001

Adequate endoscopic mucosal resection for early gastric cancer obtained from the dissecting microscopic features of the resected specimens.

BACKGROUND: We have employed endoscopic mucosal resection (EMR), using a cap-fitted panendoscope (EMRC), for early gastric cancer since 1992. The presence of an adequate surgical margin is a requirement because of the radicality of EMR, and dissecting microscopic examination is useful in regard to the diagnosis of spread of the disease. METHODS: To devise an adequate method of EMR that allows no lateral residue, we examined gastric mucosal specimens obtained by EMRC. One hundred and sixty-seven specimens from 97 lesions in 85 patients treated by EMRC were examined in regard to characteristic features, the recovery of marks made around the lesion, and the frequency of residue, and comparisons were made between the dissecting microscopic and histopathological findings. RESULTS: The first specimen obtained with a large cap under full suction was a circular shape measuring 21 x 19mm. The second specimen from fractionated resection was a half-moon or crescent shape, and the third specimen had a ginkgo leaflike or irregular shape. In the elevated lesions, coincidence regarding the spread, as determined by dissecting microscopy and histopathology, was present in 62 (93%) of the 67 lesions. In 16 (53%) of 30 flat or depressed lesions, there was a difference of 2 to 5 mm between the spread determined by these two examinations. CONCLUSION: It is important to place an adequate number of marks around the lesion and recover all marks by resection. When an elevated lesion measures 15mm or more, and a flat or depressed lesion is not clearly demarcated, aggressive use of planned fractionated resection seems to be the best way to prevent a lateral residue in EMR.

Aged↗

PubMed2004

Bloodless liver resection using the monopolar floating ball plus ligasure diathermy: preliminary results of 16 liver resections.

Blood loss during liver transection and ischemia-reperfusion injury associated with hepatic inflow occlusion are significant drawbacks during liver surgery. Sixteen patients underwent liver resection using the Monopolar Floating Ball (FB) plus LigaSure (LS) diathermy without occlusion of the hepatoduodenal ligament (group FB-LS). The liver parenchyma was precoagulated using the FB, and the uncovered tiny vessels were sealed using LS. Surgical outcomes were retrospectively compared with 16 well matched patients who underwent liver resection using the conventional clamp crushing method with Pringle's maneuver (group CC). The amount of blood loss during liver transection was significantly less in group FB-LS than in group CC [200 ml (0-990 ml) vs. 480 ml (120-1800 ml); p = 0.006]. The median time it took to complete the liver transection was significantly longer in group FB-LS than in group CC [144 minutes (43-335 minutes) vs. 58 minutes (18-94 minutes); p < 0.0001]. Hepatic inflow occlusion was temporally used in five patients in group FB-LS to achieve hemostasis in hepatic venous tributaries for 6, 10, 19, 26, and 61 minutes, respectively. Using these two electronic devices allows liver resection to be safely performed, with the advantage of minimal blood loss and a reduced inflow occlusion period compared to the conventional method. The major disadvantage may be a slower transection speed. A prospective randomized trial is needed to clarify the clinical benefits of liver resections performed using this novel technique.

Adult↗

PubMed2004

Survival and recurrence after a sphincter-saving resection and abdominoperineal resection for adenocarcinoma of the rectum at or below the peritoneal reflection: a multivariate analysis.

PURPOSE: The purpose of this study was to determine whether the type of operation [sphincter-saving resection (SSR) or abdominoperineal resection (APR)] for primary adenocarcinoma of the rectum at or below the peritoneal reflection affects survival and recurrence after curative surgery. METHODS: This retrospective study included 184 patients who underwent curative surgery achieved by the following two types of operation between 1989 and 1998: (1) SSR ( n = 116 patients) including a low anterior resection with either double-stapling technique ( n = 86) or transanal coloanal anastomosis ( n = 30); (2) APR ( n = 91). The outcome factors evaluated were survival and tumor recurrence. Both univariate and corrected (multivariate Cox's and logistic regression) analyses were used to evaluate the data. The median follow-up was 47.4 months for patients alive at study conclusion. RESULTS: Disease-free and disease-specific survivals, and the frequency and location of recurrence after surgery did not differ between the two types of operations. Multivariate analyses showed that the type of operation was not a significant independent variable in predicting disease-free survival or in the development of both local and distant recurrences after surgery. In addition, tumor-related factors (stage or histologic grade) were significant predictors of the outcome after surgery. CONCLUSIONS: The type of operation (SSR or APR) did not affect the survival or recurrence after a curative resection for adenocarcinoma of the rectum at or below the peritoneal reflection.

Abdomen↗

PubMed1991

The role of the prosthodontist in restoring root-resected molars: a study of 70 molar root resections.

Root resection is a complex, multidiscipline technique to eliminate molar furcation invasions. In the short term of 3 or 4 years it has been highly successful, but after 10 years approximately one third fail. A substantial number of failures were attributed to recurrent periodontal disease. This study examined 70 root resected molars in 62 patients for the quality of the resections. Twenty-one (30%) of the resections were considered faulty when subgingival, residual roots, furcal lips, and/or ledges were present. Failures were more frequent in maxillary molars (33.3%) than mandibular molars (22.7%). Clinically hidden roots/lips and ledges in mandibular molars were readily observed in radiographs, but were seen radiographically only 37.5% of the time in maxillary molars. Since subgingival defects are believed to encourage future periodontal disease, it is important that the dentist detect these structures and correct them before proceeding with the permanent restoration.

Adult↗

PubMed1983

Seminal vesicle tissue in "resectate" of transurethral resection of prostate.

We reviewed the histologic specimens from 123 consecutive patients undergoing transurethral resection of the prostate to determine the presence of seminal vesicle tissue. Additionally, relevant patient data were collected from the records, and a questionnaire regarding pre- and postoperative sexual function was given. The incidence of seminal vesicle tissue in the resectate was 23 per cent. No significant morbidity such as acute epididymitis or impairment of sexual function was associated with the occurrence of seminal vesicle tissue in the specimens. Consequently, no prophylactic measures seem indicated in patients undergoing partial resection of the seminal vesicles in connection with transurethral resection of the prostate.

Aged↗

PubMed1989

Appraisal of resection and end-to-end anastomosis for repair of coarctation of the aorta in infancy: preference for resection.

Between 1973 and 1987, 70 consecutive infants under-went repair of coarctation of the aorta. Age at operation was 80.0 +/- 77 days (mean +/- standard deviation); mean weight was 3.0 +/- 0.5 kg. Isolated coarctation was present in 25 patients (group 1); in 19 patients coarctation existed in association with ventricular septal defect (group 2); and in 26 patients coarctation was associated with major intracardiac defects (group 3). Subclavian flap angioplasty was performed in 19 patients and resection and end-to-end anastomosis in 51 patients. Hospital mortality was not significantly different between subclavian flap angioplasty (11%) and resection and end-to-end anastomosis (24%). Freedom from reintervention for recoarctation after 5 years was 87% in the subclavian flap angioplasty group and 95% in the group having resection and end-to-end anastomosis. Actuarial survival at 5 years was 100% for group 1, 73% for group 2, and 28% for group 3. In the subclavian flap angioplasty group, we observed detrimental effects of the sacrifice of the left subclavian artery: 1 patient had a 2.5-cm shortening of the left upper arm, and 5 others complained of claudication in the left upper limb during strenuous exercise. As no major advantage in terms of mortality and recoarctation to either technique of coarctation repair was found, and as subclavian flap angioplasty carries the possible disadvantage of late contracture of isthmic ductal tissue and possible detrimental effects on the left upper limb, resection and end-to-end anastomosis is recommended.

Anastomosis, Surgical↗

PubMed2003

Significance of hepatic resection combined with inferior vena cava resection and its reconstruction with expanded polytetrafluoroethylene for treatment of liver tumors.

BACKGROUND: Resection of the IVC is required when a liver tumor invading the IVC is completely removed. The purpose of this study was to evaluate the clinical significance of hepatectomy combined with IVC resection and reconstruction with an ePTFE graft for treatment of invasive liver tumors and to discuss the validity of this surgery. STUDY DESIGN: Eleven selected patients with liver tumors underwent various types of hepatectomy with retrohepatic IVC resection, followed by IVC reconstruction. The postoperative courses, clinicopathologic features of the tumors, operative procedures, and outcomes of the patients were studied. RESULTS: Ten of 11 patients did not require an active ventriculovenous bypass using a biopump. Invasion to the IVC was histologically proved in 9 of the 11 patients. After reconstruction, all artificial vessel grafts maintained patency throughout the observation period. Four patients are still alive with cancer-free status ranging from approximately 11 years to 5 months. One-year, 3-year, and 5-year survival rates were 63.6%, 38.2%, and 25.5%, respectively, with a 50% survival of 29 months. CONCLUSIONS: IVC resection and its reconstruction with ePTFE for treatment of liver tumors was safely performed on 11 selected patients with a 50% survival of 29 months. Patency of the graft was maintained for the longterm without infectious complications. This surgical procedure is indicated in some select patients in whom IVC invasion is extensive.

Adrenal Gland Neoplasms↗

PubMed2005

[Agreement between type of lung resection planned and resection subsequently performed on lung cancer patients].

OBJECTIVE: To assess agreement between planned lung resections and the type subsequently performed on a series of patients, to assess whether tumor location (central or peripheral) affected the degree of discrepancy, and, in the case of unscheduled pneumonectomies, to examine why the planned resection had to be extended. METHOD: Prospective, observational clinical study of 199 patients scheduled for lung cancer surgery. Tumors were preoperatively classified as central or peripheral, and the type of operation planned--lobectomy (or bilobectomy) or pneumonectomy--was compared with the operation finally performed. Rates of agreement and Wilks' lambda statistic were calculated. RESULTS: Twenty unscheduled pneumonectomies were performed. Agreement between planned and performed operations was found in 86.9% of cases (76.9% in central tumors and 95.4% in peripheral tumors). Wilks' lambda statistic was 0.38 (0.42 for central tumors and 0.17 for peripheral tumors). Seven unscheduled pneumonectomies were performed due to hilar node involvement. CONCLUSIONS: The resections performed differed from the resections initially planned in 13% of the bronchial carcinoma operations, in most cases because the planned lobectomy had to be converted to pneumonectomy, a situation which occurred more often with central tumors and was more often due to direct invasion of anatomic structures rather than hilar spread.

Adult↗

PubMed1998

En bloc resection of the temporal bone by the lateral approach in carcinoma of the middle ear associated with skull base infiltration with reference to the resection of the petrous apex.

En bloc resection of the temporal bone was performed by the lateral approach on two patients with carcinoma of the middle ear, which was associated with destruction in the temporal bone and tumor infiltration of the cranial base. In one of the patients, the petrous apex was resected along with the temporal bone.En bloc resection on the temporal bone with the petrous apex is believed to be difficult because the internal carotid artery (ICA), cavernous sinus, and the brainstem are adjacent to each other in the petrous apex. However, the intra- and extracranial surgical procedures by this approach allow resection of the temporal bone ranging from the anterior part including the petrous apex to the posterior part including the mastoid process, the dura of the middle and posterior cranial fossae, and the sigmoid sinus, without exposure of the tumor. Special attention should be paid to the procedural points of surgery, such as, exposure of the petrous ICA, bleeding from the petrous sinus, and dural suturing in the vicinity of the apex. With regard to surgical indication, it is important to determine whether tumor infiltration is confined to the temporal bone and the dura of the middle and posterior fossa. If tumor infiltration into the petrous ICA, the dominant side of sigmoid sinus and/or the inferior cranial nerve is observed, then indication for surgery should be determined in a more critical manner.

Journal Article↗

PubMed2005

Volumetric resection using the SurgiScope: a quantitative accuracy analysis of robot-assisted resection.

OBJECTIVE: This study evaluates the hypothesis that current image guidance technology can effectively guide the resection of a predefined intracranial volume from the surgical field in the absence of a visually distinct lesion. METHODS: An in vitro model was constructed to simulate the resection of a visually nondistinct lesion. Preoperative CT was acquired, and the lesion was resected from the model with a cavitating ultrasonic aspirator using image guidance information provided by the SurgiScope system. RESULTS: On average, 77% of the 8.2-cm(3) surgical target volume was removed. Over a series of 5 trials, the underresection volume was 1.9 cm(3) on average or 23% of the surgical target volume. The overresection volume was 1.0 cm(3) on average, representing 13% of the surgical target volume. CONCLUSION: This in vitro model developed to evaluate the accuracy and limitations of our current image guidance technology provided quantitative data to demonstrate the potential for robotic navigation systems to guide the volumetric resection in the absence of visual differentiation between the lesion and the surrounding brain.

Models, Anatomic↗

PubMed2002

Combined-modality treatment for resectable metastatic colorectal carcinoma to the liver: surgical resection of hepatic metastases in combination with continuous infusion of chemotherapy--an intergroup study.

PURPOSE: Despite technical improvements that have minimized the morbidity and mortality of hepatic surgery, the long-term outcome of resection of hepatic metastases of colorectal cancer remains poor, with the majority of patients experiencing treatment failure in the liver. Because arterial chemotherapy regimens targeted to the liver have demonstrated high response rates, an intergroup trial of adjuvant therapy for patients undergoing hepatic resection of liver metastases from colorectal cancer was initiated. PATIENTS AND METHODS: Patients with one to three potentially resectable metastases were randomized preoperatively to receive no further therapy (control arm, 56 patients) or postoperative hepatic arterial floxuridine combined with intravenous continuous-infusion fluorouracil (chemotherapy arm, 53 patients). After exclusion of patients identified as ineligible for the planned treatment at the time of surgery, there were 45 control patients and 30 on the chemotherapy arm. The study was powered to evaluate improvement in time to recurrence and hepatic disease-free survival, not overall survival. RESULTS: The 4-year recurrence-free rate was 25% for the control arm and 46% for the chemotherapy group (P =.04). The 4-year liver recurrence-free rate was 43% in the control group and 67% in the chemotherapy group (P =.03). The median survival of the 75 assessable patients was 49 months for the control arm and 63.7 months for the chemotherapy arm (P =.60). The median survival of all 109 patients was 47 months for the control arm compared with 34 months for the chemotherapy arm (P =.19) CONCLUSION: These data demonstrate that adjuvant intra-arterial and intravenous chemotherapy was beneficial in prolonging time to recurrence and pre-venting hepatic recurrence after hepatic resection of colorectal cancer.

Antimetabolites, Antineoplastic↗

PubMed2002

[Elective resection of the spleen--overview of resection technics and description of a new technic based on radiofrequency coagulation and dessication].

The authors present a short overview of the development of elective splenic resections. Past and present indications are presented. Contemporary hemostatic technique for elective splenic resection are discussed. An original new technique for transsegmental partial splenic resection using RF generator Radionic Cool Tip(without any aditional hemostatic procedures is presented. This technique is inovative and when use properly it is a practically zero blood loos technique. A patient with transsegmental splenic resection using RF generator is presented. Further clinical application of the technique is necessary.

Catheter Ablation↗

PubMed1990

Sialomucin at the resection margins and likelihood of local recurrence of carcinoma of the rectum after anterior resection.

The histochemical changes in mucin at the postoperative resection margins in carcinoma of the upper and middle third of the rectum after anterior resection were studied retrospectively in 52 patients. The sialomucinous change was most likely to occur at the intestinal margins of those patients who had tumour recurrence (P less than 0.001). The histological types of tumour, degree of differentiation, Dukes' stages and their distance from the anal verge were virtually the same in patients with and without tumour recurrence. By using high iron diamine-alcian blue staining technique we identified patients with higher risk conditions of tumour recurrence after anterior resection. This technique should increase the likelihood of a cure for patients with recurrent carcinoma of the rectum after anterior resection.

Carcinoma↗

PubMed1998

Surgery for recurrent colon cancer: strategies for identifying resectable recurrence and success rates after resection. Eastern Cooperative Oncology Group, the North Central Cancer Treatment Group, and the Southwest Oncology Group.

BACKGROUND: Follow-up testing after surgery for colon cancer is recommended principally to identify resectable recurrences, but data on the efficacy of, outcomes of, and optimal strategies for this testing are limited. OBJECTIVES: To determine the relation between follow-up tests and salvage surgery, assess outcomes, and document surgical mortality. DESIGN: Retrospective cohort study. SETTING: A North American multi-institutional trial comparing postoperative chemotherapy plus follow-up with follow-up alone. PATIENTS: 1247 patients with resected stage II and stage III colon cancer. INTERVENTION: The protocol mandated follow-up testing that could be supplemented at the discretion of treating physicians. Indications of recurrent disease were documented. MEASUREMENTS: Recurrence, resectable recurrence, surgical mortality, and survival were studied. RESULTS: 548 patients had recurrence of colon cancer. Salvage surgery was attempted in 222 patients (41%). In 109 patients (20%), curative-intent surgery was done for hepatic recurrence (28 patients), pulmonary metastasis (20 patients), local recurrence (24 patients), or recurrence at other sites (37 patients). Most curative-intent surgical procedures were motivated by follow-up testing (36 patients), elevated carcinoembryonic antigen level (41 patients), or symptoms (27 patients). The median follow-up time after curative-intent surgery exceeded 5 years; the estimated 5-year disease-free survival rate was 23%. A solitary lesion was a favorable prognostic factor. The surgical mortality rate was 2%. Curative-intent resections were done in 15 patients with second primary colorectal cancer; 12 of these patients have survived disease-free. CONCLUSIONS: Second operations for colon cancer that are triggered by follow-up testing or symptoms are common and can result in long-term disease-free survival.

Colonic Neoplasms↗

PubMed2000

The long-term results of resection and multiple resections in Crohn's disease.

Crohn's disease is a panenteric, transmural inflammatory disease of unknown origin. Although primarily managed medically, 70% to 90% of patients will require surgical intervention. Surgery for small bowel Crohn's is usually necessary for unrelenting stenotic complications of the disease. Fistula, abscess, and perforation can also necessitate surgical intervention. Most patients benefit from resection or strictureplasty with an improved quality of life and remission of disease, but recurrence is common and 33% to 82% of patients will need a second operation, and 22% to 33% will require more than two resections. Short-bowel syndrome is unavoidable in a small percentage of Crohn's patients because of recurrent resection of affected small bowel and inflammatory destruction of the remaining mucosa. Although previously a lethal and unrelenting disease with death caused by malnutrition, patients with short-bowel syndrome today can lead productive lives with maintenance on total parenteral nutrition (TPN). This lifestyle, however, does not come without a price. Severe TPN-related complications, such as sepsis of indwelling central venous catheters and liver failure, do occur. Future developments will focus on more powerful and effective anti-inflammatory medication specifically targeting the immune mechanisms responsible for Crohn's disease. Successful medical management of the disease will alleviate the need for surgical resection and reduce the frequency of short-bowel syndrome. Improving the efficacy of immunosuppression and the understanding of tolerance induction should increase the safety and applicability of small-bowel transplant for those with short gut. Tissue engineering offers the potential to avoid immunosuppression altogether and supplement intestinal length using the patient's own tissues.

Adrenal Cortex Hormones↗

PubMedDate not supplied

Practical guidelines for the preservation of the pancreaticoduodenal arteries during duodenum-preserving resection of the head of the pancreas: clinical experience and a study using resected specimens from pancreaticoduodenectomy.

BACKGROUND/AIMS: The purpose of this study was to create a practical guideline for vascular preservation during duodenum-preserving resection of the head of the pancreas. METHODOLOGY: We examined the anatomy of pancreaticoduodenal arteries by specimen angiography and dissection using 12 pancreaticoduodenectomy specimens. We also reviewed our experiences with duodenum-preserving resection of the head of the pancreas. RESULTS: In the specimens, the posterior pancreaticoduodenal artery and its duodenal branches were easily separated from the posterior surface of the pancreas, and its papillary branch was identified in two-thirds of the cases. It was difficult to dissect the anterior superior pancreaticoduodenal arteries from the pancreas because they were partially buried in the pancreatic parenchyma. The anterior inferior pancreaticoduodenal artery located in the posterior and inferior surface of the pancreas could be safely dissected in two-thirds of the cases. Duodenum-preserving resection of the head of the pancreas was performed in 7 patients. In every case, the anterior superior pancreaticoduodenal artery was sacrificed and the anterior inferior pancreaticoduodenal artery was preserved. In 3 cases, the entire posterior pancreaticoduodenal artery was preserved and in 4 cases a short segment of the posterior pancreaticoduodenal artery was removed accidentally. The pancreatic head was totally removed and the intrapancreatic common bile duct was preserved. There were 3 postoperative complications, pancreatic leakage, intraabdominal fluid collection and bile duct stricture. They improved with conservative management. CONCLUSIONS: To safely perform duodenum-preserving resection of the head of the pancreas, preservation of the whole posterior pancreaticoduodenal artery and anterior inferior pancreaticoduodenal artery is recommended because they can be safely dissected from the pancreas, and the posterior pancreaticoduodenal artery provides the major blood supply to the papilla and distal bile duct. However, removal of a short segment of posterior pancreaticoduodenal artery does not preclude a good blood supply to the duodenum because of bidirectional blood flow.

Adult↗

PubMed2002

Influence of preoperative transcatheter arterial chemoembolization on liver resection in patients with resectable hepatocellular carcinoma.

OBJECTIVE: To assess the influence of preoperative transcatheter arterial chemoembolization (TACE) on liver resection in patients with resectable hepatocellular carcinoma (HCC). METHODS: Of 126 patients with resectable HCC, 62 received preoperative TACE (TACE group) and the remaining 64 patients were selected as controls (non-TACE group). Perioperative risk factors including liver function alteration, mean blood loss during operation, mean time of clamping the porta hepatis, length of operation, postoperative abdominal drainage at day 1, 2 and 3, morbidity and mortality were compared between the two groups. RESULTS: Neither significant difference in liver function alteration nor mortality was observed between the two groups. More severe hepatic cirrhosis, longer operation time, more blood loss and postoperative abdominal drainage were noted in the TACE group than in the non-TACE group. There was no significant difference in postoperative morbidity between the two groups. CONCLUSIONS: Preoperative TACE for resectable HCC increases surgical difficulty and risk, and therefore should be considered prudently according to the individuality of patients.

Abdomen↗

PubMedDate not supplied

High en bloc resection rate achieved by endoscopic mucosal resection with IT knife for early gastric cancer.

BACKGROUND/AIMS: Circumferential endoscopic mucosal resection (EMR) around lesions performed by an insulation-tipped diathermic knife (IT knife) increases en bloc resection rates, suggesting the possibility of expanding indications for EMR. METHODOLOGY: Clinical outcome of EMR performed by IT knife under general anesthesia was evaluated for 26 patients with 29 early gastric cancer. RESULTS: Successful en bloc resection rates obtained by the IT knife were 100, 87.5, 90.0 and 100% for lesions < or =10 mm in size, 11-20 mm, 21-30 mm, and > or =31 mm, respectively. They were significantly higher with the IT knife than those obtained by the conventional method (IT knife method: 93.1% vs. conventional method: 28.5%, p<0.0001). Two lesions were lateral margin positive, and in three cases invasion of lesions was observed as deep as the submucosa. Distal, total, and proximal gastrectomy with D2 lymphadenectomy, respectively, was provided in 3 cases; however, no lymph node involvement was found in any of the resected specimens. Bleeding and perforation were observed in 3 cases, respectively, however, no additional surgical treatment was required for these patients. CONCLUSIONS: EMR by means of the IT knife under general anesthesia can be performed safely and adequately. It is a useful treatment modality for early gastric cancer.

Aged↗