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At least 217 records · Page 12Linked to original sources

PubMed1993

A patient with hepatocellular carcinoma who underwent resection of the primary lesion 10 years ago and resection of a giant adrenal metastasis 8 and a half years later.

A 56-year-old male consulted us because of a palpable mass and pain of the left flank 8 and a half years after resection of hepatocellular carcinoma of the left lobe about 3 cm in diameter. Ultrasound examination of the abdomen demonstrated a tumor about 10 cm in diameter showing a mosaic of hyperechoic and hypoechoic areas on the upper pole of the left kidney. By angiography, the tumor was found to be supplied mainly by the inferior adrenal artery. PIVKA-II was increased. Adrenal metastasis of hepatocellular carcinoma was suspected, and adrenalectomy was carried out. No intrahepatic metastasis was noted. The tumor was histopathologically identified as a pseudo-glandular type of moderately differentiated hepatocellular carcinoma with a trabecular pattern similar to the primary lesion. In this patient, a resectable giant metastasis was observed only in the left adrenal gland and no intrahepatic metastasis was demonstrated 8 and a half years after resection of hepatocellular carcinoma. The patient has survived 10 years after the first operation. This case is considered to be important for evaluation of the treatment for distant metastasis of hepatocellular carcinoma.

Adrenal Gland Neoplasms↗

PubMed2003

Laparoscopic-assisted bowel resection in pediatric/adolescent inflammatory bowel disease: laparoscopic bowel resection in children.

PURPOSE: The purpose of this study is to discuss indications, technical approach, and morbidity of laparoscopic approaches to major bowel resection in the pediatric/adolescent population with inflammatory bowel disease and familial polyposis. METHODS: Retrospective review of laparoscopic-assisted bowel procedures between May 1991 and January 2002 was performed. Laparoscopic-assisted bowel resection is defined as complete intracorporeal mobilization and devascularization of a segment of colon or rectum. The indications for extracorporeal vs. intracorporeal anastomosis will be discussed. Clinically unstable, septic, or massively bleeding patients were not candidates for this technique. The decision to attempt the laparoscopic approach was based on the experience of the consulting surgeon. There were 31 patients, including 14 females. Five patients had undergone prior surgery. Twenty-nine patients had inflammatory bowel disease, one had familial polyposis, and one had a cavernous hemangioma. We included all pediatric/adolescent patients in our practice undergoing laparoscopic resection. RESULTS: Twenty-nine patients had 33 laparoscopic operations, including proctocolectomy with ileal pouch-anal anastomosis (n = 14), proctocolectomy with ileostomy (n = 3), ileocolectomy with ileocolic anastomosis (n = 13), and small-bowel obstruction (n = 1). Average operating time was 158 (range, 30-400) minutes, with average blood loss of 159 ml. Average wound length was 4.9 cm. The complication rate was 16 percent (n = 5), with one anastomotic leak. The rate of conversion to open operations was 5.8 percent. Liquid diet was begun on Day 3, and the average length of stay was 5.9 days. CONCLUSION: Major laparoscopic bowel surgery can be performed safely in the pediatric/adolescent population, with reasonable operative times, low conversion to open operations, and low morbidity.

Adolescent↗

PubMed2002

Laparoscopic sigmoid resection for cancer: curative resection and preliminary medium-term results.

PURPOSE: Despite reservations about compliance with oncologic radical criteria, laparoscopic resection of the sigmoid colon is increasingly being used with curative intent in oncologic surgery of the colorectum. The aim of the present study was to obtain further information on the perioperative course, the oncologic radicalness of the procedure, and medium-term outcome. METHODS: The data presented here were obtained from a prospective, multicenter study conducted in Germany and Austria. These data were acquired from an analysis of subgroups derived from a total of 3,133 recruited patients. RESULTS: A total of 292 patients from 36 hospitals underwent laparoscopic resection of the sigmoid colon with curative intent. The definitive histopathologic work-up of surgical specimens revealed the following International Union Against Cancer tumor stages: 122 Stage I, 86 Stage II, and 84 Stage III. The mean operating time was 172 minutes, and the mean intraoperative blood loss was 241 ml. The conversion rate to open surgery was 5.5 percent, the majority of such conversions being made necessary by vascular lesions. Sixty-five of the patients reported at least one postoperative problem or complication (22.3 percent); the mortality rate was 2.7 percent. With a mean of 13.4 recovered lymph nodes and a mean aboral safety margin of 72 mm, the formal criteria for the assessment of oncologic radicalness were met. Intraoperative cell dissemination occurred in two patients. The long-term results, which, at a mean follow-up of 2.1 years and a follow-up rate of 73.3 percent, must be considered preliminary, show a calculated stage-related survival rate of 88.8, 90.9, and 64.1 percent, respectively, for the International Union Against Cancer Stages I, II, and III. CONCLUSIONS: Laparoscopic sigmoid resection can be performed technically reliably-also with curative intent-with acceptable complication and mortality rates and, to date, with survival rates that are at least comparable with those achieved with open surgical procedures.

Adult↗

PubMed2006

Therapeutic results in low-rectal cancer patients treated with abdominosacral resection are similar to those obtained by means of anterior resection in mid- and upper-rectal cancer cases.

AIMS: To present the experiences of the Regional Comprehensive Cancer Center in Wroclaw with abdominosacral resection (ASR) carried out in low-rectal cancer patients. METHODS: Rectal cancer patients (n=294) were operated on by the same surgical team using the standardized TME technique between May 5, 1998 and February 23, 2001. Depending on the distance from the anal verge, the primary tumor was removed by means of standard abdominal resection (AR-mid- and upper-rectal cancers) or abdominosacral resection (ASR-low-rectal cancers). The patients who underwent the different operative procedures were comparable in terms of distributions of age, gender, tumor infiltration depth and regional lymph node involvement with no significant statistical difference between the groups. RESULTS: Ninety-seven cases were excluded from the analysis of survival based on exclusion criteria defined. Consequently, 197 cases were left for further analysis, including 154 patients operated on by AR and 43 who underwent ASR. AR and ASR patients did not differ significantly in terms of postoperative morbidity (11% and 14%, respectively), observed (57.1% vs. 60.4%) and relative 5-year survivals (74.3% vs. 73.2%) and the cumulative 5-year local recurrence rate (5.8% vs. 4.7%). CONCLUSION: The combined use of the modern TME technique and the "historical" abdominosacral excision of the rectum seems to give new, potentially attractive perspectives for successful surgical treatment of low-rectal cancers.

Abdomen↗

PubMed1997

Low grade gliomas: functional mapping resection strategies, extent of resection, and outcome.

The impact of surgery on outcome of adult patients with low-grade gliomas is controversial. Without prospective randomized treatment trials, one is primarily dependent on retrospective studies to address this issue. This paper reviews the recent clinical series of low-grade gliomas in which the association between extent of resection (EOR) and outcome could be analyzed. Functional stimulation mapping methods will be described to point out their critical role in maximizing the extent of resection while minimizing the risk associated with radical resection of low-grade gliomas. Studies from the CT-era analyzed with multivariate statistical methods were emphasized. The analysis of these studies points out that, for astrocytomas, there is no clear consensus that a greater EOR improves survival, but in most series under review, greater EOR significantly extended the survival of patients with oligodendroglioma. Unfortunately, there is little data which specifically analyzes and stratifies the outcome for other end-points such as time to progression, malignant degeneration, mortality and morbidity, and duration of high quality survival by EOR.

Adult↗

PubMed1996

Isothermic irrigation during transurethral resection of the prostate: effects on peri-operative hypothermia, blood loss, resection time and patient satisfaction.

OBJECTIVES: To investigate the effect using irrigation fluid at body temperature (isothermic) on patients' (core) temperature during a transurethral resection of the prostate (TURP) and on the amount of peri-operative blood loss, the resection time and the subjective assessment of comfort by the patients. PATIENT AND METHODS: In a randomized study, patients undergoing TURP under spinal anaesthesia were divided into those receiving either isothermic irrigation fluid (Group 1.28 patients) or fluid at room temperature (Group 2.31 patients). In Group 1, a fluid heater maintained the irrigation fluid at body temperature until it reached the bladder. The body temperature of the patients was recorded rectally and orally during and after TURP and the peri-operative blood loss was also measured. The patients were interviewed on the first day after TURP to determine their assessment of comfort during the procedure. RESULTS: The decrease in body temperature was 0.74 degree C in Group 1 and 1.71 degrees C in Group 2, which was significantly different (P < 0.001). There was no significant difference in blood loss or resection-time. In Group 1, only four (14%) of the patients were aware that their body was cooler, compared to 15 (50%) in Group 2 (P = 0.038). CONCLUSION: Isothermic irrigation during TURP prevents excessive cooling and reduces the level of hypothermia. The reported increased mortality after TURP is probably related to peri-operative cardiac stress, an important factor which could be caused by the rapid decrease in body temperature which accompanies normal irrigation. Because the heating equipment presently available does not interfere with TURP, there are strong arguments for performing every TURP with irrigation fluid at body temperature.

Aged↗

PubMed1994

[Partial endoscopic resections with CO2 laser in laryngeal cancer. I. Resection techniques].

The laser surgical technique as used in more than 250 laryngeal carcinomas since 1979 is described. The CO2 laser is always used as a cutting instrument and not to vaporize the tumour, since this would not enable a control of complete tumour removal. The vaporisation technique is used only in combination with the cutting technique for laser surgical debulking of large laryngeal tumours. Five cutting techniques are differentiated: 1) excisional biopsy; 2) excision of the tumour in several portions; 3) incision of large tumours for staging purposes; 4) palliative excision of primary tumours in inoperable lymph node metastases; 5) palliative reduction of large tumours (debulking). T1a vocal cord carcinomas and circumscribed carcinomas of the border of the epiglottis are resected by means of a so-called excisional biopsy. This means that the tumour is resected in toto with a small line of adjoining healthy tissue. For the removal of large carcinomas of the vocal cord, or of tumours that cross the anterior commissure, or of larger supraglottic tumours, an unusual technique is employed. The tumorous tissue is cut with the laser and resected in several fragments. This may seem to contradict current oncological principles and is only possible because of laser-specific tissue reactions. When using a modern micromanipulator (711 Acuspot, Sharplan, London; diameter of the laser beam: 0.25 mm at 400 mm working distance) at low power levels (1-2 watts) and continuous wave mode, very slight or no bleeding is caused on the surface of the dissected tissue allowing differentiation between tumour and healthy tissue with the operating microscope.(ABSTRACT TRUNCATED AT 250 WORDS)

Biopsy↗

PubMed2002

Extended transthoracic resection compared with limited transhiatal resection for adenocarcinoma of the esophagus.

BACKGROUND: Controversy exists about the best surgical treatment for esophageal carcinoma. METHODS: We randomly assigned 220 patients with adenocarcinoma of the mid-to-distal esophagus or adenocarcinoma of the gastric cardia involving the distal esophagus either to transhiatal esophagectomy or to transthoracic esophagectomy with extended en bloc lymphadenectomy. Principal end points were overall survival and disease-free survival. Early morbidity and mortality, the number of quality-adjusted life-years gained, and cost effectiveness were also determined. RESULTS: A total of 106 patients were assigned to undergo transhiatal esophagectomy, and 114 to undergo transthoracic esophagectomy. Demographic characteristics and characteristics of the tumor were similar in the two groups. Perioperative morbidity was higher after transthoracic esophagectomy, but there was no significant difference in in-hospital mortality (P=0.45). After a median follow-up of 4.7 years, 142 patients had died--74 (70 percent) after transhiatal resection and 68 (60 percent) after transthoracic resection (P=0.12). Although the difference in survival was not statistically significant, there was a trend toward a survival benefit with the extended approach at five years: disease-free survival was 27 percent in the transhiatal-esophagectomy group, as compared with 39 percent in the transthoracic-esophagectomy group (95 percent confidence interval for the difference, -1 to 24 percent [the negative value indicates better survival with transhiatal resection]), whereas overall survival was 29 percent as compared with 39 percent (95 percent confidence interval for the difference, -3 to 23 percent). CONCLUSIONS: Transhiatal esophagectomy was associated with lower morbidity than transthoracic esophagectomy with extended en bloc lymphadenectomy. Although median overall, disease-free, and quality-adjusted survival did not differ statistically between the groups, there was a trend toward improved long-term survival at five years with the extended transthoracic approach.

Adenocarcinoma↗

PubMed1999

A temporal bone study of posterior semicircular canal resection for exposure of the internal auditory canal (PSCC resection).

Partial resection of the labyrinth is becoming accepted as a means of improving access to the internal auditory canal and central skull base neoplasms. In this investigation, an infralabyrinthine approach was performed on 20 temporal bones. The dissection was extended by transection of the endolymphatic duct, then excision of the posterior semicircular canal. The maximal lateral exposure of the internal auditory canal (IAC) was measured after each manoeuvre. Resection of the posterior semicircular canal increased lateral exposure in 7/20 specimens to an average 61% of the length of the IAC. Posterior canal resection improved superior exposure and increased the circumference of exposure in all specimens.

Ear, Inner↗

PubMed2006

Curative resection for low rectal adenocarcinoma: abdomino-perineal vs anterior resection.

OBJECTIVE: Local recurrence after abdomino-perineal excision of the rectum for tumours has been reported to occur in up to a third of patients in contrast to 4% after restorative anterior resection. METHOD: Low rectal tumours were defined as tumours within 8 cm of the anal verge and were treated by either stapled low anterior resection (SLAR) or abdomino-perineal excision of the rectum (APER). One hundred and seventy-eight patients with tumours in the lower third of the rectum (30% of 591 rectal cancers) underwent surgical resection between 1980 and 2001. Data were collected prospectively; 68 (38%) had SLAR and 110 (62%) had APER with median follow up of approximately 12 years; 54 SLAR (79%) and 76 APER (69%) had curative procedures on clinical and pathological criteria. RESULTS: Local and distant recurrence occurred in seven (13%) and eight (15%) patients in the SLAR group and six (8%) and 14 (18%) patients in the APER group, respectively. Overall 5-year survival was 63% and 60% in the SLAR and APER groups, respectively CONCLUSION: For rectal cancers within 8 cm of the anal verge, both procedures achieved equivalent results measured by low local recurrence rates and overall survival.

Adenocarcinoma↗

PubMed2004

Focus on the conditions of resection and reconstruction in gastric cancer. What extent of resection and what kind of reconstruction provide the best outcomes for gastric cancer patients?

To assess the roles of the extent of gastric resection and duodenal food passage reconstruction in gastric cancer, we examined a consecutive series of 1,061 patients who underwent total or partial (proximal and distal) gastrectomies with or without duodenal food passage reconstruction between August of 1974 and January of 2002, and received gastrectomies with D2-3 lymph node dissection. Patients who underwent distal or proximal gastrectomy were found to have significantly better survival rates than those who underwent total gastrectomy in stages 1A (10-year survival: 86.6 and 78.9 vs. 61.6%), 2 (56.5 and 65.6 vs. 34.4%), 3A (45.9 and 33.3 vs. 15.2%), and 4 (5-year survival rates: 23.7 and 50.0 vs. 7.1%). Additionally, patients with duodenal food passage reconstruction or double tract reconstruction also showed significantly better survival rates than those without duodenal food reconstruction in stages 1A (10-year survival: 86.4 and 82.5 vs. 61.7%), 1B (69.9 and 90.6 vs. 54.1%), 2 (60.5 and 63.3 vs. 16.5%), and 3A (39.9 and 47.4 vs. 23.1%). In multivariate analysis, the independent prognostic factors were age at operation, depth of tumor, duodenal food passage reconstruction, and lymph node metastasis. Our results indicate that both the extent of gastric resection and duodenal food passage reconstruction were important factors in the outcome of gastric cancer patients, and that surgeons should perform minimal gastric resection with preservation of the duodenal food passage when the gastric stump is tumor-free.

Adenocarcinoma↗

PubMed2003

Tracheal resection with primary anastomosis in cadavers: the effects of releasing maneuvers and length of tracheal resection on tension.

To determine the relationships among length of trachea resected, total tracheal length, and anastomotic tension when using various release maneuvers, we studied 10 adult human cadavers: 5 male and 5 female. The trachea was transected between rings 2 and 3. Precision, handheld spring tensiometers (Geneva Gage, LLC) were used to measure the tension required to approximate, and then overlap, the proximal segment relative to the distal segment, and the distal segment relative to the proximal segment after these maneuvers: no release, blunt dissection, neck flexion, suprahyoid release (SHR) without neck flexion, SHR with neck flexion, and right hilar release. After the tension measurements were recorded, the trachea was harvested and the total tracheal length was measured. Length-tension curves were plotted for both the superior and inferior tracheal segments after each release maneuver. The stiffness coefficient for the trachea and the resting load on the trachea following each release maneuver were calculated. An exponential length-tension relationship existed for the distal tracheal segment regardless of whether release maneuvers were performed. The proximal tracheal segment exhibited a linear length-tension relationship initially, but displayed an exponential relationship after SHR. We could resect 6.68 cm (range, 4.2 to 9.9 cm), 13.3 rings (range, 10 to 20 rings), or 65.5% (range, 42% to 100%) of the trachea without undue tension (<1,000 g) on the anastomosis. We conclude that various tracheal release maneuvers are effective in increasing the length of trachea that can be relatively safely resected. However, these maneuvers are not uniformly effective across subjects.

Aged↗

PubMed2003

Zones of approach for craniofacial resection: minimizing facial incisions for resection of anterior cranial base and paranasal sinus tumors.

OBJECTIVE: Anterior cranial base tumors are surgically resected with combined craniofacial approaches that frequently involve disfiguring facial incisions and facial osteotomies. The authors outline three operative zones of the anterior cranial base and paranasal sinuses in which tumors can be resected with three standard surgical approaches that minimize transfacial incisions and extensive facial osteotomies. METHODS: The zones were defined by performing dissections on 10 cadaveric heads and by evaluating radiographic images of patients with anterior cranial base tumors. The three approaches performed on each cadaver were transbasal, transmaxillary, and extended transsphenoidal. RESULTS: Three zones of approach were defined for accessing tumors of the anterior cranial base, nasal cavity, and paranasal sinuses. Zone 1 is exposed by the transbasal approach, which is limited anteriorly by the supraorbital rim, posteriorly by the optic chiasm and clivus, inferiorly by the palate, and laterally by the medial orbital walls. This approach allows access to the entire anterior cranial base, nasal cavity, and the majority of maxillary sinuses. The limitation imposed by the orbits results in a blind spot in the superolateral extent of the maxillary sinus. Zone 2 is exposed by a sublabial maxillotomy approach and accesses the entire maxillary sinus, including the superolateral blind spot and the ipsilateral anterior cavernous sinus. However, access to the anterior cranial base is limited. Zone 3 is exposed by the transsphenoidal approach. This approach accesses the midline structures but is limited by the lateral nasal walls and intracavernous carotid arteries. An extended transsphenoidal approach allows further exposure to the anterior cranial base, clivus, or cavernous sinuses. The use of the endoscope facilitates tumor resection in the nasal cavity and paranasal sinuses. CONCLUSION: The operative zones outlined offer minimally invasive craniofacial approaches to accessing lesions of the anterior cranial base and paranasal sinuses, obviating facial incisions and facial osteotomies. Case illustrations demonstrating the approach selection paradigm are presented.

Adult↗

PubMed2002

[Pancreas head resection combined with resection of the superior mesenteric vein: extensive procedure for tumors of the pancreas head].

Surgical treatment for locally advanced cancer of the pancreas head with vascular invasion is controversial. It is regarded as a contraindication for resection by most surgeons, others perform resection involving the vessel. We performed pancreaticoduodenectomy with vascular resection in a 61 year old patient. The vascular reconstruction was performed using reversed saphenous vein. We review and analyse clinical, and operative data and results.

Female↗

PubMedDate not supplied

[Resection of the celiac axis increase resectability rate in locally advanced pancreatic body and gastric tumor].

Celiac axis involvement in locally advanced neoplasia was considered in the past a criteria of non resectability. Carcinoma of the body and tail of the pancreas is often diagnosed at an advanced stage or metastatic stage. Gastric carcinoma (particularly antral localization) can also be locally invasive. Celiac axis can be invaded in both neoplasias. In order to increase resectability rate in those two types of neoplasia celiac trunk resection was proposed (en bloc with distal pancreatectomy, loco-regional lymph node excision with or without total gastrectomy). We report our experience on 3 patients and some considerations about this surgical technique from medical literature.

Adenocarcinoma↗

PubMed1990

[Low pressure trocar resection versus Iglesias suction resection].

Trocar resection is superior to Iglesias' backwash resection. The main criteria on which this assessment is based are the larger operative specimen obtained, the shorter duration of the operation, and the much smaller intraoperative infiltration volume. This last was determined using a glycine irrigation solution, by measuring the increase in glycine in the serum by means of column chromatography. This showed that the intravesical irrigation pressure determines the absorption volume after opening of the venous sinus, while the duration of the resection and the volume of irrigation solution employed perioperatively are of less importance. In the case of alcohol-based irrigation solutions these results can be confirmed by measuring the "standby" alcohol in the respiratory air.

Glycine↗

PubMed1986

[Segmental resection of the spleen as function-preserving therapy in pediatric rupture of the spleen. Sealing of the resected surface with fibrin glue, collagen fleece and dexon net].

Segmentary resection of a traumatic ruptured spleen was carried out in two children. Bleeding of the resected area was prevented by stitching, and the resected space was sealed up by means of a layer of a collagen preparation and with fibrin adhesive. Furthermore, the parenchymal space was enveloped in a dexon net that was fastened under slight tension to the capsule of the residual spleen by means of fibrin adhesive. Postoperative progress of both children was without complications. Postoperatively a residual spleen was seen sonographically having approximately the size of an organ of substandard dimension.

Aprotinin↗

PubMed1989

Adverse effects of preoperative hepatic artery chemoembolization for resectable hepatocellular carcinoma: a retrospective comparison of 138 liver resections.

During the past 8 years we have treated 268 patients with primary hepatocellular carcinoma (HCC); total extirpation of the tumor was carried out in 138. Thirty-one of the patients with resectable HCCs had already been treated with transcatheter arterial embolization (TAE) of the liver before they were referred to us. The clinical values of preoperative TAE were retrospectively evaluated for those 31 patients and for the remaining 107 patients without TAE. There were no substantial differences between the two study groups in the clinical and histopathologic backgrounds. No differences were observed in the extent of liver resection, estimated blood loss during surgery, and operation time. During surgery, however, troublesome intra-abdominal complications relevant to TAE were encountered in 15 patients, and detection of tumors was impossible, even with intraoperative ultrasonography, in five patients in the group with TAE. Such findings were not present in any of the patients without TAE. Postoperative morbidity and mortality rates were similar in the two groups. There was no significant difference in the rate of recurrence of tumor in the liver, but the recurrence time was significantly shorter in the group with TAE. TAE did not improve the long-term survival rates in patients either with or without cirrhosis. Results of our study seem to indicate that preoperative TAE is meaningless in the treatment of resectable HCCs and therefore should be avoided, particularly in patients with advanced cirrhosis of the liver.

Carcinoma, Hepatocellular↗