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PubMed1982

[Bacterial colonization following resective and non-resective stomach-surgery (author's transl)].

Studies on why there is a higher disposition of carcinoma developing in the residual portion of the stomach of patients having undergone resections have led to the assumption that bacterial colonization constitutes a co-carcinogenic factor. It has been the purpose of this investigation to compare the ensuing bacterial growth following resective and nonresective stomach surgery. 120 Sprague-Dawley rats were divided into six groups: 1) control group: laparotomy. (2)SPV: with assured preservation of the antrum innervation. 3) SPV + Pypl.: the pyloroplasty was performed according to the Heinecke-upsilon. Mikulicz method. 4) TV + Pypl.: abdominal severance of the trunci nervi vagi. 5) BII: antecolonic without enteroanastomosis. 6) TV + BII. Eight months postoperative a smear was obtained under general anaesthesia from the transition segment between the fundus and antrum or at the site of the anastomosis. Tests for aerobic and anaerobic bacteria as well as cultures for fungi were begun. The control and SPV + Pypl. groups did not differ significantly in total bacteria count and in the ratio of nitrobacter. In contrast, the SPV group without pyloroplasty displayed an approximately tenfold higher concentration of nitrobacters--an amount equivalent to the sum of nitrobacters in the two resection techniques. The TV + BII group had a threefold higher total bacteria count than the BII group. According to our studies, a reduced stomach acid production, the bile secretion reflux and more importantly, a retarded food passage promote intragastric bacterial growth thus expediting the formation of intragastric carcinogenic nitrosamines.

Animals↗

PubMed1981

Mucosal changes of the Billroth II resected stomach. A follow-up study of patients resected for duodenal ulcer,with special reference to gastritis, atypia and cancer.

In a follow-up study of a consecutive series of 1000 patients, who underwent Billroth II resection for duodenal ulcer 22-30 years earlier, the mucosal changes of the gastric stump could be studied by endoscopy and biopsy in 196 cases. At the histological examination only 7.1% of the patients had a normal gastric mucosa: the remaining 92.9% had chronic atrophic gastritis., which was diffuse and most marked at the gastro-jejunostomy. In 7.1% of the cases the inflammation was accompanied by focal accumulation of lipophages. 12.2% had non-neoplastic polyp formation caused either by cystic glandular dilatation of the mucosa at the gastro-jejunostomy, eosinophilic granulomatous polyps or protrusion of the mucosa at the lesser curvature caused by invagination at the resection. 14.8% of the patients had epithelial atypia close to the anastomosis, but no cancers were found, and it is concluded that the presented results do not indicate a cancer prophylactic endoscopic screening of patients treated with Billroth II resection for duodenal ulcer.

Adult↗

PubMed1995

Resection versus resection combined with adjuvant pre- and post-operative chemotherapy--immunotherapy for metastatic colorectal liver cancer. A new look at an old problem.

Forty patients with metastatic liver disease from colorectal carcinoma are presented in this study. Patients were randomly assigned to two groups: Group A (20 patients) who had liver resection and Group B (20 patients) who had liver resection combined with post-operative locoregional immuno- therapy + chemotherapy. Thus, during the first year following surgery, they have four courses of targeted locoregional transarterial chemotherapy-immunotherapy, two courses during the second year and one course during the third year. Two patients died, one in each group, during the first 30 postoperative days. Survival in Group A (19 surviving patients) ranged from 4 to 25 months, mean 11 months. Eight (8) patients had intrahepatic recurrence of the disease and 11 are still alive and free of disease. Of those with intrahepatic recurrence, three (3) patients died 15, 15 and 17 months following surgery of causes related to the disease. In Group B (19 surviving patients), survival ranged from 3 to 30 months, mean 20 months. At present, all 19 patients are alive and free of disease (p < 0.001). None has had intrahepatic recurrence (p < 0.001). On the basis of present results, liver resection supplemented with postoperative targeted transarterial locoregional immunotherapy-chemotherapy is associated with optimal results. It is highly recommended as the procedure of choice in dealing with patients operated upon for metastatic liver disease due to colorectal carcinoma.

Adenocarcinoma↗

PubMed1997

Curative resection in potentially resectable tumours of the gallbladder.

OBJECTIVE: To study the value of surgical treatment in patients with potentially resectable gallbladder cancer. DESIGN: Prospective non-randomised study. SETTING: University hospital, Chile. SUBJECTS: 109 Patients with gallbladder cancers, most of which were detected in the cholecystectomy specimen. INTERVENTIONS: 53 Patients underwent reoperation with the aim of doing a lymphadenectomy and resecting the gallbladder bed. MAIN OUTCOME MEASURES: Morbidity and short and long term mortality RESULTS: Residual tumour after cholecystectomy was mainly observed in patients with serosal and adipose tissue infiltration. Lymph nodes and liver invasion were associated with recurrence. Survival analysis was focused on the group with subserosal infiltration because it is the largest subgroup in this study and prognosis is intermediate. Patients who underwent curative resection had a significantly better survival than those treated by simple cholecystectomy (p = 0.005). CONCLUSIONS: Extended cholecystectomy improved the prognosis of patients whose cancers were restricted to the subserosal layer. Additional treatments are necessary to improve the results obtained with operation alone.

Adult↗

PubMed2001

Holmium laser resection of the prostate is more cost effective than transurethral resection of the prostate: results of a randomized prospective study.

OBJECTIVES: A cost-effectiveness analysis was carried out comparing electrosurgical transurethral resection of the prostate (TURP) with holmium:yttrium-aluminum-garnet laser resection of the prostate (HoLRP). METHODS: One hundred twenty patients with benign prostatic hyperplasia and urodynamically proved obstruction were randomized to undergo either TURP or HoLRP. Economic and clinical outcome data were recorded prospectively out to 1 year postoperatively. RESULTS: The HoLRP group experienced fewer complications and had a shorter hospital stay and catheterization time than the TURP group, with equivalent clinical outcomes at 12 months. HoLRP cost 24.5% less (New Zealand dollars $651) than TURP during the first year. CONCLUSIONS: Because the clinical outcomes out to 1 year were equivalent, HoLRP was more cost-effective than TURP. On the basis of these savings, a minimum of 93 cases per year are required to recover the capital and service costs of the holmium:yttrium-aluminum-garnet laser.

Aged↗

PubMed2006

Plasmakinetic resection of the prostate versus standard transurethral resection of the prostate: a prospective randomized trial with 1-year follow-up.

The aim of this study was to compare the clinical results of plasmakinetic resection of the prostate (PRP) with standard transurethral resection (TUR) of the prostate (TURP). A total of 240 patients (mean age 63.5; age range 52-90 years), with symptomatic benign prostatic hyperplasia were randomized into two groups and treated with two different techniques (TURP and PRP). We evaluated pre-operative, per-operative and post-operative (first and 12th months) findings of all patients. The mean catheterization time was 3 and 4.5 days in the PRP and standard TURP groups, respectively (P<0.001). We observed the improvements in maximum flow rates in PRP group were significantly higher than TURP group (P<0.001). TUR of the prostate using plasmakinetic energy seems to be a promising treatment alternative to conventional TURP. It has the advantages of low intraoperative and post-operative complications, short convalescence, excellent intraoperative hemostasis, absence of fluid absorption and TUR syndrome.

Aged↗

PubMed2000

Histologic effects of holmium:YAG laser resection versus transurethral resection of the prostate.

BACKGROUND AND PURPOSE: Holmium laser resection (HoLRP) is an effective surgical alternative to transurethral resection of the prostate (TURP). We investigated whether an adequate histologic diagnosis could be made from HoLRP tissue specimens. PATIENTS AND METHODS: A series of 120 patients were randomized to TURP (N = 59) or HoLRP (N = 61). Each histologic specimen was reviewed by a single pathologist, who was blinded to the treatment. Weight of tissue, histologic diagnosis, and degree of thermal artifact were assessed. Thermal damage was graded as follows: 1 = no significant thermal injury; 2 = <25% of the tissue damaged (minimal); 3 = 25% to 80% of the tissue damaged (moderate); and 4 = >80% of the tissue damaged, with loss of prostatic architecture (extensive). RESULTS: The mean weight of the TURP and HoLRP specimens was 15.6 g and 9.6 g, respectively. The mean grade of thermal artifact for the TURP group was 1.8 and for the HoLRP group 2.6. Of the HoLRP specimens, 56 (92%) were grade < or = 3. Of the entire series of 120 specimens, 5 contained malignant tissue, all of which were from the TURP group. Four of these specimens were adenocarcinoma of the prostate, whereas the other was a transitional-cell carcinoma. Of the four specimens that contained prostate cancer, two were stage pTla tumors. CONCLUSIONS: Although identifiable prostatic architecture was maintained in the majority of histologic specimens from the HoLRP group, the tissue quality was inferior to that of TURP. There was significantly more vaporization and subsequent tissue loss with HoLRP, and the thermal damage to tissue was greater.

Adenocarcinoma↗

PubMed2004

Holmium laser resection of the prostate versus transurethral resection of the prostate: results of a randomized trial with 4-year minimum long-term followup.

PURPOSE: It has previously been shown that holmium laser resection of the prostate (HoLRP) is superior to transurethral resection of the prostate (TURP) with regard to perioperative morbidity and is equivalent to TURP in the short term. We present the long-term results of a randomized, prospective trial comparing HoLRP to TURP since information regarding the durability of holmium prostatectomy is lacking in the literature to date. MATERIALS AND METHODS: A total of 120 patients with urodynamic obstruction were randomized (April 1996 to August 1997) into 2 comparable groups and assigned to HoLRP or TURP. All patients were assessed preoperatively and followed prospectively at 3 weeks, 3, 6, 12, 24 and 48 months postoperatively with an American Urological Association symptom score, quality of life score, peak urinary flow rate, and questionnaires concerning sexual function and continence. Preoperative pressure flow studies, ultrasound prostatic volume assessment and post-void residual volume measurement were repeated at the 6-month visit. All adverse events were noted. RESULTS: Of 120 patients 73 completed the 48-month assessment. HoLRP and TURP resulted in significant improvements in all parameters. There was no difference between the 2 techniques in terms of urodynamic parameters, potency, continence and symptom scores at the 48-month assessment. HoLRP took significantly longer to perform but perioperative morbidity, catheter time, nursing contact time and hospital stay were significantly less for HoLRP compared to TURP. CONCLUSIONS: HoLRP and TURP give equivalent and satisfactory long-term results, with no differences noted in major morbidity. This confirms the durability of these 2 treatments. Peri-operative morbidity is less with HoLRP.

Aged↗

PubMed1984

Survival and recurrence after sphincter saving resection and abdominoperineal resection for carcinoma of the middle third of the rectum.

Sphincter saving resections (SSR) are being performed with increasing frequency in patients with carcinoma of the lower two-thirds of the rectum. It is not clear, however, whether local and distant recurrence and long term survival after these operations will be comparable with those following abdominoperineal resection (APER). In this retrospective study, we have compared survival and recurrence in patients with carcinoma of the middle third of the rectum (7.5-12 cm from the anal verge) who were treated by APER (n = 83) or low SSR (n = 71). There was a higher proportion of men in the APER group, the mean age was higher and APER patients had tumours with less favourable pathological features. To minimize bias between the two groups, patients with tumours with similar pathological characteristics were compared. The overall cancer specific 5-year survival rate after SSR was 74 per cent and after APER was 62 per cent; the overall recurrence rates were 27 per cent after SSR and 41 per cent after APER; the incidence of local recurrence was 11 per cent after SSR and 8 per cent after APER. In these comparisons and when the patients' tumours were matched for one or two pathological variables, no significant difference was found between the two groups. These results suggest that patients with carcinoma of the middle third of the rectum who are treated by SSR will fare as well as patients who are treated by APER, with respect both to recurrence and to survival. A prospective controlled trial, however, is required to provide final proof of these points.

Aged↗

PubMed1986

Comparison of the mortality, morbidity and incidence of local recurrence in patients with rectal cancer treated by either stapled anterior resection or abdominoperineal resection.

One hundred patients with rectal cancer treated by one surgeon over a 7 year period are reviewed. Fifty-five patients were treated by stapled anterior resection (SAR) and 45 by abdominoperineal resection (APR). Dukes' classification, degree of differentiation and local spread were similar in both groups. Operative mortality was 7.2 per cent for SAR and 2.2 per cent for APR. Anastomotic leakage following SAR occurred clinically in two patients (3.6 per cent), one of which proved fatal, and radiologically in five patients. Morbidity after SAR and APR was otherwise similar. There was no significant difference in local recurrence rates after SAR (14.7 per cent) and APR groups (25.0 per cent). The results of this study suggest that for patients with rectal cancer radical excision with sphincter presentation using the circular stapler has a mortality, morbidity and risk of local recurrence comparable with radical excision with a permanent colostomy.

Adult↗

PubMed1995

Abdominoperineal resection and anterior resection in the treatment of rectal cancer: results in relation to adjuvant preoperative radiotherapy.

The outcome of patients with rectal cancer treated by abdominoperineal or anterior resection, with or without preoperative radiotherapy, was assessed to detect any differences attributable to the operative method and interactions between radiotherapy and type of surgery. The study was based on 1292 patients included in two consecutive controlled randomized trials of preoperative radiotherapy in operable rectal carcinoma. The outcome was not related to surgical method. Radiotherapy increased postoperative mortality and complications and reduced local and distant recurrence, but had no effect on overall survival. Effects of radiotherapy were similar irrespective of the type of surgery, except that the increase in postoperative mortality in irradiated patients was greater in those treated with abdominoperineal resection. Sphincter-saving procedures appear to have no adverse effects on outcome of rectal cancer, but the optimum use of radiotherapy is still to be defined.

Adult↗

PubMed1982

Primary procedure in carcinoma of the tongue: local resection versus combined local resection and radical neck dissection.

Whether to perform local resection alone (LR) or to combine local resection with ipsilateral radical neck dissection (LR and RND) as primary treatment for carcinoma clinically confined to the tongue is controversial. To compare the outcomes of the two procedures, we reviewed the records of 502 patients treated for carcinoma of the tongue from 1949 to 1974, 128 of whom had no evidence of disease beyond the tongue. Immediate LR and RND was performed in 39; 16 (41%) had recurrences, and 14 (36%) died. On the other hand, 89 patients underwent LR alone; 43 (48%) had recurrences, and 29 (31%) died. All were followed for a minimum of 5 years or until their deaths. There was no statistical difference between the two procedures in recurrence or outcome. The two groups were compared with respect to tumor size according to the TNM classification, and no significant differences in recurrence or survival were apparent. LR alone appears to be adequate primary treatment for patients with no evidence of metastatic disease, provided close postoperative follow-up is observed. LR and RND may result in increased morbidity and certainly in disfigurement, and fails to improve prognosis or survival.

Adult↗

PubMed1990

Cortical resections outside the temporal lobe for intractable epilepsy--excluding multilobar resections and hemispherectomy.

The principles underlying such surgery are reviewed, together with details of the necessary investigation, and a review of long term results from the literature. Cortical Resection for epilepsy remains a useful treatment for drug resistant epilepsy when a cortical focus can be identified by neurophysiological or radiological means. Such a resection has a reasonable chance of relieving or ameliorating the epilepsy with only a small chance of producing or worsening any neurological deficit.

Cerebral Cortex↗

PubMed1993

Survival and recurrence after low anterior resection and abdominoperineal resection for rectal cancer: the results of a long-term study with a review of the literature.

Morbidity, survival, and recurrence in 203 patients treated with curative low anterior resection (LAR) were compared with those in 100 patients treated with curative abdominoperineal resection (APR). The overall 5-year survival figures for the total number of, LAR and APR patients were 75.6 +/- 5.7%, 79.8 +/- 6.4% and 67.7 +/- 9.6%, respectively. The prognosis for cancers situated low enough in the rectum to involve the anal canal was poor even when managed by APR, as evidenced by a low survival at 5 years of 59.0 +/- 9.6% and a high pelvic recurrence rate of 34%. For all except these tumors, LAR proved at least equal to, or better than APR as a curative surgical method for middle and low rectal cancers, on the basis of 5-year survival being 79.8 +/- 6.4% vs 78.7 +/- 5.2%, operative mortality being 1.5% vs 1.0%, morbidity being 39.4% vs 59.0%, and the incidence of pelvic recurrence being 8.9% vs 13.5%. When deciding upon the most appropriate surgical procedure for rectal cancer, especially for middle or low rectal lesions, the patient should not simply be condemned to a permanent colostomy. Thus, we first attempt LAR for every lesion except those which are very advanced or those with anal canal involvement, if technically feasible and suitable for the individual patient.

Adult↗

PubMed1995

Rate and treatment of pelvic recurrence after abdominoperineal resection and low anterior resection for rectal cancer.

PURPOSE: This study was designed to analyze factors of importance for local recurrence after radical surgery for rectal cancer and to analyze course and outcome of treatment of pelvic recurrence. METHODS: One hundred seventy-five patients treated for rectal cancer with low anterior resection (LAR) or abdominoperineal resection (APR) were studied, retrospectively. Seventy-four patients had LAR and 101 had APR. RESULTS: The two groups were comparable with respect to Dukes classification, histologic differentiation, and male to female ratio. The rate of pelvic recurrence was 18 percent for LAR and 24 percent for APR (not significant). Recurrence rates were 27 percent after stapled anastomoses and 10 percent after handsewn anastomoses respectively (P = 0.09). Twenty five had pelvic recurrence diagnosed without signs of distant metastatic disease. They were treated with radiotherapy, palliative operations, or analgesics. The group receiving radiotherapy had a significantly longer survival (15.9 months) compared with other groups (2.4 months; P < 0.001). CONCLUSIONS: There is no difference in local recurrence rate after LAR and APR. Radiotherapy seems to increase survival in patients with an unresectable recurrence and should be offered irrespective of pain.

Abdomen↗

PubMed1995

Transurethral resection syndrome after transurethral resection of bladder tumours.

The transurethral resection syndrome has not previously been described after bladder surgery. This article reports four patients who developed signs of this syndrome after transurethral resection of bladder tumours (TURB). Symptoms included abdominal pain, arterial hypotension, nausea and vomiting. There was evidence in all cases that the cause was absorption of irrigating fluid by the extravascular route. Fluid absorption was detected by ethanol in two patients and the urologist noted a perforation during the third operation. The most complicated clinical course occurred in the case where there was a delay of three hours before the diagnosis was made. Medical treatment consisted of antiemetics and volume expansion of the extracellular fluid compartment as extravasation is associated with hypovolaemia. Diuretics were not given until the circulation had been restored.

Abdominal Pain↗

PubMed2002

In vitro comparison of transurethral vaporization of the prostate (TUVP), resection of the prostate (TURP), and vaporization-resection of the prostate (TUVRP).

PROBLEM: Transurethral vaporization of the prostate (TUVP) and vaporization-resection of the prostate (TUVRP) ("vapor cut, band electrode") seem to be alternatives to conventional resection of the prostate (TURP). For TUVP and TUVRP, little in vitro data has yet been published. The aim of this study was to determine settings for optimal performance with TUVP and TUVRP and to investigate electrosurgical parameters relevant to safety. METHODS: Standardized experiments were performed on porcine muscle. Mass loss and coagulation zones were measured optically. Additionally, electrical parameters were recorded. RESULTS: The maximum tissue ablation rates were 3.8 cm3 per min and 6.1 cm3 per min for TUVP and TUVRP, respectively, compared to 6.5 cm3 per min for TURP. The maximum coagulation depths reached 2.1 mm (TUVP), 1.4 mm (TUVRP), and 0.9 mm (TURP). Optimal in vitro settings for TUVP/TUVRP/TURP were as follows: generator power of 250/120/90 W, drag speed of 5/15/20 mm/s, and pressure of 0.40/0.15/0.05 N. Different power generators and electrodes showed considerably varying performance. The energy to remove 1 g of tissue averaged 7.500 J (TUVP), 620 J (TUVRP). and 400 J (TURP). CONCLUSIONS: These results allow quantification of the influence of different variables on TUVP, TUVRP, and TURP in vitro. The TUVP proves to be an effective ablation alternative. Nevertheless, a 15 to 20 times higher energy demand has to be considered. TUVRP combines excellent ablation features with greater coagulation volumes, indicating better hemostasis.

Electrodes↗

PubMed2002

Laparoscopic wedge resection for gastric perforation after endoscopic mucosal resection: report of a case.

We performed laparoscopic wedge resection to treat gastric perforation that occurred as a complication of endoscopic mucosal resection (EMR) in a 53-year-old man. We believe this is an appropriate procedure to treat gastric perforation after EMR for early gastric cancer because it is safe and minimally invasive, and faster recovery can be expected than after conservative therapy.

Gastric Mucosa↗