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PubMedDate not supplied

Extrahepatic bile duct resection in combination with liver resection for hilar cholangiocarcinoma: a report of 42 cases.

From September 1986 until December 2001, 42 patients (20 males and 22 females) underwent a combined extrahepatic bile duct resection (EHBDR) and liver resection (LR) for hilar cholangiocarcinoma (HC). The aim of this study was to analyze patient survival, morbidity, and mortality as well as to seek predictive factors. The 1-, 3-, and 5-year actuarial patient survival was 72%, 37%, and 22%, respectively. Median survival was 19 months. Hospital mortality, all due to septic complications, was 12%. Morbidity was observed in 32 patients (76%). Infections were the most dominant complication. Patients (n=11) with American Joint Committee on Cancer (AJCC) stage I or stage II tumors exhibited a superior survival compared with patients (n=31) with stage III or IV tumors (p=0.023). Patients with tumor-free lymph nodes (n=26) indicated a greater survival compared with patients with tumor-positive lymph nodes (n=16) (p=0.004). Patients undergoing vascular reconstructions indicated a trend toward higher mortality and lower survival (p=0.068). Over 20% of the patients with hilar cholangiocarcinoma can survive more than 5 years after a combined EHBDR and LR at the cost of 12% perioperative mortality and a 76% morbidity. Results might improve with the prevention of infectious complications and improved selection of patients to avoid vascular reconstruction and to predict a negative nodal state.

Adult↗
PubMed2000

Laparoscopic lower anterior resection is equivalent to laparotomy for lower rectal cancer at the distal line of resection.

BACKGROUND: Procedures that involve resection of the distal rectum challenge the current limitations of laparoscopic technology, because of lack of compact articulating stapling instruments. METHOD: We improve the procedure with the aid of a Lap disk, an abdominal wall sealing device that was developed for hand-assisted manipulation. A linear stapler capable of changing its stop angle is inserted through the disk, and the rectum is transected by the disk during a second pneumoperitoneum. RESULTS: The transection line becomes equivalent to that obtained with laparotomy. CONCLUSION: This new technique made laparoscopic lower anterior resection possible to transect the lower rectum in the same way as is done with laparotomy.

Abdominal Muscles↗
PubMed2001

[Radio-guided resection of residual metastatic lymph node from a previously resected neuroendocrine tumor].

Neuroendocrine tumors are slowly growing and carry a high risk of recurrence. Somatostatin receptor scintigraphy is considered as the gold standard for preoperative evaluation and postoperative follow-up. The use of an intraoperative detection probe makes easier a complete resection of abdominal residual or recurrent tumor. These resections may be incomplete because of the small size of the tumor and the postoperative adhesions. Radio-guided surgery is recommended in order to reduce the need for reoperation.

Humans↗
PubMed1991

Nonelective colon resection. Alternatives to multistage resections.

Compared with the prolonged cumulative hospitalization and morbidity that accompany staged resection for the treatment of obstructing or inflammatory disorders of the left colon, our results confirm that resection with intraoperative lavage and primary anastomosis is a safe alternative. In the absence of intraoperative lavage, all patients in our series would have required a multistage procedure. Intraoperative lavage with primary anastomosis does not challenge the accepted criteria for safe bowel anastomosis. Rather, it offers another means for meeting those criteria. This alternative should be considered in the management of any patient whose primary indication for colostomy is the lack of adequate mechanical preparation of the colon. Although our experience indicates that intraoperative lavage and primary anastomosis can be employed safely in the treatment of inflammatory disorders of the colon, it is not recommended in the presence of fecal peritonitis, a large contiguous pelvic abscess, or systemic sepsis. In these individuals, the additional operating time required for intraoperative lavage and the potential consequences of anastomotic dehiscence pose too great a risk.

Colectomy↗
PubMed1996

Video-resection does not stop corneal contamination during transurethral resection of the prostate.

OBJECTIVES: To determine the efficacy of video-resection systems in reducing the risk of corneal contamination during transurethral resection of the prostate (TURP) and thus in decreasing the possibility of transmission of blood-borne diseases from the patient. MATERIALS AND METHODS: After performing a TURP using a video camera system in 30 patients, the number of potential corneal droplets was measured for one operator wearing a pair of spectacles and, for a second operator, over an identically sized area of a standard disposable plastic eyeshield. RESULTS: In 20 (67%) of cases, droplets were observed on the eye protection, correlating with potential corneal contamination. Splashes were also seen on the face-mask of the eyeshield. CONCLUSION: Urologists should use eye and face protection when performing TURP using a video system.

Blood-Borne Pathogens↗
PubMed1999

Histologic features associated with lymph node metastasis in stage T1 and superficial T2 rectal adenocarcinomas in abdominoperineal resection specimens. Identifying a subset of patients for whom treatment with adjuvant therapy or completion abdominoperineal resection should be considered after local excision.

Local excision of rectal adenocarcinomas that are confined to the submucosa is an accepted method of surgical excision. Adjuvant therapy and possibly completion abdominoperineal resection (APR) may be appropriate if lymph node (LN) metastases are present. Identifying the patients at high risk of having LN metastases would assist in disease management. We retrospectively examined 73 APR resection specimens with T1 or superficial T2 adenocarcinomas. The leading edge of the tumor was evaluated for budding, microacinar structures, or isolated or small clusters of undifferentiated cells. The features were correlated with LN metastases. Eleven specimens had LN metastases. Extensive budding, microacinar structures, or undifferentiated cells, tumor grade 3, and small vessel vascular space invasion were associated with LN metastases. Limiting the comparison to grade 1 and 2 adenocarcinomas showed association of extensive budding, microtubular architecture, and undifferentiated cells along the advancing edge with LN-metastases. If these histologic features are extensively present, the patient may be a candidate for adjuvant therapy or completion APR. The morphologic features of the advancing edge are independent of the tumor grade of the neoplastic glands within the body of the tumor; they can be incorporated into the evaluation of overall tumor grade.

Adenocarcinoma↗
PubMed1989

Surgical margin and recurrence after resection of hepatocellular carcinoma in patients with cirrhosis. Further evaluation of limited hepatic resection.

This report attempts to elucidate the manner in which the surgical margin is linked to a recurrence after curative hepatectomy for hepatocellular carcinoma (HCC) in patients with cirrhosis. Forty patients were divided into two groups: those in whom the margin from the cut surface to HCC in the fresh resected specimen was less than 10 mm wide, and patients in whom the surgical margin was equal to or exceeded 10 mm. These margins were expressed as tumor wedge positive [TW(+)], and tumor wedge negative [TW(-)], respectively. There were 24 and 16 patients in the TW(+) and TW(-) groups, respectively. There was no statistically significant difference in clinicopathologic variables, except for age and values of serum albumin between the two groups. There was a recurrence in ten of 24 patients (42%) of the TW(+) group and in eight of 16 patients (50%) of the TW(-) group. Mean disease-free periods were 21.4 months in the TW(+) group and 23.6 months in TW(-) group. These 40 patients were also divided with regard to the time of recurrence, the early recurrence within 24 months, and the late recurrence after 24 months. There was no statistically significant difference in the rate of recurrence and mean disease-free period between the TW(+) and TW(-) groups in the early and late recurrence groups. In both the TW(+) and TW(-) groups, there were no recurrences in 13 of 16 patients (81.3%) with a tumor less than 4 cm in diameter, yet there were recurrences in seven of eight patients (87.5%) with a tumor exceeding 4 cm in diameter, regardless of the time to recurrence. These results suggest that in patients with a tumor less than 4 cm, the extent of TW is not linked to an early recurrence. However, when the tumor size exceeds 4 cm, 10 mm of TW is inadequate to achieve curability. When a wide resection is not feasible, then adjuvant chemotherapy should be aggressive.

Adult↗
PubMed2004

Treatment of locally advanced pancreatic cancer: should we resect when resectable?

While the outcome of surgery for locally advanced pancreatic cancer is still quite poor, over the past 2 decades, surgical outcomes have gradually improved in Japan. Because the advantages of surgery over radiochemotherapy have not yet been confirmed by randomized, controlled trials, it has long been discussed whether surgical resection could be indicated for locally advanced pancreatic cancer. We recently performed a multicenter, randomized, controlled trial comparing surgical resection and radiochemotherapy for locally advanced pancreatic cancer. Twenty patients were assigned to the surgery group, and 22 to the radiochemotherapy group. Although there was 1 operative death, surgery offered significantly better results than radiochemotherapy, as measured by 1-year survival (62% vs. 32%, P = 0.05), mean survival time (>17 vs. 11 months, P < 0.03), and hazard ratio (0.46, P = 0.04). There was no significant difference in the quality of life score or laboratory data, apart from increased diarrhea after surgery. In this article, the results of our trial are reviewed in brief, and our opinion on surgical treatment of locally advanced pancreatic cancer is discussed.

Adult↗
PubMed2006

Long-term outcome of laparoscopic wedge resection for gastric submucosal tumor compared with open wedge resection.

Little is known about the outcomes of laparoscopic wedge resection (LWR) in comparison with conventional open wedge resection (OWR) for gastric submucosal tumor. Outcomes of 21 patients who underwent LWR (n = 14) or OWR (n = 7) for gastric submucosal tumor between 1993 and 2004 were investigated. We compared the short-term and long-term operative results between the 2 groups. LWR showed several advantages over OWR for gastric submucosal tumor: less blood loss, lower fever on day 1, lower analgesic usage rate, earlier first postoperative flatus and oral intake, lower leukocyte count on days 1 and 7, and lower C-reactive protein level on days 1 and 3. All patients, except 2 with histologically diagnosed high-risk gastrointestinal stromal tumor, survived during the mean follow-up period of 60 months. LWR is feasible for the management of patients with gastric submucosal tumor.

Aged↗
PubMed2006

A qualitative study of anterior resection syndrome: the experiences of cancer survivors who have undergone resection surgery.

This study aimed to explore how individuals recovered and adapted following surgical resection of their rectal cancer and the syndrome that occurs as a consequence of this operation. This syndrome, 'anterior resection syndrome', consists of frequency, urgency, fragmentation and incontinence of faeces, and is thought to occur in 90% of patients who have received this type of surgery. Little qualitative research has been undertaken in this area, and this study adds to current quality of life data and explores supportive care strategies that nurses could use to assist patients. This study uses a grounded theory approach and in-depth interviews to explore patient's experiences. Participants were recruited from a cancer unit within the UK. Participants were recruited from a total population sample of 27 patients who had received surgery from 2001 to 2002. Following eligibility criteria to exclude those who had disease progression, seven patients were identified 1 year following surgery. Interviews were used to explore the experience of the syndrome. Three categories were identified: adapting to the physical changes, psychological adaptation and stigma. A secondary theme, running throughout all these categories, was the feeling of confidence and normality. Although the physical changes were expected as a consequence of surgery, most participants described the difficulty in controlling and managing symptoms in their period of recovery. Developing a philosophical stance was important in managing the lack of control and returning to perceived normality, despite the social stigma of bowel problems. Information on a range of strategies to manage physical symptoms is helpful in providing supportive care. Understanding that patients often rely on inappropriate strategies for management and are reluctant to discuss symptoms is important. The specialist nurse has a role in providing supportive care in managing chronic symptoms following cancer treatment.

Adaptation, Physiological↗
PubMed2006

Abdominoperineal resection or anterior resection for rectal cancer: patient preferences before and after treatment.

OBJECTIVE: Literature data do not provide any evidence as to whether oncological outcome and quality of life after anterior resection (AR) are superior to those observed after abdominoperineal resection (APR) for low-lying rectal cancer. In view of this, patient preferences should play an important role in the process of decision making. The aim of this study was to investigate these preferences. PATIENTS AND METHODS: A series of consecutive patients with rectal cancer (60 prior to surgery, 65 after APR and 124 after AR) who attended our outpatient clinic were asked to express their preference as to the type of surgery. The second part of the study was performed 4 years later; 30 patients evaluated before surgery, free of disease, were again asked to express their preference as to the type of treatment. RESULTS: Patient preferences as to performing APR, AR or as to leaving the decision to the surgeon were as follows: (i) the group prior to surgery - 5%, 30% and 65%, respectively, (ii) group after APR - 46%, 22% and 32%, respectively, and (iii) group after AR - 4%, 69% and 28%, respectively. Patients after AR pointed to the type of surgery that they had undergone more frequently than patients after APR (69%vs 46%, respectively, P < 0.001). Sixty per cent of patients evaluated twice had altered their initial preferences, usually choosing the type of surgery that they had undergone. CONCLUSIONS: Our results suggest that the sequelae of AR are generally perceived as more acceptable than those of APR. Nevertheless, approximately half of the patients after APR prefer the type of surgery that they have undergone, which suggests the positive reappraisal of APR, once experienced.

Adult↗
PubMed1994

Total transurethral resection versus minimal transurethral resection of the prostate--a 10-year follow-up study of urinary symptoms, uroflowmetry and residual volume.

OBJECTIVE: To assess the long-term results of total transurethral resection (T-TURP) and minimal transurethral resection of the prostate (M-TURP) in patients with obstructive symptoms caused by benign prostatic hyperplasia. PATIENTS AND METHODS: Between September 1979 and September 1980, 167 patients were studied: 83 were randomized to T-TURP and 84 to M-TURP. The patients were examined pre-operatively and 6 and 12 months post-operatively. Ten years post-operatively they were invited to attend for further examination, including uroflowmetry, determination of residual volume and evaluation of subjective symptoms. RESULTS: At the 10-year follow-up 39 patients were found to have died and 47 were lost to follow-up. Twelve patients had undergone repeat TURP and seven had been treated for urethral stricture. Thus 33 T-TURP and 29 M-TURP patients underwent detailed examination. Significant relief in obstructive and irritative symptoms was seen in both groups. The improvement in maximum flow rate remained stable throughout the follow-up period, with no significant differences between the two groups. Post-void residual urine decreased throughout follow-up, with minor differences between the groups. CONCLUSION: M-TURP is recommended as an alternative to T-TURP.

Adult↗
PubMed1983

Haemorrhagic complications during pulmonary resection. A retrospective review of 1428 resections with 113 haemorrhagic episodes.

A series of 1428 standard pulmonary resections (pneumonectomy 30%, lobectomy 66%, segmentectomy 4%) performed over a 13-year period was reviewed with regard to haemorrhagic complications. The incidence of intra-operative vascular injuries was 5%. The pulmonary artery was damaged in 50 of these 73 injuries, the pulmonary vein in 21, and the superior vena cava and the subclavian vein in one case each. Two deaths were associated with the intra-operative bleeding. The vascular lesions could be repaired without extensive resection of pulmonary tissue in all but 3 of the other patients, in whom two, three and five pulmonary segments, respectively, had to be sacrificed. Postoperative bleeding necessitated emergency thoracotomy in 37 patients (2.6% of the series), and in 3 patients autopsy disclosed such haemorrhage. The cause of the bleeding in 12 cases was slipping or cutting through of ligatures applied to divided major vessels (pulmonary artery in 8 cases, pulmonary vein in 3 and azygos vein in 1 case). Systemic arterial haemorrhage occurred in 15 patients and diffuse bleeding in 12, while one patient had a coagulation disorder causing bleeding. Nine of the 40 patients died, 7 of the haemorrhage and 2 of bronchopleural fistula. The death rate was significantly higher in postoperative than in intra-operative bleeding. The study demonstrated that the widely used and recommended transfixion suture is not absolutely safe to prevent slipping of ligatures from divided major intrathoracic vessels. A purse-string suture has proved to be a safer alternative.

Constriction↗
PubMed2004

Is the vascular endothelial growth factor messenger RNA expression in resectable hepatocellular carcinoma of prognostic value after resection?

AIM: To study whether vascular endothelial growth factor messenger RNA (VEGF mRNA) in the hepatocellular carcinoma (HCC) tissues obtained after curative resection has a prognostic value. METHODS: Using a reverse-transcription polymerase chain reaction (RT-PCR)-based assay, VEGF mRNA was determined prospectively in liver tissues of 50 controls and in HCC tissues of 50 consecutive patients undergoing curative resection for HCC. RESULTS: Among the isoforms of VEGF mRNA, VEGF(165) and VEGF(121) were expressed. By multivariate analysis, a higher level of VEGF(165) in HCC tissue correlated with a significant risk of HCC recurrence (P=0.038) and significantly with recurrence-related mortality (P=0.045); while VEGF(121) did not. Other significant predictors of HCC recurrence included cellular dedifferentiation (P=0.033), an absent or incomplete capsule (P=0.020), vascular permeation (P=0.018), and daughter nodules (P=0.006). The other significant variables of recurrence related mortality consisted of vascular permeation (P=0.045), and cellular dedifferentiation (P=0.053). The level of VEGF mRNA in HCC tissues, however, did not significantly correlate with tumor size, cellular differentiation, capsule, daughter nodules, vascular permeation, necrosis and hemorrhage of tumors. CONCLUSION: The expression of VEGF mRNA, especially isoform VEGF(165), in HCC tissues, may play a significant and independent role in the prediction of postoperative recurrence of HCC.

Adult↗
PubMed2000

Management strategies in resection for carcinoma of the hepatic duct confluence: how to increase the resectability rate. Our experience and literature review.

The resectability rate of hilar bile duct carcinoma is reported to be variable and to inversely correlate with the size of the associated liver resection. In an attempt to reduce the risk of postoperative liver failure, the induction of a hypertrophy of remnant liver by preoperative portal vein embolization (PVE) has been proposed. We hereby analyse the results and the technical aspects of this procedure along with our personal experience.

Bile Duct Neoplasms↗
PubMed2002

The UPAO test in preoperative evaluation for major pulmonary resection: an operative case with markedly improved ventilatory function after radical pulmonary resection for lung cancer associated with pulmonary emphysema.

A 65-year-old man was admitted to our hospital for treatment of a squamous cell carcinoma in his right lung. Respiratory function testing showed an extremely reduced forced expiratory volume in 1 second (FEV1) of 1.0 l (29.9% of predicted), and a reduced FEV1/FVC ratio of 24.1%. Arterial blood gases on room air showed a pH of 7.41, a PaCO(2) of 36.7 mmHg, and a PaO(2) of 79.3 mmHg. To assess the predictive postoperative cardiopulmonary function, unilateral pulmonary artery occlusion (UPAO) testing was performed. In the condition of right main PA occlusion, the mean pulmonary artery pressure (mPAP), cardiac index (CI) and total pulmonary vessel resistance index (TPVRI) was 18 mmHg, 3.2 l/min/m(2) and 443.37 dyne.sec.cm(-5)/m(2), respectively. He underwent a middle lobectomy with combined partial resection of both the upper and lower lobes. He also underwent simultaneous resection of a giant bulla arising from the right upper lobe as lung volume reduction surgery. At 80 days after the operation, his FEV1 rose to 1.88 l, and the PaO(2) on room air was improved to 88.9 mmHg. UPAO testing was suggested to be more useful than routine pulmonary function test to determine the accurate predictive postoperative cardiopulmonary function and to decide indication for a radical operation.

Aged↗
PubMed1991

[Follow-up of patients with Roux-technique gastric resection. Comparison of Billroth I and Billroth II gastric resections].

The paper reports the results of a follow-up of 25 patients who underwent gastric resection using Roux's technique, 15 patients undergoing reconstructive surgery according to Pean-Billroth and 15 who underwent Billroth II operations. Controls were performed more than 5 years after surgery and included endoscopic tests with biopsy and the evaluation of the biliary salt reflux in the gastric stump. Roux's operation was preferred both as a routine operation following gastric resection and as a reconversion operation due to the absence of biliary reflux, the negative biopsy tests at the level of the stump and anastomosis, and negative clinical aspects.

Anastomosis, Roux-en-Y↗