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The relationship between the extent of distal clearance and survival and local recurrence rates after curative anterior resection for carcinoma of the rectum.

With increasing use of low anterior resection, the length of rectum removed below the tumor is often less than the recommended 2 to 5 cm. It is important to know if this decreases the chance of cure. Between 1963 and 1975, 334 patients survived radical restorative operations for single rectal adenocarcinoma. The length of rectum below the tumor measured on fixed pinned-out pathologic specimens was 2 cm or less in 55 patients (group 1), 2 to 5 cm in 177 (group 2), and 5 cm or more in 102 (group 3). The Dukes' classification, histologic grade, and extent of local spread of the tumors were similar in the three groups. Overall crude 5-year survival rates for groups 1, 2, and 3 were 69.1%, 68.4%, and 69.6%, respectively. Corresponding cancer-specific death rates were 25.5%, 23.2%, and 21.6%. These rates were also similar in matching pathologic subgroups of the three main groups. Of 23 observed or suspected local recurrences, there were four recurrences in group 1 (7.3%), 11 in group 2 (6.2%), and eight in group 3 (7.8%). These results suggest that a margin less than 2 cm below a rectal carcinoma does not affect survival or local recurrence adversely.

Adenocarcinoma↗

Carcinoma of the vulva: critical analysis of survival and treatment of recurrences.

Survival analysis of 181 vulvar cancer patients shows that stage and lymph nodal spread remain the most important prognostic factors. Other prognostic elements are: depth of stromal infiltration, thickness and site of the lesion, vascular space invasion. Precise definition of these pathological prognostic elements may be obtained only after appropriate surgical pathological evaluation of the primary lesion and regional nodes. Treatment must be adequate in the cost-benefit balance and surgery is the cornerstone in vulvar cancer management. Risk of relapse is statistically correlated with site of primary tumour, depth of infiltration, lymph nodal invasion and vascular space invasion. The treatment of recurrence is personalized for different sites but surgery is the elective treatment of the local recurrences.

Aged↗

Melanoma: the management of local recurrence and in-transit metastasis.

Following the primary treatment of melanoma, subsequent appearance of local recurrence and in-transit metastasis remains one of the most difficult problems faced by surgeons. In managing the disease at this stage, it is important to realize that, because of a favourable immune reaction in some patients, the disease may remain localized for many months or years. Consequently, local control should be attempted in the best possible manner when the disease is confined to a specific region and there are no signs of dissemination. Methods of local control include local surgical procedures, local and systemic chemotherapy, immunotherapy, radiotherapy, amputation and isolation-perfusion. After reviewing the literature and based upon personal experience, the author found that hyperthermic isolation-perfusion can be effective in the management of local recurrences of melanomas and in-transit metastasis.

Humans↗

Radiologic staging of gastrointestinal neoplasms.

In this article, the ability of computed tomography as well as other imaging methods to detect local and distant metastases in patients with either newly diagnosed or suspected recurrent gastrointestinal tumors is discussed. The role of the radiologic examination in the diagnosis of complications resulting from different types of treatment is also addressed.

Esophageal Neoplasms↗

[Recurrence and survival rate after surgical therapy of rectal carcinoma].

Between 1983 and 1993, 680 patients with rectal carcinoma were treated at Ulm University. The resection rate was 84%. After undergoing radical surgery, 492 of the patients were followed up regularly at our hospital for a median of 66.9 months (range 4-177.6). Recurrences occurred in 172 patients (35%) and were diagnosed a median of 13 months (range 4-106 months) postoperatively; 9.4% had regional recurrences, 10.4% regional recurrences and distant metastases and 10.2% distant metastases. The 10-year survival rate of the patients in tumour stages I, II and III was 88%, 62%, and 32%. In patients with carcinoma of the midrectum, after anterior resection or abdominoperineal amputation the same local recurrence rate was found.

Follow-Up Studies↗

Should all melanoma patients undergo sentinel lymph node biopsy?

PURPOSE OF REVIEW: It is now well established that sentinel lymph node biopsy is a powerful test to predict prognosis for melanoma patients. Controversy exists, however, regarding the appropriate selection of patients for sentinel lymph node biopsy, especially among patients with thin melanomas (< 1 mm Breslow thickness), thick melanomas (> 4 mm Breslow thickness), or locally recurrent melanoma. RECENT FINDINGS: The majority of the studies in the past 2 years regarding sentinel lymph node biopsy have been concerned with identifying factors that can better predict regional nodal metastasis and survival. Other studies have proposed a better risk stratification model, which includes these factors, to best select those patients at increased risk of nodal positivity. SUMMARY: Although much research has been done to select appropriate patients for sentinel lymph node biopsy based on multiple prognostic factors, further studies are necessary to completely define the indications for this procedure in patients with thin, thick and locally recurrent melanomas.

Humans↗

Parotid tumor operations; the case against enucleation.

So-called mixed "encapsulated" parotid tumors are best managed by surgical procedures which avoid contact with the "capsule." Enucleation is often a hazardous and incomplete procedure. Subtotal or total parotidectomy with exposure of the facial nerve to avert accidental damage to it is the treatment of choice. Microscopic study of the periphery of such tumors reveals that the "capsule" does not fully encapsulate; hence, enucleation and lesser procedures may leave neoplastic tissue behind.Surgical procedures to achieve complete excision without endangering the facial nerve were carried out in 123 cases. There was local recurrence in one case.

Adenoma, Pleomorphic↗

[DNA impulse cytophotometry measurements in head and neck tumors. Initial results of a correlation with clinical stage, therapeutic response and pattern of recurrence].

The DNA index and proliferation rate (percentage of S-phase cells) of 52 head and neck tumours were analysed by flow cytometry. Thirty-one (60%) of these tumours were aneuploid, 21 (40%) diploid. The distribution of aneuploid tumours was nearly equal in all T-stages. In contrast, the number of aneuploid tumours increased with higher N-stages. Locoregional recurrences developed more often (69%) in aneuploid tumours than in diploid tumours (54%). Furthermore, recurrence presented earlier (median 5 months) than in the latter (median 11 months). Regional recurrences were mainly observed in aneuploid tumours, local recurrences in diploid tumours.

DNA, Neoplasm↗