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PubMed1985

[Locoregional recurrence following the operative treatment of rectal cancer. Basic principles of prevention and therapy].

The frequency of local recurrences has been observed in dependence on sex, tumour specific parameters (typing, grading, staging, macroscopical form of growth, level of primary tumour) and technical parameters (method of operation, distal margin of resection). In case of early diagnosis, there is a possibility of differentiating technically caused local recurrences from those caused by the tumour because of their localization. Recurrences caused by the tumour may proceed from incompletely removed primary tumours. Technically caused recurrences may be primarily due to insufficiently resected tumours, which could have been removed completely. Only technically caused recurrences make a curative second operation possible. If the criteria of radicality are strictly observed during the primary operation, there should be no need for the so-called 'surgically curative' local recurrences to be treated anymore.

Adenocarcinoma↗
PubMed1995

[Results of treatment for lip carcinoma].

233 patients with lip carcinoma were treated in ENT Department of County Hospital No 1 in Rzeszów from 1974 to 1990. Analysing the kind of surgery according to clinical stage of the disease it was stated that the most patients with advanced tumors required reconstruction operations-125 (53.6%). Authors analyzed 3, 5 and 10 years survivals, separately for patients treated either surgically or with combined method and for patients who were treated with radiotherapy followed by surgery because of local recurrence of the disease.

Adult↗
PubMed2005

Surgical trauma and peritoneal recurrence of colorectal carcinoma.

BACKGROUND: Local peritoneal recurrence is a relatively common complication after intentionally curative surgery for colorectal cancer and has unfavourable prognosis. METHODS: This manuscript reviews the relevant experimental and clinical literature on surgical trauma and development of local recurrences, which was obtained by extensive search in the PubMed database. RESULTS AND CONCLUSION: Although surgery is required as the only option for treatment, operative trauma and subsequent wound healing promote development of local recurrences. Minimizing peritoneal trauma reduces local tumour outgrowth in animal models, but clinical trials have not been conclusive so far. Recognition of the increased susceptibility to tumour establishment in the early post-operative phase challenges the aim for further research, targeting at strategies that obstruct local tumour implantation or outgrowth and/or improve (local) anti-tumour response.

Colorectal Neoplasms↗
PubMed1991

Intraoperative gamma detection probe with presurgical antibody imaging in colon cancer.

In this study, presurgical gamma camera imaging and an intraoperative gamma detection probe were used in 12 consecutive patients 6 to 22 days after infusion with indium 111-labeled anticarcinoembryonic antigen monoclonal antibody (111In-MoAb). In three of 11 patients who underwent laparotomy, clinical management was affected by the probe findings: localization of occult retroperitoneal disease, identification of an occult cecal lesion, and localization of residual disease at a site of local recurrence. Of all intra-abdominal lesions seen using any method, the probe identified 18 (86%) of 21, compared with 14 (67%) of 21 with the 111In-MoAb scan, 10 (48%) of 21 by computed tomographic scan, and 16 (76%) of 21 after surgical exploration. Uptake of 111In-MoAb in the portal (n = 3) and mediastinal (n = 3) lymph nodes was not associated with histologic findings of malignant neoplasms. For all pathologically confirmed extrahepatic and nonportal sites of cancer, the probe localized nine of nine, compared with five of nine by 111In-MoAb scan, two of nine by computed tomographic scan, and six of nine by surgical exploration. Important clinical uses of the intraoperative probe included occult lesion identification, localization of areas with 111In uptake shown with MoAb scanning, and verification of complete resection of areas with 111In-MoAb uptake.

Abdominal Neoplasms↗
PubMed2002

[Reconstruction after total circular pharyngolaryngectomy: comparison between gastric interposition and free jejunal flap].

AIM OF THE STUDY: To elucidate hospital mortality, morbidity and actuarial survival rates of patients with carcinoma of the hypopharynx and cervical oesophagus and to identify the technique of choice for reconstruction after pharyngolaryngectomy. PATIENTS AND METHODS: We reviewed the records of 209 patients who underwent total pharyngolaryngectomy between May 1982 and January 2000. The majority of patients had advanced cancer: hypopharyngeal in 131 cases and cervical oesophageal in 78 cases. Follow-up was complete for all patients. Chi 2 and log rank tests were used, with a limit of significance of 5%. RESULTS: The postoperative mortality and morbidity rates were 4.8% and 38.3%, respectively. Alimentary continuity was achieved using the stomach (127 patients), colon (5 patients), or free jejunal autograft (77 patients). The 1-year and 5-year survival rates were 62% and 24%, respectively. There was no significant difference with regard to the survival between gastric transposition and free jejunal autograft, but there were fewer complications in the gastric pull-up group with regard to the respiratory complications (33% vs 47.0%, p < 0.05), local recurrences (15.8% vs 33.8%, p = 0.004) and survival without dysphagia (76% vs 89%, p < 10(-5)). CONCLUSION: Surgical ablation is a viable option for advanced hypopharyngeal and cervical oesophageal neoplasms, and stomach interposition is the preferred method of reconstruction.

Actuarial Analysis↗
PubMed1995

Ultrasonic resection of neuroblastomas. Long-term local tumor control.

OBJECTIVE: To evaluate the effectiveness of ultrasonic aspiration in achieving local tumor control of bulky neutroblastomas that are considered unresectable by conventional means. DESIGN: A retrospective review of 12 patients undergoing ultrasonic aspiration as part of multimodal treatment protocols. SETTING: A pediatric oncology referral center. PATIENTS: Twelve children with large neuroblastomas located in the abdomen (n = 5), chest (n = 5), and neck (n = 2). Follow-up was 1.5 to 7.5 years. INTERVENTIONS: Ultrasonic aspiration of the tumor was primary therapy (n = 7) or followed initial chemotherapy (n = 5). All patients underwent subsequent chemotherapy or autologous bone marrow transplantation. MAIN OUTCOME MEASURES: The incidences of residual disease and local recurrence were examined. RESULTS: Tumor-related symptoms were effectively relieved in all 12 patients. Recurrent local disease led to death in two. One patient died of distant metastases. CONCLUSIONS: Ultrasonic aspiration minimized blood loss and did not cause damage to adjacent organs. It provided nearly complete tumor resection, enhanced the effectiveness of chemotherapy protocols, and decreased the need for supportive care. Ultrasonic aspiration is a safe and effective method for obtaining local control of large neuroblastomas.

Abdominal Neoplasms↗
PubMed2002

Sarcomas of the head and neck.

Sarcomas of the head and neck are extremely rare, accounting for less than 1% of all neoplasms of the head and neck. These sarcomas arise in both soft tissues and bone and thus cannot be treated by a single approach. The clinical behavior of these tumors varies considerably. Patients with low-grade lesions are prone to local recurrence, whereas those with high-grade lesions develop both local recurrence and disseminated disease. An additional complicating factor is the multiple sites in which sarcomas may arise in the head and neck. All of these factors make it difficult to ascertain the optimal treatment approach for sarcomas. This article reviews the current literature (as well as the author's own experience) and provides a general treatment guideline for sarcomas of the head and neck.

Clinical Trials as Topic↗
PubMed1993

Cancerous residue in breast-conserving surgery.

Local tumor extension was studied using a continuous series of multiple blocks of mastectomy specimens to assess malignancy remaining after breast-conserving surgery for early-stage breast cancer. In this study, 183 cases were chosen, consisting of 6 noninvasive ductal carcinoma cases and 177 invasive ductal carcinoma cases. The histopathology in 59 (32%) of the 183 cases corresponded to that showing extensions of more than 2.6 cm from the tumor margin. These wide extensions were also seen in 17% of breast cancers with a tumor size of less than 2 cm. The incidence of wide extension was higher in younger patients with cases of noninvasive ductal carcinoma. Extension to the nipple-areola was seen in 14% of cases with a tumor size of less than 2 cm. Breast cancers with multicentric development accounted for 3% of those with a tumor size under 2 cm. These findings suggest that if lumpectomy is performed with a margin of 2 cm for tumors with a size of 2 cm or less, a cancerous residue would be found in the surgical margin of 15-20% of the cases. The actual incidence was 23% of cases after breast-conserving treatment in our study. On the basis of the data, breast-conserving treatment with only local resection of the primary lesion showed cancerous residue such as intraductal cancerous extension in about 20% of cases. Therefore, it was concluded that, as part of breast-conserving therapy of early-stage breast cancer, radiation therapy of the whole breast should be performed after surgery with clear margins to control local recurrence.

Adult↗
PubMed1992

DNA index as a significant indicator of lymph node metastasis and local recurrence of rectal cancer.

To confirm the prognostic significance of the DNA index (DI) in cases of rectal cancer, the nuclear DNA content of tumor cells was examined in 184 cases of rectal cancer treated with curative surgery, and the incidence of lymph node metastasis and recurrence of the cancer was analyzed. The incidence of lymph node metastasis was 43.9 percent in cases with aneuploidy (DI above 1.5), being statistically different from the 18.0 percent incidence in cases with diploidy (P < 0.001). Although the extent of lymph node metastasis was limited to adjacent lymph nodes in cases with diploidy, distant lymph node metastases were frequent in cases with aneuploidy, especially in those with a DI above 1.5. Furthermore, the incidence of recurrence of cancer, and especially of local recurrence, was significantly higher (P < 0.001) in cases with aneuploidy (DI above 1.5) than in cases with diploidy and aneuploidy (DI below 1.4). These findings indicate the significant value of the DNA index for the prediction of lymph node metastasis and local recurrence in patients with rectal cancer.

Aneuploidy↗
PubMed2004

[Differential diagnosis of soft tissue sarcomas].

INTRODUCTION: Soft tissue sarcoma often goes undetected. PATIENTS AND METHODS: Over a 10-year period, the patients referred to us with a soft tissue tumor (STT) of the extremities and wall of the trunk were analyzed retrospectively. The aim of the present study was to investigate the differential diagnoses, the number of incompletely operated STS, and local recurrences together with their percentage fluctuations. RESULTS: A total of 490 patients with an STT were referred to our department, and of these patients 55% were diagnosed with an STS. In addition to STS, the differential diagnoses for STT included 2% lymphomas, 18% isolated carcinoma metastases, 18% benign mesenchymal tumors, 5% inflammatory processes, and 2% old hematomas. Only 45% of the STS had not undergone previous surgery. Of these, 15% had been incompletely resected, while 39% of the STS patients were admitted with a local recurrence. Within the 10-year period, referrals with STT and STS remained relatively constant, but referrals of patients with incompletely resected or recurrent STS doubled in the last 2 years under observation. DISCUSSION: In view of the numerous differential diagnoses of an STT, both the possibility of an STS and also carcinoma manifestations in the soft tissues should receive more attention. With the aim of reducing the relatively high number of STS re-resections and local recurrences, the treatment of patients with suspicious STT should be reserved for a specialized center.

Abdominal Neoplasms↗
PubMed2004

Endorectal ultrasound detection of focal carcinoma within rectal adenomas.

BACKGROUND: The misdiagnosis of a rectal adenoma by biopsy and subsequent finding of invasive cancer after transanal excision is associated with a number of pitfalls. Problems include suboptimal therapy for a potentially curable cancerous lesion, potential tumor transgression of the local site with increased chance for local recurrence, and increased potential for more radical surgery or adjuvant chemoradiation. The utility of endorectal ultrasound (ERUS) in guiding treatment decisions of rectal villous adenomas has been reported, but series are small and are from single institutions. To determine the utility of ERUS in the diagnosis of rectal adenomas, we compared diagnosis made by biopsy alone to diagnosis made by a combination of biopsy and ERUS. METHODS: A systematic literature review was performed by way of a PubMed search to find articles with the following terms: "biopsy-negative rectal adenomas," "preoperative ERUS diagnosis," and "surgical histopathology." Five studies met the criteria, thus providing data for 258 adenomas. A quantitative meta-analysis was performed on the data. RESULTS: Among the 258 biopsy-negative rectal adenomas, 24% had focal carcinoma on histopathology. ERUS correctly established a cancer diagnosis in 81% (95% confidence interval 69 to 90) of these misdiagnosed lesions. Thus, ERUS diagnosis of biopsy-negative rectal adenomas could be expected to decrease the need for additional surgery and other associated problems caused by misdiagnosis from 24% to 5%. CONCLUSIONS: ERUS is a useful adjunct to biopsy in the preoperative workup of rectal villous adenomas, and we recommend its routine use. Accurate preoperative assessment allows the surgeon to counsel the patient appropriately regarding the best operation, the perioperative risks, and the chances of local recurrence.

Adenoma, Villous↗
PubMed1997

Chondrosarcoma of the pelvis.

Thirty-one patients with chondrosarcoma of the pelvis were reviewed. The median followup period of the surviving patients was 66 months. Thirteen of 23 tumors after surgery with inadequate margins (57%) and 1 of 8 after surgery with adequate margins (13%) relapsed locally. Four of 10 patients had local recurrence, 2 of 2 patients had metastasis, and 4 of 4 patients who had local recurrence and metastasis died. A cumulative 10-year overall survival of patients with pelvic chondrosarcoma was 54%. Patients who had primary or high grade chondrosarcoma had a poor prognosis. Multivariate analysis (Cox proportional hazard model) showed that tumor type was the most important prognostic factor. Eight patients underwent hindquarter amputation, 6 patients had resection alone, and 17 patients had resection and reconstruction as follows: 3 interpubic arthrodeses, 2 iliosacral arthrodeses, 3 ischiofemoral arthrodeses, 8 hip prostheses (3 prostheses alone and 5 prostheses with allograft), and 1 hip transposition. Failure of reconstruction was attributed to infection in 5 patients, local recurrence of tumor in 5, and local recurrence and fracture of implant in 1 patient.

Adolescent↗
PubMed1982

Pelvic recurrence after curative resection for carcinoma of the rectum.

Cases of carcinoma of the rectum have been prospectively studied from 1971-80. Two hundred and ten patients had curative resections and 25 of these developed clinical pelvic recurrence in the period of follow-up which ranges from one to eleven years. The rate of recurrence is found to be dependent on the level of the lesion and the degree of its local and lymphatic spread. Results from other papers are discussed. Measures to minimise local recurrence are discussed.

Aged↗
PubMed1983

Malignant melanoma prognostic factors 3: surgical margins.

Narrow margins of excision for melanomas less than 0.85 mm thick neither shorten the length of survival nor increase the local recurrence rate. Similarly, narrow margins of excision for melanomas greater than 0.85 mm thick do not adversely affect the survival rate. However, for thicker melanomas, the local recurrence rate increases when the surgical margin is reduced to less than 3 cm.

Humans↗