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PubMedDate not supplied

Hand-assisted laparoscopic surgery for cancer.

Minimally invasive surgical approaches were designed to enhance quality of care and improve patient outcome by minimizing postoperative pain, shortening hospital stay, reducing costs, and facilitating early return to work and presurgical lifestyle. The hand-assisted laparoscopic approach for resection of cancer is still in its formative stage, and this review places it in proper perspective within the context of minimally invasive surgery currently being performed for both benign and malignant disease. The review also outlines the potential advantages and disadvantages, techniques, and site-specific procedures of hand-assisted laparoscopic surgery for cancer.

Abdominal Neoplasms↗
PubMed2006

New developments in gastrointestinal stromal tumor.

PURPOSE OF REVIEW: This review will provide an update of important studies in gastrointestinal stromal tumor with an emphasis on those published over the past 2 years. RECENT FINDINGS: Over the past 60 years basic scientists, pathologists and clinical investigators have studied gastrointestinal stromal tumor with no major advances in patient care until the late 1990s. Discovery at that time of the critical biological role of Kit in gastrointestinal stromal tumor led to the development of one of the most exciting examples of targeted therapy to date. The success of the Kit tyrosine kinase inhibitor, imatinib mesylate (Gleevec, formerly STI-571), has caught the attention of the medical community. With the use of targeted therapy in a targetable disease, new developments in our understanding of epidemiology, genetics, histopathology, radiographic imaging and the biology of gastrointestinal stromal tumor have become apparent. Recent findings are discussed herein. SUMMARY: Continued intense study of gastrointestinal stromal tumor may lead to new paradigms that could revolutionize all of oncology.

Antineoplastic Agents↗
PubMed2005

NF1-associated gastrointestinal stromal tumors have unique clinical, phenotypic, and genotypic characteristics.

Gastrointestinal stromal tumors (GIST) have been reported to occasionally occur in patients with neurofibromatosis type 1 (NF1). This study aims to describe the phenotypic and genotypic characteristics of GIST in NF1 patients and attempts to elucidate the relationship between them. We analyzed GIST arising in 15 NF1 patients (8 males and 7 females, 19-82 years of age). Eleven patients had multiple GISTs (3 to >100 tumors) ranging from 1 mm to 10 cm in size and predominantly involving the small intestine including the duodenum. Tumors were symptomatic in 8 patients and incidental findings in the remaining 7 patients. Microscopically, the tumors cells were typically spindled and the mitotic rate low; 9 patients had tumors classified as very low or low risk and 6 as intermediate risk GIST. Nine patients were treated surgically and none developed metastases or died of disease. Immunohistochemical stains for CD117 were strongly positive in 47 of 50 GIST; they also accentuated hyperplastic foci (diffuse and focal) of the interstitial cells of Cajal that were often associated with microscopic GIST in the surrounding intestinal muscle wall. No KIT or PDGFRA mutations were detected in 24 GIST from 12 patients using dHPLC analysis and DNA sequencing. We conclude that patients with NF1 have a high risk of developing GIST. NF1-associated GIST are also phenotypically and genotypically distinct from sporadic GIST, indicating that different pathogenetic mechanisms are involved in their evolution.

Adult↗
PubMed2003

Newly designed multifunctional coil catheter for gastrointestinal intervention: feasibility determined by experimental study in dogs.

RATIONALE AND OBJECTIVE: Conventional vascular catheters or sizing catheters are often inconvenient and time-consuming for gastrointestinal procedures. Our purpose was to evaluate the feasibility of a newly designed coil catheter by experimental study in dogs. MATERIALS AND METHODS: Two catheter models were fabricated using a stainless-steel coil covered by heat shrinkable tube. The distal uncovered coil part was not elongated in model A but was elongated in model B. We developed 3 different types in each model: types II and III had 65-cm and 240-cm nitinol wires on the coil surfaces, respectively, but no wire was attached in type I. On the middle covered coil part, multiple holes were made into which to inject contrast medium, and multiple radiopaque markers were attached. In an experimental study using 4 mongrel dogs, we evaluated the ability of the coil catheter to pass over a guide wire to 30 cm distal from the pylorus, the ability of contrast to pass through the injection holes, the visibility of the radiopaque markers, and the ability of the coil catheter to be pushed without a guide wire to 120 cm distal from the pylorus. RESULTS: All catheters were successfully passed to 30 cm distal from the pylorus. Contrast passage through the injection holes and visualization of the radiopaque markers were excellent. To advance to 120 cm distal from the pylorus, the average success rates of models A and B were 100% and 69%, respectively. In particular, model A type II showed the best results in average success rate and average number of trials to achieve success. CONCLUSION: This experimental study demonstrated the feasibility of the newly designed coil catheter for gastrointestinal intervention.

Animals↗
PubMed2006

Combined surgical and molecular therapy: the gastrointestinal stromal tumor model.

OBJECTIVE: This review describes the pathologic and epidemiologic features of gastrointestinal stromal tumor (GIST) as well as the contemporary management of this tumor. The integration of surgery and treatment with targeted molecular agents in the treatment of GIST is highlighted. SUMMARY BACKGROUND DATA: GIST is the most common mesenchymal tumor of the gastrointestinal tract. Its cellular origin from the interstitial cell of Cajal and distinctness from smooth muscles tumors were only recently appreciated. The discovery of the centrality of KIT proto-oncogene mutations in the pathogenesis of this tumor, and the development of imatinib mesylate, a specific inhibitor of KIT tyrosine kinase function have revolutionized the treatment of GIST. METHODS: We conducted a review of the English literature on GIST. The pathology, epidemiology, diagnosis, and treatment of this tumor are summarized with particular emphasis on recent developments in the field. RESULTS: GIST is a rare tumor that usually arises from the stomach or small intestine. It is characterized by immunohistochemical staining for KIT. Treatment of primary localized tumors is surgical. The benefit of adjuvant treatment with the KIT tyrosine kinase inhibitor imatinib is the subject of investigation. The treatment of unresectable, recurrent, or metastatic GIST is primarily imatinib treatment. The integration of surgery or ablative modalities is often employed, particularly when all disease is amenable to gross resection or destruction, or when GIST becomes resistant to imatinib. Newer tyrosine kinase inhibitors, such as sunitinib are the subject of ongoing investigation. CONCLUSIONS: The treatment paradigm for GIST has required the integration of surgery and molecular therapy and this will likely serve as a paradigm for the treatment of other solid tumors as targeted agents are developed.

Antineoplastic Agents↗
PubMed1987

The Leeuwenhoek lecture, 1986. Environmental carcinogens and papillomaviruses in the pathogenesis of cancer.

In many areas of the world there is a geographically localized high incidence of alimentary and bladder cancer in cattle. Studies in western Scotland have demonstrated that this phenomenon is associated with ingestion of bracken fern. However, the affected animals and herds were shown also to have an unusually high infection rate of alimentary papillomas caused by a previously unrecognised bovine papillomavirus (BPV) and that these tumors could undergo malignant transformation. Long-term field and experimental studies were started and indicate that the pathogenesis of the tumours and their relationship to virus infection and food-derived mutagens is complex. Results from these studies, and from cellular and molecular biology experiments, are presented and discussed in the context of recent papillomavirus findings in the human subject.

Animals↗
PubMed1981

Multiple metachronous gastro-intestinal carcinoma.

A patient who developed multiple metachronous gastro-intestinal carcinoma is described. This patient has had multiple invasive carcinoma of the colon, jejunum and stomach over a 34 year period, commencing at the age of 44 years. All the colonic tumours have been Duke's A Grade, although penetration has occurred to the serosal level. The family pedigree of the propositus shows an autosomal Mendelian dominant gene pattern with a characteristic early age of onset and a significant frequency of multiple metachronous primary malignant neoplasms. Identification of this syndrome provides an opportunity to include in a surveillance program, those unaffected patients in the pedigree who have an extra risk of early development of cancer at specific sites.

Adenocarcinoma↗
PubMed1997

Concurrent colonic adenocarcinoma and two ileal carcinoids in a 72-year-old male.

A case of synchronous rectal cancer and two small-bowel carcinoid tumours was recently encountered in a 72-year-old man. This will be presented and discussed with a literature review. It emphasizes the importance of the concept of synchronous malignancy within the gastrointestinal tract and that patients presenting with any gastrointestinal neoplasm, especially colonic cancer and carcinoids, should undergo thorough exploration of the peritoneal cavity and its organs at initial surgery.

Adenocarcinoma↗
PubMed1998

Palliation of obstructing gastric carcinoma with metal stents through a gastrostomy.

Gastric cancer is the world's second most common malignancy. In the U.S., patients present with advanced disease, and surgery with curative intent accounts for only 30% of gastric malignancies. Palliative surgery has significant morbidity and mortality. Recently, there have been encouraging reports of self-expanding endoprostheses in obstructing gastrointestinal neoplasms. We report a case of a 70-yr-old woman with inoperable outlet stenosis secondary to a mucinous infiltrating adenocarcinoma involving nearly the entire stomach, except the anterior wall, which provided a percutaneous access site for gastrostomy and subsequently successful management of outlet obstruction with metallic stents.

Adenocarcinoma, Mucinous↗
PubMed1998

Metastatic breast cancer masquerading as gastrointestinal primary.

Seven patients with metastatic breast cancer presenting as gastrointestinal primary are described. These included six gastric and one colonic lesions. None of the patients had known systemic metastases at the time of diagnosis. The mean age at presentation was 66.7 yr (range 55-78). Median interval between breast cancer and gastrointestinal metastasis diagnosis was 6 yr (range 0.25-12.5). Original breast cancer histology included infiltrating lobular cancer (n = 4), infiltrating ductal cancer (n = 1), and a mixed type (n = 2). All patients with gastric involvement presented with epigastric pain and early satiety; the patient with colonic involvement had heme-positive stool. In three cases of gastric tumor and the one case of colonic tumor presentation, a definitive diagnosis of metastatic breast cancer was only confirmed after surgical resection of a presumed primary gastric or colonic malignancy. In the other three cases, pathological diagnostic confirmation was obtained through endoscopic biopsies and comparison to breast biopsy material, and operative treatment was avoided in favor of systemic cytotoxic therapy. The diagnosis was confirmed through similarities between mammary and gastric histopathology with regard to growth pattern, hormone receptor status, or gross cystic disease fluid protein. A high level of suspicion for metastatic breast cancer and a detailed pathological analysis will help avoid unnecessary surgical treatment in patients with a history of mammary carcinoma presenting with a newly diagnosed gastrointestinal neoplasm.

Aged↗