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PubMed1997

Predictors of recurrent febrile seizures. A prospective cohort study.

OBJECTIVES: To define the risk and identify predictors of single and multiple recurrent febrile seizures. METHODS: Children (n = 428) with first febrile seizures were prospectively identified and followed for 2 or more years. Parents were interviewed soon after their children's first febrile seizure and were called every 3 months to ascertain recurrent febrile seizures. Medical records of first and recurrent seizures were reviewed for additional information. RESULTS: A total of 136 children (31.8%) experienced recurrent seizures: 73 (17.1%) had only 1 recurrence, 38 (8.9%) had 2 recurrences, and 25 (5.8%) had 3 or more recurrences. Young age at onset, a history of febrile seizures in a first-degree relative, low degree of fever while in the emergency department, and a brief duration between the onset of fever and the initial seizure were strong independent predictors of recurrent febrile seizures. With these 4 factors combined, it is possible to define groups of children having very high and very low probabilities of having any recurrences (> 70% vs < 20%), having 2 or more recurrences (> 60% vs < 10%), and having 3 or more recurrence (12% vs about 0%). In children who had at least 1 recurrence, age at the time of the first recurrence and a family history of epilepsy were predictors of subsequent recurrences. CONCLUSIONS: In children who have had a first febrile seizure, recurrences are common. The risk for 1 or more recurrences can be meaningfully predicted at the time of the initial febrile seizure with a combination of the 4 factors identified in this study.

Child, Preschool↗

PubMed2002

Survival after recurrence of Ewing tumors: the St Jude Children's Research Hospital experience, 1979-1999.

BACKGROUND: Despite improved therapies, 30-40% of patients with Ewing tumors (ET) experience recurrence and have a poor prognosis. The authors analyzed factors prognostic of survival in patients with recurrent ET. METHODS: The authors assessed the relation between postrecurrence survival (PRS) and demographic, disease, and treatment factors in 71 patients who experienced recurrent ET after treatment on one of three consecutive institutional protocols. RESULTS: Thirty-four patients (47.9%) had distant recurrence, 25 patients (35.2%) had local recurrence, and 12 patients (16.9%) had both distant and local recurrence at a median of 1.7 years after diagnosis. The probability of 5-year PRS (+/- 1 standard error) was 17.7%+/-4.5%. Recurrence > or = 2 years after diagnosis predicted a significantly better outcome (5-year PRS, 34.9%+/-8.5%) compared with earlier recurrence (5.0%+/-2.8%; P < 0.001). Patients who had both local and distant recurrence fared worse (5-year PRS, 12.5%+/-8.3%) compared with patients who had local recurrence alone (21.7%+/-7.8%) or distant recurrence alone (17.6+/-6.1%). Among patients with local recurrence alone, those who underwent salvage with radical surgery had significantly higher 5-year PRS estimates (31.4%+/-11.6%) compared with the other patients (9.1%+/-6.1%; P = 0.023). Pulmonary irradiation significantly improved the outcomes of patients with isolated pulmonary recurrence (5-year PRS estimate, 30.3%+/-12.5% vs. 16.7%+/-10.8%, respectively; P = 0.018). CONCLUSIONS: Although outcomes are generally poor after patients experience recurrence of ET, certain patient groups differ appreciably in their likelihood of survival. Patients who experience recurrence > or = 2 years after diagnosis and patients who have local recurrence that can be treated with radical surgery and intensive chemotherapy have the most favorable outcomes.

Adolescent↗

PubMed2002

Late recurrence in 1263 men with testicular germ cell tumors. Multivariate analysis of risk factors and implications for management.

BACKGROUND: Testicular germ cell tumors are highly curable. However, 10-30% of patients have recurrence after initial treatment. The time-course of recurrence has implications for the duration of follow-up. This study was undertaken to assess the risk and time-course of recurrence and to identify patients at higher risk of late recurrence. METHODS: The records of 1263 patients with primary testicular germ cell tumors presenting to the Royal Marsden Hospital between December 1979 and December 1993 were reviewed. In all, 255 episodes of recurrence were documented (including 44 patients with multiple recurrences) and used to calculate recurrence-free survivals. RESULTS: Fifty-three patients (15 seminomas; 38 nonseminomatous germ cell tumors [NSGCT]) had recurrence more than 2 years after initial presentation. A multivariate analysis of risk of recurrence after 2 years identified positive markers at presentation and the presence of differentiated teratomas in postchemotherapy surgical specimens as significant predictors. Very late recurrence (> 5 years) occurred mainly in patients with metastatic NSGCT (12 of 14 patients) with a 1% annual risk of recurrence between 5 and 10 years. Very late recurrence was also seen in one case of metastatic seminoma and one case of Stage I NSGCT managed by surveillance. Most late recurrences (n = 9) were detected at routine annual follow-up visits but five had recurrences with symptoms leading to an unscheduled clinic visit. CONCLUSION: Late recurrences are rare in patients with testicular germ cell tumors and follow-up to detect recurrence may not be needed after 5 years, except in those presenting with metastatic NSGCTs.

Adolescent↗

PubMed2006

Economic burden associated with breast cancer recurrence: findings from a retrospective analysis of health system data.

BACKGROUND: The economics of breast cancer recurrence are poorly understood. For this retrospective cohort study, the authors evaluated the economic burden of breast cancer recurrence by using data from a large Midwestern healthcare system. METHODS: Women with Stage I or II breast cancer (according to the American Joint Commission on Cancer staging criteria) were identified from the tumor registry of the Henry Ford Health System. The economic burden of breast cancer recurrence was estimated from patient charges (adjusted to 2003 U.S. dollars). RESULTS: From 1996 to 2002, 1616 patients with early breast cancer were identified, including 192 patients who had recurrent tumors. Patients with recurrence had significantly greater charges in the 6-month and 12-month postrecurrence periods (45,855 U.S. dollars and 79,253 U.S. dollars, respectively) compared with the 6-month and 12-month prerecurrence periods (10,715 U.S. dollars and 12,344 U.S. dollars, respectively; both P <.001). This was evident for all recurrence types (locoregional, contralateral breast, and distant), but it was most evident for distant recurrences. In a regression analysis that was adjusted for baseline characteristics, the mean monthly charges were significantly greater for patients with recurrence versus patients without recurrence (P <.001), and this was true for each recurrence type. For women with recurrence (n = 74 patients), the mean charges during the 6-month postrecurrence period were significantly greater than mean charges during the initial 6-month period after diagnosis (50,355 U.S. dollars vs. 38,254 U.S. dollars; P <.01). Quarterly charges for continuing care postrecurrence were significantly greater than prerecurrence charges (4934 U.S. dollars vs. 1825 U.S. dollars; P <.001). The mean charges for terminal care were significantly greater (P <.01) for women with recurrence (n = 27 patients, 63,434 U.S. dollars) versus women without recurrence (n = 65 patients, 53,872 U.S. dollars). CONCLUSIONS: Patients with early breast cancer who experienced recurrence required more costly care than patients who did not develop recurrent disease. Therapies that reduce the risk of recurrence may reduce costs significantly.

Adult↗

PubMed2004

Recurrence of hepatocellular carcinoma after liver transplant: patterns and prognosis.

Very little is known about the natural history, effects of therapy, and survival after recurrence of hepatocellular carcinoma (HCC) after liver transplantation. All adult patients undergoing liver transplant from September 19, 1988, until September 19, 2002, were reviewed. Only patients with histologically proven HCC in the explant who subsequently developed recurrence were included in further analysis. The endpoints analyzed were survival from time of transplant and survival from time of recurrence. Recipient demographics and laboratory values, technique of transplant (whole cadaver, split, or living donor), and tumor characteristics were analyzed. The time to, location of, and any medical or surgical treatment of recurrences also were considered. Of the 311 patients with HCC in the explant, 57 (18.3%) eventually were diagnosed with recurrent tumor after transplant. Median time to recurrence was 12.3. Five-year survival was significantly lower for patients with recurrence (22%) than for patients without recurrence (64%)(P < 0.0001). Multivariate analysis demonstrated that the size and differentiation of the original tumor, as well as the presence of bone recurrence, were independently associated with survival from transplant in patients with recurrence. When survival from the time of recurrence was analyzed, multivariate analysis showed that the absence of bone metastases, recurrence more than 12 months from transplant, and surgical treatment of the recurrence were independently associated with significantly longer survival. In conclusion, recurrence of HCC significantly shortens survival after transplant. Nonetheless, some patients with recurrence can be expected to live for a considerable period of time. Recurrent disease should be treated surgically when possible, because surgery is independently associated with longer survival.

Aged↗

PubMed1997

[The locoregional recurrence of rectal carcinoma. A computed tomographic analysis and a target volume concept for adjuvant radiotherapy].

BACKGROUND: In the adjuvant postoperative radiotherapy of rectal carcinoma the knowledge of the predominant areas of recurrences is of major importance for the definition of the target volume. We analysed the pattern and locations of tumor recurrences in the CT scans of 155 patients and correlated the findings with the primary tumor location (above and below the peritoneal duplication) and the operating method (abdominoperineal extirpation, anterior resection. Hartmann procedure). PATIENTS AND METHOD: Hundred and fifty-five patients with the diagnosis of rectal carcinoma recurrences were treated in our institution between 1980 and 1995. To determine the extension of the recurrent tumor within the pelvic levels (presacral levels S1-S5, precoccygeal, pelvic floor level and perineal level) and the tumor infiltration of pelvic organs and muscles we analysed the pretherapeutic CT images. The lymph node recurrences were classified as: pararectal, presacral, iliac internal, iliac external, iliac communis and para-aortal recurrences. RESULTS: Sixty-one percent of the patients with rectum extirpation and 66% with anterior resection showed a combined local and nodal recurrence. Isolated lymph node recurrences were rare (4% and 5%) (Tables 2 and 3). The local recurrence was mostly situated in the presacral pelvis, predominantly there was an infiltration of the presacral space at the level of S4, S5 and os coccygis regardless of the operating method and the primary tumor location (Figure 1). The anastomosis was involved in the tumor recurrence in 93% of the anteriorly resected patients (Table 3). In 9 out of 96 patients after rectum extirpation the pelvic region caudal of the tip of the coccyx was the origin of the recurrent tumor (Table 2, Figure 2). Primarily all 9 patients had a deep-seated carcinoma (< 6 cm ab ano). Only 2 patients showed an isolated perineal recurrence after rectum extirpation (Table 2. Figure 2). Two thirds of the deep-seated tumors showed a vaginal involvement (Figures 3 and 4). The incidence of iliac internal and presacral nodal recurrence was 47 to 59% (Figures 3 and 4). The incidence of iliac external lymph node recurrences was 7% after rectum extirpation and 2% after anterior resection/Hartmann procedure. CONCLUSION: Our data demonstrate that 2/3 of the patients with tumor-bed recurrences also show lymph node recurrences predominantly in the iliac internal and presacral groups. This has to be considered in the definition of the boost target volume. The target volume must also include the dorsal wall of the urogenital organs. A ventral extension of target volume up to iliac external lymph nodes is not necessary.

Adenocarcinoma↗

PubMed2004

Clinicopathological features of recurrence after radical surgery for nonmetastatic renal cell carcinoma.

BACKGROUND: The objective of this study was to clarify the clinicopathological features of recurrent renal cell carcinoma (RCC) in patients who had undergone curative surgical resection of primary disease. METHODS: The study included 171 patients treated by radical surgery for nonmetastatic RCC in our institution. Several clinicopathological factors were analyzed to determine differences between patients with and without disease recurrence. We further investigated predictive factors for disease recurrence, as well as prognostic factors after disease recurrence, using univariate and multivariate analyses. RESULTS: Thirty-four of the 171 patients (19.9%) developed recurrence, and the median time from surgery to recurrence was 11 months (range, 1 to 146 months). The incidence of disease recurrence was significantly associated with sex, mode of detection, tumor size, pathological stage, tumor grade, and microvascular invasion (MVI). Univariate analysis showed that five factors--mode of detection, tumor size, pathological stage, tumor grade, and MVI--were found to be significant risk factors for recurrence after surgery, while only the pathological stage was an independent predictor of recurrence by multivariate analysis. After disease recurrence, the 1-, 3-, and 5-year cancer-specific survival rates were 66.3%, 45.9%, and 13.4%, respectively. Despite the absence of independent prognostic predictors after recurrence, recurrence more than 1 year after surgery and complete resection of recurrent lesions were shown to be significant prognostic factors by univariate analysis. CONCLUSION: These findings suggest that careful follow-up should be performed for patients showing a high pathological stage after radical surgery for nonmetastatic RCC, because of the higher probability of disease recurrence, and that after recurrence, intensive treatment should be considered, particularly for patients with unresectable recurrent disease occurring within 1 year after initial radical surgery.

Aged↗

PubMed2001

Prognostic index for extremity soft tissue sarcomas with isolated local recurrence.

BACKGROUND: Local recurrence occurs in 10% to 20% of patients with extremity soft tissue sarcomas despite optimal treatment. The association of local recurrence with subsequent survival is controversial and conflicting. There is a need for a staging system to predict outcome in this subset of patients and also to plan optimal treatment, including adjuvant systemic therapy. METHODS: Data collected from 110 patients with locally recurrent extremity soft tissue sarcomas were studied. The influence of clinical and pathologic factors on local recurrence, distant metastasis, and disease-specific survival were analyzed by univariate and multivariate techniques. RESULTS: Of the 110 patients who presented with local recurrence, 92 had an isolated local recurrence and 18 had prior or concomitant distant metastases. The 5-year disease-specific survival for all patients was 63% and for those with isolated local recurrence, it was 69%. Histologic grade, malignant fibrous histiocytoma histology, pathologic margins, previous local recurrence, and prior radiotherapy were independent prognostic factors for subsequent local recurrence. Tumor size, histologic grade, and time to local recurrence were independent prognostic factors for distant metastasis and disease-specific survival. A prognostic index was calculated by assigning a score of 1 to 3 for each of the three independent prognostic factors for survival and added to give the prognostic index for each patient. As the prognostic index increased from 3 to 9, there was a progressive increase in the hazard ratios and a corresponding deterioration in survival. The patients were then categorized into three prognostic groups based on the hazard ratios for disease specific survival. The differences in the survival curves were highly statistically significant (P < .0001). CONCLUSIONS: Tumor size, histologic grade, and time to local recurrence are the primary determinants of distant metastases and survival in locally recurrent extremity soft tissue sarcomas. The impact of local recurrence on survival varies considerably. The nature of the local recurrence, rather than its presence per se, is a more useful guide to prognosis. We propose a simple staging system based on size, grade, and time to recurrence that correlates extremely well with prognosis and may serve as a guide to make therapeutic decisions in patients with locally recurrent extremity soft tissue sarcomas.

Adolescent↗

PubMed1992

Prognostic significance of pelvic recurrence and distant metastasis in prostate carcinoma following definitive radiotherapy.

This report is a retrospective analysis of 317 patients with recurrent prostate carcinoma, following definitive radiation therapy to 738 patients with histologically confirmed, clinical Stage T1b-T4(A2-D1) adenocarcinoma of the prostate. Seventy-four patients (10%) experienced pelvic recurrence only; 100 (13%) both pelvic recurrence and distant metastasis, while 143 (20%) developed distant metastasis only. The diagnosis of prostate recurrence was histologically confirmed in 92/174 (53%), while in the others diagnosis was based on clinical and radiographic evidence. Ninety percent of all recurrences occurred within 7 years of initial treatment. The median survival from time of recurrence for all patients was 27 months, with 5-, 8-, and 10-year survival rates of 24%, 12%, and 7%, respectively. In patients who experienced pelvic recurrence only, the 5-, 8-, and 10-year survival rates were 50%, 30%, and 22%, respectively (p < 0.0001). The 5-year survival rate from time of recurrence for patients who experienced pelvic recurrence with initial Stage T1b(A2) and T2(B) disease was 71% as opposed to 39% for patients with initial Stage T3(C) disease. The time of recurrence (i.e., the disease-free interval from initial treatment) significantly affected subsequent survival: the 5-year survival rates from time of recurrence for patients with pelvic recurrence were 20%, 49%, and 94% for those who recurred within 2 years, 2 to 5 years, and more than 5 years, respectively. Two-thirds of the patients with recurrence received hormonal therapy, including bilateral orchiectomy. Salvage therapy with hormones, including bilateral orchiectomy, has a favorable impact on patient survival: The 5-year survival rate from time of pelvic recurrence salvaged with hormones was 70% compared with 21% for patients not receiving hormonal therapy. In conclusion, the prognostic factors that affect subsequent patient survival after pelvic recurrence include initial stage, disease-free interval from initial treatment, and salvage therapy with hormones. Patients with distant metastasis with or without pelvic recurrence showed statistically worse survival and were apparently not influenced by initial tumor stage, or disease-free interval from initial treatment.

Adenocarcinoma↗

PubMed2004

Recurrent hepatocellular carcinoma after hepatic resection: prognostic factors and long-term outcome.

AIM: The prognosis of patients with recurrent hepatocellular carcinoma (HCC) after hepatic resection varies widely. This study analyzed long-term survival and prognostic factors of patients with recurrent HCC after hepatectomy. METHODS: From July 1991 to December 2000, 623 patients underwent hepatic resection for HCC. Of those, 347 (56.5%) patients had tumour recurrence, and 286 patients with follow-up time more than 24 months after recurrence were enrolled. Twenty-seven clinicopathologic factors underwent both univariate and multivariate analysis. RESULTS: Of these 286 patients, survival times after tumour recurrence were mean 672+/-619 days; median 468 days; and, range 10-3753 days. The overall 1-, 3-, 5-, and 10-year post-recurrence survival rates were 61.5, 33.4, 18.2, and 9.0%, respectively. Seventy (24.5%) patients were alive at the time of study, and 10 of the 34 patients who underwent re-resection were disease-free. By Cox regression analysis, multiple initial tumours (relative risk (RR) 1.428), recurrent multiple (RR 1.372), extrahepatic recurrence (RR 2.434), recurrent tumour size >2 cm (RR 1.926), post-hepatectomy period until recurrence <1 year (RR 1.769), and non-resectional treatment of recurrent tumours (RR 3.527) were independent prognostic factors for post-recurrent survival rates. CONCLUSIONS: In patients with recurrent HCC after hepatectomy, both initial and recurrent tumour factors influenced their prognosis. Early detection of recurrent tumours is important. Re-resection correlated with better post-recurrent survival rates.

Aged↗

PubMed2002

Aggressive management of patients with extrahepatic and intrahepatic recurrences of hepatocellular carcinoma by combined resection and locoregional therapy.

BACKGROUND: Resection of hepatocellular carcinoma (HCC) is associated with a high incidence of recurrence. Aggressive management of recurrence is an important strategy in prolonging survival. This study evaluated the role of combined resection and locoregional therapy in the management of selected patients with extrahepatic and intrahepatic recurrences. STUDY DESIGN: From a prospective database of 399 patients with hepatectomy for HCC from 1989 to 1998, 63 patients were identified with extrahepatic and intrahepatic recurrences either concurrently or sequentially. Survival outcomes of patients who underwent resection of extrahepatic recurrence and re-resection or locoregional therapy for intrahepatic recurrence were evaluated. RESULTS: Ten patients underwent resection of solitary extrahepatic recurrence and locoregional therapy for intrahepatic recurrence. Transarterial chemoembolization was the main treatment modality for intrahepatic recurrence. Two of these patients also underwent re-resection of intrahepatic recurrence at the time of resection of extrahepatic metastasis. Median survival after recurrence of these 10 patients was 44.0 months (range 18.6 to 132.9 months), and the median overall survival from initial hepatectomy was 49.0 months (range 21.6 to 134.6 months). In contrast, median survival after recurrence of the remaining 53 patients with extrahepatic and intrahepatic recurrences treated by nonsurgical means (locoregional therapy, systemic chemotherapy, or hormonal therapy) was only 10.6 months (p = 0.002). CONCLUSIONS: Aggressive management with combined resection of isolated extrahepatic recurrence and re-resection or locoregional therapy for intrahepatic recurrence may offer longterm survival in selected patients who develop both intrahepatic and extrahepatic recurrences after hepatectomy for HCC.

Adult↗

PubMed2004

Predictors of early and late recurrence of atrial fibrillation after catheter ablation of paroxysmal atrial fibrillation.

INTRODUCTION: The outcome of patients with early recurrence of atrial fibrillation (AF) (within one month) after ablation procedure is controversial. Furthermore, the predictors of early and late (up to mean follow-up 30 months) recurrence of AF are not investigated in depth. AIMS OF THE STUDY: The aim of the present study was to investigate the predictors of early and late recurrence of AF after catheter ablation of arrhythmogenic foci initiating AF in patients with paroxysmal AF. METHODS AND RESULTS: The study included 207 patients (155 men; mean age 62 +/- 13 years) who received catheter ablation of paroxysmal AF. Eighty-one (39%) patients had early recurrence of AF. Five clinical variables were related to the early recurrence of AF: (1) old age (>/=65 years) ( P = 0.004); (2) presence of associated cardiovascular disease ( P = 0.01); (3) presence of multiple AF foci ( P = 0.004); (4) presence of AF foci from left atrial free wall ( P = 0.039); (5) left atrial enlargement ( P = 0.038). Multivariate analysis demonstrated that presence of multiple AF foci could predict early recurrence of AF ( P = 0.013; ratio = 2.24; 95% CI 1.18 to 4.25). During the follow-up period (30 +/- 11 months), 70 (34%) patients had late recurrence of AF, and two clinical variables were related to the late recurrence of AF: (1) presence of early recurrence of AF ( P = 0.025); (2) presence of multiple AF foci ( P = 0.034). Multivariate analysis found that presence of early recurrence of AF could predict late recurrence of AF ( P = 0.046; hazard ratio = 1.62; 95% CI 1.01 to 2.59). Late recurrence of AF happened in 35 (43%) of the 81 patients with early recurrence of AF, and in 35 (28%) of the 126 patients without early recurrence of AF. CONCLUSIONS: Early AF recurrence could predict late AF recurrence.

Age Factors↗

PubMed2003

Clinicopathological analysis for recurrence of early gastric cancer.

BACKGROUND: Although the prognosis of early gastric cancer (EGC) is considered to be satisfactory, some patients experience disease recurrence after curative resection. This study was aimed at evaluating the recurrence rate, the recurrence patterns and the prognostic factors for recurrence of EGC as well as treatment results after recurrences. METHODS: We investigated follow-up records of 1452 EGC patients on whom curative operations were performed at Seoul National University Hospital from 1986 to 1995 with special reference to cancer recurrence. RESULTS: Twenty-one patients showed recurrences with a 1.5% 5-year cumulative recurrence rate. Four cases were locoregional recurrences, two were peritoneal recurrences, nine were distant recurrences and six were mixed type recurrences. The 5-year survival rates of T1N0, T1N1, T1N2 and T1N3 were 99.3, 96.8, 72.7 and 0%, respectively (P < 0.001). Multivariate analysis revealed a significantly high correlation between positive lymph node metastasis and recurrence (P < 0.001). Median survival after recurrence of EGC was 4.3 months. Median survival after recurrence was 5.8 months after chemotherapy and 3.1 months after conservative management (P = 0.69). CONCLUSION: Although the recurrence of EGC is very rare in general, EGC with lymph node metastasis has a higher possibility of recurring, especially with >6 positive lymph nodes. Even after curative resection of EGC, patients with EGC with >6 positive lymph nodes should be closely followed and be considered as candidates for adjuvant treatment.

Adult↗

PubMed1988

The preperitoneal approach and prosthetic buttress repair for recurrent hernia. The evolution of a technique.

Repair of recurrent groin hernias is associated with a high incidence of repeat recurrences (2-19%). Reported herein is a 10-year experience of the management of recurrent groin hernias through the use of the preperitoneal approach with the addition of a reinforcing prosthetic mesh buttress. Two hundred and three recurrent groin hernias in 195 patients (192 men, three women) were treated between July 1975 and October 1986. The preperitoneal approach to the inguinal region was performed under regional anesthesia to define the nature of the recurrent hernia. Initial experience in a randomized trial between the use of local endogenous tissue repair versus endogenous repair with a prosthetic polypropylene mesh buttress demonstrated superiority of the latter in reducing repeat recurrences of anatomically defined direct or combined recurrent hernias. Pure indirect and femoral recurrences did not mandate mesh reinforcement. Long-term follow-up was available for 115 hernias (56%) in 102 patients (52.3%) over a period of 6 months to 10 years. Eight patients had repeat recurrences a mean of 30 +/- 22 months after repair. Six recurrences (four direct, two indirect) occurred in an early experience, when no mesh was used. Two recurrences (one indirect and one lateral to the mesh) representing 1% of all hernias (1.7% of those followed-up) have occurred after routine use of the mesh buttress, with the last re-recurrence seen in December 1982. Three ventral hernias (1.5%) occurred at the wound of entry, but none have occurred since placement of the mesh was modified to cover this wound. There were five (2.5%) wound infections and one (0.5%) hydrocele with no re-recurrences. It is concluded that the preperitoneal approach to recurrent groin hernias, together with the appropriate use of a reinforcing mesh buttress, is safe, allows anatomic definition of the hernial defect, and is followed by few repeated recurrences. The evolution of this approach during the last 10 years has made it the procedure of choice for the management of all recurrent groin hernias at the University of Illinois College of Medicine.

Female↗

PubMed1999

Recurrent and de novo glomerular disease after renal transplantation: a report from Renal Allograft Disease Registry (RADR).

INTRODUCTION: Short-term and long-term results of renal transplantation have improved over the past 15 years. However, there has been no change in the prevalence of recurrent and de novo diseases. A retrospective study was initiated through the Renal Allograft Disease Registry, to evaluate the prevalence and impact of recurrent and de novo diseases after transplantation. MATERIALS AND METHODS: From October 1987 to December 1996, a total of 4913 renal transplants were performed on adults at the Medical College of Wisconsin, University of Cincinnati, University of California at San Francisco, University of Louisville, University of Washington, Seattle, and Washington University School of Medicine. The patients were followed for a minimum of 1 year. A total of 167 (3.4%) cases of recurrent and de novo disease were diagnosed by renal biopsy. These patients were compared with other patients who did not have recurrent and de novo disease (n=4746). There were more men (67.7% vs. 59.8%, P<0.035) and a higher number of re-transplants (17% vs. 11.5%, P<0.005) in the recurrent and de novo disease group. There was no difference in the rate of recurrent and de novo disease according to the transplant type (living related donor vs. cadaver, P=NS). Other demographic findings were not significantly different. Common forms of glomerulonephritis seen were focal segmental glomerulosclerosis (FSGS), 57; immunoglobulin A nephritis, 22; membranoproliferative glomerulonephritis (GN), 18; and membranous nephropathy, 16. Other diagnoses include: diabetic nephropathy, 19; immune complex GN, 12; crescentic GN (vasculitis), 6; hemolytic uremic syndrome-thrombotic thrombocytopenic purpura (HUS/TTP), 8; systemic lupus erythematosus, 3; Anti-glomerular basement membrane disease, 2; oxalosis, 2; and miscellaneous, 2. The diagnosis of recurrent and de novo disease was made after a mean period of 678 days after the transplant. During the follow-up period, there were significantly more graft failures in the recurrent disease group, 55% vs. 25%, P<0.001. The actuarial 1-, 2-, 3-, 4, and 5-year kidney survival rates for patients with recurrent and de novo disease was 86.5%, 78.5%, 65%, 47.7%, and 39.8%. The corresponding survival rates for patients without recurrent and de novo disease were 85.2%, 81.2%, 76.5%, 72%, and 67.6%, respectively (Log-rank test, P<0.0001). The median kidney survival rate for patients with and without recurrent and de novo disease was 1360 vs. 3382 days (P<0.0001). Multivariate analysis using the Cox proportional hazard model for graft failure was performed to identify various risk factors. Cadaveric transplants, prolonged cold ischemia time, elevated panel reactive antibody, and recurrent disease were identified as risk factors for allograft failure. The relative risk (95% confidence interval) for graft failure because of recurrent and de novo disease was 1.9 (1.57-2.40), P<0.0001. The relative risk for graft failure because of posttransplant FSGS was 2.25 (1.6-3.1), P<0.0001, for membranoprolifera. tive glomerulonephritis was 2.37 (1.3-4.2), P<0.003, and for HUS/TTP was 5.36 (2.2-12.9), P<0.0002. There was higher graft failure (64.9%) and shorter half-life (1244 days) in patients with recurrent FSGS. CONCLUSION: In conclusion, recurrent and de novo disease are associated with poorer long-term survival, and the relative risk of allograft loss is double. Significant impact on graft survival was seen with recurrent and de novo FSGS, membranoproliferative glomerulonephritis, and HUS/TTP.

Adult↗

PubMed2007

Role of surgical salvage for regional recurrence in laryngeal cancer.

OBJECTIVES: The aims of this study were to analyze the pattern of regional recurrence in laryngeal cancer, evaluate the role of surgical salvage, and identify factors affecting salvage outcome. METHODS: Retrospective analysis was conducted on medical records from a 16-year period. Of 463 patients diagnosed with laryngeal cancer, 25 patients with regional recurrence managed with salvage neck dissection were identified and subject to study. Isolated local recurrences and all distant metastases were excluded. RESULTS: All patients were male with a median age of 61 years. The overall rate of regional recurrence was 5.4%. Median time to regional recurrence was 13 months. Isolated regional recurrence occurred in 76% of cases, whereas locoregional recurrence occurred in 24%. A 5-year survival rate for patients undergoing neck dissection as salvage management was 61.2%. Patients with recurrence in the contralateral neck were definitely associated with poor prognosis. Although standard statistical significance was not met, trends for poorer salvage result were identified in patients with a history of local recurrence before regional recurrence, recurrence in a previously dissected neck, and recurred node size of 3 cm or above. CONCLUSIONS: Our study shows that salvage neck dissection for regional recurrence in laryngeal cancer is an acceptable approach. Surgical eradication of disease should be warranted whenever possible. Prudent planning of management is mandatory in the presence of history of local recurrence before regional recurrence, previously dissected neck, large size of recurrent node, and contralateral neck recurrence.

Adult↗

PubMedDate not supplied

A case control study on risk factors involved in inflammatory breast recurrence after breast-conserving surgery.

Recurrence that poses the biggest problem after breast-conserving surgery is local recurrence. Particularly, in the case of inflammatory breast recurrence which is rare but has a specific pathologic nature, it is important to elucidate the pathology and risk factors and to consider appropriate countermeasures. In the present study, we classified 133 cases of recurrence following breast-conserving surgery, collected from 18 key hospitals/institutes in Japan. Recurrence types were divided into three groups, namely, inflammatory breast recurrence, noninflammatory breast recurrence and distant metastasis only, and the risk factors involved in recurrence were investigated by the case control study allotting 2 controls to each case. The study population consisted of 9 cases of the inflammatory type, 64 cases of the noninflammatory type and 60 cases of distant metastasis. The significant risk factor for inflammatory breast recurrence was positive lymph node metastasis, which was significantly more frequent in lymphatic invasion-positive cases unlike in the distant metastasis group. The positive surgical margin and nonradiation therapy which have been shown to be significant risk factors for noninflammatory breast recurrence were entirely unrelated with inflammatory breast recurrence. In addition, the inflammatory-type recurrence time was as short as about 12 months irrespective of whether radiation therapy was performed or not. The inflammatory type was accompanied with local wide extension (cancerous embolus of the dermal lymphatic vessels), and distant metastasis (lymphangitis carcinomatosa) at the time of recurrence, and further surgery was impossible in most cases, with a significantly poorer prognosis than the other recurrence types. These findings suggest that this recurrence corresponds to the so-called 'occult' case of primary inflammatory breast carcinoma. We think it important to predict this recurrence by close pathological examination, particularly in patients with lymph node metastasis, and to consider appropriate measures.

Adenocarcinoma↗

PubMed2005

Prognostic factors for survival in patients with locally recurrent extremity soft tissue sarcomas.

BACKGROUND: Factors prognostic for survival in patients with locally recurrent extremity soft tissue sarcomas (STS) are poorly defined, thus making it difficult to identify high-risk patients who may benefit from adjuvant therapy. METHODS: A total of 1421 patients underwent surgical treatment for primary extremity STS at a single institution between 1982 and 2002. Of these, 179 (13%) patients underwent complete surgical resection of an isolated local recurrence and were the subjects of this study. Clinicopathologic factors from both the primary tumor and the local recurrence were analyzed. RESULTS: The median interval to initial local recurrence was 16 months: 65% developed a local recurrence by 2 years and 90% by 4 years. Only four patients who presented with a low-grade primary tumor progressed to a high-grade local recurrence. Independent prognostic factors for disease-specific survival after local recurrence were a high histological grade (hazard ratio, 5.1; P = .0004), a large local recurrence tumor size (hazard ratio, 1.5; P = .0001), and a short local recurrence-free interval (hazard ratio, 1.6; P = .0001). Patients who developed a local recurrence >5 cm in < or =16 months (n = 44; 0 low grade) had a 4-year disease-specific survival of 18%, compared with 81% for patients who developed a local recurrence < or =5 cm in >16 months (n = 46; 11 low grade). CONCLUSIONS: Histological grade, local recurrence size, and local recurrence-free interval are independently predictive of survival in patients with locally recurrent extremity STS. A large local recurrence that develops in a short interval indicates a biologically aggressive tumor with a high tumor-specific mortality. Patients who develop such recurrences are ideal subjects for systemic neoadjuvant therapy trials.

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