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PubMed2006

Recurrent phyllodes tumours of the breast: pathological features and clinical implications.

BACKGROUND: Phyllodes tumours (PT) of the breast are fibro-epithelial neoplasms that are known to recur locally in up to 19% of patients. The failure to achieve adequate surgical margins is an important risk factor for local recurrence. This, however, is a common problem as PT are clinically similar to the more common fibro-adenoma and are therefore often locally excised without any gross surgical margins. It is still debatable as to whether it is necessary to subject the patient to repeat surgery to obtain pathologically negative margins after a diagnosis of a benign or borderline PT is made. Although the majority of recurrences are histologically similar to the initial tumour, a malignant recurrence is possible. Malignant tumours can metastasize through the haematogenous route and metastases are associated with a poor prognosis as they are poorly responsive to conventional chemotherapy. METHODS: We retrospectively reviewed 37 women who presented with local recurrence over a 10-year period to the Singapore General Hospital. Data, including age at the time of diagnosis, clinical presentation, histological features, type of surgery carried out, clinical progression and characteristics of locally recurrent disease, were analysed. Comparisons were made between those with benign, borderline and malignant tumours, as well as between those who developed a malignant recurrence and those who did not. RESULTS: The mean age at the time of diagnosis was 39.6 +/- 7.4 years and the mean tumour size was 6.0 +/- 5.1 cm. A total of 22 patients were classified as having benign tumour, 9 as having borderline tumour and 6 as having malignant tumour. Tumour grade did not influence the tumour size, the adequacy of surgical margins or the time interval to local recurrence or the number of recurrences. Local recurrence occurred after a median interval of 20 months. Although malignant tumours tended to recur earlier, this was not found to be statistically significant. The majority of recurrent tumours were histologically similar to the initial tumour; however, seven patients (19%) developed a malignant recurrence from an initially benign or borderline tumour. Although these tumours were larger, recurred more frequently and within a shorter interval, no significant predictive factor was found on multivariate analysis. Distant metastasis developed only in patients with malignant tumours and accounted for all three mortalities in the study. CONCLUSIONS: It may be acceptable to use an expectant management towards benign and borderline tumours that are excised without adequate surgical margins. However, surgery for locally recurrent tumours, as well as malignant tumours, should aim to achieve adequate surgical margins to reduce the risk of local recurrence, particularly that of a malignant recurrence.

Adult↗

PubMed2004

Mechanism of immediate recurrences of atrial fibrillation after restoration of sinus rhythm.

An immediate recurrence of AF may occur after restoration of sinus rhythm. Although pulmonary vein (PV) isolation has been shown to prevent immediate recurrence of AF, the specific trigger for immediate recurrence of AF has not been described. In 89 consecutive patients (mean age 53 +/- 11 years) who had sinus rhythm restored by spontaneous or transthoracic cardioversion in the course of a PV isolation procedure, electrograms recorded within a PV and in the adjacent left atrium were analyzed to determine the mechanism of initiation of immediate recurrence of AF. Immediate recurrence of AF was defined as a recurrence of AF within 90 seconds after restoration of sinus rhythm. There were 124 episodes of immediate recurrence of AF at a mean of 18 +/- 23 seconds after cardioversion. Recordings within the PV that triggered the immediate recurrence of AF were available in 23 (19%) of the 124 immediate recurrence of AF episodes. Among these 23 episodes of immediate recurrence of AF, all (100%) were triggered by a burst of PV tachycardia (P < 0.001). The coupling interval and prematurity index (coupling interval/preceding sinus cycle length) of the premature depolarizations that did and did not trigger immediate recurrence of AF were 246 +/- 67 ms and 0.30 +/- 0.11 vs 378 +/- 117 ms and 0.49 +/- 0.16, respectively (P < 0.01). Immediate recurrence of AF was abolished by PV isolation. The mechanism of immediate recurrence of AF is a burst of PV tachycardia, not a single premature depolarization. Immediate recurrence of AF identifies patients with AF in whom the PVs may play a major role in the initiation of AF.

Atrial Fibrillation↗

PubMed1993

Gall stone recurrence and its prevention: the British/Belgian Gall Stone Study Group's post-dissolution trial.

The British/Belgian Gall Stone Study Group (BBGSG) post-dissolution trial was a prospective, multicentre, randomised, double blind trial of: (i) low dose ursodeoxycholic acid, (ii) placebo, and (iii) a high fibre, low refined carbohydrate diet in the prevention of gall stone recurrence in patients with complete gall stone dissolution. Further aims included establishing the timing and frequency of recurrence and its association with biliary symptoms, a comparison of the sensitivity of ultrasonography v oral cholecystectography in detecting recurrent stones, and a search for risk factors predicting recurrence. Ninety three patients entered the study, and 82 were followed up for up to five years (mean (SEM) 28 (1.5) months) with six monthly ultrasonography and yearly oral cholecystectography. There were 21 recurrences (26 by oral cholecystectography or ultrasonography, or both), only two of which were symptomatic, which were detected between 12 and 42 months after trial entry. This corresponded to an actuarial recurrence rate of 33.9 (7.0%) by lifetable analysis at 42 months and subsequently. There were four recurrences in the ursodeoxycholic acid, six in the placebo, and 11 in the diet groups, corresponding to 21.9 (9.9)%, 27.4 (10.1)%, and 45.8 (12.4)% respectively at 42 months by lifetable analysis (NS). Variables including age, obesity, menopausal state, pregnancy, and oestrogen containing drugs were not shown to affect recurrence rate. Men had more frequent recurrence than women (NS). Patients who had had multiple stones experienced more recurrences than did those with single stones (NS). Recurrence did not occur in patients who took non-steroidal anti-inflammatory drugs (NSAIDs) (p < 0.02). The stone free interval between stone dissolution and trial entry proved to be important--those stone free > nine months had a recurrence rate of only 12.7 (6.0)% at 42 months compared with 55.4 (12.5)% in those stone free < nine months (p < 0.01). There was imbalance between the ursodeoxycholic acid and placebo groups for this factor, and after applying a statistical correction, the adjusted recurrence rate in the ursodeoxycholic acid group was 15% compared with 30% in both placebo and diet groups (NS). These data suggest that after medical dissolution, the risk of gall stone recurrence is not reduced by a high fibre, low refined carbohydrate diet: it may be lowered, but not abolished, by low dose ursodeoxycholic acid.

Adult↗

PubMed2004

Early and late recurrence of ischemic lesion on MRI: evidence for a prolonged stroke-prone state?

BACKGROUND: Based on previous observations of a high rate of ischemic lesion recurrence on diffusion-weighted imaging (DWI) within 1 week after an acute ischemic stroke, the authors hypothesized that silent new ischemic lesions are common between 1 week and 90 days after index stroke and that early lesion recurrence may be associated with late lesion recurrence. METHODS: The authors studied 80 acute ischemic stroke patients who had initial MRI performed within 48 hours, and follow-up scans at 5 days and at 30 or 90 days after onset. Early lesion recurrences were defined as new ischemic lesions on 5-day DWI, and late lesion recurrences were defined as those on 30- or 90-day DWI or fluid attenuation inversion recovery image. Early lesion recurrence occurring outside the initial perfusion deficit was termed distant lesion recurrence. RESULTS: Late lesion recurrence occurred in 26%, more frequently observed on 30-day MRI than 90-day MRI (p = 0.016). Early lesion recurrence (OR 4.0; 95% CI 1.3 to 11.7) and distant early lesion recurrence (OR 6.9; 95% CI 1.5 to 32.2) were independently associated with late lesion recurrence by multiple logistic regression analyses. CONCLUSIONS: There may be a continued risk for recurrent ischemic lesions in the weeks following the clinically symptomatic stroke. Future studies are needed to investigate whether MRI-defined ischemic lesion recurrences predict subsequent clinical recurrence and thus may be a potential surrogate endpoint in stroke secondary prevention trials.

Adult↗

PubMed1988

The value of thoracic computed tomography in the detection of recurrent Hodgkin's disease.

Fifty chest radiographs and concurrent thoracic computed tomography (CT) scans obtained in a total of 44 patients with 50 separate episodes of suspected recurrent Hodgkin's disease were reviewed. Recurrent disease was present in 18 episodes, involving the mediastinum in 12, the lung parenchyma in five and both mediastinum and lung parenchyma in one. In four episodes, mediastinal recurrence was demonstrated on both the chest radiograph and CT scan. In a further two cases, the chest radiograph appeared normal but CT detected recurrence in the mediastinum. In 20 cases, the mediastinal appearances on chest radiography were suspicious but not diagnostic of recurrence, usually because of previous radiotherapy resulting in residual mediastinal widening. Computed tomography diagnosed recurrent disease which was subsequently proven in seven of these cases. Recurrent disease was suggested by CT in a further case, subsequently shown to be radiation fibrosis. Of the 12 remaining chest radiographs in which the mediastinal assessment was indeterminate, CT was true negative for recurrent disease in 10 cases and was also indeterminate in two. Recurrent disease in the lung parenchyma was demonstrated on the chest radiograph and CT scan on five occasions. There was one incident in which the chest radiograph was normal but CT detected recurrent parenchymal disease. The appearances of the lung parenchyma were indeterminate for recurrent disease on three chest radiographs but CT was helpful in only one case in which radiation change alone was diagnosed. In eight cases the diagnosis of recurrent disease by CT resulted in a decision to initiate treatment. Computed tomography is of value in detecting relapse in patients with suspected recurrent Hodgkin's disease when the chest radiograph is inconclusive, and may enable differentiation of radiation change from recurrent disease in the mediastinum.

Adult↗

PubMed1997

Mammographic features of local recurrence in women who have undergone breast-conserving therapy for ductal carcinoma in situ.

OBJECTIVE: This study was undertaken to evaluate the mammographic features of local recurrence in women who have undergone breast-conserving therapy for ductal carcinoma in situ (DCIS). MATERIALS AND METHODS: Retrospective review revealed 162 women with DCIS treated with breast-conserving therapy from 1978 to 1990 for whom follow-up data were available. Subsequent to therapy, 33 (20%) patients had a pathologically proven carcinoma in the treated breast. Mammograms at the time of local recurrence were available for 20 patients. We reviewed mammograms, clinical charts, and histopathologic findings in these 20 patients. For 14 of 20 patients, we also reviewed mammograms obtained at the time of the original DCIS. RESULTS: The median interval from diagnosis of the original DCIS to local recurrence was 26 months (range, 6-168 months). Recurrences were detected solely by mammography in 17 (85%) of 20 patients, by mammography and physical examination in two (10%), and solely by physical examination in one (5%). Eighteen (90%) local recurrence contained calcifications and eighteen (90%) involved the tumorectomy quadrant. When we compared available mammographic findings of the original DCIS and the local recurrence we found the mammographic pattern and calcification morphology to be the same in 11 (79%) of 14 DCIS and nine (82%) of 11 DCIS, respectively. Histopathologic analysis of recurrences found DCIS in 13 (65%) of 20 patients and DCIS and infiltrating carcinoma in the remaining seven (35%) patients. Of 13 pure DCIS recurrences, 12 (92%) were detected solely by mammography. CONCLUSION: In our study, local recurrence after breast-conserving therapy for DCIS invariably contained DCIS; 35% of recurrences also contained invasive carcinoma. The most common mammographic pattern of local recurrence was calcifications in the tumorectomy quadrant that were morphologically similar to the original DCIS. These findings suggest that many of these local recurrences reflect failure to eradicate the primary DCIS. Mammography achieved high sensitivity in revealing these lesions: 85% of local recurrences and 92% of recurrences that were pure DCIS were detected solely by mammography.

Breast Neoplasms↗

PubMed2002

Early and late recurrences after gastrectomy for gastric cancer: a multiple logistic regression analysis.

PURPOSE: Although many studies have focused on clinical risk factors for prognosis of patients with surgically treated gastric cancer, little information is available regarding the timing of recurrent malignant disease. The purpose of this study was to determine the factors that are predictive of early and late recurrences after gastrectomy. PATIENTS AND METHODS: We reviewed the hospital records of patients with hisotological proof of gastric cancer who were admitted to Sendai National Hospital during the period from 1985 to 1995. A total of 923 records were examined, and 251 patients with recurrent disease were identified. The patients were divided into an "early recurrence group" consisting of 195 patients (died within one year after surgery) and a "late recurrence group" of 56 patients (died two years or more after surgery). Clinicopathological characteristics were examined, and independent risk factors influencing the timing of recurrence were determined by a multiple logistic regression analysis. RESULTS: The mean tumor size of early recurrence cases was larger than that of late recurrence cases (p=0.0294). Tumors penetrating the serosa with direct invasion to continuous structures were found more frequently in the early recurrence group than in the late recurrence group. The patients with early recurrence showed a higher tendency to have nodal involvement, lymphatic invasion and vascular invasion. The relative risks of early and late recurrences associated with different variables were estimated by a multiple logistic regression method. The following variables were found to be significant risk factors for early recurrence: male gender (p=0.0382), lymph node metastasis (p=0.0016), and vascular invasion (p=0.0006). CONCLUSION: Male patients who have node-positive gastric cancer with vascular invasion have a high risk of early recurrence.

Female↗

PubMed1999

Histopathologic features and MIB-1 labeling indices in recurrent and nonrecurrent meningiomas.

BACKGROUND: Predicting the behavior of meningiomas based on histopathologic features alone has remained problematic. DESIGN: This study retrospectively compared several histopathologic features and MIB-1 labeling indices (LIs) in recurrent meningiomas with those of nonrecurrent meningiomas. Six histopathologic features, including mitoses, necrosis, loss of architectural pattern, hypervascularity/hemosiderin deposition, prominent nucleoli, and nuclear pleomorphism, were compared between 32 recurrent and 27 nonrecurrent meningiomas using Fisher exact tests. MIB-1 LIs (% positive tumor cell nuclei) were compared using the Wilcoxon rank sum test. RESULTS: The patients in the recurrent group included 26 women (mean age, 55 years), who developed 1 to 5 recurrences. Time intervals to the first recurrence ranged from 5 to 183 months (mean, 55 months). The nonrecurrent group included 21 women (mean age, 56 years), with follow-up ranging from 88 to 124 months (mean, 109 months). Of the histopathologic features evaluated, statistically significant differences between the recurrent and nonrecurrent groups were found only with respect to prominent nucleoli (P =.024) and nuclear pleomorphism (P <.001), both of which were more common in the recurrent group. In the recurrent group, 9 tumors were considered malignant (defined by brain invasion or metastasis) versus 2 of the nonrecurrent meningiomas. Nineteen percent of nonrecurrent tumors versus 41% of recurrent tumors had 2 or more of the 6 histopathologic features. MIB-1 LIs in the nonrecurrent group ranged from 0 to 8.3 (mean, 1.5) and were generally lower than those in the recurrent group (range, 0-32.5; mean, 5.4); no statistical difference was identified between these groups. No statistically significant difference with regard to histology or MIB-1 LIs was noted between the initially excised recurrent tumor and the most recently resected recurrence. CONCLUSIONS: Of the histopathologic features examined, only prominent nucleoli and nuclear pleomorphism were found to be statistically more common in recurrent than nonrecurrent meningiomas. The mean MIB-1 LI was higher in the recurrent than in the nonrecurrent group, although there was no statistical difference between means and there was clear overlap with regard to MIB-1 LI ranges.

Adult↗

PubMed1999

Predictors of local recurrence after treatment of ductal carcinoma in situ: a meta-analysis.

BACKGROUND: Management of patients with ductal carcinoma in situ (DCIS) is a dilemma, as mastectomy provides nearly a 100% cure rate but at the expense of physical and psychologic morbidity. It would be helpful if we could predict which patients with DCIS are at sufficiently high risk of local recurrence after conservative surgery (CS) alone to warrant postoperative radiotherapy (RT) and which patients are at sufficient risk of local recurrence after CS + RT to warrant mastectomy. The authors reviewed the published studies and identified the factors that may be predictive of local recurrence after management by mastectomy, CS alone, or CS + RT. METHODS: The authors examined patient, tumor, and treatment factors as potential predictors for local recurrence and estimated the risks of recurrence based on a review of published studies. They examined the effects of patient factors (age at diagnosis and family history), tumor factors (sub-type of DCIS, grade, tumor size, necrosis, and margins), and treatment (mastectomy, CS alone, and CS + RT). The 95% confidence intervals (CI) of the recurrence rates for each of the studies were calculated for subtype, grade, and necrosis, using the exact binomial; the summary recurrence rate and 95% CI for each treatment category were calculated by quantitative meta-analysis using the fixed and random effects models applied to proportions. RESULTS: Meta-analysis yielded a summary recurrence rate of 22.5% (95% CI = 16.9-28.2) for studies employing CS alone, 8.9% (95% CI = 6.8-11.0) for CS + RT, and 1.4% (95% CI = 0.7-2.1) for studies involving mastectomy alone. These summary figures indicate a clear and statistically significant separation, and therefore outcome, between the recurrence rates of each treatment category, despite the likelihood that the patients who underwent CS alone were likely to have had smaller, possibly low grade lesions with clear margins. The patients with risk factors of presence of necrosis, high grade cytologic features, or comedo subtype were found to derive the greatest improvement in local control with the addition of RT to CS. Local recurrence among patients treated by CS alone is approximately 20%, and one-half of the recurrences are invasive cancers. For most patients, RT reduces the risk of recurrence after CS alone by at least 50%. The differences in local recurrence between CS alone and CS + RT are most apparent for those patients with high grade tumors or DCIS with necrosis, or of the "comedo" subtype, or DCIS with close or positive surgical margins. CONCLUSIONS: The authors recommend that radiation be added to CS if patients with DCIS who also have the risk factors for local recurrence choose breast conservation over mastectomy. The patients who may be suitable for CS alone outside of a clinical trial may be those who have low grade lesions with little or no necrosis, and with clear surgical margins. Use of the summary statistics when discussing outcomes with patients may help the patient make treatment decisions.

Age Factors↗

PubMedDate not supplied

Clinical outcome in children with recurrent craniopharyngioma after primary surgery.

PURPOSE: The purpose of this article is to report the clinical outcome in children with recurrent craniopharyngioma after primary surgery. PATIENT AND MATERIALS: Fourteen children with craniopharyngioma treated with primary surgery developed local recurrence. The median time to recurrence from primary surgery was 19 months (range, 2-156 months). At first recurrence (n = 14), seven children (50%) underwent reoperation. Five children (36%) received radiotherapy, and two children did not undergo any treatment. At second recurrence (n = 7), six children underwent radiotherapy (86%), and one had surgery. External-beam radiation was delivered with 6-MV or 10-MV x-rays by use of three-dimensional conformal technique (n = 4) or fractionated stereotactic radiotherapy (n = 7) using the Laitinen stereoadapter. Total dose ranged from 54 to 55.8 Gy at 1.8 Gy/fraction. RESULTS: The median follow-up from primary surgery is 8.5 years (range, 3-15.8 years). The 5-, 10-, and 15-year overall survival was 100%, 86%, and 86%, respectively, and the disease-free survival was 92%, 60%, and 60%, respectively. The median follow-up from date of first relapse was 6 years (range, 2.5-10 years). After treatment for first recurrence, the 2- and 5-year second-recurrence-free survival was 71% and 29%, respectively. After radiotherapy, the 2- and 5-year second-recurrence-free survival was 100% and 100%, respectively, compared with 43% and 0%, respectively, for surgery alone. Univariate analysis revealed significantly superior local control with radiotherapy compared with surgery. The local control rate at last follow-up, after stratifying for treatment at first and second recurrence, were analyzed at first and second relapse was 90% and 0% after radiotherapy and surgery, respectively. If radiotherapy was used for first or second recurrence, the 5-, 10-, and 15-year relapse-free survival was 100%, 83%, and 83%, respectively, compared with 67%, 0%, and 0%, respectively, for surgery alone. The median time to second relapse after surgery for first relapse was 12 months (range, 2-36 months). After primary surgery, all 14 children developed panhypopituitarism, requiring lifelong hormone supplementation. After surgery at recurrence, three children (3/7, 43%) experienced intraoperative bleeding, resulting in permanent neurologic deficits in two. No child has shown any signs of radiation-induced optic neuropathy. DISCUSSION: In children with recurrent craniopharyngioma after radical resection, the use of three-dimensional conformal radiotherapy or fractioned stereotactic radiotherapy results in very good local control with a low incidence of complications. In young children with stable tiny recurrences, a policy of close surveillance could be adopted for the brain to mature before beginning radiotherapy. The use of secondary surgery for recurrent tumors is associated with a low cure rate and a high risk of complications.

Adolescent↗

PubMedDate not supplied

Recurrence of intussusception in childhood.

Intussusception is the most common cause of intestinal obstruction between 3 months and 6 years of age. Recurrence after reduction of intussusception in childhood is not rare. To assess the incidence and determinants of recurrence of intussusception in childhood, we conducted a prospective observation in an emergency service of a large referral center during a four-year period. We encountered 89 cases with intussusception of whom nine cases (10.1%) had episodes of recurrent intussusception. Five patients had a single recurrence, three had double recurrence and one had triple recurrence. Age of first intussusception, sex, or concurrent adenovirus infection was not related to the recurrence. None of the 27 patients who needed operative reduction had recurrence, while 9 of 62 patients who were reduced successfully by barium enema developed recurrence (P = 0.05). Compared with the first episode, significantly less vomiting, rectal bleeding and shorter duration of abdominal pain or irritable crying were noted during recurrent episodes. All the recurrent episodes were reduced successfully by barium enema. We conclude that recurrent intussusception in childhood tends to be diagnosed earlier than previous episodes and treated successfully by hydrostatic reduction without complication. Surgical reduction of recurrent intussusception may be reserved for cases of failure of hydrostatic reduction, positive peritoneal sign or existence of pathological lead point because of favorable response to barium reduction. Recurrent intussusception seldom occurs in patients who underwent surgical reduction.

Adolescent↗

PubMed2001

Survival of non-small cell lung cancer patients with postoperative recurrence at distant organs.

BACKGROUND: Recurrence after complete resection of non-small cell lung cancer (NSCLC) is often observed. However, its influence on the prognosis of patients with recurrence is still unclear. PATIENTS AND METHODS: Of 468 consecutive patients with NSCLC undergoing complete resection during 10 years, 118 experienced recurrence at distant organs. In such patients, the influence of the following variables on post-recurrent survival was analyzed; sex, age at recurrence, disease-free interval, cell type, pathological (p-) stage at operation, adjuvant therapy (thoracic radiation and/or chemotherapy), site of recurrence, and treatment against recurrence. To identify independent factors, multivariate analysis was performed for variables which were considered to be influential in univariate analysis. RESULTS: Mean post-recurrent survival time was 418 days, and survival rate at 2-years was 15.7%. Multivariate analysis revealed that female, early p-stage, younger age at recurrence, metastasectomy and intra-pulmonary metastasis were the significant favorable factors in patients with distant metastases. Adjuvant therapy and bone metastasis were marginally significant unfavorable factors. Chemotherapy for recurrence tended to prolong survival. Length of disease-free survival and post-recurrent survival exhibited a positive relationship with p-stage. Seven out of 16 patients who underwent metastasectomy survived more than 1000 days after recurrence. CONCLUSIONS: Patients even with recurrence in distant organs could expect for long survival if they are in the early p-stage of primary cancer or a resectable recurrent disease.

Adenocarcinoma↗

PubMed2001

[Total endoscopic pre-peritoneal mesh implant in primary or recurrent inguinal hernias].

INTRODUCTION: Since 1994 we perform laparoscopic total extraperitoneal hernia repair (TEP) for primary and recurrent inguinal hernias at our institution. The aim of this study was to investigate and compare the results of TEP in primary inguinal hernias and recurrent inguinal hernias and to determine whether there are differences in patient data, complication rates and outcome between these two groups. METHODS: In a prospective trial 338 patients were analyzed who underwent 500 laparoscopic TEP repairs. In all, 431 TEP repairs were performed for primary inguinal hernias, and 69 for recurrent inguinal hernias. For data acquisition the SALTC study protocol was used. All patients were clinically examined 3 and 12 months after the operation. RESULTS: The mean operation time was 67.3 min for TEP repair of primary hernias and 68.1 min for TEP repair of recurrent hernias, respectively. The conversion rate to an open procedure was 0%. Conversion from TEP into TAPP was required in 0.5% of patients with primary inguinal hernias and 1.4% of patients with recurrent inguinal hernias. As the sole difference between the two groups the intraoperative complication rate could be identified. In the TEP repair group of recurrent inguinal hernias a higher incidence of injury to the peritoneum and a higher occurrence of bleeding from the epigastric vessels was found (P = 0.03). The postoperative complication rate was identical in the two groups, amounting to 5.1% and 5.7%, respectively. No differences were found in the 1 year follow-up between the two groups. The 1-year recurrence rate was 0.5% for primary hernias. However, in the group of recurrent hernias there have been no recurrences to date. CONCLUSIONS: The use of laparoscopic TEP repair has proven to be a safe and effective treatment in patients with primary and recurrent inguinal hernias. Because of scar tissue with possible adhesions a higher intraoperative complication rate was observed in the TEP repair of recurrent hernias than in TEP repair of primary inguinal hernias. However, no single recurrence was observed in the TEP repair group of recurrent hernias. In our opinion TEP is the optimal hernia repair for recurrent and bilateral inguinal hernias.

Adult↗

PubMed2002

Laparoscopic transabdominal preperitoneal inguinal hernia repair for recurrent inguinal hernia.

Laparoscopic transabdominal preperitoneal inguinal herniorrhaphy (TAPP) was attempted on 989 hernias in 708 patients. Of these 137 (14%) hernias were recurrent after conventional anterior repair. Laparoscopic repair was performed on 135 recurrences in 120 patients (the study cohort). There were 119 males and three females with an average age of 59 years (22-83 years). One hundred twelve (83%) were the first recurrences, and 23 (17%) were multiple recurrences. In 90 recurrences (66.7%) the last repair was performed more than 10 years previously. Seventy-seven patients (64%) had a prior or concomitant repair of a contralateral hernia. Direct recurrences and right-side recurrences were more common (73% and 61% respectively). Postoperative complications occurred in 18 repairs (13%). These included 15 hematomas, two seromas, and one urinary retention. Re-recurrence occurred in one patient (0.7%) in whom hernia staples were not used. No recurrence has occurred since the hernia staples became available. We conclude that the overall incidence of recurrent inguinal hernia is high (14%). Patients with recurrent hernia have a tendency toward a contralateral hernia (64%). Most recurrences occurred 10 or more years after the previous repair (66.7%). The laparoscopic repair (TAPP) offers a good repair for recurrent inguinal hernia avoiding the scar tissue and with low complication and recurrence rates.

Adult↗

PubMedDate not supplied

Causes of death and pattern of recurrence after esophagectomy and extended lymphadenectomy for squamous cell carcinoma of the thoracic esophagus.

Improved understanding of how esophageal cancer behaves following curative resection, including knowledge of other causes of death, is essential for informed decision making. The medical records of 246 consecutive patients with squamous cell carcinoma of the thoracic esophagus who had undergone esophagectomy and lymphadenectomy of the neck, chest, and abdomen that was deemed macroscopically curative, were reviewed. Patients who had had other malignancies or anticancer treatment were excluded. Median follow-up period was 1289 days (minimum, 730 days). The initial patterns of recurrence were classified as intramediastinal, hematogenous, or lymphatic. Forty-two patients died of a cause other than recurrence. The in-hospital death rate was 3.6%, and 19 patients died of pulmonary disease. Sixteen patients developed a second primary, most of which were in the upper aerodigestive tract; five of those patients died. Ninety-eight patients developed recurrence. Depth of invasion and number of nodal metastases predicted recurrence. The pattern of recurrence was intra-mediastinal, lymphatic, and hematogenous in 11, 21, and 67 patients, respectively. The patients with lymphatic recurrence survived longer than the patients with either of the other types of recurrences. Eighty-three percent of recurrences presented within 24 months. The time-to-recurrence correlated with survival after recurrence. The disease recurred earlier in patients with advanced stage than unadvanced disease at the time of esophagectomy. The time-to-recurrence, and anticancer therapy after the recurrence related to the survival. Meticulous care must be taken to detect hematogenous recurrence as early as possible so that adjuvant therapy may be started. Maintaining a good performance status permits the use of aggressive therapy should there be a recurrence. Pulmonary physiotherapy and treatment of metachronous primary tumors may improve overall survival.

Aged↗

PubMed2003

[Study of the causes of recurrence of patients with glottic cancer after partial laryngectomy].

OBJECTIVE: To study the causes of recurrence of patients with glottic cancer after partial laryngectomy and to propose some possible measures for the prevention of glottic cancer postoperative recurrence. METHOD: A retrospective review of consecutive 46 patients with recurrent glottic cancer after partial laryngectomy was conducted. The sites of primary tumors, the ways of operations and the sites of tumor recurrence were investigated. RESULT: Among 46 patients diagnosed with glottic cancer recurrence after partial laryngectomy, 32 cases were local recurrences and 14 were regional metastasis or local-regional recurrences. 13 cases of the second primary lesions in larynx were the cause of the failure and occupied 40.6% of all cases of local recurrences (13/32). In the regional metastasis, the commonest recurrent site was encountered in the upper neck. The upper neck metastasis or local recurrences were common in local recurrent cases treated by salvage surgery. CONCLUSION: It is very important for the prevention of glottic cancer recurrence after partial laryngectomy to properly manage the upper cervical lymph node in the advanced glottic cancers and the local recurrences in larynx and to know the relation of the postoperative recurrence of glottic cancer and the second primary lesions in larynx and carry out corresponding management.

Adult↗

PubMed1992

[Study on local recurrence in patients undergoing curative surgical resection of lung cancer].

Clinical features of recurrence in patients of lung cancer undergoing curative surgical resection were examined with special reference to the local recurrence. Subjects were 308 patients, consisting of 160 adenocarcinomas, 121 squamous cell carcinomas, 15 large cell carcinomas, 12 small cell carcinomas. They underwent curative resection in our department between 1973 and 1987. Local recurrence developed in 54 patients (18%). There was no significant difference in the incidence of local recurrence among the four histological types of carcinoma. According to the pathological stage, the incidence was 9% in stage I, 15% in stage II, and 35% in stages IIIA+IIIB. The local recurrence was subdivided into the following patterns: 1) lymphatic metastases to the hilar, mediastinal, or supraclavicular sites, 2) recurrence at the surgical margin, 3) malignant pleuritis or pericarditis, 4) so-called "endobronchial metastasis". The incidence of recurrence according to the patterns was 15%, 2%, 2% and 1%, respectively. The incidence of recurrence due to lymphatic metastases was correlated significantly with the pN factor but not with the pT factor. Patients with central type lung cancer showed a significantly higher incidence of lymphatic recurrence than patients with the peripheral type. Patients having postoperative radiotherapy to prevent local recurrence showed a lower incidence of lymphatic recurrence than patients having no radiotherapy. In conclusion, lymphatic recurrence was the most frequent pattern in local recurrence after curative resection of lung cancer, and therefore improvements in the operative procedure of lymphatic dissection, as well as in postoperative adjuvant therapy including radiotherapy will be urgently required for the purpose of reducing local recurrence.

Adenocarcinoma↗

PubMed2005

[Dysfunction of lower urinary tract in 5-18 years old children with recurrent urinary tract infections].

The purpose of this article was to evaluate function of lower urinary tract for 5-18 years old children with recurrent urinary tract infections and to compare urodynamic changes in two groups: with recurrent lower urinary tract infections and with recurrent upper urinary tract infections. 35 urodynamic studies in 5-18 years old children (3 boys and 32 girls) with recurrent urinary tract infection were performed at the Clinic of Children's Diseases of Kaunas University of Medicine in 2004. 21 of these children had recurrent lower urinary tract infections and 14 recurrent upper urinary tract infections. Changes in urodynamics were present in 91.4% of children: in all children with recurrent lower urinary tract infections and in 11 children with upper recurrent urinary tract infections (78.6%). Detrusor instability was found in 20 (57.1%) children: in 14 (66,7%) with recurrent lower urinary tract infections and in 6 (42.9%) with recurrent upper urinary tract infections. In 32 (85%) children detrusor instability was accompanied by changes in bladder volume. Changes of bladder volume were present for 26 (74.3%) children with recurrent urinary tract infections. Detrusor after contraction was diagnosed in 57.1% of children with recurrent lower urinary tract infections and in 28.6% with recurrent upper urinary tract infections. For children with recurrent urinary tract infections attention for urinary tract dysfunction must be paid.

Adolescent↗