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PubMed1994

Extensive resection of the bile ducts combined with liver resection for cancer of the main hepatic duct junction: a cooperative study of the Keio Bile Duct Cancer Study Group.

BACKGROUND: It is necessary to elucidate whether extensive resection of the bile ducts combined with liver resection is a feasible and valid procedure for cancer of the main hepatic duct junction. METHODS: Based on a multi-institutional study, resectability rate, operative mortality, long-term survival, and factors contributory to long-term survival were investigated. RESULTS: Between January 1973 and December 1991, a total of 158 patients with this cancer were admitted to Keio University Hospital and six affiliated institutions. Eighty-three (53%) of the 158 patients underwent resection, with seven (8.4%) postoperative deaths. The operations were performed by seven surgeons who were in charge of liver surgery at each respective institution. The 5-year actuarial survival rate of the 83 patients who underwent resection was 20%. Twelve patients survived more than 5 years, and these patients underwent curative resection. Three of the 12 patients were doing well after 10 years. Procedures of liver resection were right trisegmentectomy in two patients and left lobectomy with resection of the right portal vein in one. CONCLUSIONS: It is clear that cancer of the main hepatic duct junction has become a curable disease. The operation is a valid procedure that can be widely practiced by competent surgeons.

Adenocarcinoma↗

PubMed2002

Vapor resection: a good alternative to standard loop resection in the management of prostates >40 cc.

BACKGROUND AND PURPOSES: The morbidity of transurethral vesection of the prostate (TURP) necessitates constant attempts at modifications to the standard equipment and technique. Patients with larger prostates (>40 cc) need a longer time for the procedure, and the blood loss, requirement for irrigation fluid, and incidence of postoperative complications tend to be greater. We report on the safety and efficacy of TURP with the thick vapor resection loop compared with the standard wire loop in comparable groups of patients with prostates >40 cc. PATIENTS AND METHODS: We randomized 100 patients with benign prostatic hyperplasia (BPH) into two groups of 50 each which were similar in age. The inclusion criteria included an indication for prostatectomy and prostate size >40 cc. Patients who were on finasteride preoperatively (six) and those who had histopathologic adenocarcinoma of the prostate (three) were excluded. Preoperative evaluation included assessment of International Prostate Symptom Score (IPSS), prostate volume by abdominal ultrasonography, maximum flow rate (Q(max)), and residual urine volume. The two groups were similar in the signs and symptoms of BPH. Patients in Group 1 underwent transurethral vapor resection of the prostate (TUVRP) using the vapor resection loop (Wing trade mark; Richard Wolf, Germany), while patients in Group 2 underwent TURP using a standard wire loop. All procedures were performed by consultant urologists with equivalent experience. We used a Martin ME 401 (Gebruder Martin, Tuttlingen, Germany) electrosurgical generator with settings of 120 to 150 Watts and 50 to 70 W for cutting and coagulating, respectively, for the thick loop and 70 to 80 W and 40 to 50 W for the standard loop. Operating time, resected tissue weight, duration of catheterization, nursing contact time, hospital stay, hemoglobin change, serum sodium concentrations, and any complications were noted and analyzed using the Kruskal-Wallis paired variables test, and P values were calculated. P value <0.04 was considered significant. The IPSS, Q(max), and residual urine volume were reevaluated at 6 months and 1 year after the procedure and compared for the two groups. RESULTS: The median prostate volume was 63 cc and 54 cc in Groups 1 and 2, respectively, and the median resected weight was 20 and 19 g, respectively (P = NS). The differences in operating time (median 45 v 60 minutes; P < 0.0001), intraoperative irrigant use (15 v 21 L; P < 0.0001), and intraoperative blood loss (median 52.5 v 150 mL; P < 0.0001) in the two groups were statistically significant. Peroperative blood loss was estimated by the indicator dilution method of Freedman et al in three 5-mL samples of the irrigant fluid and arriving at the average of the three values and adjusted for the volume of irrigant fluid used. The differences in postoperative irrigant (P < 0.01) and catheter duration (P = 0.04) were also significant. Two patients received blood transfusion in Group 2 and none in Group 1. The difference in the change in hemoglobin and serum sodium postoperatively in the two groups was not statistically significant. The complications were dysuria in six patients lasting for a month and one capsular perforation in Group and incontinence lasting for 6 months in two patients and stricture in one patient in Group 2. The efficacy, assessed with IPSS, Q(max), and residual urine volume, was comparable at 6 months and at 1 year. CONCLUSION: The use of a thick vapor resection loop for TURP coupled with higher generator settings as recommended for them, especially for prostates >40 cc, is beneficial, as it significantly reduces operating time, blood loss, irrigant requirement, nursing contact time, and duration of catheterization, besides providing clear vision during surgery and ease of resection. There was no reduction in efficacy or increase in complications.

Aged↗

PubMed1991

Surgical resection of pulmonary metastases from colorectal adenocarcinoma. Special reference to repeated pulmonary resections.

Pulmonary resection of metastatic lesions from colorectal adenocarcinoma was performed in 35 patients. The cumulative 5-year survival was 38%. The primary site of cancer was the colon in about half of the patients. Patients with a solitary metastasis or tumors smaller than 3 cm in diameter survived longer than did patients with multiple metastases or tumors larger than 3 cm but the differences were not significant. Other factors, including age, sex, histologic grade of tumor, location and stage of primary carcinoma, location of pulmonary metastases, disease-free interval, and type of pulmonary resection, had no apparent influence on survival time. The lung was the major site of recurrence following pulmonary resection. Seven patients underwent two or more pulmonary resections for metastasis from a colorectal carcinoma. At the time of last follow-up, four patients were alive and free of recurrent disease at 5, 34, 39, and 58 months after the second pulmonary resection. These data suggest that some patients will survive for a long time following pulmonary resection of colorectal metastases, and for highly selected patients, repeated pulmonary resection may further extend survival.

Adenocarcinoma↗

PubMed1976

Abdominoperineal resection following anterior resection.

A series of 11 patients undergoing abdoninoperineal resection for "suture line recurrence" following anterior resection is presented. Five-year survival is 10%. Technically, the procedure is difficult and major problems are encountered, including large blood loss and ureteral complications. These patients had an inadequate distal margin of resection at the time of anterior resection. The survival of this group of patients underscores the importance of making the correct judgment about anterior or abdominoperineal resection at the time of the initial presentation of the patient. The phrase "suture line recurrence" is a misnomer; all of these patients had advanced pelvic malignancy. If the adequacy of the distal margin is questionable or a distal margin of 5 cm cannot be obtained safely at the time of anterior resection, abdominoperineal resection should be performed, as the opportunity for cure of a recurrence should this rule be compromised is limited.

Female↗

PubMed1990

Recurrence of resected esophagogastric adenocarcinoma: results of re-resection.

Isolated local recurrence following potentially curative resection for carcinoma of the esophagus or esophagogastric junction does not necessarily imply pending systemic disease and early demise. While radiation alone or in combination with chemotherapy is standard treatment for such patients, resection is another available option. Resection may also be a consideration should localized disease persist after non-operative therapy in the absence of metastases. A 5 year retrospective review was performed examining 204 resections performed prior to 1989. Only 5 patients underwent resection of locally recurrent esophagogastric (EG) adenocarcinoma during this period. No squamous carcinoma recurrences were resected. One patient is well 15 months later while another died at 18 months of other causes without recurrence. Recurrence after re-resection occurred at 8, 11, and 24 months in the 3 other patients. Although there were no postoperative deaths, major complications occurred in 4 patients. All 5 patients swallowed normally after operation.

Adenocarcinoma↗

PubMedDate not supplied

Surgery for hyperthyroidism: hemithyroidectomy plus contralateral resection or bilateral resection? A prospective randomized study of postoperative complications and long-term results.

Fifty consecutive patients undergoing surgical treatment for hyperthyroidism were randomized to have either bilateral subtotal resection (n = 23) or hemithyroidectomy plus contralateral resection (n = 27). No significant differences in operating time or intra-operative bleeding were found. No postoperative bleeding and no temporary or persistent recurrent laryngeal nerve paralysis occurred. Four patients who underwent bilateral resection and 2 patients who had hemithyroidectomy resection needed temporary calcium supplementation, and the serum calcium concentrations were slightly lower during the first few postoperative days in the patient undergoing hemithyroidectomy/resection. No persistent hypocalcemia occurred in either of the groups. At follow-up 3-4 years (mean 3.6 years) postoperatively, 1 patient in the bilateral resection group developed recurrent hyperthyroidism; no patients in the hemithyroidectomy/resection group developed recurrent hyperthyroidism. Twelve (44%) patients in the hemithyroidectomy/resection group and 8 (35%) patients in the bilateral resection group needed thyroxine supplementation because of a rise in thyroid stimulating hormone concentration combined with clinical signs of hypothyroidism that developed during follow-up. Hyperthyroidism can be treated by hemithyroidectomy plus contralateral resection without increasing the risk of complications. The results also suggest that when using this method, a slightly larger thyroid remnant should be left to avoid an increase in the incidence of hypothyroidism postoperatively.

Adult↗

PubMed2003

Laparoscopic ileocecal resection in Crohn's disease: a case-matched comparison with open resection.

BACKGROUND: Despite some encouraging preliminary results, the role of laparosropic surgery in the treatment of Crohn's disease (CD) is a subject of controversy and still under evaluation. The aim of this case-matched study was to compare the postoperative course of laparoscopic and open ileocecal resection in patients with CD in order to define the potential role of laparoscopic surgery in CD. METHODS: From 1998 to 2001, 24 consecutive patients with isolated Crohn's terminal ileitis treated by laparoscopic ileocecal resection (laparoscopy group) were compared with 32 patients matched for age, gender, duration of disease, preoperative steroid treatment, fistulizing disease, and associated surgical procedure, and treated by open resection (open group). RESULTS: In the laparoscopy group, four procedures (17%) were converted. There were no deaths. The morbidity rate was 20% in the laparoscopy group and 10% in the open group (NS). There was no significant difference between the two groups in operating time, size of bowel resection and resection margin, postoperative morphine requirement, resumption of intestinal function, tolerance of solid diet, or length of hospital stay. CONCLUSIONS: Laparoscopic ileocecal resection in CD is safe and effective, even for fistulizing disease. There are no significant differences between laparoscopic and open ileocecal resection, especially in terms of the mortality and mortality rates. Consequently, because laparoscopic surgery seems to offer cosmetic advantages, it should be considered the procedure of choice for patients with ileocecal CD.

Adult↗

PubMed1999

Laparoscopic sigmoid resection for acute and chronic diverticulitis. An outcomes comparison with laparoscopic resection for nondiverticular disease.

BACKGROUND: Sigmoid diverticulitis is a common benign condition; however, cases of acute and chronic diverticulitis may be difficult for the surgeon to treat. We designed a study to compare the outcomes of patients who undergo laparoscopic resections for sigmoid diverticulitis with those who have similar resections for other indications. METHODS: From a prospectively accumulated database of 397 consecutive laparoscopic colorectal procedures performed by three surgeons, we reviewed the outcomes of 178 patients who underwent laparoscopic sigmoid resections with primary anastomosis. RESULTS: Laparoscopic sigmoid colectomies or anterior resections were performed in 22 patients with acute diverticulitis (AD), 70 patients with chronic diverticulitis (CD), and 86 patients with nondiverticular disease (ND). Patients with ND were significantly older than those with AD or CD (67 +/- 14 year versus 55 +/- 13 year, 55 +/- 12 year, p < 0.05). Conversion to open surgery was required in three AD patients (14%), three CD patients (4%), and 17 ND patients (20%) (chi2 = 8.23, p = 0.016). In cases completed laparoscopically, there was no significant difference in median operative time (AD, 165 min; CD, 150 min; ND, 165 min), proportion of patients with intraoperative complications (AD, one; CD, six; ND, one), or postoperative complications (AD, four; CD, 13; ND, 11). The occurrence of a postoperative complication significantly prolonged median time to full diet (4 days vs 3 days, p < 0.001) and discharge (9 days vs 5 days, p < 0.001) but not return to normal activity (16 days vs 15 days). CONCLUSIONS: In this study, patients who underwent laparoscopic sigmoid colectomies and anterior resections had similar outcomes regardless of diagnosis. This finding substantiates our view that laparoscopic resections for diverticulitis can be performed safely and with the same benefits as resections for other indications.

Acute Disease↗

PubMed1998

Appraisal of surgical resection of gallbladder carcinoma with special reference to hepatic resection.

Carcinoma of the gallbladder a gastrointestinal malignancy with an extraordinarily poor prognosis. However, aggressive surgery, with special reference to hepatic resection, may improve survival. To prove this, we performed a retrospective analysis over an 18-year period to investigate the experience of a center that began employing liver resection in patients with gallbladder cancer in 1978. The analysis was based on patients' documentation and regular follow-up to January 1996. The standard procedures were extended cholecystectomy (cholecystectomy with lymphadenectomy and wedge hepatic resection), anatomic segmentectomy of segments IVa and V, and extended hepatectomy. Significance was assessed by the log-rank test. Thirty-nine patients were resected, curatively in 41% (n = 22; group I) and palliatively in 31% (n = 17; group 2). In 28% (n = 15; group 3) a palliative or no operation was performed. Only curatively resected patients were analyzed and followed up to January 1996. No patients in group 1 died postoperatively. The actuarial 5-year survival rate of the patients with curative resection was 55%. Four patients had stage I, two had stage II, four had stage III, and two had stage IV disease according to TNM-classification. Six of the 16 patients without lymph node metastasis survived more than 5 years. A significant difference in long-term survival was recognised between stage II and stage IV patients and between stage (pT1a)- and (look table 1b) (pT1b)-patients (P < 0.01). Diagnostic efforts should focus on detecting early stages I and II gallbladder cancer. In advanced cases, aggressive surgery, particularly with hepatic resection, is the method of choice and is successful even in patients 70 years and older.

Aged↗

PubMed1993

The motor response to intestinal resection: motor activity in the canine small intestine following distal resection.

BACKGROUND: The mucosal response to intestinal resection has been extensively studied; little is known of the motor response. Our aim was to evaluate motility in the intestinal remnant following distal resection. METHODS: Motor activity, duodenocecal transit, nutrition, and absorption were studied over a 3-month period in control animals (n = 9) and in groups of dogs who had undergone 25% (n = 6), 50% (n = 5), and 75% (n = 5) distal resection. RESULTS: Diarrhea and steatorrhea developed in each resection group, and the 75% group alone developed true short bowel syndrome. Resection did not affect migrating motor complex frequency or periodicity; phase 1 duration was shorter in the 75% group (control vs. 75%: 22 +/- 4 vs. 6 +/- 2 minutes, P < 0.03). The most striking motor effect was the development of prominent cluster activity in the distal part of the remnant in 25% and 50% resection animals and throughout the remaining intestine in the 75% group. Duodenocecal transit slowed during the study period from 13 +/- 1 to 20 +/- 2 minutes in the 50% and from 10 +/- 2 to 14 +/- 2 minutes in the 75% group (P < 0.05). CONCLUSIONS: The initial motor response to major resections of the distal small intestine is dominated by the development of abnormal patterns. This motor disruption may contribute to the symptomatology and clinical features of the short bowel syndrome.

Animals↗

PubMed2004

Causes of death within 1 year of resection for lung cancer. Early mortality after resection.

OBJECTIVES: Some of the lung cancer patients who are treated surgically with curative intent ultimately die in the early postoperative period. The aim of this study is to analyze the causes of death within 1 year of resection for lung cancer in our patients. METHODS: Six hundred and twenty patients, who underwent resection for lung cancer with a curative intent were reviewed retrospectively. Eighteen patients (2.9%) died due to postoperative complications or within the first month and 51 (8.4%) patients (group 1) died within the first year after operation. Fifty-one patients (group 1) were compared with the survivors (group 2) in terms of age, gender, preoperative FEV 1, pathological tumor node metastasis (TNM), histopathological subtypes, type of resection, completeness of the resection, preoperative Karnofsky performance status and application of postoperative radiotherapy. RESULTS: Pathological TNM (P<0.001) type of resection (P<0.01) histopathological subtype (P<0.001) completeness of the resection (P<0.05) and postoperative radiotherapy (P<0.001) were determined to be significant factors in mortality within 1 year after resection for lung cancer. CONCLUSIONS: The patients with pathological stage 3 disease, with large cell histology or who had undergone pneumonectomy have a higher risk of mortality within 1 year. These patients require detailed preoperative work up in terms of metastatic disease and cardiopulmonary physiological status.

Adult↗

PubMed2006

Endoscopic submucosal dissection allows curative resection of locally recurrent early gastric cancer after prior endoscopic mucosal resection.

BACKGROUND: Repeat endoscopic mucosal resection (EMR) to cure locally recurrent early gastric cancer (EGC) is difficult to perform because the initial EMR causes submucosal fibrosis; however, ESD allows submucosal dissection through the fibrosis and provides an en bloc specimen. OBJECTIVE: The objective was to determine the safety and efficacy of ESD and compare the results to historical controls. DESIGN: This was a retrospective, case-control study. PATIENTS: We used our prospectively entered database (1993-2003) to identify 64 patients who had locally recurrent EGC after EMR. MAIN OUTCOME MEASUREMENTS: We defined the resections as curative when the lateral and vertical margins were free of cancer and repeat endoscopy showed no recurrent disease. RESULTS: Among 46 patients who underwent ESD, 41 (89.1%) en bloc resections were achieved compared to none in 18 conventional procedures (P < .0001). The specimen of 1 lesion (2.4%) out of 41 en bloc resections was histologically nonevaluable, compared with 10 lesions (43.4%) in 23 piecemeal resections (P < .0001). Three residual tumors (27.3%) were found in the 11 nonevaluable specimens. Three perforations occurred during ESD; all were successfully treated endoscopically with endoclips. LIMITATIONS: The limitation of the study was retrospective design. CONCLUSIONS: ESD provides high en bloc resection rate for locally recurrent EGC after previous EMR. In turn, en bloc resections allow precise histological staging to be assessed and prevent residual disease and recurrence.

Aged↗

PubMed2005

[Long-term results of hysteroscopic resection of endometrial polyps in 367 patients. Role of associated endometrial resection].

OBJECTIVE: To assess the results of hysteroscopic resection of endometrial polyps and the eventual role of associated endometrial resection. PATIENTS AND METHODS: Retrospective study. Between 1998 and 2001, 367 patients had hysteroscopic resection of endometrial polyps, which were initially confirmed by diagnostic hysteroscopy. Fifty-four percent of these had associated endometrial resection. RESULTS: Five intraoperative complications and/or incidents were noted, but there was no major complication. 83% of patients were followed up and the median follow-up period was 40 months (range 17-66 months). The success rate in this study was 96.4%. This is higher in the group of patients that had associated endometrial resection: 98.3 vs 93.7%. DISCUSSION AND CONCLUSION: Hysteroscopic resection is the optimal method for treatment of benign endometrial polyps. Associated endometrial resection in older patients or in patients not desiring to conserve their fertility potential improves the success rate and decreases the rate of recurrences.

Adult↗

PubMed1999

5-aminolevulinic acid-induced fluorescence endoscopy applied at secondary transurethral resection after conventional resection of primary superficial bladder tumors.

OBJECTIVES: A prospective investigation was carried out to evaluate the use of 5-aminolevulinic acid (5-ALA)-induced fluorescence diagnosis with secondary transurethral resection (TUR). METHODS: Fifty patients underwent secondary TUR of the former resection area 6 weeks after conventional TUR for superficial bladder carcinoma. 5-ALA-induced fluorescence diagnosis was used in addition to standard white light endoscopy. All former resection areas were biopsied regardless of fluorescence findings. In addition, specific red fluorescent areas were resected, as were suspicious areas seen at white light endoscopy. RESULTS: One hundred thirty areas or tumors were resected. The sensitivity of fluorescence cystoscopy was 77.8% (95% confidence interval 52.4% to 93.6%). Residual tumors were found in the area of the former resection in 7 (14%) of 50 patients; 4 of these 7 were fluorescence negative and 3 were fluorescence positive. In an additional 7 patients (14%), exclusively fluorescing tumors not visible under white light could be detected outside the areas of former resection (n = 5, Stage pTaG1/2; n = 1, Stage pT1G1/2; n = 1, carcinoma in situ). CONCLUSIONS: Despite high sensitivity, fluorescence diagnosis at this early stage of control does not allow us to evaluate sufficiently the granulation tissue of necrotic areas after TUR without biopsy. The main advantage of the 5-ALA-induced fluorescence endoscopy is in the evaluation of untreated urothelium because of the easier detection of tumors not visible by conventional endoscopy.

Adult↗

PubMed2000

Phase II trial of induction high-dose chemotherapy followed by surgical resection and radiation therapy for patients with marginally resectable non-small cell carcinoma of the lung.

The combination of carboplatin and paclitaxel is an active regimen in non-small cell lung cancer (NSCLC). Historically, patients with stage III disease have manifested higher response rates than patients with metastatic disease, and patients achieving a pathologic complete response to induction chemoradiation therapy prior to surgery have shown better long-term outcome. Based upon our pilot data using high-dose carboplatin and paclitaxel, we designed a phase II trial in patients with marginally resectable stage IIIA NSCLC. Ten patients, with bulky nodal stage IIIA disease, initially received etoposide (2 g/m2) and granulocyte colony-stimulating factor (G-CSF) to mobilize peripheral blood stem cells (PBSC). Two cycles, 28 days apart, of carboplatin (AUC 12 in seven patients; AUC 16 in three patients) and paclitaxel (250 mg/m2) were administered with filgrastim (5 microg/kg) and PBSC support. After re-evaluation, patients underwent a thoracotomy followed by radiotherapy (44-60 Gy) if deemed resectable, or radiotherapy alone (60 Gy) if not resectable. The median age was 58.5 years (48-66) with a median ECOG performance status of 0 (0-1). Histology was adenocarcinoma in seven patients; the remainder had either squamous cell, large cell or bronchoalveolar carcinoma. Based on CT radiography, the overall response rate was 40%. Eight of ten patients underwent resection with four right pneumonectomies, three right upper lobectomies and one wedge resection of the right upper lobe. Six patients had a complete resection. Of eight patients resected, four were downstaged by induction therapy, three remained unchanged and one was found to have more extensive disease. The remaining two patients developed metastatic disease while receiving chemotherapy. The median dose of postoperative radiotherapy was 54 Gy (35-66 Gy). Actual median follow-up for all patients was 89 weeks (25 to 136+). The actuarial median overall survival was 124 weeks (25 to 136+) and time to progression was 57 weeks (17 to 136+). The median dose of carboplatin delivered expressed as mg/m2 was 779 (615-1540). Neutropenic fever occurred in two patients during the initial mobilization cycle only. The median number of units of RBC and/or platelets transfused was 0 (0-2 and 0-6, respectively). There were no significant non-hematologic toxicities. High-dose induction chemotherapy with stem cell rescue is feasible and safe with an acceptable response rate. Thoracotomy, including pneumonectomy and postoperative radiotherapy, were well tolerated by patients after undergoing high-dose induction chemotherapy with no apparent increase in peri-operative morbidity. The pathologic complete response rate was low--one out of ten patients. These results indicate that dose escalation of induction chemotherapy does not improve response rates even in this highly selected patient population. Accordingly, the complexity and potential toxicity of high-dose chemotherapy, as delivered in this trial as neoadjuvant treatment of non-small cell lung cancer, is not warranted.

Adenocarcinoma↗

PubMed2004

Colorectal cancer with non-resectable synchronous metastases: should the primary tumor be resected?

OBJECTIVES: In asymptomatic patients presenting with non-resectable synchronous metastatic disease from colorectal adenocarcinoma, the beneficial effect of resecting the primary tumor remains to be documented. The aim of this study was to compare survival of patients with metastatic colorectal cancer who underwent elective resection of the primary tumor to those who did not. METHODS: A retrospective analysis of patients with metastatic colo-rectal cancer treated between June, 1996 and December, 1999 was performed. Overall survival was compared between patients who underwent first-line resection of the primary colorectal tumor (group 1) or those who did not undergo elective resection of the primary (group 2). The probability of surgical resection of the primary tumor for gastrointestinal complications in group 2 was evaluated. RESULTS: Thirty-one and 23 patients were included in groups 1 and 2 respectively. Five patients (21.7%, 95% confidence interval CI95% 4.9-38.5%) in group 2 required surgical treatment for intestinal obstruction due to the primary tumor. Two clinical characteristics were significantly different between groups 1 and 2: rectal localization (9.7% versus 34.7%; P=0.03) and presence of fewer than three metastases (29.0% versus 4.3%; P=0.03). Survival curves were not significantly different (logrank). Median duration of survival was 21 and 14 Months, respectively (P=0.718). CONCLUSION: In patients with non-resectable synchronous metastatic disease, non-surgical management of the primary tumor is a rational alternative if asymptomatic. A prospective randomized trial integrating the quality-of-life factor should be organized.

Adult↗

PubMed2003

Chylothorax: a complication following lung resection in patients with NSCLC - chylothorax following lung resection.

BACKGROUND: Chylothorax following lung resection is not as rare as a postoperative complication as previously reported due to systematic lymph node dissection in patients undergoing lung resection for NSCLC. METHODS: We retrospectively reviewed our cases that had undergone lung resection for NSCLC and investigated the frequency and outcome of chylothorax in these patients. The factors investigated were the site and type resection, technique of systematic lymph node dissection, tumour histology and disease stage. RESULTS: Seven of 673 patients that had undergone lung resection were complicated by chylothorax (1.04 %), following lobectomy in 5 (1.28 %) and pneumonectomy in 2 (0.7 %) (p = 0.36). The fistula closed spontaneously in 5 patients between 4 - 17 days postoperatively (71 %). One of the patients in the conservative management group died on the 28th day postoperatively due to pneumonia (14 %). The remaining 2 patients underwent rethoracotomy on the 5th and 6th days. CONCLUSIONS: These results suggest that the site of operation, type resection, and technique of systematic nodal dissection, tumour histology and disease stage do not influence the development of chylothorax in patients with NSCLC. The chylous fistula following lung resection for NSCLC tends to close spontaneously.

Adenocarcinoma↗

PubMed2003

Liver resection (and associated extrahepatic resections) for metastatic well-differentiated endocrine tumors: a 15-year single center prospective study.

BACKGROUND: The timing and benefits of hepatectomy remain controversial for metastatic well-differentiated endocrine neoplasms, which are generally considered slow growth tumors. However, surveillance alone yields only a 22% 5-year survival when metastases occur. The aim of this study was to determine the results of hepatic and extra hepatic resections and to clarify the indications of surgery. METHODS: To define the role of hepatic resection, a database regrouping all patients (n = 47) who underwent hepatectomy with curative intent (R0 status) for well-differentiated endocrine neoplasms in the Gustave-Roussy Institute was constructed in 1984. New prognostic factors such as tumor growth and liver tumor mitotic index were studied. Median follow-up was 62 months. RESULTS: Hepatectomy was associated with extrahepatic tumor resection in 77% of the patients (primary tumor in 51%, lymph nodes in 21%, peritoneal carcinomatosis in 25%, and other in 6%). Resection was curative (R0) only in 53% of the patients, despite removing at least 97% of the tumor in each patient. Mortality was 5%, and morbidity was 45%. Median survival was 91 months, 5-year and 10-year overall survival rates were 71% and 35%, respectively. Liver recurrence rate was 75% at 10 years. No prognostic factor was correlated with overall survival in this population in which at least 97% of the tumor load was resected. The completeness of surgery, the presence of bilateral liver metastases, the number of liver metastases (>10) and a primary tumor from pancreatic origin were all significantly correlated with the disease-free survival. Preoperative tumor growth rate, mitotic index, and Ki67 expression were not predictive of prognosis. No significant prognostic factors could be found by the comparison of the patients who did and did not recur during the 3 years after hepatectomy. CONCLUSION: Hepatectomy for liver metastases from well-differentiated endocrine neoplasms is indicated when all visible intra- and extra hepatic lesions can be resected safely. The number, size, and localization of the tumor sites are less important than performing a complete (or near-complete) resection.

Adult↗