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PubMed2001

Laparoscopic repair of inguinal hernias with higher risk for recurrence: independent assessment of results from 121 repairs.

This study attempts to determine by independent review the results of laparoscopic transabdominal preperitoneal (TAPP) inguinal hernia repair for hernias with increased risk for recurrence. Indicators used for increased recurrence risk were recurrent hernias or simultaneously repaired bilateral inguinal hernias. Office and hospital records of all such patients who had undergone TAPP repair were reviewed from one surgeon's 242-patient laparoscopic inguinal hernia database from 1992 to 1998. All were called for assessment by an independent surgeon at least 4 months postoperatively (median 34 months). Those unable to come in person were interviewed by telephone. There were 121 hernias: 34 recurrent and 100 bilateral (13 overlap). Recurrence rate was 3 per cent, which was similar for repair of bilateral and recurrent hernias. All recurrences occurred within 3 months of surgery. No unknown recurrence was detected by the independent observer. Laparoscopic TAPP inguinal hernia repair, often claimed as the method of choice for bilateral and recurrent hernia repair, is indeed a safe and effective procedure with a low early recurrent rate in these higher-risk situations.

Databases, Factual↗

PubMedDate not supplied

Carcinoembryonic antigen for the detection of recurrent disease following curative resection of colorectal cancer.

BACKGROUND: During recent years a discussion about cost-effectiveness and importance of follow-up determination of carcinoembryonic antigen (CEA) after curative resection of large bowel cancer has developed. PATIENTS AND METHODS: Between 1990 and 1998 follow-up CEA levels of 1,321 patients after curative colorectal cancer resection were prospectively collected in cooperation with family physicians, CEA determinations were made with different assays by various laboratories. The reported findings were adjusted for the different methods used. RESULTS: 306 patients developed recurrent disease following curative cancer resection (23.2% of all patients). Regarding the role of follow-up CEA determination, they were divided into: I. no preoperative CEA determination/insufficient follow-up (N = 47); II. no elevation of CEA with primary cancer, a) elevation with recurrent disease (N = 62), b) no elevation at any time point (N = 53), c) role of CEA not completely elucidated (N = 41); III. elevated CEA levels with primary cancer, a) no increase with recurrent disease (N = 21), b) increase with other symptoms of recurrent disease (N = 45), c) increased levels as early symptom of recurrent disease (N = 37). 30 patients (9.8% of all patients with recurrent disease; 2.3% of all patients) with increased CEA levels at the time of recurrent disease underwent surgical resection with curative intention (R0 resection). CONCLUSIONS: Our findings indicate that up to 47% of the patients with recurrent disease and 11% of all patients (N = 144, groups IIa + IIIb + IIIc) could benefit from routine follow-up CEA determinations after curative colorectal cancer resection. Nonetheless, only 2.3% of all patients with elevated CEA levels underwent R0 resection of recurrent disease. Despite these detection and R0 resectability rates, CEA plays a crucial role in the early detection of recurrent disease and remains an important part of routine patient care after curative resection of colorectal cancer.

Biomarkers, Tumor↗

PubMed1999

[Inquiring the causes of recurrence of hepatocellular carcinoma after surgical resection].

OBJECTIVE: To analyze the causes of recurrence of hepatocellular carcinoma (HCC) after resection according to pathologic findings of the resected primary tumor and angiographic features of the recurrent tumor. METHODS: In this series, 142 cases with recurrent HCC were analyzed with respect to (1) size, number, gross and histologic findings of the primary tumor, (2) time when recurrence occurred, (3) size, number, blood supply, staining property of, and deposition of lipiodol oil in the recurrent tumor. Following angiography, arterial embolization was performed. RESULTS: In 101 of the 142(71.1%) cases, the primary tumor was > 5 cm in diameter, and in 41 cases (28.9%) it was < 5 cm. In 67.7% of the cases, the capsule of the primary tumor was incomplete or absent. In 47 cases (33.1%), satellite tumor nodules were seen during operation but they were seen on pathologic sections in 94 cases (66.2%). Tumor thrombus was present in the portal vein in 26 (18.3%) and 121 cases (85.2%) during operation and on pathologic examination, respectively. In the majority of the cases (99/142), recurrence occurred within 6 months after operation. The recurrent foci consisted of multiple tumor nodules of < 5 cm in 68.3% of the cases. On angiography, the recurrent tumors were rich in blood supply with good deposition of lipiodol. CONCLUSION: Recurrence is apt to occur in HCC patients with large (> 5 cm) primary tumor which has incomplete or no capsule, satellite tumor nodules and portal vein tumor thrombus. It is suggested to perform angiography 1-2 months after surgery to detect early recurrence and, if confirmed, the patients can be treated by transcatheter arterial chemo-embolization.

Adult↗

PubMed2002

[The plug system and laparoscopic hernioplasty in recurrent inguinal hernia].

A total of 1511 patients were operated on at the 1st Department of Surgery Charles University in Prague during 1996 through 2000. Of this number, 81.3% underwent surgery for primary and 18.7% for recurrent inguinal hernia. Among the patients with recurrences, 81% had the first, 15% patients the second, and 4% at least the third episode of recurrent hernia. A total of 604 patients were operated on during 1999-2000, when a plug system (Bard Mesh Perfix Plug) was introduced into surgery protocols. Of this number, 113 patients had a recurrent hernia with an identical ratio of recurrences. The following plastic surgery interventions were carried out during the latter period: McVay-Lotheissen (54.2%), TAPP (26.5%), PHS (13.2%), Plug (3.3%), and Lichtenstein (2.6%). The following interventions were used when operating recurrences: McVay-Lotheissen (20.3%), TAPP (31%), PHS (21.2%), Plug (16.8%), and Lichtenstein (9.7%). During the 1-24-month follow-up period, recurrences occurred 1x after the TAPP procedure, 1x after McVay-Lotheissen, and 1x after the Lichtenstein procedure (95% and 88% patients who underwent plug and Lichtenstein procedures, respectively, were included in the follow-up). Comparison of plug vs. TAPP in patients with recurrent hernia (Plug/TAPP): mean age of patients: 62/45 years, length of operation: 66/48 minutes, overall post-operative morbidity: 9.4%/3.6%, hospitalization: 4.3/1.8 days, return to the working process 28 days (range 9-38 days) vs. 7.2 days (range 2-15 days). Both procedures can be considered safe and reliable interventions for treatment of recurrent inguinal hernia. They meet the requirements for elastic strength (more the plug procedure), closure, and bridging of defects even in several layers. The plug system can be implanted under local anaesthesia, it is capable of bridging large defects in a firm and elastic manner, and appears to be a very suitable solution for large defects in patients with advanced biological age. In these indications, the plug system brings many benefits but also the risk of more open access and greater "quantity" of materials. TAPP appears to be more suitable in younger patients with recurrences and large defects. We evaluate favourably in particular, all aspects of the postoperative period. An experienced team of surgeons is needed to achieve good results in both procedures.

Hernia, Inguinal↗

PubMed2002

[Factors of recurrence of basal cell carcinomas of the eyelid].

UNLABELLED: Basal cell carcinomas of the eyelids can recur, although these recurrences are uncommon. In this retrospective study, all basal cell carcinomas treated at Reims Regional Hospital since 1985 were studied to determine the frequency of recurrence and the factors for recurrence. MATERIAL: and methods: All basal cell carcinomas treated at Reims Regional Hospital since 1985 were studied. A total of more than 200 patients had been operated on for basal cell carcinoma during this period. Those with orbital extension or a location on 2 eyelids were excluded. Epidemiological factors such as sex, age, tumor location, tumor size, and treatment were noted. Recurrences were uncommon, presenting in ten patients. These recurrences were studied in relation to the existing epidemiological data and the treatment provided, particularly the histological results. DISCUSSION: Basal cell carcinomas located on only 1 eyelid or 1 canthus can usually be treated with one surgical intervention. Extemporaneous histological study can preclude a local recurrence in most cases, but in some cases the condition may recur some years later. Factors favoring recurrence are difficult to determine. CONCLUSION: The authors report the number of recurrences after surgical treatment of basal cell carcinomas of the eyelids. The recurrences are relatively uncommon when the treatment has been done with extemporaneous histological examination of the resected edges. These recurrences arise particularly in relatively young patients with no other obvious risk factor.

Basal Cell Carcinoma↗

PubMed2001

[Local recurrence of nasopharyngeal carcinoma with normal mucous membrane after radiation therapy: MR imaging findings].

OBJECTIVE: The purpose of this work was to investigate and analyze the MR imaging features of postradiation local recurrence of nasopharyngeal carcinoma (NPC) with normal mucous membrane. METHODS: 24 such cases were studied. The diagnosis of NPC recurrence was pathologically confirmed in 15 patients, and was corroborated by repeated radiation therapy and serial follow-ups in 9 patients. MR imaging routine procedures and Gd-DTPA enhancement were performed for all patients. RESULTS: The MR imaging findings were as follows: 1. The recurrent tumor mass was located in the prestyloid space in 8 patients, with skull base erosion and intracranial infiltration in 7 patients; 2. Retrostyloid space recurrence in 2 patients; 3. Direct bony erosion of the skull base in 7 patients; 4. Recurrence in nasal cavity and ethmoid sinuses in 3 patients; 5. Submucous cystic recurrence in 2 patients; 6. Mixed patterns of recurrence in 2 patients. Except 2 cases of cystic tumor recurrence, all cases exhibited slight hypo- or iso-intensity on T1-weighted images, slight hyper-intensity on T2-weighted images, and moderate to marked enhancement after Gd-DTPA administration. CONCLUSION: There are several special patterns of local NPC tumor recurrence after radiation therapy in the presence of normal nasopharyngeal mucosa. MR imaging is the method of choice to depict the location and extent of NPC tumor recurrence.

Adult↗

PubMed2002

Recurrence and metastasis of hepatocellular carcinoma: progress and prospects.

BACKGROUND: Recurrence after resection of hepatocellular carcinoma (HCC) is a major obstacle to improve prognosis. Therefore, further improvement of long-term survival may depend on prevention and treatment of the recurrent tumor. OBJECTIVE: To evaluate the progress of surgery for HCC, the risk factors for recurrence, and clinical and basic studies on the prevention and management of recurrence and metastasis after resection of HCC. DATA SOURCES: A review of currently available data in the mentioned areas. DATA SYNTHESIS: Encouraging changes in the prognostic pattern were observed when the primary liver cancer (PLC) data of 1958-1967 (n=118), 1968-1977 (n=356), 1978-1987 (n=715) and 1988-1997 (n=2038) were compared. The 5-year survival was 2.8%, 7.3%, 27.1% and 52.5%, respectively, and the 10-year survival 2.8%, 4.3%, 19.8% and 39.9%, respectively. Risk factors for recurrence included symptomatic patient, high gamma-glutamyl-peptidase (gamma-PGT), large tumor size, portal vein embolus, advanced tumor stage, etc. Active hepatitis activity in the nontumorous liver and perioperative transfusion enhanced the recurrence. Molecular research into the invasiveness of HCC identified some factors positively related to invasiveness, P16 and P53 mutation, H-ras, c-cerbB2, mdm2, transforming growth factor (TGF), epidermal growth factor receptor (EGF-R), matrix metalloproteinase-2 (MMP-2), urokinasetype plasminogen activator (uPA), its receptor (uPA-R) and inhibitor (PAI-1), intercellular adhesion molecule-1 (ICAM-1), vascular endothelial growth factor (VEGF), platelet-derived endothelial cell growth factor (PD-ECGF), and basic fibroblast growth factor (bFGF). In contrast, some factors were negatively related to HCC invasiveness: nm23-H1, Kai-1, tissue inhibitor of metalloproteinase-2 (TIMP-2), integrin 5, and E-cadherin. Re-resection of subclinical recurrence yielded a 5-year survival of 56.0% calculated from the first resection (n=202). Postoperative transarterial chemoembolization (TACE, n=103), hepatic artery cannulation during operation (n=105), postoperative biotherapy (n=49), and cryohepatectomy (cryosurgery followed by immediate resection of the frozen tumor, n=84) might decrease the recurrence rate, and the 3-year recurrence rate was 7.6%, 18.0%, 11.1%, and 30.1%, respectively. Minimal intraoperative blood loss and transfusion could reduce postoperative recurrence, although the exact mechanism remains to be elucidated. CONCLUSIONS: HCC invasiveness is the major topic to be studied, particularly in the molecular level. Anti-angiogenesis, biotherapy, novel approach based on molecular findings, and multidisciplinary interventions might also be important for HCC.

Carcinoma, Hepatocellular↗

PubMed2004

Inguinal hernia recurrence following preperitoneal Kugel patch repair.

Three hundred eighty-six preperitoneal inguinal herniorrhaphies using a polypropylene Kugel patch (Davol) were performed in 355 consecutive patients by six surgeons. Variables for recurrence evaluated included age, gender, hernia type, whether the Kugel patch was placed for a primary or recurrent hernia, and the experience of the surgeon. Of 336 patients with long-term follow-up available (18 months to 63 months, median 42 months) 28 recurrences developed 1 to 48 months (mean 16 months) after 366 Kugel patch repairs (7.7%). Recurrence was highest (27.8%) in the subset of patients who had a Kugel patch placed for recurrent inguinal hernias (P < 0.05). Patients with direct primary hernias involving the entire floor had a recurrence rate of 22.7 per cent (P < 0.05). Patient age and gender had no bearing on recurrence. Surgeon experience did play a role, as the recurrence rate was 18.2 per cent during each surgeon's first 36 cases and 2.9 per cent thereafter (P < 0.0005). Surgeons using a preperitoneal Kugel patch for inguinal herniorraphy had a recurrence rate that was unacceptably high. The technique may not be suitable for repair of recurrent inguinal hernias or primary large direct inguinal hernias. Surgeons in this study saw a learning curve of 36 cases.

Digestive System Surgical Procedures↗

PubMedDate not supplied

Patterns and relevant factors of tumor recurrence for extrahepatic bile duct carcinoma after radical resection.

BACKGROUND/AIMS: The complete surgical removal of bile duct cancer offers the only chance of cure. Long-term survival, however, is very limited because of frequent recurrence after surgery. As it is important to know the mode of recurrence and its relevant factors for early detection, prevention, and selecting an ideal strategy for adjuvant therapy, we determined the frequent mode of recurrence after curative surgery and analyzed its risk factors. METHODOLOGY: Eighty-three patients who underwent radical resection for bile duct cancer were evaluated. The tumors comprised 24 proximal and 59 middle or distal bile duct carcinomas. The clinicopathologic findings and the modes of recurrence were reviewed. RESULTS: Tumor recurrence developed in 18 of 24 proximal and 34 of 59 non-proximal cancers at an average interval of 16.7 and 17.8 postoperative months, respectively. T-stage (p=0.031) and age (p=0.019) were independent factors affecting recurrence on multivariate analysis. The factors, however, were different according to tumor location that while histological grade was the only factor for proximal tumor, nodal status and age were independent factors for non-proximal tumors. The precise recurrent sites were identifiable in 14 proximal and 24 non-proximal lesions. While the predominant pattern of recurrence was locoregional in most proximal tumors (13/14), non-proximal tumors showed frequent recurrences at distant sites including liver, peritoneum, and lung (13/24). The median survival was longer in non-proximal (45.3 months) than proximal tumor (18.0 months), in T0,1-tumor (>120 months) than T2,3-tumor (20.4 months), and in N0-tumor (60.2 months) than N1,2-tumor (13.0 months). The 5-year survival rates were also higher in non-proximal cancers (46.7% vs. 32.0%). CONCLUSIONS: Our results suggested that the need for postoperative adjuvant therapy, and strategies to detect and to prevent recurrence should be individualized not only by stage but also by tumor location to improve survival in patients with extrahepatic bile duct cancer.

Age Distribution↗

PubMedDate not supplied

Risk factors of intrahepatic recurrence after curative resection of hepatocellular carcinoma.

BACKGROUND/AIMS: Although the risk factors for the development of intrahepatic recurrence after hepatectomy for hepatocellular carcinoma (HCC) have been widely studied, little attention has been given to the prognostic factors affecting such patients. METHODOLOGY: Intrahepatic recurrence occurred in 105 (56%) of 188 patients who underwent curative hepatic resection of HCC and were discharged from the hospital. Among them, 17 (16%) also had simultaneous extrahepatic recurrence. Independent prognostic factors were evaluated by multivariate analysis using Cox's proportional hazards model. RESULTS: Multivariate analysis revealed that presence of extrahepatic recurrence, hepatitis B, and non-surgical treatments for recurrence were independent predictors of poor overall survival after initial hepatic resection or after recurrence. Risk factors of extrahepatic recurrence were young age, solitary and large HCC, high hepatitis activity, and large amount of intraoperative blood loss and blood transfusion. CONCLUSIONS: Survival of patients with intrahepatic recurrent HCC after resection should be stratified by the type of recurrence, type of hepatitis, and type of treatment for recurrence.

Aged↗

PubMed2006

Survival rate of recurrent cervical cancer patients.

OBJECTIVES: To determine the survival rate of recurrent cervical cancer patients and factors influencing survival. MATERIAL AND METHOD: The subjects were identified from the Gynecologic Oncology Unit tumor registry record The pathological, clinical data including the follow-up information of recurrent cervical cancer patients who were treated in the Gynecologic Oncology Unit, Bangkok Metropolitan Administration Medical College and Vajira Hospital between 1992 and 2003 were retrospective reviewed. RESULTS: During the study period, 144 recurrent cervical cancer patients were identified. Mean age of the patients was 52 years. The median time from complete primary treatment to disease recurrence was 14.8 months. Seventy-two patients (50%) had previous stage III disease. The most common histopalogy was squamous cell carcinoma (72.9%). Approximately half of the recurrences were local (73 patients or 50.7%) and distal recurrences were encountered in 71 patients or 49.3%. Overall 109 patients received treatmentfor their recurrences, i.e. radiation alone (55 patients, 38.2%), chemotherapy (31 patients, 21.5%), chemotherapy and radiation (18 patients, 12.5%), surgery (5 patients, 3.5%), and 35 patients (24.3%) received only supportive treatment. Two-year survival rate of the group was 18.5%. Median survival was 8 months (95%CI, 7-10 months). The patients with only local recurrence had a 2-year survival rate of 22.2% compared to 14.6% in those with distant recurrence. (p = 0.245). Two-year survival rate of those who received any kind of treatment was 22.4% compared to 4.0% in those who received only supportive treatment (p = 0.014 and 0.017 in univariable and multivariable analysis respectively). CONCLUSION: Survival rate of recurrent cervical cancer was low, especially in those who received only supportive treatment.

Carcinoma, Squamous Cell↗

PubMed1991

Factors affecting local or regional recurrence in breast cancer.

Between 1975 and 1989, 535 patients with infiltrating ductal carcinoma of the breast in various clinical stages were treated by modified radical mastectomy and axillary node clearance, followed by chemotherapy, endocrine therapy or radiotherapy. Median follow-up was 3 years (5 months to 15 years). Fifty-eight local or regional recurrences occurred. The 5-year and 10-year actuarial risks of breast recurrences were 14% +/- 2% and 23% +/- 4%, respectively. Using multivariate analysis with the Cox regression model, the most important multivariate-adjusted independent contributing factors to local or regional breast recurrences were age less than or equal to 40 (p less than 10(-4), relative risk = 2.94), positive lymph nodes greater than 3 (p less than 10(-3), relative risk = 2.57), and multicentricity (p = 0.044, relative risk = 2.73). The overall 5-year survival rate of recurrent patients was 64 +/- 7%, and was significantly worse when breast recurrence occurred in the first 18 months after operation. The multivariate-adjusted relative risk of death for early recurrence was 4.35 (p = 0.04). The unadjusted 5-year survival rate for early recurrence was 58% +/- 1%, and 85% +/- 8% for late recurrence. This study confirms the relationship between young age and low breast control rates. It emphasizes the adverse prognosis of early breast recurrences as compared to the relatively favorable outcome of late recurrences.

Adult↗

PubMed2006

[Recurrent laryngeal nerve decompression].

OBJECTIVE: To study the result of recurrent laryngeal nerve decompression in the treatment of functional disturbance of recurrent laryngeal nerve caused by thyroid surgery or thyroid benign tumors. METHODS: From October 2002 to June 2005, 9 cases of unilateral recurrent laryngeal nerve paralysis and 4 cases of glottic insufficiency were treated with recurrent laryngeal nerve decompression. Seven cases of the nerve paralysis were caused by the surgery of benign thyroid tumors resection which were done by general surgeons. The paralysis nerve were found ligated in 6 of the 7 cases, and nerve-scar adhesion was found in the other case. Beside nerve decompression, type I thyroplasty have been undertaken in the same time to 2 of the 7 cases with severe hoarseness. One case of thyroid adenoma and 1 case of nodular goiter with unilateral recurrent laryngeal nerve paralysis were treated with tumor resection and nerve decompression respectively. Four cases of glottic insufficiency, 3 cases of nodular goiter were treated with tumor resection and nerve decompression, and Hashimoto's thyroiditis in the other case was treated with partial lobe resection and nerve decompression. The recovery of function of recurrent laryngeal nerve were detected to the recovery of vocal cord mobility through electrolaryngoscope postoperatively. RESULTS: For the 7 cases of recurrent laryngeal nerve paralysis after thyroid surgery, the motion of the paralysed vocal cord restored within 3 months in 6 cases with the interval of 1 week to 3 months between the two operations, no restoration was found in the other patient with an interval above 4 months between the two operations after 1 year follow-up. For the thyroid adenoma and nodular goiter with unilateral recurrent laryngeal nerve paralysis, the motion of paralysed vocal cord restored within 3 months respectively after decompression. The glottic closure recovered within 1 week after decompression in the 4 cases of the glottic insufficiency patient. CONCLUSIONS: Exploration and decompression as soon as possible to the paralysed recurrent laryngeal nerve because of thyroid surgery are very important for the restoration of the function of the nerve. For the patient with serve hoarseness, nerve decompression and type I thyroplasty at the same time is recommended in an effort to relieve hoarseness as soon as possible. For the functional disturbance of recurrent laryngeal nerve with thyroid neoplasm patient, early exploration and decompression of the nerve is imperative.

Decompression, Surgical↗

PubMed2006

Intraoperative pathological investigation of recurrent nerve nodal metastasis can guide the decision whether to perform cervical lymph node dissection in thoracic esophageal cancer.

Three-field lymph node dissection has been widely used to treat thoracic esophageal cancer, but is very invasive and can cause serious complications. Whether cervical lymph node dissection should be performed in all patients with thoracic esophageal cancer remains controversial. We pathologically examined the recurrent nerve lymph nodes during surgery in patients with thoracic esophageal cancer to determine the presence or absence of lymph node involvement. In patients without recurrent nerve nodal involvement, cervical lymph node dissection was not performed. Treatment outcomes were analyzed to evaluate whether intraoperative pathological investigation was a useful procedure. Among 71 patients with thoracic esophageal cancer who underwent 3-field lymph node dissection, the rate of cervical lymph node metastasis was 40.9% in patients with recurrent nerve nodal metastasis on intraoperative pathological investigation, as compared with 10.2% in patients without recurrent nerve nodal metastasis (p=0.007). Multiple logistic-regression analysis showed that recurrent nerve nodal metastasis was a strong predictor of cervical lymph node metastasis (odds ratio, 2.98; 95% confidence interval, 1.139-7.775; p=0.03). Among 41 patients who underwent intraoperative pathological investigation, 10 had recurrent nerve nodal metastasis and underwent cervical lymph node dissection. Two of these patients had histological evidence of cervical lymph node metastasis. The remaining 31 patients had no recurrent nerve nodal metastasis on intraoperative pathological examination and therefore did not receive cervical lymph node dissection. None of these patients had cervical lymph node recurrence on follow-up. We compared patients who underwent intraoperative pathological investigation with those who underwent conventional 3-field lymph node dissection (without performing intraoperative pathological investigation). The rates of cervical lymph node recurrence were similar among the groups (2.6% vs. 6.7%), but the 3-year survival rate was significantly higher in the patients who underwent intraoperative pathological dissection (83.3%) than in those who underwent 3-field dissection (57.2%; p<0.05). Although this was a retrospective study, our results suggest that outcomes of patients undergoing cervical lymph node dissection according to the results of intraoperative pathological investigation are at least as good as those in patients undergoing 3-field lymph node dissection. We conclude that intraoperative pathological investigation of recurrent nerve nodal metastasis is useful for determining whether cervical lymph node dissection should be performed in patients with thoracic esophageal cancer.

Aged↗

PubMed1991

[Control of colorectal cancer recurrence treated with curative surgery: results of a prospective study].

Eighty four colorectal cancer patients who underwent presumably curative surgery were considered as candidates for control recurrence study. The study protocol included physical exam, blood biochemistry, chest X-ray, and CEA every 3 months (every 6 months after the third year) as well as an opaque enema, colonoscopy, abdominal echography, and pelvic CT scan (in case of abdominoperineal resection of a distal rectum cancer) every six months (once a year after the third year). Thirteen patients (15%) refused to participate in the study or abandoned it early, thus 71 patients are finally evaluated. After a mean follow up of 64 months, 32 patients presented a total of 42 recurrences (several patients underwent complete resection of the recurrence and presented new relapses). Recurrence diagnosis was always done by conventional exam (there was no second look guided by CEA values). Complete resection of the initial recurrence was achieved in 22% of cases (7 patients), but only 2 (6.5% of total relapses) are up to date tumor free and potentially cured after a long follow up. The most useful tests for the diagnosis of organ specific recurrences were chest X-ray (lung metastasis), liver echography (liver metastasis), liver echography (liver metastasis), colonoscopy (intraluminal local recurrence) and pelvis CT scan (pelvic recurrences). The carcinoembryogenic antigen was very specific, but only moderately sensitive, in predicting tumoral recurrency. However, CEA levels at relapse predicted the complete resection of recurrent tumor (58% with carcinoembryogenic antigen equal to or lower than 10 ng/ml compared to 5.5% with carcinoembryogenic antigen above this value p less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

Adenocarcinoma↗

PubMed1991

Value of follow-up in the management of recurrent colorectal cancer.

The purpose of this article was to study the effectiveness of a prospective follow-up programme in patients after curative surgery for colorectal cancer. Of the initial 151 selected patients, 61 (40%) developed a recurrence in whom only six cases (10%) of potentially curable recurrent lesions were detected. The first clues to recurrence in the 61 patients were history or physical examination in 49%, a rising CEA in 29% and a positive imaging finding in 10%, being difficult to decide which test first signalled a recurrent cancer in an additional 11%. Endoscopy and CEA determinations were the most rewarding investigations. CEA was a sensitive means of identifying disseminated recurrent disease and liver metastases compared with liver function tests or liver ultrasound every 3 months. Endoscopy was useful in the diagnosis of local recurrences. However no follow-up test was capable of detecting recurrent colorectal cancer when it might still have been curable. As a direct result of this follow-up programme 15 patients (23%) underwent re-exploration. No symptomatic patients were candidates for curative re-operation. Of the asymptomatic patients six (four colonic and two rectal cancers) (19.5%) were re-resected for cure. Only three of these were alive and without evidence of disease, 40, 43 and 69 months later so that long term survivors after curative re-resection represent only 5% of all patients with recurrences (7.2% of the recurrent colonic cancer and 3% of the rectal cancer). Our follow-up programme did not permit us to alter the incidence of disseminated recurrent disease, and the effectiveness of the curative re-resection represents an increase of only 1.3% in the global 5-year survival rates for colorectal cancer. Our study does not demonstrate any great value of 'classical' postoperative follow-up programme.

Adult↗

PubMed1990

Simultaneous measurement of CA 125, CA 19-9, tissue polypeptide antigen, and immunosuppressive acidic protein to predict recurrence of ovarian cancer.

We studied the utility and limitations of CA 125 for the early diagnosis of recurrence of ovarian cancer and investigated whether the precision of diagnosis could be enhanced by combining CA 125 with other tumor markers. Of 181 patients with epithelial ovarian cancer, 149 were in clinical remission and 35 had developed recurrence. Thirty-four women with recurrence had preoperative CA 125 values of 35 U/mL or more, and 21 (62%) had CA 125 levels of 35 U/mL or more at the time of detection of clinical recurrence. Eleven had levels that remained elevated 3 months before identification of the recurrence. However, in 13 cases CA 125 was below 35 U/mL at the time recurrence was detected. To enhance the efficacy of tumor markers to predict recurrence, patients in whom multiple tumor markers had been measured were studied retrospectively. At the time of clinical recurrence and 3 months earlier, the diagnostic sensitivity of CA 125 alone for recurrence was 64 and 33%, respectively, whereas the sensitivity of a combination of tumor markers (CA 125, CA 19-9, tissue polypeptide antigen, and immunosuppressive acidic protein) was 89 and 66%. Thus, prediction of recurrence of ovarian cancer can be improved by the use of a combination of these tumor markers.

Adenocarcinoma↗

PubMed1985

Recurrent subretinal neovascularization.

A retrospective analysis of a consecutive series of patients treated with krypton red laser (KRL) photocoagulation for subretinal neovascularization (SRN) secondary to drusen-related macular degeneration (DMD) was carried out to investigate the frequency and nature of recurrent neovascularization (recurrence). A classification of various types of recurrences based on the clinical and fluorescein angiographic features and the onset of their appearance in the postoperative course was used in this study. Patient, fundus, and membrane variables were examined in search of relevant high risk factors predisposing to recurrences. The membrane's proximity to the fovea and its relative lack of pigmentation were individual factors which were associated with a high risk of recurrence (P less than 0.05 for distance and P = 0.005 for color). Multivariate analysis also indicated that a greater distance from the fovea (P less than 0.05) and a darker color (P = 0.002) were favorable features to the primary membrane, reducing the probability of a recurrence. Overall, 39% of the patients experienced recurrences (23% of the patients had treatable recurrences and 16% had non-treatable recurrences extending under the center of the fovea). The membranes recurred predominantly at the margin of the photocoagulation burn. The recurrences were also noted relatively early in the postoperative course, 65% within two months after photocoagulation of the primary membrane. The fluorescein angiographic and clinical nature of these membranes and the visual effect of retreatment are also discussed in the paper.

Aged↗