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At least 145 records · Page 8Linked to original sources

PubMed1991

Regional mesenteric recurrence of colorectal cancer after anterior resection or left hemicolectomy: inadequate primary resection demonstrated by angiography of the remaining arterial supply.

Inferior mesenteric angiography was carried out in 14 patients with locoregional recurrence following sphincter-saving resection of a colorectal primary tumour in the left hemicolon or rectum. The aim was to check the margins of clearance of the lymphatic drainage. All patients had been operated on electively and with curative intent. All patients had a biopsy-proven recurrence and 11 of the 14 patients (79%) showed residual arteries that should have been resected at primary surgery, and at laparotomy for the recurrence incomplete resection of the lymphatic drainage area was confirmed. In 6 patients the recurrence was resected, in 4 of them with no evidence of microscopic residual disease. From these findings it may be argued that the lymph nodes incompletely resected at primary operation may have been the origin of the locoregional recurrence. Angiography may detect this situation, and may be worthwhile when planning a reintervention.

Angiography↗

PubMed1997

Motorised resection device for transurethral resection of the prostate: a laboratory evaluation.

Transurethral resection of the prostate is the most common method of relieving urinary outflow obstruction secondary to prostatic enlargement. However, this procedure can be responsible for various complications, including irrigant-fluid absorption and blood loss, both of which are strongly dependent on operation duration time. To reduce the latter, a new resection device has been designed for transurethral prostatectomy. The device basically consists of a rotating cutting loop controlled externally, with three degrees of freedom, to fit the adenoma shape. Its performance is assessed in vitro by drilling conical and semi-ellipsoidal cavities in agar gel models. The mean difference between the calculated and obtained cavity volumes is 3% (SD = 0.9%). The volume cutting rate, found to be independent of the type of cavity drilled, is equal to 2.9 +/- 0.3 cm3 min-1. The advantages of this motorised resection device prototype are reduction in operation duration and accuracy of the resected volume. In vivo resection of a 20 cm3 adenoma in less than 15 min can be expected.

Agar↗

PubMed2003

Comparison of local resection of the head of the pancreas combined with longitudinal pancreaticojejunostomy (frey procedure) and duodenum-preserving resection of the pancreatic head (beger procedure).

The etiology of pain in chronic pancreatitis may be ductal hypertension, increased parenchymal pressure, or neural damage. It is difficult to assess the severity of pain in this patient population, a problem made more challenging by the frequency of narcotic dependency. Therapeutic interventions developed to relieve the pain of chronic pancreatitis include denervation of the pancreas, decompression of the main duct of the pancreas, resection of part or all of the diseased pancreas, and reduction of pancreatic secretion. Operative intervention for patients with chronic pain is indicated when severe pain, complications of pain, or potential malignancy are present. The operations that consistently provide long-lasting pain relief all have in common resection of all or a portion of the head of the pancreas. Adverse effects on exocrine and endocrine function, nutrition, and quality of life are related to the amount of pancreas resected. The ideal procedure should be easy to perform, have a low morbidity and mortality rate, provide long-lasting pain relief, and not augment endocrine and exocrine insufficiency. No single operation fulfills this ideal. The local resection of the head of the pancreas combined with longitudinal pancreaticojejunostomy (LR-LPJ) proposed by Frey and the duodenum-preserving resection of the head of the pancreas (DPHR) proposed by Beger are discussed. The conceptualization, development, and technique of LR-LPJ are discussed, and comparisons of patient outcomes are made with the outcomes of other procedures for chronic pancreatitis.

Chronic Disease↗

PubMed1999

Value of extended resection and intraoperative radiotherapy for resectable pancreatic cancer.

Since 1984 intraoperative radiotherapy (IORT) combined with extended resection for pancreatic cancer has been performed in our clinic to prevent local recurrence. Following extended resection, a dose of 30 Gy of 9- to 12-MeV electrons is administered to the operative field, including the paraaortic area from the diaphragm above to the inferior mesenteric artery below. The 5-year survival rate was 15.3% in all 37 cases, 20.2% in patients who had macroscopic tumor clearance, and 16.9% in patients with stage IVa tumor according to the Japanese classification. In autopsies of 10 patients who underwent combined therapy, four had local recurrence enclosed by thick, firm connective tissue. There was no local control recurrence in two patients who underwent noncurative resection. Enhanced local control induced by the combined therapy, however, has only a limited impact on overall survival because of the systemic spread of disease, especially hepatic metastases. At present, as we have no effective treatment for hepatic metastases, it is important to perform an extended resection with IORT on carefully selected patients. The combined therapy may offer the best approach to control local recurrence when dealing with advanced, but not highly advanced, cancer as defined by the stage of tumor. Therefore a combination of IORT and extended resection can have an impact on the results of surgical treatment for pancreatic cancer when anticancer treatment of hepatic metastases is established.

Adult↗

PubMed2001

Laparoscopic abdominoperineal resection and anterior resection with curative intent for carcinoma of the rectum.

BACKGROUND: Within a 5-year period, 380 rectal carcinoma patients undergoing laparoscopic abdominoperineal excision or laparoscopic anterior resection were recruited to a multicenter study by 23 institutions in Germany and Austria. This study was initiated by the Laparoscopic Colorectal Surgery Study Group. RESULTS: One hundred forty-nine patients (39.2%) underwent abdominoperineal resection (APR), and 231 patients (60.8%) were treated by anterior resection (AR). The mean operating time was 208 min, and the conversion rate was 6.1%. Intraoperative complications, mostly vascular or bowel injuries, were observed in 22 patients (5.8%). Overall, a total of 257 postoperative complications and problems occurred in 143 patients, resulting in a morbidity rate of 37.6%. In the AR group, the anastomotic leakage rate increased as the distance of the tumor from the anal verge decreased. The perioperative mortality rate was low (6/1.6%). Most of the patients received a high transsection of the inferior mesenteric artery with radical lymph node dissection (342/90.0%); the mean number of recovered lymph nodes was 13.0, with considerable variation among the individual institutions. Intraoperative tumor cell spillage was reported in 12 patients (3.2%). Sufficient follow-up findings are available for 288 (77%) patients. To date, 19 patients have sustained a local recurrence (6.6%), and 30 (10.4%) have developed distant metastases. Within the (admittedly limited) mean follow-up of 24.8 months, the overall survival rate is 86.6%, the disease-free survival (freedom from both local recurrence and distant metastases) rate is 62.4% for APR, with the corresponding rates for AR being 71.7 and 54.8%, respectively, as established by the Kaplan-Meier function. These data show no alarmingly high recurrence rates at this time. CONCLUSION: In principle, laparoscopic anterior resection with curative intent generates considerably more reservations than laparoscopic abdominoperineal resection, which is technically much easier to perform.

Abdomen↗

PubMed1997

A four-point fixation method for the resection of early gastric cancer, with particular reference to the analysis of cases of incomplete resection.

We developed a four-point fixation method for the resection of gastric lesions. The aim of the present study was to compare the characteristics of early gastric cancer between the complete-resection group (56 patients) and the incomplete-resection group (10 patients). The results showed that the incomplete-resection group included a significantly higher proportion of patients with large lesions and patients in whom the lesion was located at the body or lesser curvature of the stomach. These results were similar to those previously reported for treatment with conventional strip biopsy. However, in contrast to conventional strip biopsy, relatively few patients with depressed-type gastric cancer were included in the incomplete-resection group. This is considered one of the most important features of the four-point fixation method.

Adenoma↗

PubMed2006

Comparison between hepatic wedge resection and anatomic resection for colorectal liver metastases.

Some investigators have suggested that wedge resection (WR) confers a higher incidence of positive margins and an inferior survival compared with anatomic resection (AR) of colorectal liver metastases (CLM). We sought to investigate the margin status, pattern of recurrence, and overall survival of patients with CLM treated with WR or AR. We identified 253 consecutive patients, in a multi-institutional database from 1991 to 2004, who underwent either WR or AR. WR was defined as a nonanatomic resection of the CLM, and AR was defined as single or multiple resections of one or two contiguous Couinaud segments. Clinicopathologic factors were analyzed with regard to pattern of recurrence and survival. One hundred six WRs were performed in 72 patients and 194 ARs in 181 patients. There was no difference in the rate of positive surgical margin (8.3%), overall recurrence rates, or patterns of recurrence between patients treated with WR vs. AR. Patients who had a positive surgical resection margin were more likely to recur at the surgical margin regardless of whether they underwent WR or AR. The median survival was 76.6 months for WR and 80.8 months for AR, with 5-year actuarial survival rates of 61% and 60%, respectively. AR is not superior to WR in terms of tumor clearance, pattern of recurrence, or survival. WR should remain an integral component of the surgical treatment of CLM.

Adult↗

PubMed2004

Experimental study of extracorporeal lung resection in dogs: ex situ sleeve resection and autotransplantation of the pulmonary lobe after extended pneumonectomy for central lung cancer.

OBJECTIVE: Extracorporeal lung resection as an alternative to pneumonectomy for central lung cancer is a procedure in which the unilateral lung is extirpated, removing the pulmonary lobe with the cancers and replanting the residual pulmonary lobe. The aim of this study was to investigate whether extracorporeal lung resection for lung cancer can be performed safely. METHODS: Nineteen dogs were divided into the control and extracorporeal lung resection groups. The former (n = 5) underwent lung autotransplantion, and the latter was subdivided into ND1 (n = 7) and ND2 (n = 7) groups on the basis of the manner of lymph node dissection. By comparing the 3 groups, the adverse effects of lymph node dissection were examined. RESULTS: All dogs in the control group had no complications. Four dogs in the ND1 group survived for 90 to 630 days after the operation. In the ND2 group 5 dogs succumbed within 30 days after the operation, although the other 2 dogs survived for 391 and 573 days, respectively. Bronchopulmonary fistulas were seen in 1 of the ND1 dogs and 3 of the ND2 dogs. Two of the latter were free of thrombus formation in the pulmonary arteries and veins of the autografts. In the ND2 group, compared with the control and ND1 group, the tissue blood flow at the bronchial anastomotic site indicated reduction between the 3rd and 14th postoperative days. CONCLUSION: The extensive lymph node dissection had severe adverse effects on bronchial anastomotic healing in extracorporeal lung resection. Therefore extracorporeal lung resection can be applied to only a very limited number of patients with N0 or N1 disease.

Anastomosis, Surgical↗

PubMed2003

A serum factor(s) after small bowel resection induces intestinal epithelial cell proliferation: effects of timing, site, and extent of resection.

BACKGROUND/PURPOSE: After small bowel resection (SBR), serum induces proliferation in rat intestinal epithelial cells (RIEC-6). This study was designed to elucidate the effects of postoperative time interval, site, and magnitude of SBR on RIEC-6 proliferation. METHODS: Serum was collected from rats at various times after a 75% mid-SBR or sham operation and added to RIEC-6 cells and growth determined over 5 days. In other experiments, cell growth was recorded in the presence of serum from rats after 25%, 50%, or 75% SBR, or after jejunal or ileal SBR. RESULTS: SBR serum enhanced RIEC-6 cell proliferation as early as 12 hours after resection. The extent of SBR directly correlated with the level of adaptation; however, the effects on cell growth by the serum were similar. SBR serum induced proliferation equally after either proximal or distal resection. CONCLUSIONS: Serum contains a factor that stimulates intestinal cell proliferation soon after SBR but independent of the degree or site of intestinal resection. Although humoral factor(s) play a role in the early induction of enterocyte proliferation after SBR, further modulation of adaptation to varied lengths or sites of intestinal resection are probably governed by mechanisms independent of factors that circulate in the serum.

Adaptation, Physiological↗

PubMed1996

Resection of the internal carotid artery and replacement with greater saphenous vein: a safe procedure for en bloc cancer resections with carotid involvement.

PURPOSE: Many patients who have advanced cancer of the neck will have involvement of the internal carotid artery. The management of this condition remains controversial, and a wide range of therapeutic options have been suggested including ligation, "shaving" the tumor off the carotid, or en bloc resection and replacement of the internal carotid artery by polytetrafluoroethylene, vein, or superficial femoral artery. We reviewed our experience with en bloc resections of the internal carotid artery in a consecutive series of patients who had malignancies involving the internal carotid artery at a single institution from 1989 to 1995. METHODS: We used a retrospective chart review based on a list of 20 patients generated by the Hospital Cancer Registry and our Vascular Surgery clinical database. RESULTS: All patients had their internal carotid artery removed and replaced with a greater saphenous vein while they were under general anesthesia. A resection of their cervical malignancy was also performed. Concomitant myocutaneous flaps were rotated over the carotid bypass in six (30%) patients. Eight (40%) of the bypass grafts were nonreversed, and 12(60%) were reversed, with a clear trend towards using nonreversed veins more recently. Shunts were used in 18(90%). Eighteen of the 20 patients had some form of intraoperative contamination including tracheostomies, pharyngostomies, or fistulas. Half of the patients had intraoperative radiation therapy, and 16(80%) patients underwent operation for recurrent cancer. During the follow-up period two (10%) patients had strokes (one minor and one major), and one patient had a graft blowout, which was treated by ligation without stroke. One patient had an asymptomatic occlusion of his graft. CONCLUSIONS: From these results we conclude that the use of the greater saphenous vein to replace the internal carotid artery after en bloc resection is not attended by a high rate of infectious complications or graft blowout even in the presence of intraoperative tracheopharyngeal contamination and that the greater saphenous vein is the conduit of choice for replacing an internal carotid artery after cancer resections.

Carcinoma, Squamous Cell↗

PubMed1998

Single-step fronto-orbital resection and reconstruction with individual resection template and corresponding titanium implant: a new method of computer-aided surgery.

In the cranio-maxillofacial field, computer-aided surgery based on computed tomography (CT) data is becoming more and more important. Navigation systems, which allow the precise intraoperative orientation of surgical instruments, can be used for greater accuracy in determining resection margins of tumours. These techniques support ablative procedures very well, but defect reconstruction still remains a problem. In contrast, computer-aided design (CAD) and computer-aided manufacturing (CAM) systems allow the construction and fabrication of individual templates for bone resection based on coherent numerical 3-D models. The template determines the exact pathway of an oscillating saw so that the planned extent of the resection and, if necessary, also the orientation of the cutting plane are verified. An individual titanium implant is prefabricated with a geometry fitting to that of the template. This implant closes the bone defect so that the contour is reconstructed precisely and individually. This new method was used for the first time for a single-step resection of a meningioma and defect-reconstruction. The tumour which had infiltrated the frontal bone resulting in a protrusion. Fronto-orbital resection and insertion of the titanium implant worked precisely as planned, so that this method offers promising new applications in the field of computer-aided surgery.

Adult↗

PubMed2002

Factors affecting complete resection of gastric tumors by the endoscopic mucosal resection procedure.

BACKGROUND: In Japan, endoscopic mucosal resection (EMR) has been widely used as a treatment option for small early gastric cancer (EGC). The present study reviewed 178 cases for the 10-year period 1987-1997 in order to clarify the factors affecting the successful outcome of EMR. METHODS: Logistic regression analysis was used to examine whether complete resection of EGC correlated with the patient's age, gender, the characteristics of the tumor (location, macroscopic form, and size), the duration of the procedure and the experience of the doctor. RESULTS: The location of the tumor and the duration of the procedure correlated with the completeness of the resection (P < 0.01 and P < 0.05, respectively). Endoscopic mucosal resection was more difficult to perform for tumors in the gastric body than in the antrum or incisura region, and the longer the procedure the less complete the resection. CONCLUSION: The outcome of EMR is affected significantly by the location of the EGC.

Aged↗

PubMed2001

Endoscopic mucosal resection and full thickness resection with complete defect closure for early gastrointestinal malignancies.

BACKGROUND AND STUDY AIMS: We developed a new endoscopic technique, the endoscopic full-thickness resection (EFTR) and endoscopic complete defect closure (ECDC), for the treatment of early gastrointestinal malignancies. PATIENTS AND METHODS: Two rectal and one duodenal carcinoid were treated by EFTR with ECDC and resectability, complications and pathological findings were evaluated. RESULTS: In all cases, the lesion was completely resected without serious complications. The histology of the specimen also confirmed complete resection of the tumor. CONCLUSIONS: This technique has great potential for the treatment of early gastrointestinal malignancies. Preliminary results have shown that early malignant gastrointestinal lesions can be safely and completely resected by EFTR with ECDC.

Duodenal Neoplasms↗

PubMed2004

Saline-assisted endoscopic resection of rectal carcinoids: cap aspiration method versus simple snare resection.

BACKGROUND AND STUDY AIMS: Complete resection of small carcinoid tumors of the rectum is difficult during endoscopic polypectomy, because these tumors are often located in the submucosal layer of the rectal wall. To completely remove these tumors, we have used aspiration lumpectomy. In this study, we evaluated its clinical usefulness in comparison with strip biopsy. PATIENTS AND METHODS: We performed strip biopsy (December 1996 through March 2000) or aspiration lumpectomy (April 2000 through February 2003) in a consecutive series of patients with rectal carcinoid tumor. Eight carcinoid tumors in eight patients were resected by strip biopsy, and eight tumors in eight patients were resected by aspiration lumpectomy. RESULTS: The rate of complete removal of carcinoid tumors with aspiration lumpectomy (100 %) was significantly higher (P < 0.05) than that with strip biopsy (37.5 %). CONCLUSIONS: Endoscopic resection with aspiration lumpectomy is a useful and safe method for resection of small carcinoid tumors of the rectum.

Carcinoid Tumor↗

PubMed2005

[Resection and reconstruction of the retrohepatic vena cava in combination with liver resections].

Liver resection combined with the resection and reconstruction of the vena cava represents the only potential curative therapy for malignant hepatic tumors with invasion of the vena cava. We performed a liver resection with segmental replacement of the retrohepatic vena cava by synthetic grafts in 29 patients. In three cases, the additional presence of central involvement of all three hepatic veins required ex situ tumor resection. Four patients underwent a simultaneous exstirpation of the primary tumor (kidney or suprarenals). The remaining hepatic veins were reimplanted into the graft in three cases, and in two cases the renal veins were reimplanted. There was no perioperative mortality. A distal arteriovenous fistula was not applied. Five patients revealed postoperative transient liver insufficiency, requiring temporary dialysis in three cases. Two of these patients developed a transient multiorgan failure with the need of mechanical ventilation. 18 patients died during the course of follow-up, 17 of these cases due to recurrent metastases of the primary disease. Infection or thrombosis of the prosthetic vascular graft have not been observed. Beside tumor exstirpation, extended liver resection and concomitant vena cava replacement may prevent embolism as well as the obstruction of the vena cava with lower extremity swelling and the possibility of developing a Budd Chiari syndrome. We were able to achieve a long-term survival for surgically treated patients even in cases with advanced tumor stages.

Adult↗

PubMed2006

Survival after resection for primary lung cancer: a population based study of 3211 resected patients.

BACKGROUND: Very few population based results have been presented for survival after resection for lung cancer. The purpose of this study was to present long term survival after resection and to quantify prognostic factors for survival. METHODS: All lung cancer patients diagnosed in Norway in 1993-2002 were reported to the Cancer Registry of Norway (n = 19 582). A total of 3211 patients underwent surgical resection and were included for analysis. Supplementary information from hospitals (including co-morbidity data) was collected for patients diagnosed in 1993-8. Five year observed and relative survival was analysed for patients diagnosed and operated in 1993-9. Factors believed to influence survival were analysed by a Cox proportional hazard regression model. RESULTS: Five year relative survival in the period 1993-9 was 46.4% (n = 2144): 58.4% for stage I disease (n = 1375), 28.4% for stage II (n = 532), 15.1% for IIIa (n = 133), 24.1% for IIIb (n = 63), and 21.1% for stage IV disease (n = 41). The high survival in stage IIIb and IV was due to the contribution of multiple tumours. Cox regression analysis identified male sex, higher age, procedures other than upper and middle lobectomy, histologies such as adenocarcinoma and large cell carcinoma, surgery on the right side, infiltration of resection margins, and larger tumour size as non-favourable prognostic factors. CONCLUSIONS: Survival was favourable for resected patients in a population based group including subgroups such as elderly patients, those with advanced stage, small cell lung cancer, tumours with nodal invasion, and patients with multiple tumours. These results question the validity of the current TNM system for lung cancer with regard to tumour size and categorization of multiple tumours.

Adolescent↗

PubMed1978

Role of the ileocecal valve and site of intestinal resection in malabsorption after extensive small bowel resection.

Intestinal absorption after extensive small bowel resections, for diseases other than Crohn's disease, was studied in 17 patients. When the ileocecal valve and the right colon were preserved, malabsorption was transient and moderate and had no prejudicial nutritional effect (fecal fat: 8.8 +/- 1.8 g/24 h in resections sparing the 2 distal bowel loops, and 16.2 +/- 4.8 g/24 h in resections including the distal ileum; mean +/- SEM). When colectomy was associated, malabsorption was severe and persistent (fecal fat: 47.4 +/- 12.2 g/24 h; mean +/- SEM). These findings suggest that the most important prognostic factor in extensive small bowel resection is the site of the resection, and particularly the presence or absence of the right colon and ileocecal valve.

Adolescent↗

PubMed1995

Back pain in patients with ductal pancreatic cancer. Its impact on resectability and prognosis after resection.

BACKGROUND: Back pain is a frequent and often ominous clinical sign in patients with ductal pancreatic cancer. METHODS: From 1971 to 1993 a pancreatic carcinoma could be resected in 192 patients, whereas 261 patients underwent either probatory laparotomy alone or palliative bypass procedures. In a retrospective study including uni- and multi-variate survival analysis we have determined the impact of preoperative back pain on both resectability and long-term prognosis after resection. RESULTS: Among the presenting symptoms of patients with ductal pancreatic cancer back pain was a predictive sign of irresectability. In the presence of preoperative back pain the long-term prognosis after resection of the tumour was also significantly impaired. In a multivariate analysis it could be demonstrated that the prognostic impact of back pain was as strong as the influence of residual tumour, tumour grading, and tumour size. CONCLUSIONS: Back pain often indicates irresectability of ductal pancreatic carcinoma and also impairs the long-term prognosis even after curative resection.

Adult↗