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Surgical Resection (surgical + resection)
Kinds of Surgical Resection Terms modified by Surgical Resection Selected AbstractsResponse: Surgical Resection for Intractable Epilepsy in "Double Cortex" Syndrome Can Yield Adequate ResultsEPILEPSIA, Issue 5 2004Frederick Andermann No abstract is available for this article. [source] Management of Metastatic Melanoma to the Breast with High-Dose Interleukin-2 and Surgical ResectionTHE BREAST JOURNAL, Issue 2 2005Ian K. Komenaka MD No abstract is available for this article. [source] Fine-needle aspiration cytology of giant cell fibroblastoma: Case report and review of the literatureDIAGNOSTIC CYTOPATHOLOGY, Issue 6 2002Lester J. Layfield M.D. Abstract Giant cell fibroblastoma is an uncommon soft tissue neoplasm occurring in childhood. It appears to be the juvenile form of dermatofibrosarcoma protuberans, with which it shares some histologic, cytogenetic, and immunohistochemical features. We report, to our knowledge, the second description of the cytologic features of giant cell fibroblastoma. The present case represents a recurrent lesion in the soft tissues of the scrotum of a 17-yr-old male. The aspirate produced moderately cellular smears containing mononuclear cells, usually lying singly, but occasionally forming clusters. The majority of the individual cells possessed scanty bipolar cytoplasm or were devoid of cytoplasm. The nuclei were bland, with small nucleoli. Nuclear membranes frequently contained notches, creases, or folds. Small fragments of metachromatic stroma were present in the background and were often associated with small aggregates of cells. Rare multinucleated giant cells containing bland oval or basillary-shaped nuclei were admixed with the spindle-cell component. Necrosis and mitotic figures were not a component of the smears. Surgical resection of the mass confirmed the diagnosis of giant cell fibroblastoma. We review the characteristic cytologic features of giant cell fibroblastoma and compare them with other soft tissue tumors in the differential diagnosis. Diagn. Cytopathol. 2002;26:398,403. © 2002 Wiley-Liss, Inc. [source] Impact of treating facilities' volume on survival for early-stage laryngeal cancer,HEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 9 2009Amy Y. Chen MD Abstract Background Treatment at a high-volume facility has been associated with better outcomes in a variety of conditions. The relationship between volume and survival from laryngeal cancer has not been examined previously. Methods A total of 11,446 early-stage laryngeal cancer patients (1996,1998) who reported to the National Cancer Database (NCDB) were analyzed. Proportional hazards regression was used to assess the relationship between survival and treatment volume controlling for other factors associated with survival. Results Treatment at low-volume facilities was associated with a significantly increased likelihood of death (hazard ratio 1.20, 95% CI 1.04,1.38). Surgical resection, as compared with radiation treatment, was associated with lower mortality (HR 0.74, 95% CI 0.69,0.80). Conclusion This study is the first to assess the relationship between survival and treatment volume in laryngeal cancer. Treatment at a high-volume facility is associated with better survival. Surgical treatment rather than radiation was also associated with better survival, although we could not control for confounders that may bias treatment selection. © 2009 Wiley Periodicals, Inc. Head Neck, 2009 [source] Disease control, survival, and functional outcome after multimodal treatment for advanced-stage tongue base cancerHEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 7 2004James P. Malone MD Abstract Background. Surgical resection and postoperative radiation for advanced-stage malignancies of the oral cavity, oropharynx, and hypopharynx result in a dismal overall survival of 38%. Patients with carcinoma of the tongue base frequently have advanced disease at the time of presentation, and combined-modality therapy is usually required to achieve cure. Because of the poor survival rates with advanced malignancies with standard therapy, new and innovative approaches continue to be developed in an attempt to have a greater impact on disease control, patient survival, and functional outcome after therapy. This study examines functional outcome, survival, and disease control in patients receiving an intensified treatment regimen with concomitant chemoradiotherapy, surgery, and intraoperative radiotherapy for previously untreated, resectable, stage III and IV squamous cell carcinoma (SCC) of the tongue base. Methods. Forty patients with previously untreated, resectable, stage III and IV squamous cell carcinoma of the tongue base were treated in one of three sequential phase II intensification regimens (IRs). Treatment consisted of perioperative, hyperfractionated radiotherapy (9.1 Gy) with concurrent cisplatin followed by surgical resection with intraoperative radiotherapy boost (7.5 Gy). Postoperative treatment involved concurrent chemoradiotherapy (40 Gy to the primary site and upper neck and 45 Gy to the supraclavicular areas) with cisplatin with or without paclitaxel. Locoregional and distant disease control, 2-year overall, and disease-specific survival rates were calculated. The Performance Status Scale (PSS) for Head and Neck Cancer Patients was administered to 25 of the surviving patients. The effects of the method of surgical reconstruction, surgery involving the mandible and/or larynx, and early versus advanced T stage on PSS score were evaluated with the Wilcoxon rank-sum test. Results. Median follow-up in months for IR1, IR2, and IR3 were 83.6, 75.2, and 26.8. The locoregional control rate was 100%, and the rate of distant metastases was 7.5% for all patients. Two-year overall and disease-specific survival rates for the entire study population were 74.7% and 93.6%, respectively. Mean PSS scores by subscales Eating in Public, Understandability of Speech, and Normalcy of Diet were 55 (range, 0,100), 73 (range, 25,100), and 49 (range, 0,100), respectively. PSS scores were significantly higher in patients with primary closure of the surgical defect, no mandibular surgery, and early T-stage lesions. Conclusions. Although functional outcome may be decreased by certain surgical interventions and advanced T stage, the high rate of locoregional and distant disease control and excellent 2-year disease-specific survival supports an aggressive treatment regimen for advanced tongue base cancer. © 2004 Wiley Periodicals, Inc. Head Neck26: 561,572, 2004 [source] Aggressive surgical resection for the management of hepatic metastases from gastrointestinal stromal tumours: a single centre experienceHPB, Issue 1 2007D. Gomez Abstract Background: The outcome of surgical intervention for hepatic metastases from gastrointestinal stromal tumours (GIST) is still uncertain. This study evaluated the outcome of patients following aggressive surgical resection and Imatinib mesylate therapy (IM). Patients and methods: This was a retrospective analysis of patients managed with hepatic metastases from GIST over a 13-year period (January 1993 to December 2005). Results: Twelve patients were identified with a median age at diagnosis of 62 (32,78) years. The primary sites of GIST were stomach (n= 5), jejunum (n= 4), sigmoid (n= 1), peritoneum (n= 1) and pancreas (n= 1). Eleven patients underwent surgical resection with curative intent and one patient had cytoreductive surgery. Following surgery with curative intent (n= 11), the overall 2- and 5-year survival rates were both 91%, whereas the 2- and 5-year disease-free rates following primary hepatic resection were 30% and 10%, respectively. The median disease-free period was 17 (3,72) months. Eight patients had recurrent disease and were managed with further surgery (n= 3), radiofrequency ablation (RFA) (n= 2) and IM (n= 8). Overall, there are four patients who are currently disease-free: two patients following initial hepatic resection and two patients following further treatment for recurrent disease. There was no significant association in clinicopathological characteristics between patients with recurrent disease within 2 years and patients who were disease-free for 2 years or more. Overall morbidity was 50% (n= 6), with one postoperative death. The follow-up period was 43 (3,72) months. Conclusion: Surgical resection for hepatic GIST metastases may improve survival in selected patients. Recurrent disease can be managed with surgery, RFA and IM. [source] Radiofrequency ablation-assisted liver resection: review of the literature and our experienceHPB, Issue 4 2006Peng Yao Abstract Background: Surgical resection is the best established treatment known to provide long-term survival and possibility of cure for liver malignancy. Intraoperative blood loss has been the major concern during major liver resections, and mortality and morbidity of surgery are clearly associated with the amount of blood loss. Different techniques have been developed to minimize intraoperative blood loss during liver resection. The radiofrequency ablation (RFA) technique has been used widely in the treatment of unresectable liver tumors. This review concentrates on the use of RFA to provide an avascular liver resection plane. Methods and results: The following review is based on two types of RFA device during liver resection: single needle probe RFA and the In-Line RFA device. Conclusion: Liver resection assisted by RFA is safe and is associated with very limited blood loss. [source] Indications for non-transplant surgery in primary sclerosing cholangitisHPB, Issue 4 2005Bastian Domajnko Abstract Primary sclerosing cholangitis (PCS) is a progressive disease leading to secondary biliary cirrhosis. Patients are at increased risk of developing cholangiocarcinoma, which is usually diagnosed at an advanced stage. Treatment of PCS includes medical therapy, endoscopic biliary dilation, percutaneous transhepatic stenting, extrahepatic biliary resection and liver transplantation. The most effective management of primary sclerosing cholangitis before the onset of cirrhosis remains unclear. Non-transplant surgical procedures have a limited but defined role in patients with PCS. Resection of the extrahepatic biliary tree in symptomatic non-cirrhotic patients improves hyperbilirubinaemia and prolongs both transplant-free and overall survival when compared with non-operative dilation and/or stenting. Surgical resection may also definitively establish or exclude a diagnosis of cholangiocarcinoma in patients with dominant extrahepatic or perihilar strictures. Extrahepatic bile duct resection may also reduce the risk of cholangiocarcinoma. Extrahepatic biliary resection should be considered in selected non-cirrhotic patients with symptomatic biliary obstruction and dominant extrahepatic and/or perihilar strictures. Those patients in whom cholangiocarcinoma is suspected should also undergo resection. [source] Clinical manifestations and survival of hepatocellular carcinoma patients with peritoneal metastasisJOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY, Issue 5 2009Chien-Chu Lin Abstract Background and Aim:, Peritoneal metastasis is an uncommon manifestation of hepatocellular carcinoma (HCC). The aim of the present paper was to investigate the characteristics and survival of HCC patients with peritoneal metastases. Methods:, From January 1985 to December 2004, we retrospectively reviewed the records of 53 Taiwanese HCC patients with peritoneal metastases. Results:, Peritoneal metastases were detected at the time of HCC diagnosis (synchronously) in 10 patients and after the initial therapy for the primary tumors (metachronously) in 43 patients. The mean time for development of the metachronous peritoneal metastases was similar whether the primary cancer was treated with surgery (24 months) or transarterial chemoembolization (22.2 months). The single patient whose primary cancer was treated with supportive care alone developed peritoneal metastasis only 7.5 months after detection of the primary cancer. Surgical resection of the peritoneal metastases was possible in two-thirds of the 43 metachronous patients. The median survival for those who received surgery for these metastases was 12.5 months vs. 2.1 months for those without surgery (P = 0.0013). However, there was no difference in survival if patients were stratified to Child-Pugh grade. Conclusions:, Peritoneal metastases of HCC are rare and can occur synchronously or metachronously. Though increased long-term survival was found in patients who had surgical removal of peritoneal metastases, the main determinant of better survival is Child-Pugh grade. [source] Radiation therapy for intractable bleeding in extremity arteriovenous malformation: Considerations on a clinical caseJOURNAL OF MEDICAL IMAGING AND RADIATION ONCOLOGY, Issue 3 2009JS Goda Summary Arteriovenous malformations are rare clinicopathological entities with varied distribution and a constellation of symptoms. In the extremities they are usually associated with dermatological manifestations, such as angiodermatitis with a potential risk of torrential haemorrhage. Surgical resection is a morbid procedure. Transcatheter embolization and sclerotherapy is an attractive alternative to surgical resection. However, proper case selection is a prerequisite and may not be possible in all the cases. The case reported here is a paradigm of a complex and extensive vascular malformation with torrential haemorrhage where a unique therapeutic approach of radiation therapy was used as an alternative to morbid surgery after embolization and sclerotherapy failure. [source] Role of radiology in the treatment of malignant hilar biliary strictures 1: Review of the literatureJOURNAL OF MEDICAL IMAGING AND RADIATION ONCOLOGY, Issue 1 2004Michael WJ Hii SUMMARY Malignant strictures of the biliary tree are an uncommon cause of obstructive jaundice. There are a number of pathological subtypes, but tumours in this region tend to have similar clinical and diagnostic features and therapeutic and prognostic implications. We review the published literature on this topic discussing diagnostic modalities and treatment options with a focus on radiological intervention. Diagnosis currently is best achieved using a range of procedures. Direct cholangiography remains the gold standard in delineating anatomy, but the invasiveness of this procedure limits its use as a purely diagnostic tool. Magnetic resonance technology, in particular magnetic resonance cholangiopancreatography, has an increasing role as accessibility is improved. Treatment of these tumours is difficult. Surgical resection and palliative biliary enteric bypass are the most common methods used with endoscopic and percutaneous therapies reserved for palliating patients not fit for surgery. There is little firm evidence to suggest that any one palliative modality is superior. Interventional radiology is particularly suitable for palliative management of difficult and expansive lesions as the anatomy can preclude easy access by surgical or endoscopic techniques. Good palliative results with minimal mortality and morbidity can be achieved with percutaneous stenting . [source] Pheochromocytoma associated with pregnancyJOURNAL OF OBSTETRICS AND GYNAECOLOGY RESEARCH (ELECTRONIC), Issue 5 2003Jaswinder K. Kalra Abstract Pheochromocytoma associated with pregnancy is rare with potentially lethal consequences. Antepartum diagnosis improves the maternal and perinatal outcome. The issue of mode of delivery is unresolved. Its definitive treatment is surgical resection preceded by medical management. Surgical resection may be done during caesarean section as is reported in the present case. [source] Intraoperative magnetic resonance imaging in the surgical treatment of cerebral metastasesJOURNAL OF SURGICAL ONCOLOGY, Issue 5 2010Christian Senft MD Abstract Background and Objectives To report on the value of intraoperative magnetic resonance imaging (iMRI) in the neurosurgical treatment of cerebral metastases (CM). Methods We performed a total of 204 surgical procedures with the use of a mobile ultra-low-field iMRI-unit. Of these, there were 12 craniotomies and 2 minimal-invasive procedures for CM, and 63 craniotomies for glioblastoma (GBM). Results On intraoperative imaging, all tumors could be localized and targeted with the help of the integrated neuronavigation system. Intraoperative imaging resulted in continued tumor resection due to unexpected residual tumor tissue in 13 patients harboring GBM (20.6%), but no patient with a CM (0%). In two patients with cystic CM, iMRI helped to achieve complete collapse of cysts by means of stereotactic aspiration, relieving mass effect and allowing for adjuvant radiotherapy. All patients subsequently received adjuvant treatment according to clinical protocols. Conclusion Surgical resection represents one of several treatment modalities in metastatic brain disease. iMRI is useful for neuronavigation and resection control and as an adjunct in minimal-invasive procedures in patients with CM; however, its exact value is yet to be determined by prospective randomized trials. J. Surg. Oncol. 2010; 101:436,441. © 2010 Wiley-Liss, Inc. [source] Surgical resection of primary and metastatic hepatic malignancies following portal vein embolizationJOURNAL OF SURGICAL ONCOLOGY, Issue 3 2009Brian Mailey MD Abstract Background Portal vein embolization (PVE) has been used to induce hypertrophy in future liver remnants (FLRs) in preparation for major hepatic resection. We report our initial experience with PVE and identify potential predictors of unresectability following PVE. Methods Patients with primary and metastatic hepatic malignancies (n,=,20) who underwent PVE between 2004 and 2008 were categorized by surgical resection status and clinicopathologic factors were compared. Results The cohort had the following histologies: colorectal adenocarcinoma (45%, n,=,9), hepatocellular carcinoma (20%), cholangiocarcinoma (20%), and other (15%). Seven patients (35%) had previous liver-directed or regional therapy; 55% subsequently underwent successful liver resection, whereas 45% were deemed unresectable. Patients who underwent successful resection had tumor shrinkage after PVE compared to unresectable patients (% change in maximal tumor diameter, ,6% vs. +45%, respectively; P,=,0.027) and had a lower rate of baseline liver function test abnormality (0% vs. 56%, respectively; P,=,0.004). Resected patients had an 83% 5-year overall survival. Conclusions Baseline liver dysfunction may predict subsequent unresectable hepatic disease following PVE and tumor progression after PVE appears to increase the likelihood for finding unresectable hepatic disease. Select patients should be considered for PVE with careful surveillance during the period of FLR hypertrophy. J. Surg. Oncol. 2009;100:184,190. © 2009 Wiley-Liss, Inc. [source] The case for routine use of adjuvant therapy in pancreatic cancerJOURNAL OF SURGICAL ONCOLOGY, Issue 7 2007Eugene P. Kennedy MD Abstract Pancreatic cancer is a devastating disease with a poor prognosis for most patients. Surgical resection remains the cornerstone of treatment, providing the only realistic hope of long-term survival. Even with optimal surgical management, 5-year survival averages 15% to 20% for resectable disease. Progress is being made, however. Currently, the benefits of postoperative therapy for resected pancreatic ductal adenocarcinoma appear clear, and recommendations for such therapy appear to us to be well justified. Additional benefit to patients awaits the development of new agents, molecular targeted drugs, and novel approaches such as immunotherapy. J. Surg. Oncol. 2007;95:597,603. © 2007 Wiley-Liss, Inc. [source] Retroperitoneal sarcomas: Combined-modality treatment approachesJOURNAL OF SURGICAL ONCOLOGY, Issue 1 2006Chandrajit P. Raut MD Abstract Retroperitoneal sarcomas (RPS) are rare tumors, accounting for approximately 15% of soft tissue sarcomas. Surgical resection of localized tumors with gross and microscopically negative margins remains the standard of care. However, because RPS are frequently large and locally advanced, resections are often incomplete, resulting in local recurrence. Investigators are evaluating combined-modality therapies to improve local control and disease-specific survival. This review outlines current concepts and evolving treatment strategies in the diagnosis, staging, and management of RPS. J. Surg. Oncol. 2006;94:81,87. © 2006 Wiley-Liss, Inc. [source] Meta-analysis: interferon improves outcomes following ablation or resection of hepatocellular carcinomaALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 7 2010A. K. Singal Aliment Pharmacol Ther 2010; 32: 851,858 Summary Background, Hepatocellular carcinoma (HCC) is third most common cause of tumour-related death in the US with hepatitis C virus (HCV) the most common aetiology. Surgical resection and tumour ablation are curative in patients who cannot be transplanted. With native liver having cirrhosis, HCC recurrence is a potential problem. Aim, To perform a systematic review and meta-analysis of studies evaluating efficacy of IFN to prevent HCC recurrence after its curative treatment in HCV-related cirrhosis. Methods, Ten studies (n = 645, 301 treated with IFN) on the use of IFN after resection or ablation of HCV-associated HCC were analysed. Results, Pooled data showed benefit of IFN for HCC prevention with OR (95% CI) of 0.26 (0.15,0.45); P < 0.00001. The proportion of patients surviving at 5 years (n = 505 in 6 studies) was in favour of IFN with OR of 0.31 [(95% CI 0.21,0.46); P < 0.00001]. Data were homogeneous for HCC recurrence (,2 12.05, P = 0.21) and survival (,2 6.93, P = 0.44). The benefit of IFN was stronger with sustained virological response compared with nonresponders for HCC recurrence [0.19 (0.06,0.60); P = 0.005] and survival [0.31 (0.11,0.90); P = 0.03]. Conclusion, Interferon treatment after curative resection or ablation of HCC in HCV-related cirrhotics prevents HCC recurrence and improves survival. [source] Retrospective Analysis of Spinal Arachnoid Cysts in 14 DogsJOURNAL OF VETERINARY INTERNAL MEDICINE, Issue 6 2002Helena Rylander Spinal cord dysfunction secondary to spinal arachnoid cysts (SACs) has been reported previously in dogs. This retrospective study reviews the clinical signs, radiographic findings, and outcome after surgical resection of SACs in 14 dogs. Plain vertebral column radiographs and myelography were done in all dogs. Computed tomography (CT) was done in 7 dogs and magnetic resonance (MR) imaging in 3 dogs. Affected dogs were between 1 and 12 years of age, and 8 of 14 were Rottweilers. Abnormalities detected on neurological examination depended on the location of the SAC. Five dogs had bilobed or multiple SACs. SACs were located in the cervical vertebral column in 11 dogs and in the thoracic vertebral column in 4 dogs. All dogs had dorsally or dorsolaterally located SACs. Two dogs also had additional ventrally located SACs. Spinal cord compression secondary to intervertebral disc extrusion or protrusion was demonstrated at the site of the SACs in 2 dogs. Surgical resection of the SACs was completed in all dogs. Eleven dogs were available for follow-up. Five weeks postoperatively, 7 dogs improved in neurological function, with some residual ataxia and paresis in 6 of these dogs. Neurological function had deteriorated in 4 dogs. It was concluded from this study that Rottweilers have a higher incidence of SACs than other breeds of dog. Furthermore, bilobed or multiple SACs can occur commonly, and myelography effectively localized SACs in dogs. Surgical resection of SACs resulted in improvement in neurological function in the majority of treated dogs. [source] Outcome of patients with hepatocellular carcinoma referred to a tertiary centre with availability of multiple treatment options including cadaveric liver transplantationLIVER INTERNATIONAL, Issue 9 2007John F. Perry Abstract Hepatocellular carcinoma (HCC) is a primary cancer of the liver with an established causal link to viral hepatitis and other forms of chronic liver disease. Aims: The aim of this study was to analyse the determinants of outcome in patients with HCC referred to a tertiary centre for management. Method: Two hundred and thirty-five prospective patients with HCC and minimum 12-month follow-up were studied. Results: The cohort was heterogeneous, with 52% Caucasian, 40% Asian and 5% of Middle-Eastern origin. Independent predictors of outcome included tumour size and number, the presence of ascites or portal vein thrombosis, ,-foetoprotein >50 U/L and an impaired performance status. Treatment was determined on an individual case basis by a multidisciplinary tumour team. Surgical resection was primary treatment in 43 patients, liver transplantation in 40 patients, local ablation (percutaneous radiofrequency ablation or alcohol injection) in 33 patients, transarterial chemoembolisation in 33 patients, chemotherapy or other systemic therapy in 30 patients and no treatment in 56 patients. After adjustment for significant covariates, both liver transplantation (P<0.001) and surgical resection (P=0.029) had a significant effect on patient survival compared with no treatment, but local ablation (P=0.410) and chemoembolisation (P=0.831) did not. Liver transplantation resulted in superior overall and, in particular, disease-free survival compared with surgical resection (disease-free survival 84 vs 15% at 5 years). Conclusion: In conclusion, both surgical resection and liver transplantation significantly improve the survival of patients with HCC, but improvements need to be made to the delivery of loco-regional therapy to enhance its effectiveness. [source] Surgical resection of hepatocellular carcinoma.LIVER TRANSPLANTATION, Issue S2 2004Post-operative outcome, long-term results in Europe: An overview A multicenter retrospective review of 1467 patients treated by liver resection (LR) for hepatocellular carcinoma (HCC) in Europe over a 13-year period showed a mean mortality rate of 10.6%, which was correlated with the extent of LR, the etiology of cirrhosis and the study period with an improvement during the last years. Improved 5-year overall survival (20,51%) and disease-free survival (20,33%) reached similar rates in cirrhotic than in non-cirrhotic patients. Overall results were similar to those reported in Asian series as far as patients and tumor characteristics were comparable. (Liver Transpl 2004;10:S58,S63.) [source] The Barcelona approach: Diagnosis, staging, and treatment of hepatocellular carcinomaLIVER TRANSPLANTATION, Issue S2 2004Josep M. Llovet Hepatocellular carcinoma (HCC) is the fifth most common neoplasm in the world, and the third most common cause of cancer-related death. It affects mainly patients with cirrhosis of any etiology. Patients with cirrhosis are thus usually included in surveillance plans aiming to achieve early detection and effective treatment. Only patients who would be treated if diagnosed with HCC should undergo surveillance, which is based on ultrasonography and ,-fetoprotein every 6 months. Upon diagnosis, the patients have to be staged to define tumor extent and liver function impairment. Thereafter, the best treatment option can be indicated and a prognosis estimate can be established. The present manuscript depicts the Barcelona-Clínic Liver Cancer Group diagnostic and treatment strategy. This is based on the analysis of several cohort and randomized controlled studies that have allowed the continuous refinement of treatment indication and application. Surgical resection is considered the first treatment option for early stage patients. It is reserved for patients with solitary tumors without portal hypertension and normal bilirubin. If these conditions are not met, patients are considered for liver transplantation (cadaveric or live donation) or percutaneous ablation if at an early stage (solitary , 5 cm or up to 3 nodules , 3 cm). These patients will reach a 5-year survival between 50 and 75%. If patients are diagnosed at an intermediate stage and are still asymptomatic and have preserved liver function, they may benefit from chemoembolization. Their 3-year survival will exceed 50%. There is no effective treatment for patients with advanced disease and thus, in such instances, the patients have to be considered for research trials with new therapeutic options. Finally, patients with end-stage disease should receive only palliative treatment to avoid unnecessary suffering. (Liver Transpl 2004;10:S115,S120.) [source] Surgical Management of Jugular Foramen Meningiomas: A Series of 13 Cases and Review of the Literature,THE LARYNGOSCOPE, Issue 10 2007Mario Sanna MD Abstract Objective: Primary meningiomas occurring within the jugular foramen are exceedingly rare lesions presumed to originate from arachnoid-lining cells situated within the jugular foramen. The objective of this study is to analyze the management and outcome in a series of 13 primary jugular foramen meningiomas collected at a single center. Study Design: Retrospective study. Setting: Quaternary referral otology and skull base private center. Methods: Charts belonging to 13 consecutive patients with pathologically confirmed jugular foramen meningioma surgically treated between September 1991 and May 2005 were examined retrospectively. The follow-up of the series ranged from 12 to 120 (mean, 42.8 ± 27.5) months. Results: Four (28.5%) patients underwent single-stage tumor removal through the petro-occipital transigmoid (POTS) approach. In two patients with preoperative unserviceable hearing, a combined POTS-translabyrinthine approach was adopted. Two patients underwent a combined POTS-transotic approach because of massive erosion of the carotid canal. A modified transcochlear approach type D with posterior rerouting of the facial nerve and transection of the sigmoid sinus and jugular bulb was performed in two patients with a huge cerebellopontine angle tumor component with extension to the prepontine cistern together with massive involvement of the petrous bone and middle ear and encasement of the vertical and horizontal segments of the intrapetrous carotid artery. In one patient with evidence of a dominant sinus on the site of the tumor, a subtotal tumor removal via an enlarged translabyrinthine approach (ETLA) was planned to resect the intradural component of the tumor. Two patients in our series underwent a planned staged procedure on account of a huge tumor component in the neck. One of these patients underwent a first-stage infratemporal fossa approach type A to remove the tumor component in the neck; the second-stage intradural removal of the tumor was accomplished via an ETLA. The last patient underwent a first-stage modified transcochlear type D approach to remove the intradural tumor component followed by a second-stage transcervical procedure for removal of the extracranial component. Gross total tumor removal (Simpson grade I,II) was achieved in 11 (84.6%) cases. Subtotal removal of the tumor was accomplished in two patients. Good facial nerve function (grades I and II) was achieved in 46.1% of cases, whereas acceptable function (grade III) was achieved in the remaining cases 1 year after tumor removal. Hearing was preserved at the preoperative level in all four patients who underwent surgery via the POTS approach. After surgery, no patient recovered function of the preoperatively paralyzed lower cranial nerves. A new deficit of one or more of the lower cranial nerves was recorded in 61.5% of cases. Conclusions: Surgical resection is the treatment of choice for jugular foramen meningiomas. Among the various surgical techniques proposed for dealing with these lesions, we prefer the POTS approach alone or combined with the translabyrinthine or transotic approaches. Despite the advances in skull base surgery, new postoperative lower cranial nerve deficits still represent a challenge. [source] External Beam Radiation Followed by Planned Neck Dissection and Brachytherapy for Base of Tongue Squamous Cell Carcinoma,THE LARYNGOSCOPE, Issue 10 2000David M. Kaylie MD Abstract Background Surgical resection of tongue base cancer can leave the patient with significant functional deficits. Other therapies, such as external beam radiation followed by neck dissection and radiation implants, have shown equal tumor control with good functional outcome. Methods Between March 1991 and July 1999, 12 patients at Oregon Health Sciences University, the Portland Veterans Administration Medical Center and West Virginia University School of Medicine Hospital were treated with external beam radiation followed by neck dissection and Ir192 implants. Two patients had T1 disease, two had T2, five patients had T3 tumors, and three had T4 tumors. Six had N2a necks, three had N2b necks, and three had N2c. Follow-up ranged from 13 months to 8 years. Results After external beam radiation, five patients had complete response and seven had partial response in the neck without complications. One patient underwent a unilateral radical neck dissection, eight had unilateral selective neck dissections involving levels I to IV, and three had dissections involving levels I to III. One of the five patients who had a complete clinical response in the neck had pathologically positive nodes. One patient had a pulmonary embolus that was treated and had no permanent sequelae. There were three complications from brachytherapy. Two patients had soft tissue necrosis at the primary site and one patient had radionecrosis of the mandible. All healed without further therapy. One patient had persistent disease and underwent a partial glossectomy but died of local disease. Distant metastasis developed in two patients. All others show no evidence of disease and are able to eat a normal diet by mouth. Conclusion This combination of therapies should be considered when treating tongue base cancer. [source] Pancreatic solid pseudopapillary tumours , EUS FNA is the ideal tool for diagnosisANZ JOURNAL OF SURGERY, Issue 9 2010Alina Stoita Abstract Background:, Solid pseudopapillary tumour (SPT) is a rare tumour of the pancreas with low malignant potential affecting mainly young women difficult to diagnose preoperatively. The aim of this study is to describe the endoscopic ultrasound (EUS) features and utility of EUS-guided fine needle aspiration (FNA) in diagnosing these tumours. Methods:, A retrospective analysis of SPTs identified in a tertiary institution EUS database between April 2002 and April 2009 was performed. Medical records, imaging, EUS features, cytology and histology specimens were reviewed. Patients were followed up until April 2009. Results:, Seven cases of SPTs were indentified out of 2400 EUS performed. All patients were females with a mean age of 41 years (range 22,69). The tumours were solitary with a mean diameter of 2.9 cm (range 2,4.3 cm). Five tumours were located in the body and tail of the pancreas and two in the neck. All lesions were hypoechoic, heterogenous and well circumscribed, with five having a cystic component and two having a calcified rim. FNA using a 22-gauge needle was performed in six cases with no complications. A preoperative diagnosis of SPT based on cytology was obtained in 5/6 cases (83%). Surgical resection was done in six cases with confirmation of SPT and no metastatic disease. Conclusion:, EUS-guided FNA is a minimally invasive, safe and reliable way of diagnosing SPT by providing characteristic cytological specimens. Definitive preoperative diagnosis leads to targeted and minimally invasive surgical resection. [source] Surgical management of benign duodenal tumours,ANZ JOURNAL OF SURGERY, Issue 7-8 2010Ji-Qi Yan Abstract Background:, While benign duodenal tumours are rare compared with malignant tumours, they comprise a wide variety of pathologies. Despite their diagnostic challenge, the optimal management of benign duodenal tumours remains undefined. We aimed to review the diagnosis and surgical treatment of benign duodenal tumours. Methods:, Records of all patients with post-operative pathological diagnosis of benign duodenal tumour were retrieved. Information on clinical presentations, diagnostic methods, tumour locations, surgical approaches, pathological results and patient outcomes were analysed. Results:, The operative spectrum included local resection in 8 cases, segmental duodenectomy in 1 case, subtotal gastrectomy in 1 case, papilla resection with sphincteroplasty in 3 cases and pancreaticoduodenectomy in 5 cases. The post-operative pathology results indicated 5 cases of adenoma, 2 cases of tubular adenoma, 2 cases of villous adenoma, 2 cases of tubulovillous adenoma, 2 cases of hamartoma and 1 case each of hamartomatous polyp, Brunner's adenoma, adenomyoma, fibromatosis and ectopic pancreas. Post-operatively, one patient died of unrelated disease, one case was lost in follow-up and the remaining patients survived recurrence-free with a good quality of life. Conclusion:, The presentation of benign duodenal tumours is non-specific, with upper abdominal discomfort and upper gastrointestinal bleeding as common symptoms. Surgical resection is the preferable therapeutic choice with satisfactory prognosis. [source] Making use of the primary tumourBIOESSAYS, Issue 1 2003Arnold Baars Surgical resection of a primary tumour is often not sufficient to cure a patient. Even when no residual cancer can be detected at time of surgery, metastases may appear in the following years, which indicates that the primary tumour had apparently spread before surgery. Following surgery, systemic chemotherapy may be used to eradicate micro-metastatic disease. Here we present two unconventional strategies that implement new insights into tumour biology and tumour immunology in the treatment of patients with cancer. Both experimental strategies use the individual characteristics of the patient's primary tumour to optimise the control of life-threatening micro-metastases. We aim to modulate the patient's adaptive immune system, targeting it towards the patient's own tumour cells to eradicate residual disease following local treatment. In one approach, this is done by autologous tumour cell vaccinations as adjuvant treatment for colon cancer patients and, in a second approach, by giving chemo-imunotherapy before local treatment to women with locally advanced breast cancer. BioEssays 25:79,86, 2003. © 2002 Wiley Periodicals, Inc. [source] Pathological determinants of survival in node-negative oesophageal cancer,BRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 12 2004O. A. Khan Background: Many studies have analysed prognostic factors following oesophagectomy, but few have examined survival determinants in node-negative (N0) oesophageal cancer. The prognostic significance of a number of histological variables following surgical resection of N0 oesophageal cancer was studied. Methods: The case notes of 219 patients undergoing potentially curative oesophagectomy for N0 squamous cell carcinoma or adenocarcinoma of the oesophagus were reviewed. Details of the patient's sex, age at operation, histological type, longitudinal tumour length, tumour (T) stage, circumferential resection margin involvement, tumour grade, presence of vascular invasion, perineural invasion, Barrett's metaplasia, and survival were noted. Univariate and multivariate analyses were performed to identify prognostic factors. Results: Univariate analysis revealed three factors that correlated with poor prognosis: T stage (P = 0·024), adenocarcinoma (P = 0·033) and degree of differentiation (P = 0·001). Multivariate analysis revealed that all three were significant independent adverse prognostic indicators. Conclusion: Surgical resection of node-negative oesophageal cancer is associated with diverse long-term outcomes. This diversity of outcome is not reflected in the tumour node metastasis (TNM)-based staging system. The utility of the TNM system in predicting prognosis after surgical resection is open to question. Copyright © 2004 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. [source] Six of the Best, Colorectal 20BRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue S1 2002D.L. Francis Aims: Surgical resection is the only potential cure for patients with colorectal liver metastases (CLM), but patient selection relies on accurate preoperative staging. The aim of this study was to assess the accuracy of routinely using whole-body FDG-PET (WBPET) for preoperative staging of patients being considered for resection of CLM. Methods: A prospective study of patients referred for possible hepatic resection was undertaken. Patients were initially staged by spiral CT and subsequently underwent WBPET. These modalities were considered independently before findings were compared and a decision regarding patient management was made. Accuracy of each modality was compared with histology, clinical/radiological follow-up or operative findings if appropriate. Results: Twenty-nine patients were recruited. Ten solitary CLM were correctly identified by both WBPET and CT. Nineteen patients had multiple CLM or extrahepatic disease, of these CT correctly staged seven patients (36 per cent), understaged 10 patients (53 per cent) and overstaged two (11 per cent). WBPET correctly staged 18 patients (95 per cent) and overstaged just one (5 per cent). WBPET was more sensitive and specific (100 and 92 per cent, respectively) for detecting multiple CLM and extrahepatic disease compared to CT (41 and 83 per cent). As a result of routine WBPET, patient management was altered in 10 patients (34 per cent), of whom four (14 per cent) avoided inappropriate surgery. Conclusions: WBPET is both more sensitive and specific in the preoperative staging of CLM, and we recommend its inclusion in the management algorithm of all patients being considered for hepatic resection. Altered patient management such as avoiding inappropriate laparotomy may also ultimately lead to financial savings. [source] Neoadjuvant chemoradiotherapy for operable oesophageal carcinoma: preliminary results from SheffieldBRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 3 2001I. McL. Background: Surgical resection is the mainstay of treatment for potentially curable oesophageal carcinoma but the long-term survival rate remains 10,20 per cent. Neoadjuvant administration of chemoradiotherapy (NCR) may improve these values. In this study the authors reviewed their preliminary experience with NCR in Sheffield. Methods: Twenty-five patients with potentially resectable oesophageal carcinoma embarked on a regimen of NCR, with resection planned 4,6 weeks later. Chemotherapy incorporated two cycles of intravenous cis -platinum and 5-fluorouracil with external-beam radiotherapy administered synchronously (30,45 Gy). Results: Twenty-two of the 25 patients suffered side-effects from NCR, including one death, and seven patients failed to complete NCR as planned. The median interval from diagnosis to surgery was 121 days. Twelve out of 24 patients had significant postoperative complications, including two deaths. Seven patients had a complete histological response to NCR (three out of 15 for adenocarcinoma, four out of nine for squamous carcinoma). Conclusion: The complete histological response rate to NCR in these patients compares favourably with previous studies, as does the postoperative mortality, but this was at the expense of substantial morbidity and was associated with long delays from diagnosis to operation. At present it is not possible to predict which patients will respond favourably to NCR and whether they will benefit with improved survival. © 2001 British Journal of Surgery Society Ltd [source] Adjuvant irradiation for cervical lymph node metastases from melanomaCANCER, Issue 7 2003Matthew T. Ballo M.D. Abstract BACKGROUND The risk of regional disease recurrence after surgery alone for lymph node metastases from melanoma is well documented. The role of adjuvant irradiation remains controversial. METHODS The medical records of 160 patients with cervical lymph node metastases from melanoma were reviewed retrospectively. Of these, 148 (93%) presented with clinically palpable lymph node metastases. All patients underwent surgery and radiation to a median dose of 30 grays (Gy) at 6 Gy per fraction delivered twice weekly. Surgical resection was either a selective neck dissection in 90 patients or local excision of the lymph node metastasis in 35 patients. Only 35 patients underwent a radical, modified radical, or functional neck dissection. RESULTS At a median follow-up of 78 months, the actuarial local, regional, and locoregional control rates at 10 years were 94%, 94%, and 91%, respectively. Univariate analysis of patient, tumor, and treatment characteristics failed to reveal any association with the subsequent rate of local or regional control. The actuarial disease-specific (DSS), disease-free, and distant metastasis-free survival (DMFS) rates at 10 years were 48%, 42%, and 43%, respectively. Univariate and multivariate analyses revealed that patients with four or more involved lymph nodes had a significantly worse DSS and DMFS. Nine patients developed a treatment-related complication requiring medical management, resulting in a 5-year actuarial complication-free survival rate of 90%. CONCLUSIONS Adjuvant radiotherapy resulted in a 10-year regional control rate of 94%. Complications for all patients were rare and manageable when they did occur. The authors recommend adjuvant irradiation for patients with extracapsular extension, lymph nodes measuring 3 cm in size or larger, the involvement of multiple lymph nodes, recurrent disease, or any patient having undergone a selective therapeutic neck dissection. Cancer 2003;97:1789,96. © 2003 American Cancer Society. DOI 10.1002/cncr.11243 [source] | ||||||||||||||||||||||||||||||||||||||||