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Tumour Resection (tumour + resection)
Selected AbstractsOne-year survey of carcinoma of the oesophagus and stomach in WalesBRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 2 2001J. K. Pye Background: The aim of the study was to identify all patients who presented with oesophagogastric malignancy within a single National Health Service region (Wales) over 1 year, and to follow the cohort for 5 years. Management and outcome were analysed to identify current practice and draft guidelines for Wales. Methods: Patients were identified from hospital records. Details were recorded in structured format for analysis. Results: Analysable data were obtained for 910 of 916 patients. The overall incidence was 31·4 per 100 000 population. Treatment was by resection 298 (33 per cent), palliation 397 (44 per cent) or no treatment 215 (24 per cent). The 30-day mortality rate was 12 per cent and the in-hospital mortality rate was 13 per cent. Some 226 patients (25 per cent) were alive at 2 years. Resection conferred a significant survival advantage over palliation (P < 0·001) and no treatment. Anastomotic leakage occurred in 16 patients (5 per cent), of whom eight died in hospital. ,Open and close' operations were common (23 per cent), laparoscopy was infrequent (16 per cent), and many surgeons undertook small caseloads. Operating on fewer than six patients per year increased the mortality rate after partial gastrectomy (P < 0·05) and was associated with a trend to a higher mortality rate after mediastinal and cardia surgery. Operating on more than 70 per cent of patients seen resulted in a significantly higher mortality rate (P < 0·01) irrespective of case volume. Conclusion: Tumour resection conferred a survival advantage. Wider use of laparoscopy is advocated. Improved selection for surgery should result in a lower mortality rate. © 2001 British Journal of Surgery Society Ltd [source] Gravity is an important determinant of oxygenation during one-lung ventilationACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 6 2010L. L. SZEGEDI Background: The role of gravity in the redistribution of pulmonary blood flow during one-lung ventilation (OLV) has been questioned recently. To address this controversial but clinically important issue, we used an experimental approach that allowed us to differentiate the effects of gravity from the effects of hypoxic pulmonary vasoconstriction (HPV) on arterial oxygenation during OLV in patients scheduled for thoracic surgery. Methods: Forty patients with chronic obstructive pulmonary disease scheduled for right lung tumour resection were randomized to undergo dependent (left) one-lung ventilation (D-OLV; n=20) or non-dependent (right) one-lung ventilation (ND-OLV; n=20) in the supine and left lateral positions. Partial pressure of arterial oxygen (PaO2) was measured as a surrogate for ventilation/perfusion matching. Patients were studied before surgery under closed chest conditions. Results: When compared with bilateral lung ventilation, both D-OLV and ND-OLV caused a significant and equal decrease in PaO2 in the supine position. However, D-OLV in the lateral position was associated with a higher PaO2 as compared with the supine position [274.2 (77.6) vs. 181.9 (68.3) mmHg, P<0.01, analysis of variance (ANOVA)]. In contrast, in patients undergoing ND-OLV, PaO2 was always lower in the lateral as compared with the supine position [105.3 (63.2) vs. 187 (63.1) mmHg, P<0.01, ANOVA]. Conclusion: The relative position of the ventilated vs. the non-ventilated lung markedly affects arterial oxygenation during OLV. These data suggest that gravity affects ventilation,perfusion matching independent of HPV. [source] Prognostic value of serum angiogenic activity in colorectal cancer patientsJOURNAL OF CELLULAR AND MOLECULAR MEDICINE, Issue 1 2007Francisco-Jesus Gonzalez Abstract Angiogenesis, resulting from an imbalance between angiogenic activator factors and inhibitors, is required for tumour growth and metastasis. The determination of the circulating concentration of all angiogenic factors (activators and inhibitors) is not feasible at present. We have evaluated diagnostic and prognostic values of the measurement of serum angiogenic activity in colorectal carcinoma (CRC) patients. Serum proliferative activity (PA) on human umbilical vein endothelial cells (HUVEC) in vitro, and serum vascular endothelial growth factor (VEGF) levels were determined by ELISA in 53 patients with primary CRC, 16 subjects with non-neoplastic gastrointestinal disease (SC) and 34 healthy individuals. Data were compared with clinical outcome of the patients. Although serum from CRC patients significantly increased the PA of HUVEC, compared to culture control (HUVEC in medium + 10% foetal bovine serum (FBS); P < 0.001); our results indicate that serum PA in CRC patients was similar to that of SC or healthy individuals. There was no correlation between serum PA and circulating VEGF concentrations. Surgery produced a decrease of PA at 8 hrs after tumour resection in CRC patients compared to pre-surgery values (186 ± 47 versus 213 ± 41, P < 0.001). However, an increase in serum VEGF values was observed after surgery (280 [176,450] versus 251 [160,357] pg/ml, P = 0.004). Patients with lower PA values after surgery showed a worse outcome that those with higher PA values. Therefore, this study does not support a diagnostic value for serum angiogenic activity measured by proliferative activity on HUVEC but suggests it could have a prognostic value in CRC patients. [source] Enhancement of poly-adenosine diphosphate-ribosylation in human hepatocellular carcinomaJOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY, Issue 5 2000Fumio Nomura Abstract Background: Poly-adenosine diphosphate (ADP)-ribosylation, catalysed by poly(ADP-ribose) polymerase (PARP), is a post-translational modification of nuclear proteins and is involved in a wide range of biological processes including DNA repair, cell proliferation and malignant transformation. Alteration of this reaction in human hepatocellular carcinoma (HCC) is of interest, but has not yet been explored. The aim of this study was to evaluate poly-ADP-ribosylation and to compare the expression of PARP in HCC and adjacent non-tumour tissues. Methods: Tumorous and adjacent non-tumorous tissues were obtained from five consecutive patients with HCC during surgery for tumour resection. Tissue homogenates were subjected to ADP-ribosylation with [32P]-nicotinamide adenine dinucleotide. The ADP-ribosylated proteins were separated by sodium dodecylsulfate,polyacrylamide gel electrophoresis, followed by autoradiography. Expression of PARP was also evaluated by western blotting. Results: Several proteins were ADP-ribosylated in human HCC tissues. Notably, the radiolabelling of a 116-kDa protein was remarkably greater than that in adjacent non-tumorous tissues (86.5 ± 35.2 arbitrary units by densitometry vs 12.2 ± 9.9, mean± SD, n = 5, P < 0.02). The radiolabelling of the 116-kDa protein was decreased in the presence of PARP inhibitors in a concentration-dependent manner. Immunoblot analyses revealed that the radiolabelled protein was PARP and that its expression was significantly greater in HCC than in adjacent non-tumorous tissues (333 ± 204% of non-tumorous tissue, P < 0.05). Conclusions: We found that poly-ADP-ribosylation and PARP expression were significantly increased in human HCC compared with those in adjacent non-tumorous tissues in surgically obtained specimens. [source] Rehabilitation by means of osseointegrated implants in oral cancer patients with about four to six years follow-upJOURNAL OF ORAL REHABILITATION, Issue 3 2006J. SEKINE summary, This paper describes the reconstruction of mandibular defects in four oral cancer patients using iliac crest bone grafts and osseointegrated implants. In three patients, reconstructive surgery using a reconstruction plate and free forearm skin flap was performed following tumour and segmental mandibular resection. After 7,9 months, mandibular reconstruction with a free iliac bone graft was carried out. In one patient, reconstructive surgery was performed with vascularized iliac bone grafting with an anterolateral thigh flap at the same time as the tumour resection. Fixtures were placed in the transplanted bone, and abutments were connected 6,9 months later together with vestibuloplasty. Gingival grafts were used to replace the skin flap around abutments. All implants survived throughout the approximately 4,6 years observation time. Marginal bone loss of the graft was originally several millimetres but less than 1·5 mm. Bone loss as well as management of peri-implant soft tissue was also discussed. [source] Score system for elective tracheotomy in major head and neck tumour surgeryACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 5 2005B. Kruse-Lösler Background:, This study was designed to evaluate prognostic parameters for respiratory failure after major oropharyngeal resections in head and neck cancer surgery, focusing on a score system to identify patients requiring an elective tracheotomy and to avoid tracheotomy under emergency conditions. Methods:, One hundred and fifty-two out of 928 patients with oropharyngeal cancers, treated between January 1993 and June 2000 at our hospital, fulfilled the inclusion criteria for a retrospective analysis. This collective underwent tumour resection in different regions of the oropharynx combined with bony resection of the mandible and neck dissection without primary tracheotomy. The reconstruction was accomplished using radial forearm flaps (n1 = 59) or local flaps (n2 = 93). These two groups were subdivided into patients treated post-operatively by tracheotomy due to respiratory failure (n1 = 26; n2 = 12) and those without such treatment (n1 = 33; n2 = 81). The database comprising tumour localization and size, staging, general medical condition, smoking and alcohol consumption was evaluated by logistic regression. Results:, We developed a score system which predicts the likelihood of post-operative respiratory failure. For indication of tracheotomy, tumour size and localization, multimorbidity, alcohol consumption and pathologic chest X-ray findings were identified as significant parameters with different weightings. The predictive value for tracheotomy (yes/no) using the score system was 96.7% for the total collective. Conclusion:, The decision on whether or not an elective tracheotomy in major head and neck tumour surgery is necessary can be facilitated using this score system which is based on objective facts. It may reduce post-operative complications and contribute to safer treatment. [source] Mandibular reconstruction after resection of benign tumours using non-vascularised methods in a series of patients that did not undergo radiotherapyORAL SURGERY, Issue 1 2009D. Mehrotra Abstract Aim:, A case series analysis of 52 consequent subjects of immediate mandibular reconstruction after tumour resection using non-vascularised methods, undertaken at U.P. King George's University of Dental Sciences and King George's Medical University, is being reported. To assess the success of reconstruction on subjective and objective evaluation based upon Mandibular Reconstruction Assessment Scale (MRAS) questionnaire. Methods:, Patients with benign mandibular tumours irrespective of age, sex, site and socio-economic status were included. Primary reconstruction was carried out after resection in two surgical units on surgeon's choice using stainless steel wire (6/52; 12%), stainless steel reconstruction plate (10/52; 19%) or titanium reconstruction plate (36/52; 69%) without bone graft (23/52; 44%) or with bone graft (29/52; 56%). Bone grafts were harvested from iliac crest (21/52; 40%), rib (2/52; 4%) and an additional pectoralis major myocutaneous flap with iliac crest bone graft (6/52; 12%) to provide cover to the reconstruction plate was also used. Results:, The primary outcome measurements were wound healing, mouth opening, chewing efficiency, jaw movements, cosmetic achievement and speech on a five-point scale, all of which improved significantly after surgery. The overall complication rate was 17%. Three patients (6%) had loosening of the screw, two (4%) showed dehiscence of the plate, two (4%) showed tumour recurrence and one (2%) had infection of the graft that was subsequently removed. Conclusion:, Titanium reconstruction plates with iliac crest graft provided good result in the absence of microvascular reconstruction because of unavailable long operating time and lack of expertise. Long-term satisfactory rehabilitation can be achieved using removable dentures or prosthesis on dental implants on the contraption provided by the non-vascularised tissue despite non-calcified bone visible on the skiagram. [source] The effect of dobutamine on blood flow of free tissue transfer flaps during head and neck reconstructive surgery*ANAESTHESIA, Issue 10 2009A. Scholz Summary In view of the controversy over the use of inotropes in free tissue transfer surgery, we assessed the effect of different intra-operative dobutamine infusion rates on blood flow in the anastomosed recipient artery. Twenty patients undergoing head and neck tumour resection and immediate reconstructive surgery with free tissue transfer were recruited. After completion of the microvascular anastomoses, patients received dobutamine infusions of 2, 4 and 6 ,g.kg,1.min,1 in a randomised order. After steady state dobutamine concentration was achieved, mean and maximum blood flow in the arterial anastomosis was measured at each concentration, using the Medi-Stim Butterfly Flowmeter system. Systemic haemodynamic parameters were simultaneously recorded using a pulse contour cardiac output system. Both mean and maximum blood flow increased significantly in the anastomosed artery at dobutamine infusions of 4 and 6 ,g.kg,1.min,1 and this was accompanied by increased cardiac output. This may improve free flap perfusion. [source] PERITONEAL CARCINOMATOSIS FROM COLORECTAL CANCER AND SMALL BOWEL CANCER TREATED WITH PERITONECTOMYANZ JOURNAL OF SURGERY, Issue 6 2006Mena Shehata Background: This study aims to assess the survival of patients who underwent peritonectomy, to assess the morbidity and mortality associated with the procedure and to review the published reports on the survival of patients with peritoneal spread of colorectal cancer (CRC). Methods: Peritonectomy involves resection of all visible peritoneal tumour and is followed by heated intraperitoneal chemotherapy. Peritonectomy with heated intraperitoneal chemotherapy is associated with a 3-year survival of 30,50% in patients with low peritoneal cancer index (PCI) with peritoneal carcinomatosis from CRC. There are approximately 1000 patients in phase 2 studies and a large survival advantage was shown in a randomized control trial. We have carried out over 100 peritonectomy procedures. This study describes 22 patients with peritoneal spread of gastrointestinal cancer treated with peritonectomy between 1996 and March 2005. Twenty of these patients had primary colorectal cancer and two patients had primary small bowel cancer. Results: Of the 22 patients who underwent peritonectomy, 8 patients are now deceased. The median follow up is now 16.1 months. At 12 months, the survival was 61.5% and at 24 months the survival was 46.1%, which are creditable results comparable with the world published reports. We found that those patients with all macroscopic residual tumour removed at the end of the procedure (completeness of cancer resection, CCR O) had improved 24-month survival compared with patients in whom there was incomplete tumour resection (53.3% survival vs 22.2%, respectively, P = 0.024). Patients with a PCI score less than 13 had better survival (P = 0.0003). Conclusions: Peritonectomy for peritoneal carcinomatosis from CRC offers patients improved survival. Our results are consistent with the published data with respect to improved survival in patients with low PCI and complete cytoreduction. [source] Immediate administration of intravesical mitomycin C after tumour resection for superficial bladder cancerBJU INTERNATIONAL, Issue 3 2006A. HUGH MOSTAFID OBJECTIVE To assess the feasibility and safety of administering intravesical mitomycin C in theatre immediately after transurethral resection of bladder tumour (TURBT). PATIENTS AND METHODS A protocol was developed to allow the safe administration of mitomycin C in theatre immediately after TURBT. Over a 32-month period all patients not excluded by the protocol were given mitomycin C in theatre after TURBT, and any adverse events reported. RESULTS In all, 177 instillations were carried out; there were two minor patient-related complications, and no staff-related adverse events. CONCLUSION The immediate administration of mitomycin C in theatre after TURBT is feasible and safe for patients and staff. It provides the earliest and surest prophylaxis against tumour cell re-implantation at TURBT. [source] Alterations in connexin expression in the bladder of patients with urge symptomsBJU INTERNATIONAL, Issue 4 2005Jochen Neuhaus OBJECTIVE To compare the formation of gap junctions between detrusor smooth muscle cells in situ and the distribution of connexin (Cx)40, Cx43 and Cx45 expressions in bladder biopsies from a control group (with bladder tumour) and from patients with urge symptoms, as smooth muscle cells of the human detrusor muscle communicate via gap junctions and express several connexin subtypes, alterations of which may be involved in the causes of lower urinary tract symptoms. MATERIALS AND METHODS Connexin expression is prominent in myofibroblast-like cells, supposedly involved in afferent signalling pathways of the bladder. Their strategic position directly beneath the urothelium suggests they are a link between urothelial ATP signalling during bladder filling and afferent A,-fibre stimulation for co-ordination of bladder tonus and initialization of the micturition reflex. Modification of their coupling characteristics may have profound impact on bladder sensation. Bladder tissue probes of patients undergoing cystectomy or transurethral tumour resection for bladder cancer were used as controls. Tissue samples from patients with severe idiopathic urge symptoms were taken for exclusion diagnostics of interstitial cystitis (IC) and carcinoma in situ. The formation of functional syncytia between detrusor smooth muscle cells were examined in dye-coupling experiments by injecting with Lucifer Yellow. The morphology and structure of gap junctions were assessed by transmission electron microscopy and immunogold labelling of Cx43 and Cx45. The expression of connexin subtypes Cx40, Cx43 and Cx45 was compared by indirect immunofluorescence, and confocal laser scanning microscopy used for semiquantitative analysis. RESULTS There was dye coupling between smooth muscle cells of the detrusor in situ. Electron microscopy and immunogold labelling showed very small gap junctional plaques. These findings were confirmed by confocal immunofluorescence. Semiquantitative analyses showed significantly higher Cx43 expression in the detrusor muscle, and a tendency to higher Cx45 expression in the suburothelial layer associated with urge symptoms, whereas Cx40 expression was unaffected. CONCLUSIONS Smooth muscle cells of the human detrusor muscle are coupled by classical gap junctions, forming limited local functional syncytia. Both Cx43 and Cx45 are expressed at low levels in normal detrusor. Up-regulation of Cx43 in patients with urge incontinence supports the possibility of functional changes in the syncytial properties of detrusor smooth muscle cells in this condition. In addition, the observed increase of Cx45 in the myofibroblast cell layer supports the idea that alterations in sensory signalling are also involved. Comparison with previous reports implies that the pathophysiology of urgency is distinct from that of the unstable bladder and other forms of incontinence. [source] Effect of intraportal adoptive immunotherapy on liver metastases after resection of pancreatic cancerBRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 1 2000Dr M. Kobari Background: The prognosis of patients with resected pancreatic cancer remains poor. This study evaluated the effect of adoptive immunotherapy (AIT) using intraportal infusion of lymphokine-activated killer (LAK) cells after curative resection and intraoperative radiation therapy (IORT) on advanced pancreatic cancer. Methods: Twenty-nine consecutive patients with advanced pancreatic cancer (Japan Pancreas Society stage III or IV) were divided into two groups. The control group (n = 17) underwent tumour resection and IORT. The treatment group (n = 12) underwent resection, IORT and intraportal infusion of LAK cells combined with recombinant interleukin 2 (rIL-2). The incidence of liver metastasis and the survival rate of these two groups were compared. Results: Although the overall survival between groups was not statistically different (P = 0·082), there were more patients (four) alive 3 years after operation in the test group (36 per cent versus zero), and the incidence of liver metastases in the treatment group was significantly lower (three of 12 versus ten of 15; P < 0·05). LAK therapy influenced survival positively in multivariate analysis. Conclusion: These preliminary observations suggest that AIT warrants further study as a possible adjuvant for patients undergoing curative resection and IORT for pancreatic cancer. © 2000 British Journal of Surgery Society Ltd [source] | |||||||||||||||||||