共查询到20条相似文献,搜索用时 31 毫秒
1.
Michihiro Hayashi Yoshihiro Inoue Koji Komeda Tetsunosuke Shimizu Mitsuhiro Asakuma Fumitoshi Hirokawa Yoshiharu Miyamoto Junji Okuda Atsushi Takeshita Yuro Shibayama Nobuhiko Tanigawa 《BMC surgery》2010,10(1):1-12
Background
Hepatectomy is recommended as the most effective therapy for liver metastasis from colorectal cancer (CRCLM). It is crucial to elucidate the prognostic clinicopathological factors.Methods
Eighty-three patients undergoing initial hepatectomy for CRCLM were retrospectively analyzed with respect to characteristics of primary colorectal and metastatic hepatic tumors, operation details and prognosis.Results
The overall 5-year survival rate after initial hepatectomy for CRCLM was 57.5%, and the median survival time was 25 months. Univariate analysis clarified that the significant prognostic factors for poor survival were depth of primary colorectal cancer (≥ serosal invasion), hepatic resection margin (< 5 mm), presence of portal vein invasion of CRCLM, and the presence of intra- and extrahepatic recurrence. Multivariate analysis indicated the presence of intra- and extrahepatic recurrence as independent predictive factors for poor prognosis. Risk factors for intrahepatic recurrence were resection margin (< 5 mm) of CRCLM, while no risk factors for extrahepatic recurrence were noted. In the subgroup with synchronous CRCLM, the combination of surgery and adjuvant chemotherapy controlled intrahepatic recurrence and improved the prognosis significantly.Conclusions
Optimal surgical strategies in conjunction with effective chemotherapeutic regimens need to be established in patients with risk factors for recurrence and poor outcomes as listed above. 相似文献2.
Norifumi Hattori Yukihide Kanemitsu Koji Komori Yasuhiro Shimizu Tsuyoshi Sano Yoshiki Senda Tetsuya Mitsudomi Takayuki Fukui 《World journal of surgery》2013,37(6):1315-1321
Background
Surgical resection is the most effective treatment for colorectal cancer that has metastasized to the liver. Similarly, surgical resection improves survival for selected patients with pulmonary colorectal metastases. However, the indication for pulmonary metastasectomy is not clear in patients with both hepatic and pulmonary colorectal metastases. Therefore, we evaluated outcomes after pulmonary resection of colorectal metastases in patients with or without a history of curative hepatic metastasectomy.Methods
We retrospectively analyzed 96 patients who underwent pulmonary metastasectomy from March 1999 to November 2009. Patients were grouped according to treatment: resection of pulmonary metastases alone (lung metastasectomy group) or resection of both hepatic and pulmonary metastases (liver and lung metastasectomy group). Overall survival (OS) and disease-free survival (DFS) were evaluated by Kaplan–Meier analysis. Survival curves were compared using the log-rank test.Results
The 5-year OS for all patients was 61.3 %, and the 5-year DFS was 26.7 %. Group comparisons showed that the 5-year OS of the lung metastasectomy group was significantly better than that of the liver and lung metastasectomy group (69 vs. 43 %; p = 0.030). However, the 5-year DFS rates of the lung metastasectomy group (25.8 %) and liver and lung metastasectomy group (28.0 %) did not differ significantly. Recurrence was higher after resection of both hepatic and pulmonary metastases than after pulmonary metastases alone (79 vs. 45 %; p = 0.025).Conclusions
Resection of pulmonary colorectal metastases may increase survival. However, the combination of liver and lung metastasectomies had a worse prognosis than pulmonary metastasectomy alone. In selected patients, combined liver and lung metastasectomy can be beneficial and result in acceptable DFS. 相似文献3.
Lawrence F. Lau MBBS David S. Williams MBBS PhD FRCPA Sze Ting Lee MBBS FRACP Andrew M. Scott MD FRACP Christopher Christophi MD FRACS Vijayaragavan Muralidharan MBBS PhD FRACS 《Annals of surgical oncology》2014,21(7):2420-2428
Background
Biological characteristics of colorectal cancer liver metastases (CRCLM) are increasingly recognized as major determinants of patient outcome. The purpose of this study was to evaluate the prognostic value of metabolic response to preoperative chemotherapy as quantified by 18F-FDG positron emission tomography (PET) for patients undergoing liver resection of CRCLM.Methods
All patients (n = 80) who had staging PET before liver resection for CRCLM at Austin Health in Melbourne between 2004 and 2011 were included. Thirty-seven patients had PET and CT imaging before and after preoperative chemotherapy. Semiquantitative PET parameters—maximum standardized uptake variable (SUVmax), metabolic tumour volume (MTV), and total glycolytic volume (TGV)—were derived. Metabolic response was determined by the proportional change in PET parameters (?SUVmax, ?MTV, ?TGV). Prognostic scores, CT RECIST response, and tumour regression grading (TRG) were also assessed. Correlation to recurrence-free (RFS) and overall survival (OS) was assessed using Kaplan–Meier survival and multivariate analysis.Results
Semiquantitative parameters on staging PET before chemotherapy were not predictive of prognosis, whereas all parameters after chemotherapy were prognostic for RFS and OS. Only ?SUVmax was predictive of RFS and OS on multivariate analysis. Patients with metabolically responsive tumours had an OS of 86 % at 3 years vs. 38 % with nonresponsive or progressive tumours (p = 0.003). RECIST and TRG did not predict outcome.Conclusions
Tumour metabolic response to preoperative chemotherapy as quantified by PET is predictive of prognosis in patients undergoing resection of CRCLM. Assessing metabolic response uniquely characterizes tumour biology, which may allow future optimization of patient and treatment selection. 相似文献4.
Renato Micelli Lupinacci Evandro Sobrosa Mello Rafael S. Pinheiro Gilton Marques Fabrício Ferreira Coelho Jaime Arthur Pirolla Kruger Marcos Vinícius Perini Paulo Herman 《World journal of surgery》2014,38(8):2089-2096
Background
Despite advances in diagnosis and surgical strategies, up to 70 % of patients will develop recurrence of the disease after resection of colorectal cancer liver metastases (CRCLM). The purpose of our study was to determine the frequency of four different mechanisms of intrahepatic dissemination, and to evaluate the impact of each mechanism on patient outcomes.Methods
The medical records of 118 patients who underwent a first resection of CRCLM during the period between 2000 and 2010 were reviewed. Clinicopathologic variables and outcome parameters were examined. Resected specimens were submitted to routine histological evaluation, and immunohistochemical staining with D2-40 (lymphatic vessels), CD34 (blood vessels), CK-7 (biliary epithelium), and CK-20 (CRC cells).Results
The mean follow-up after resection was 38 months. Tumor recurrence was observed in 76 patients, with a median interval of 13 months after resection. Overall survival and disease-free survival (DFS) rates after hepatectomy were 62 and 56 %, and 26 and 24 % at 3 and 5 years, respectively. Intrahepatic microscopic invasion included portal venous in 49 patients, sinusoidal in 43 patients, biliary in 20 patients, and lymphatic in 33 patients. Intra-hepatic lymphatic invasion was the only mechanism of dissemination independently associated with the risk of hepatic recurrence (odds ratio 2.75) and shorter DFS (p = 0.006).Conclusion
Intrahepatic lymphatic invasion is a significant prognostic factor. Other mechanisms of invasion, although frequently observed, are not related to recurrence or survival, suggesting that the lymphatic system is the main route for dissemination of CRCLM. Furthermore, immunohistochemical detection of intrahepatic lymphatic invasion might be of value in clinical practice. 相似文献5.
Georgios Meimarakis Martin Angele Claudius Conrad Rolf Schauer Rolf Weidenhagen Alexander Crispin Clemens Giessen Gerhard Preissler Max Wiedemann Karl-Walter Jauch Volker Heinemann Sebastian Stintzing Rudolf A. Hatz Hauke Winter 《Langenbeck's archives of surgery / Deutsche Gesellschaft fur Chirurgie》2013,398(2):265-276
Background
The objective of this retrospective study was to assess the survival of patients after resection of hepatic and pulmonary colorectal metastases to identify predictors of long-term survival.Methods
Patients receiving chemotherapy alone were compared to patients receiving surgery and chemotherapy in a matched-pair analysis with the following criteria: UICC stage, grading, and date of initial primary tumor occurrence.Results
A total of 30 patients with liver and lung metastases of colorectal carcinoma underwent resection. In 20 cases, complete resection was achieved (median survival, 67 months). Incomplete resection and preoperatively elevated carcinoembryonic antigen (CEA) levels are independent risk factors for reduced survival. Patients developing pulmonary metastases prior to hepatic metastases had the worst prognosis. Surgical resection significantly increased survival compared to chemotherapy alone in matched-pair analysis (65 vs. 30 months, p?=?0.03).Conclusions
Incomplete resection and elevated CEA levels are predictors of poor outcome. Matched-paired analysis confirmed that surgical resection in combination with chemotherapy appears to be superior to chemotherapy alone. 相似文献6.
Amin Madani Jonathan Spicer Thierry Alcindor Marc David Marie Vanhuyse Jamil Asselah David Mulder Lorenzo Ferri 《Journal of gastrointestinal surgery》2014,18(2):226-233
Introduction
Incidental pulmonary nodules are frequently identified during staging investigations for esophageal cancer patients. Their clinical significance is unclear and may bias treatment decisions towards palliative options.Methods
From 2005 to 2011, 423 esophageal cancer patients were treated at a tertiary hospital. Those with incidental pulmonary nodules were identified. Demographics, imaging, pathology and perioperative outcomes were analyzed.Results
Ninety-two patients (22 %) had lung nodules. Twenty-nine (32 %) were palliative due to poor performance status or extra-pulmonary distant metastasis on imaging. Sixty-three had no evidence of extra-pulmonary metastasis and underwent curative-intent treatment comprising of neoadjuvant therapy [35 (55 %)] followed by esophagectomy [with lung resection, 33 (52 %) or without lung resection, 30 (48 %)]. Of those 33 lung resections, there were 27 benign lesions, 4 stage I lung cancers, and 1 esophageal cancer metastasis. Of 30 patients with lung nodules that underwent curative esophagectomy without lung resection, none showed interval size increase on follow-up imaging [median 9 months (3–40)]. There was no difference in perioperative complications or mortality between patients with combined esophagectomy and lung resection and those with esophagectomy alone.Conclusion
Incidental pulmonary nodules in the absence of extra-pulmonary metastases in esophageal cancer patients are rarely metastases and should not bias caregivers towards palliative therapy. 相似文献7.
Objective
We examined whether cancers frequently occur in hemodialysis patients, and therefore, investigated the features and outcomes of hemodialysis patients who had undergone surgery for non-small cell lung cancer.Methods
Between 1995 and 2011, 14 hemodialysis patients with lung cancer (8 males and 6 females) with a mean age of 67.0?years successfully underwent pulmonary resection at our institution. We investigated the 5-year survival rate and causes of death. The occurrence of multiple primary cancers in our patients and other lung-cancer patients reported in the articles were statistically compared by Chi-square test. A p value <0.05 was considered to be statistically significant.Results
The 5-year survival rate was 47.3?%, and six patients had died before our investigation. Four of the six had died of non-cancerous diseases related to hemodialysis. Five of 14 patients had a history of other primary cancers in other organs, and this incidence rate of multiple primary cancers was significantly higher than in other lung-cancer patients (p?=?0.0071).Conclusion
The frequency of cancer in hemodialysis patients can be underestimated because of their early deaths by non-cancerous diseases. However, the incidence rate of multiple primary cancers may represent a unique characteristic of such patients. 相似文献8.
Inoue Y Hayashi M Komeda K Masubuchi S Yamamoto M Yamana H Kayano H Shimizu T Asakuma M Hirokawa F Miyamoto Y Takeshita A Shibayama Y Uchiyama K 《Journal of gastrointestinal surgery》2012,16(6):1171-1180
Background
When hepatectomy is used as a primary treatment for liver metastasis from colorectal cancer (CRCLM), the balance between surgical curability and functional preservation of the remnant liver is of great importance.Methods
A total of 108 patients who underwent initial hepatectomy for CRCLM were retrospectively analyzed with respect to tumor extent, operative method, and prognosis, including recurrence.Results
The 1-, 2-, 3-, and 5-year overall survival rates (OS) for all patients were 90.5%, 77.8%, 63.2%, and 51.6%, respectively. Multivariate analysis indicated serum carbohydrate antigen 19-9 (CA 19-9) level after hepatectomy (<36 or ??36?mAU/mL) and presence of recurrence as independent prognostic factors of OS (P?=?0.0458 and 0.0249, respectively), and tumor depth of colorectal cancer (Conclusions
In CRCLM, we believe that nonanatomic hepatectomy with narrow margin is indicated, and optimal treatment would include functional preservation of as much of the remnant liver as possible. 相似文献9.
Background
Previous reports on the outcome of surgery for colorectal cancer lung metastases (CRCLM) have come from high-volume centers. This report describes the outcomes achieved in the general population of Ontario.Methods
All patients in Ontario who underwent resection of CRCLM between 1994 and 2009 were identified using the population-based Ontario Cancer Registry. Electronic treatment records identified surgical procedures and chemotherapy delivery. This report describes the volume of resections for CRCLM in relation to the incidence of colorectal cancer (CRC). Temporal trends in practice are described during three periods: 1994–1999, 2000–2004, and 2005–2009. Overall survival (OS) and cancer-specific survival (CSS) were measured from the time of lung resection.Results
A total of 709 patients underwent resection of CRCLM. Between 1994 and 2009, surgical volume increased 190 %, from 1 resection for every 282 incident cases to 1 resection for every 97 incident cases (p < 0.001). The use surgery for CRCLM varied considerably between regions, from 1 resection per 95 incident cases to 1 resection per 212 incident cases (p = 0.021). Use of perioperative chemotherapy increased during study periods, from 22 % (28/130) to 34 % (73/217) to 40 % (146/362; p < 0.001). Utilization rates varied across geographic regions (range 21–59 %; p = 0.005). The OS rate was 40 % [95 % confidence interval (CI) 36–44 %] at 5 years and 27 % (95 % CI 23–31 %) at 10 years. The CSS rate was 42 % (95 % CI 38–46 %) at 5 years and 32 % (95 % CI 27–37 %) at 10 years.Conclusions
A proportion of patients with resected CRCLM will achieve long-term survival. Outcomes in routine practice are comparable with those reported for high-volume centers. The use of surgery varies considerably across Ontario.10.
Steven C. Katz MD Zubin M. Bamboat MD Ajay V. Maker MD Jinru Shia MD Venu G. Pillarisetty MD Adam C. Yopp MD Cyrus V. Hedvat MD PhD Mithat Gonen PhD William R. Jarnagin MD Yuman Fong MD Michael I. D’Angelica MD Ronald P. DeMatteo MD 《Annals of surgical oncology》2013,20(3):946-955
Background
Tumor-infiltrating lymphocyte (TIL) counts in colorectal cancer liver metastases (CRCLM) predict survival following resection. While CD4 and CD8 T cells have been correlated with outcome following CRCLM resection, the role of regulatory T cells (Treg) is not well defined.Methods
TIL in 188 patients who underwent CRCLM resection between 1998 and 2000 were analyzed by immunohistochemistry using tissue microarrays. Correlation between TIL composition and outcome was determined while controlling for established prognostic factors. Total T cells (CD3), helper T cells (CD4), cytotoxic T cells (CD8), and Treg (FoxP3) were analyzed.Results
Median follow-up time was 40 months for all patients and 95 months for survivors. Overall survival (OS) at 5 and 10 years was 40 and 25 %, respectively. The CD4 T cell count correlated with OS (p = .02) and recurrence-free survival (p = .04). A high number of CD8 T cells relative to total T cells (CD8:CD3 ratio) predicted longer OS times (p = .05). Analysis of Treg revealed that high FoxP3:CD4 (p = .03) and FoxP3:CD8 (p = .05) ratios were independent predictors of shorter OS. Patients with a high clinical risk score (CRS) were more likely to have a high number of intratumoral Treg, and patients ≥65 years old had a less robust CRCLM T cell infiltration.Conclusions
A high number of Treg relative to CD4 or CD8 T cells predicted poor outcome, suggesting an immunosuppressive role for FoxP3 + TIL. The intratumoral immune response was an independent predictor of outcome in patients with colorectal liver metastases. 相似文献11.
Saiura A Yamamoto J Hasegawa K Koga R Sakamoto Y Hata S Makuuchi M Kokudo N 《World journal of surgery》2012,36(9):2171-2178
Background
Preoperative chemotherapy has become more common in the management of multiple resectable colorectal liver metastases; however, the benefit is unclear. This study examined clinical outcomes following liver resection for multiple colorectal liver metastases with the surgery up-front approach.Methods
Data collected prospectively over a 16-year period for 736 patients who underwent hepatic resection at two different centers were reviewed. Patients were divided into three groups depending on the number of tumors as follows: group A, between one and three tumors (n?=?493); group B, between four and seven tumors (n?=?141); and group C, eight or more tumors (n?=?102).Results
The 5-year overall and recurrence-free survival rates were 51 and 21?%, respectively, for the entire patient cohort, 56 and 29?% in group A, 41 and 12?% in group B, and 33 and 1.7?% in group C. Multivariate analysis showed that decreased survival was associated with positive lymph node metastasis of the primary tumor, the presence of extrahepatic tumors, a maximum liver tumor size >5?cm, and tumor exposure during liver resection.Conclusions
In patients with multiple liver metastases, the number of liver metastases has less impact on the prognosis than other prognostic factors. Complete resection with repeat metastasectomy offers a chance of cure even in patients with numerous colorectal liver metastases (i.e., those with eight or more nodules). A further prospective study is necessary to clarify the optimal setting of preoperative chemotherapy. 相似文献12.
Ito K Ito H Kemeny NE Gonen M Allen PJ Paty PB Fong Y Dematteo RP Blumgart LH Jarnagin WR D'Angelica MI 《Annals of surgical oncology》2012,19(5):1609-1617
Background
Hepatic arterial infusion pump chemotherapy (HAIPC) contributes to the prolonged survival of selected patients with colorectal cancer liver metastases (CRCLM). The most clinically important adverse event after HAIPC with floxuridine (FUDR) is biliary sclerosis (BS). Little is known about the etiology of BS.Methods
HAIPC was administered to 475 consecutive patients who received HAIPC on prospective protocols from 1991 to 2008. The incidence, clinical features, variables related to demographics, comorbidity, medical history, CRCLM, surgery, chemotherapy, and laboratory data were reviewed. An analysis of factors potentially associated with BS, defined as a biliary stricture related to HAIPC requiring stent placement, was performed.Results
The incidence of BS was 5.5% (16 of 293) in patients receiving HAIPC as an adjuvant therapy after hepatectomy, and 2% (2 of 100) in patients receiving HAIPC with FUDR for unresectable disease. The common hepatic duct was the site most frequently affected (87.5%). In patients receiving adjuvant HAIPC, BS was associated with abnormal postoperative flow scans (18.8% vs. 1.8%, P?=?0.006), postoperative infectious complications (50.0% vs. 14.8%, P?=?0.002), and larger dose/cycle/weight of FUDR (2.6 vs. 2.0?mg/cycle/kg, P?=?0.025) than patients without BS. No patient died directly of BS. Median survival was not compromised by the development of BS (BS vs. non-BS: 61.0?months [range 6.2?C171.6?months] vs. 47.2?months [range 2.4?C200.8?months], P?=?0.316, respectively).Conclusions
BS is an uncommon complication after HAIPC and does not compromise survival if adequately salvaged by stenting or dilatation. Surgical complications as well as type and dose of intra-arterial chemotherapy may contribute to the development of BS. 相似文献13.
Hirofumi Ichida Hiroshi Imamura Jiro Yoshimoto Hiroyuki Sugo Yoshiaki Kajiyama Masahiko Tsurumaru Kenji Suzuki Yoichi Ishizaki Seiji Kawasaki 《World journal of surgery》2013,37(2):398-407
Background
We assessed the benefit of hepatic and pulmonary resections in patients with liver and lung recurrences, respectively, after resection of esophageal carcinoma.Methods
The study population consisted of 138 consecutive patients with recurrent esophageal carcinoma after esophagectomy conducted between 2003 and 2005. The pattern, timing of appearance, and the prognosis of these recurrences were investigated, paying particular attention to those undergoing hepatic and pulmonary resections.Results
In total, 55 and 92 patients developed locoregional and distant-organ metastases 13 and 6 months (median) after surgery, respectively, including 9 patients with both types of recurrence. The distant-organ metastases were found in the liver (n = 26), lung (n = 27), bone (n = 21), and other organs (n = 29). Patients with pulmonary recurrences had a better overall prognosis (median survival after recurrence detection 13 months) than those with hepatic metastases (5 months) or nonhepatic nonpulmonary metastases. (3 months) Hepatic and pulmonary resections were carried out in patients with oligonodular (n = ≤ 2) isolated liver and lung metastases (n = 5, respectively). Although the survivals of patients with lung metastases who were treated/not treated by pulmonary resection were different (median survival: 48 vs. 10 months, p < 0.01), the difference in the survivals between patients with hepatic metastases who were treated/not treated by hepatic resection reached only borderline statistical significance (13 vs. 5 months, p = 0.06).Conclusions
Resection of pulmonary metastases yields a survival benefit in properly selected patients. The benefit of resection for hepatic metastases remains controversial. 相似文献14.
Hinz S Bockhorst J Röder C Egberts JH Schafmayer C Küchler T Becker T Kalthoff H 《Annals of surgical oncology》2012,19(8):2539-2546
Background
Despite all efforts in extending the resectability rates of colorectal liver metastases, thus improving the prognosis of the patients, tumor recurrence occurs in many patients. Occult dissemination of tumor cells might reflect a minimal residual disease that is not eliminated by primary surgery. Because the prognostic effect of disseminated tumor cells (DTC) is still uncertain in this clinical setting, we analyzed these cells in the peripheral blood and bone marrow of patients undergoing hepatic resection of colorectal liver metastases.Methods
In 108 patients with colorectal liver metastases, the presence of DTC in the peripheral blood and bone marrow was detected with CK20 RT-PCR. Clinical data were prospectively collected, and multiple variables were analyzed regarding their influence on overall survival.Results
DTC in the peripheral blood were detected in 40% of the patients. In 25% of the patients, DTC were detected in the bone marrow. The median follow-up was 34?months. Fifty-nine of 108 patients died from tumor relapse. Multivariate analysis determined detection of DTC in the bone marrow to be an independent prognostic factors for overall survival (P?=?0.038).Conclusions
This large series of patients with hepatic resection of colorectal liver metastases demonstrated that detection of CK20-positive DTC via RT-PCR in the bone marrow compartment negatively influences overall survival. The evidence of DTC in the bone marrow might serve as an additional individual marker to select patients for adjuvant treatment after liver metastases resection. 相似文献15.
George J. Arnaoutakis Deepa Rangachari Daniel A. Laheru Chris A. Iacobuzio-Donahue Ralph H. Hruban Joseph M. Herman Barish H. Edil Timothy M. Pawlik Richard D. Schulick John L. Cameron Avedis Meneshian Stephen C. Yang Christopher L. Wolfgang 《Journal of gastrointestinal surgery》2011,15(9):1611-1617
Objectives
This study was conducted to determine if pulmonary metastasectomy (PM) for isolated pancreatic cancer metastases is safe and effective.Methods
This was a retrospective case?Ccontrol study of patients undergoing PM at our institution from 2000 to 2009 for isolated lung metastasis after resection for pancreatic cancer. Clinical and pathologic data were compared with a matched reference group. Resected neoplasms were immunolabeled for the Dpc4 protein. Kaplan?CMeier analysis compared overall survival and survival after relapse.Results
Of 31 patients with isolated lung metastasis, 9 underwent 10 pulmonary resections. At initial pancreas resection, all patients were stage I or II. Other baseline characteristics were similar between the two groups. Median time from pancreatectomy to PM was 34 months (interquartile range 21?C49). During the study, 29/31(90.6%) patients died. There were no in-hospital mortalities or complications after PM. Median cumulative survival was significantly improved in the PM group (51 vs. 23 months, p?=?0.04). There was a trend toward greater 2-year survival after relapse in the PM group (40% vs. 27%, p?=?0.2).Conclusions
In patients with isolated lung metastasis from pancreatic adenocarcinoma, this is the first study to show that pulmonary resection can be performed safely with low morbidity and mortality. The improved survival in the PM group may result in part from selection bias but may also represent a benefit of the procedure. 相似文献16.
Ruys AT van Haelst S Busch OR Rauws EA Gouma DJ van Gulik TM 《World journal of surgery》2012,36(9):2179-2186
Background
Radical resection remains the only curative treatment for hilar cholangiocarcinoma (HCCA). Only a limited proportion of patients, however, are eligible for resection. The survival and prognostic factors of these patients are largely unknown. The aim of this study was to evaluate survival and prognostic factors in unresectable patients presenting with HCCA.Methods
We performed a cohort study of the denominator of HCCA patients seen in a tertiary referral center between March 2003 and March 2009. Demographics, treatment, pathology results, and survival were analyzed.Results
A total of 217 patients with suspected HCCA were identified. Ninety-five patients (40?%) underwent laparotomy, and in 57 (63?%) of these patients resection was performed. Overall median and 5-year survival of resected patients were 37?months and 43?%, respectively, as compared to 13?months and 7?% in unresectable patients. In unresectable patients, median survival was better in patients with locally advanced disease (16?months) as compared to patients with hepatic and extrahepatic metastases (5 and 3?months, p?0.001). Of the 160 unresectable patients, 17 (10?%) survived longer than 3?years.Conclusion
Of the patients presenting with HCCA in our center, 26?% proved resectable. The 7?% long-term survival rate of unresectable patients is remarkable and emphasizes the indolent growth of some of these tumors. Patients with metastases had a much worse prognosis with a median of 4?months. 相似文献17.
Hamdy Dosoky Elayouty Abd Alkader Mohamed Ba Yazeed Azeza Sayed Omar 《Indian Journal of Thoracic and Cardiovascular Surgery》2012,28(2):127-131
Introduction
In patients with resistant pulmonary tuberculosis, proper anti-mycobacterial drugs, lung resection and manipulation of their living environment should result in sputum negativity. In published literature, 10?C15?% of patients continued to be sputum- smear or culture positive or developed a relapse after proper lung resection.Objectives
The aim of current study was to review results of our surgically treated patients to definerate and possible causes of persistent or relapsing tuberculosis and also to evaluate the efficacy of a program of medical, surgical, physical and nutritional support that was offered to all patients.Patients and methods
In spite of regular four-drug anti-tuberculosis regimen including rifampin and isonecotenic acid hydrazide for 90?days or more, the examined bronchial lavage was positive for tuberculosis in 167 patients. Consequently, they had lung resection surgery, continued proper medical treatment and a staff supervised manipulation of life style by physiotherapy, nutritional support and education on hygienic measures. Follow up examination and results of sputum smear were analyzed.Results
After lung resection, four patients (2?%) had prolonged air leak and two(1?%) developed post-pneumonectomyempyema, One patient had a relapse of pulmonary tuberculosis and six(4?%) hadpersistently positive sputum smears. One of them developed broncho-pleural fistula and subsequently died.Conclusions
Pulmonary resection combined with continuation of proper anti-tuberculous drugs and manipulation of the patient??s life style with nutritional support, education and physio-therapy improved results of lung resection in this group of patients. 相似文献18.
Rondi M. Kauffmann MD MPH Li Wang MS Sharon Phillips MS Kamran Idrees MD Nipun B. Merchant MD Alexander A. Parikh MD MPH 《Annals of surgical oncology》2014,21(11):3422-3428
Background
The incidence of secondary malignancies is increased in patients with malignant and premalignant conditions. Although neuroendocrine tumors (NET) are uncommon, their incidence is increasing. We evaluated the rate of additional malignancies in patients with NET.Methods
Using the Surveillance, Epidemiology, and End Results (SEER) database, we identified a cohort of patients with pancreatic NET (PNET) or gastrointestinal NET (GINET). We determined the incidence of additional cancers diagnosed either before or after the diagnosis of PNET or GINET, by comparing these rates with the general population. Using multivariable regression, we evaluated factors that increased the risk of an additional malignancy.Results
A cohort of 9,727 NET patients was identified. A total of 3,086 additional cancers occurred in 2,508 patients (25.8 %). The most common sites of additional malignancies included colorectal (21.1 %), prostate (14.5 %), breast (13.3 %), and lung (11.6 %). Among patients with PNET, the incidence of breast, lung, uterine, lymph, and pancreatic cancers was less than expected in the general population, whereas in patients with GINET, the observed incidence of nearly all malignancies exceeded that expected. Increasing age, marital status, and localized NET were associated with increased risk.Conclusion
Our study shows that the incidence of additional malignancies in patients with PNET and GINET is 25.8 %. Patients with GINET are at increased risk of additional malignancies, whereas patients with PNET have a decreased risk compared with the general population. More vigilant surveillance for secondary malignancies should be performed in patients with GINET. Studies investigating potential etiologic oncogenic pathways are warranted. 相似文献19.
Christoph Reissfelder Nuh N. Rahbari L. Urrutia Bejarano Thomas Schmidt Nikolas Kortes Hans-Ulrich Kauczor Markus W. Büchler Jürgen Weitz Moritz Koch 《Langenbeck's archives of surgery / Deutsche Gesellschaft fur Chirurgie》2014,399(4):481-491
Purpose
Tailored operative strategies have been proposed for patients with bilobar colorectal liver metastases (CLM). The aim of the study was to evaluate the long-term outcome, safety and efficacy, including cancer-specific survival, morbidity, and mortality, of three different surgical strategies for extensive bilateral CLM.Methods
This is a retrospective study of a prospective database of 356 consecutive patients, who underwent hepatic resection due to CLM between January 2003 and January 2009. Fifty-nine patients underwent three different therapeutic approaches: 22 patients with portal vein embolization (PVE) + staged resections, 11 patients with staged resections solely, and 26 patients with an extensive liver resection and simultaneous or subsequent radiofrequency ablation (RFA).Results
The three groups were comparable regarding their general patient characteristics. The overall morbidity and mortality rates were 27.1 and 1.7 %, respectively. There were no significant differences in morbidity, mortality, or survival between the three groups. The median survival of all patients was 48 months, with a recurrence-free survival of 30 months.Conclusions
The clearance of bilobar CLM can be achieved by various strategies, all of them providing an acceptable mortality rate and survival for the patients. Therefore, patients with bilobar liver metastases should receive a procedure tailored for their individual extent of disease. 相似文献20.