Intraoperative pleural lavage for restaging of bronchogenic carcinoma

BACKGROUND: Although lung cancer staging has been recently reviewed, a significant number of recurrences and an increased incidence of mortality is common also in the initial stages of the disease. All that is probably due to disease staging underestimation and emphasizes that an exact system of staging cannot be considered a stand-alone prognostic and therapeutic index. METHODS: Between October 2000 and November 2001, 37 patients have undergone surgical intervention for NSCLC in our Surgical Unit; 28 of them were male (75.7%), 9 female (24.3%), aged between 55 and 70. Neither cancer-related pleural effusion, nor mediastinal lymphoadenopathy had been detected under Rx and TC inspection in any patient. RESULTS: Pre-surgical pleural washing (PLC), which defines the positiveness of the cytological result (D+), in 17 patients (45.9%) was positive, in the remaining 20 (54.1%) negative. The positiveness of PLC was 35.3% (6/17) and 64.7% (11/17) in the initial stage of T (T1 and T2) and in the advanced stage (T3 and T4) respectively. CONCLUSIONS: On the basis of personal experience, the authors, suggest that pre-surgical resection pleural washing searching premature microscopic pleural disseminations in NSCLC-affected patients should become an important prognostic factor for the disease outcome. Moreover, they emphasize how this procedure is easy, with a small increase in the surgical intervention time, and nearly costless.     

Intraoperative electron beam irradiation for patients with unresectable pancreatic carcinoma.

Since 1978 we have used electron beam intraoperative radiation therapy (IORT) to deliver higher radiation doses to pancreatic tumors than are possible with external beam techniques while minimizing the dose to the surrounding normal tissues. Twenty-nine patients with localized, unresectable, pancreatic carcinoma were treated by electron beam IORT in combination with conventional external radiation therapy (XRT). The primary tumor was located in the head of the pancreas in 20 patients, in the head and body in six patients, and in the body and tail in three. Adjuvant chemotherapy was given in 23 of the 29 patients. The last 13 patients have received misonidazole (3.5 mg/M2) just prior to IORT (20 Gy). At present 14 patients are alive and 11 are without evidence of disease from 3 to 41 months after IORT. The median survival is 16.5 months. Eight patients have failed locally in the IORT field and two others failed regionally. Twelve patients have developed distant metastases, including five who failed locally or regionally. We have seen no local recurrences in the 12 patients who have been treated with misonidazole and have completed IORT and XRT while 10 of 15 patients treated without misonidazole have recurred locally. Because of the shorter follow-up in the misonidazole group, this apparent improvement is not statistically significant. Fifteen patients (52%) have not had pain following treatment and 22 (76%) have had no upper gastrointestinal or biliary obstruction subsequent to their initial surgical bypasses and radiation treatments. Based on the good palliation generally obtained, the 16.5-month median survival, and the possible added benefit from misonidazole, we are encouraged to continue this approach.     

Intraoperative pleural lavage cytology in lung cancer patients

Cytology of intraoperative pleural lavage was examined in 164 lung cancer patients who underwent pulmonary resections. None of the patients had any pleural effusion or dissemination. Cytology was performed three times: (1) at thoracotomy, (2) immediately after resection, and (3) after washing the pleural cavity with 5,000 mL of physiological saline solution just before closure of the chest wall. Twenty-three patients (14%) had more than one positive cytological finding. The frequency of positive cytological findings was significantly correlated with pathological T classification, pleural status, and pathological stage. The positive lavage group had a significantly higher recurrence rate than the negative lavage group in patients with stage I or stage II cancer. Four patients in the positive lavage group (17.4%) had recurrence in pleura or pericardium whereas only 1 patient in the negative lavage group (0.7%) had a recurrence in pericardium. The positive cytological finding of pleural lavage has more important meaning as a prognostic factor in stage I and stage II and indicates a greater possibility of recurrence in pleura or pericardium, but further examinations to evaluate the viability of detected malignant cells are required so that the positive cytological findings of pleural lavage can be regarded as subclinical pleural dissemination.     

Intraoperative radiation therapy for patients with pancreatic carcinoma

The results of treatment with intraoperative and external beam radiation for patients with carcinoma of the pancreas are presented. Among patients treated with¹²⁵I implants for localized unresectable disease, local control rates ranged from 67% to 93% and median survival ranged from 7 to 12 months. In a series using intraoperative electron beam boosts, a 59% local control rate with a median survival of 16 months was achieved. Good palliation rates were achieved, although a high proportion of fatal complications occurred in one¹²⁵I series. Less promising results were seen in patients receiving intraoperative radiation following resections, with a local control rate of 50% and a median survival of 7 months in a series of 10 patients.

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Resumen Se presentan los resultados del tratamiento con irradiación intraoperatoria y con irradiación externa para carcinoma de páncreas.Entre los pacientes tratados con implantes de yodo-125 para enfermedad localizada no resecable, las tasas de control local oscilaron entre 67% y 93% y la supervivencia media varió entre 7 y 12 meses. En una serie en la cual se utilizó una sobredosis intraoperatoria con haz de electrones, se logró una tasa de control local de 59% con una supervivencia media de 16 meses. En una de las series con I-125 se obtuvieron buenas tasas de paliación, aún cuando hubo una elevada proporción de complicaciones fatales. Resultados menos promisorios fueron observados en una serie de 10 pacientes que recibieron irradiación intraoperatoria después de la resección, con una tasa de control local de 50% y una supervivencia media de 7 meses.

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Some of the material in this report was presented at the Annual Meeting of the American Surgical Association, Toronto, Canada, April 25–27, 1984, and published in the Annals of Surgery (in press). Supported in part by National Cancer Institute Contract No 1-CM-17481.     

Intraoperative assessment of lymph node involvement in gastric carcinoma.

This study compares the assessment of lymph nodes by the surgeon, at the time of operation, with the pathologist's assessment on the resected specimen in 85 cases of total gastrectomy with extended lymphadenectomy for gastric carcinoma. There was correlation in 67% of cases, in 28% the disease was overstaged, and in only 5% was it understaged by intraoperative assessment. This has important implications for the comparison of trials and management decisions based on surgical assessment.     

胃癌根治术中组织印片细胞学检查的评价

目的 探讨印片细胞学检查在胃癌根治术中的快速诊断价值。方法 在52例胃癌根治术的新鲜标本上，分别于近端切缘、远端切缘、瘤组织、近瘤旁组织及部分淋巴结232处印片取材，凉干，行细胞学检查，观察有无瘤细胞。将其结果与常规病理检查结果相对照。结果 瘤组织处假阴性1例无假阳性；切缘处无假阴性，假阳性12例；瘤旁组织假阴性3例，假阳性10例；全组标本敏感性92．8％，特异性85．8％，准确性87．9％。结论 胃癌根治术中印片细胞学检查对判断切缘有无残留病灶有一定价值，尤其是对不具备快速病理检查的基层医院有帮助，但不能完全取代快速病理检查，二者结合更为有利。     

Gastrojejunostomy for gastric outlet obstruction in patients with gastric carcinoma

OBJECTIVE: To investigate the utility of gastrojejunostomy for the palliation of gastric outlet obstruction in irresectable or incurable gastric carcinoma. METHODS: This is a retrospective review of 67 patients who underwent a gastrojejunostomy for gastric outlet obstruction caused by gastric carcinoma between 1 January 1996 and 31 May 2003. RESULTS: There were 19 complications after surgery, including 4 patients with unsatisfactory gastrojejunostomy drainage. Sixty patients were discharged from hospital having resumed normal eating. Their median survival after surgery was 9 months. CONCLUSION: Gastrojejunostomy offers worthwhile palliation and may prolong survival in a significant group of patients with irresectable gastric carcinoma and gastric outlet obstruction.     

常规检查淋巴结阴性No.7组胃癌患者的淋巴结微转移研究

目的探讨常规病理检查无淋巴结转移的胃癌淋巴结微转移的特点,并分析微转移与各种临床病理因素的关系.方法应用淋巴结组织连续切片和端粒酶 RT-PCR ELISA方法检测 46例胃癌患者常规病理检查无淋巴结转移的 No.7组淋巴结 138个,并结合胃癌患者的临床病理资料进行统计学分析.结果本组 13例(28.3%) 32枚淋巴结(23.2%)经连续切片检出有微转移;而端粒酶阳性表达为 20例(43.5%) 49枚淋巴结(35.5%).端粒酶 RT-PCR ELISA检测敏感性为 100%,特异性为 84%,阳性预测值为 65%,阴性预测值为 100%,诊断准确率为 88%.淋巴结微转移与患者年龄、性别、原发肿瘤部位、组织学类型和转移淋巴结分型无关(P >0.05),但与原发肿瘤大体类型、大小及是否浸透浆膜有关(P< 0.05).结论对常规病理检查无淋巴结转移的胃癌患者,为客观评价胃癌临床病理分期及其预后,有必要监测其微转移,端粒酶 RT-PCR ELISA方法可以作为传统组织学检查方法的补充.     

Effectiveness of intraoperative cytological examination of peritoneal washings for patients with pancreatic cancer]

To confirm the effectiveness of cytological examination of peritoneal washings for detecting invisible micro-peritoneal dissemination in patients with pancreatic cancer, results were analyzed with the survival and the background factors of the patients. Cytological examination of peritoneal washings or ascitic fluid at recto-vesical pouch or pouch of Douglas was performed in 37 patients with primary pancreatic cancer. Positive results for cancer cells were obtained in five of 9 patients (55.6%) who received cytological examination of ascitic fluid and in seven of 28 patients (25.0%) who received that of peritoneal washings. Four of 6 patients (66.7%) with visible peritoneal dissemination showed positive results. These 6 patients died of peritoneal dissemination with about 10 months. Eight of 31 patients (25.8%) without visible peritoneal dissemination showed positive results of the cytological examination. Two of the 8 patients received resection of the tumor. Other 6 patients without resection developed clinically evident peritoneal carcinomatosis. A high positive rate (66.7%) of cytological examination of the patients with visible peritoneal dissemination and a high incidence of appearance of peritoneal carcinomatosis in patients with positive cytological results but without visible peritoneal dissemination (75.0%; positive vs 26.1%; negative) indicate a high reliability of the cytological examination to detect invisible micro-peritoneal dissemination.     

低压间断循环洗胃法用于口服中毒患者抢救

目的观察低压间断循环洗胃法在抢救口服中毒患者的效果。方法将急性口服药物(包括各种农药)中毒患者237例按时间顺序分为对照组103例,采用传统的留置洗胃法;观察组134例,采用低压间断循环留置洗胃法。结果观察组洗胃不良反应,出入量平衡、胃出血发生率显著低于对照组,洗胃耐受度显著好于对照组,洗胃时间显著短于对照组(均P0.01)。结论采用低压间断循环留置洗胃法,可提高洗胃效果,降低不良反应及并发症发生率。     

Intraoperative lavage cytologic analysis of surgical margins in patients undergoing limited surgery for lung cancer

BACKGROUND: One of the unfavorable recurrent patterns after limited surgery for lung cancer is local failure, especially at the surgical margin in the pulmonary parenchyma. To prevent this failure, we preliminarily introduced a novel intraoperative lavage cytologic technique to check surgical margin status for limited surgery. In this study we analyzed the clinical utility of this technique with a larger number of patients under long-term follow-up. METHODS: A total 112 consecutive lung cancer lesions prospectively treated by limited surgery with the intraoperative lavage cytologic technique between October 1997 and August 2000 were reviewed through a median follow-up period of 27 months. RESULTS: Eleven lesions (10%) showed cytologically positive results in the attempted surgery on the surgical margin. The positive result rate was significantly higher for lesions with more advanced stage, compromised indication, incurability, and larger size. Surgical modes were converted intraoperatively for 4 lesions; in the other 7 lesions no conversion was performed because of certain disadvantages. Local recurrence in the surgical margin occurred in a total of 4 lesions, including 3 for which the operative mode was unconverted and 1 lesion with cytologically unknown status of the surgical margin that had the mode converted, whereas there were no local recurrences in the surgical margins among the lesions with final cytologically negative results. CONCLUSION: Cytologically negative results of examination of the surgical margin by the technique of intraoperative lavage cytologic in limited surgery for lung cancer may be predict lack of local recurrence in the surgical margin. This intraoperative cytologic technique is clinically useful in checking for complete resection of this primary disease.     

Intraoperative gastroscopy for gastric surgery

Background: Few reports are available on the use of intraoperative gastroscopy for gastric surgery. Methods: The details of 33 patients (25 early gastric cancers and eight gastric submucosal tumors) who underwent intraoperative gastroscopy from June 2003 to June 2004 were analyzed. The type of operation or resection margin was determined by evaluating both sides of the stomach simultaneously by combined operative and gastroscopic methods. Results: Preoperative endoscopic clipping was done preferentially for early gastric cancer. However, when precise localization was needed, intraoperative gastroscopy was used. Curative gastric resection was possible in 25 early gastric cancer patients after accurate lesion localization. Laparoscopic wedge resections of submucosal tumors were performed in seven patients without stenosis by combined laparoscopic and gastroscopic methods. Conclusions: Intraoperative gastroscopy can be used effectively during gastric surgery for early gastric cancer or submucosal tumors and can be regarded as a modern stethoscope to gastric surgeons.     

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目的分析和总结老年胃癌的临床特点.方法老年胃癌病人入院后,对可能增加手术风险的因素,尽可能在术前予以纠正.必要时,在术后继续处理.术中、术后严密观察病人全身情况,发现问题及时处理.结果318例老年胃癌病人,238例(74.84%)患有高血压、心脏病、糖尿病等老年人常见病.术后发生并发症共71例次,死亡13例.手术前有共存病者,术后并发症的发生率为25.63%;而手术前无共存病者,术后并发症的发生率为12.50%,两者差异有非常显著性意义(P<0.01).结论老年胃癌病人常患有高血压、心脏病、糖尿病等疾病.加强围手术期处理,可提高手术的安全性,减少并发症的发生.