共查询到20条相似文献,搜索用时 15 毫秒
1.
2.
3.
Background
The natural history and role of axillary staging in microinvasive breast cancer (DCISM) remains controversial. We report clinical characteristics and outcome in patients with DCISM, focusing on the role of sentinel lymph node (SLN) biopsy.Methods
From our prospective database we retrospectively identified 112 patients with DCISM who underwent SLN biopsy between 1996 and 2004 at our institution. Median follow-up was 6?years.Results
We found positive SLN in 12?% of patients (14 of 112): macrometastasis in 2.7?% (3 of 112) and micrometastases or isolated tumor cells (ITC) in 10?% (11 of 112). We performed axillary dissection (ALND) in all patients with macrometastasis (3 of 3), finding additional positive nodes in 66?% (2 of 3), and in 27?% of those with micrometastases/ITCs (3 of 11), finding no additional positive nodes. Among 98 patients with negative SLN (38?% of whom received systemic therapy), there were 5 locoregional recurrences (1 in the ipsilateral axilla, 4 in the ipsilateral breast, all DCIS) and 4 contralateral second primary cancers. Among 14 patients with positive SLN (82?% of whom received systemic adjuvant therapy), there were no locoregional or distant recurrences.Conclusions
Our results suggest that SLN biopsy may be justified for DCISM, but is clearly most beneficial to identify a very small subset of DCISM patients (2.7?%, with SLN macrometastasis) who could benefit from systemic adjuvant therapy. The benefit of SLN biopsy for patients with SLN micrometastases/ITCs (pN0mi or pN0(i+)) is uncertain, and in these cases ALND does not appear to be warranted. We suggest a wider reappraisal of routine SLN biopsy for DCISM. 相似文献4.
Zhe Sun Zhen-ning Wang Guo-lian Zhu Bao-jun Huang Kai Li Yan Xu De-ming Li Hui-mian Xu 《Annals of surgical oncology》2010,17(5):1278-1290
Background
Previous studies report that 5.9–22.2% of patients with preoperatively diagnosed early gastric cancers were eventually proven to have advanced gastric cancers by postoperative pathological examination. Such misdiagnosed cases commonly had cancers with macroscopic appearance like early gastric cancer and consequently can be recognized as a subgroup of cancer, namely advanced gastric cancer with early cancer macroscopic appearance (eAGC). Theoretically eAGCs might require D2 lymphadenectomy, but frequently undergo limited lymphadenectomy. However, the validity of the limited surgery is still unclear. 相似文献5.
Purpose
This study was designed to evaluate the benefit of staging laparoscopy (SL) in patients with suspected hilar cholangiocarcinoma (HCCA) during the past 10 years. Only 50–60% of patients with HCCA who undergo laparotomy are ultimately amenable to a potentially curative resection. In a previous study, we recommended routine use of SL to prevent unnecessary laparotomies. The accuracy of imaging techniques, however, has significantly improved during the past decade, which is likely to impact the yield and accuracy of SL. 相似文献6.
7.
Badgwell B Cormier JN Krishnan S Yao J Staerkel GA Lupo PJ Pisters PW Feig B Mansfield P 《Annals of surgical oncology》2008,15(10):2684-2691
Background The purpose of this study was to identify clinicopathologic factors associated with positive peritoneal cytology (PPC) in
patients with gastric cancer and to compare the overall survival (OS) of patients with PPC treated with and without neoadjuvant
therapy.
Methods The medical records of 3,747 patients with gastric or gastroesophageal adenocarcinoma presenting to our institution (January
1995 to December 2005) were reviewed to identify those patients who underwent diagnostic laparoscopy as a staging procedure
prior to consideration for neoadjuvant therapy. Associations between various clinicopathologic factors and OS were examined
with Cox proportional hazards models. Kaplan–Meier curves were created to compare OS between groups.
Results Of 381 patients who underwent diagnostic laparoscopy for staging, 39 were found to have PPC without gross metastatic disease.
Linitis plastica and tumors located at the gastroesophageal junction were identified as predictors of PPC (P < 0.01). Median follow-up for living patients was 51 months. Median OS for patients with PPC and no gross metastatic disease
at laparoscopy (13 months) was no different from that for patients with gross metastatic disease at laparoscopy (10 months,
P = 0.06). For the 39 patients with PPC and no gross metastatic disease, use of neoadjuvant therapy resulted in a 3-year OS
rate of 12% versus 0% for patients who did not receive neoadjuvant therapy.
Conclusion Outcomes for patients with PPC without gross metastatic disease are not significantly different from those patients with gross
metastatic disease at laparoscopy. However, some patients can achieve long-term survival and should be considered for neoadjuvant
treatment prior to attempts at surgical resection. 相似文献
8.
Kim JW Kong SH Kim MA Kim WH Lee HJ Lee KU Yang HK 《Annals of surgical oncology》2011,18(5):1274-1281
Background
According to the AJCC/UICC TNM classification, T mesocolon invasion in AGC is classified as T2b or T3 according to the presence or the absence of serosa invasion. However, many authors have considered T mesocolon invasion in AGC as T4. This study was performed to evaluate the appropriate T stage for T mesocolon invasion in AGC.Materials and Methods
From 1996 to 2008, 90 patients underwent curative gastrectomy with T mesocolon excision at the authors’ institute under the suspicion of T mesocolon invasion based on surgical findings and without pathologic invasion to any other organ. Histopathologic findings were reviewed to determine whether tumors had invaded the T mesocolon. Survival data of AGC patients registered in the SNUH database (N = 9998, from 1986 to 2007) was used as reference data for comparative purposes.Results
A total of 27 patients (30%) had proven histopathological invasion of the T mesocolon, and a significant difference in survival rates was found between these 27 and the remaining 63 (P = .012). As compared with the SNUH database population, the survival rate of T mesocolon invasion patients differed from those of T2b (P < .001) and T3 (P = .043) patients, but was similar to that of T4 patients (P = .218). Furthermore, for N1 stage patients, the survival rate differed from those of T2b (P = .001) and T3 (P = .046) patients, but was similar to that of T4 patients (P = .744).Conclusions
The T stage of T mesocolon invasion in AGC should be revised to AJCC/UICC stage T4, because the survival rate of T mesocolon invasion AGC is lower than that of stage T2b or T3. 相似文献9.
10.
11.
12.
Cheng CT Tsai CY Hsu JT Vinayak R Liu KH Yeh CN Yeh TS Hwang TL Jan YY 《Annals of surgical oncology》2011,18(6):1606-1614
Background
Surgical outcomes of multiorgan resection (MOR) for T4 gastric carcinoma reported in the literature are widely variable. We herein report a large surgical series of T4 gastric carcinoma.Methods
One hundred seventy-nine patients with cT4 gastric carcinoma were recruited onto the study. Patient characteristics, surgical strategy and related complications, long-term survival, and prognostic factors of T4 gastric carcinoma were analyzed.Results
Of 179 cT4 gastric carcinoma, there were 57 cT4 (pT3) with MOR, 91 pT4 with MOR, and 31 cT4 without MOR. pT4 with MOR were more likely to be associated with nodal metastasis, cellular dedifferentiation, and lymphoperineural infiltration compared to those of pT0–3 (P < 0.01 for all). For 91 pT4 with MOR, their surgical mortality and morbidity rates were 4.4 and 28.6%, respectively; their 1-, 3-, and 5-year overall survival rates were 55.2, 22.4, and 12.2%, respectively. The long-term survival of cT4 (pT3) with MOR was superior to pT4 with MOR (P = 0.006) and cT4 without MOR (P = 0.004). There was a striking difference between pT4 with MOR, R0 and pT4 with MOR, and R1 or R2 (P = 0.007). By means of multivariate analysis, lymph node status, liver invasion, and positive surgical margin were independent prognostic factors.Conclusions
Aggressive surgical management of pT4 gastric carcinoma should be limited to patients without adverse prognostic factors such as advanced nodal involvement and pancreatic invasion. 相似文献13.
Annals of Surgical Oncology - 相似文献
14.
Mussi C Colombo P Bertuzzi A Coladonato M Bagnoli P Secondino S Navarria P Morenghi E Santoro A Quagliuolo V 《Annals of surgical oncology》2011,18(8):2136-2142
Background
Complete tumor resection is the mainstay of treatment for retroperitoneal sarcoma (RPS), but the size and quality of surgical margins for radical resection in RPS are unknown. They are believed to be pushing tumors, but recently, aggressive surgical policies leading to multivisceral resection have seemed to suggest better local control compared with simple tumor resection. We analyzed a single-institution series of RPS to provide information useful to surgical decision-making. 相似文献15.
BACKGROUND: Acute ascending aortic dissection is a surgical emergency that requires expeditious diagnosis and prompt surgical intervention. In many centers, transesophageal echocardiography (TEE) is the test of choice on which surgical decisions are based. Echocardiographic false-positive diagnoses are rare but can occur with potentially severe consequences. CASE REPORT: Two clinical cases where ascending aortic dissections were falsely diagnosed by TEE are presented. DISCUSSION: Recent literature comparing the diagnostic accuracy of TEE and other imaging techniques are reviewed. Anatomical limitations of TEE and potential causes of false-positive results are discussed. Multiplane probe reduces, but does not eliminate, the occurrence of false-positive findings. To improve diagnostic specificity without undue delays in the course of clinical decision making, we recommend dividing positive TEE findings into "definite" and "probable" categories. Such subclassification is helpful in identifying cases where additional confirmatory tests are desirable in situations of uncertain diagnosis. 相似文献
16.
The role of palliative chemotherapy or radiotherapy (or both) in pancreatic cancer is discussed. In patients with disseminated
pancreatic cancer chemoradiotherapy has so far not been effective in prolonging survival. Recent trials with gemcitabine has
shown a modest improvement in clinical benefit and survival. Patients with locally advanced disease should be offered 5-fluorouracil
and radiation therapy, as valid data have repeatedly shown better median survival compared to no therapy. The option of a
second-look laparotomy to evaluate resectability after palliative chemoradiotherapy in patients with locally advanced disease
should be applied liberally because currently available imaging techniques sometimes do not accurately reflect tumor size
and tumor progression. New treatment strategies, such as regional perfusion, are being investigated. 相似文献
17.
Kuo LJ Liu MC Jian JJ Horng CF Cheng TI Chen CM Fang WT Chung YL 《Annals of surgical oncology》2007,14(10):2766-2772
Background Neoadjuvant chemoradiation therapy has improved the local control rate and overall survival in locally advanced rectal cancers.
The purpose of this retrospective study is to evaluate the correlation between the final pathologic stage and survival in
these patients.
Methods Patients with biopsy-proven rectal carcinoma, pretreatment staging by magnetic resonance imaging such as T3 or T4 tumors,
or node-positive disease were treated with preoperative concomitant 5-fluorouracil-based chemotherapy and radiation, followed
by radical surgical resection. Clinical outcome with survival, disease-free survival, recurrence rate, and local recurrence
rate were compared with each T and N findings using the American Joint Committee on Cancer Tumor-Node-Metastasis (TNM) staging
system.
Results A total of 248 patients were enrolled in this study. Overall survival and disease-free survival at 1, 3, and 5 years were
97.1, 92, and 89.9% and 87.5, 71.1, and 69.5%, respectively. Thirty-six patients (14.5%) had a pathologic complete response
after neoadjuvant therapy. The recurrence rate was significantly different between the pathologic complete response group
and residual group (5.6 vs 31.1%; P = .002). Five-year disease-free survival was significantly better in the complete response group than the residual tumor
group (93 vs 66%; P = .0045). There was no statistical difference in survival or locoregional recurrence rate between these two groups.
Conclusions Posttreatment pathologic TNM stage is correlated to disease-free survival and tumor recurrence rate in locally advanced rectal
cancer after preoperative chemoradiation. Also, pathologic complete response to neoadjuvant treatment has its oncologic benefit
in both overall recurrence and disease-free survival. 相似文献
18.
Background
The commonest surgical treatment used for peptic ulcer perforation is omental patching. If, however, the perforation leaks, it rarely heals by itself due to persistence of duodenal fistula (DF). We present our experience with a T-tube placed into the DF for better outcome of the patients.Methods
All patients in our hospital with DF following failure of surgery for duodenal perforation were included in this study. After identification of the perforation, a size 16 French T-tube was put in place. The patients were analyzed on basis of duration of hospital stay, complications related to the T-tube and overall complications, start of oral feeds, and follow-up.Results
In this 3-year study, ten patients with DF were admitted. The mean age was 50 years. The T-tube was kept in place within the fistula for 20.5 days. The mean duration to start oral feeds was 8.8 days. The mean duration of hospital stay was 23.2 days, and the mean follow-up period was 6.3 months. The complications observed in the postoperative period were fever in four patients, wound dehiscence in four patients, and peritoneal collection in two patients, all of which were managed easily. There was no peritubal leakage and no failure of surgery as regards placement of a T-tube. There were no deaths in this study.Conclusions
Placement of a T-tube into a DF appears to be very effective procedure for managing this complication of surgical repair of a perforated peptic ulcer with an omental patch. The technique appears to be simple and rewarding. Further use of this method by other workers will substantiate our efforts. 相似文献19.
20.
Fernando A. Herbella Ana C. Tineli Jorge L. WilsonJr. Jose C. Del Grande 《Journal of gastrointestinal surgery》2008,12(11):1912-1914
Introduction Resection of the capsule of the pancreas is part of the radical operation proposed by oriental authors for the treatment of
gastric cancer. It is unclear; however, if resection of the capsule is a safe procedure or even if it is necessary. This study
aims to assess in patients treated for gastric cancer the occurrence of: (a) pancreatic fistula and (b) metastasis to the
pancreatic capsule.
Methods We studied 80 patients (mean age 61 years, 42 males) submitted to gastrectomy with resection of the pancreatic capsule by
hydrodissection. Patients with pancreatic disease, tumoral invasion of the pancreas, submitted to concomitant splenectomy,
or anastomotic leakage were excluded. The tumor was located in the distal third of the stomach in 60% of the patients, in
the middle third in 27%, and proximally in 12%. Total gastrectomy was performed in 27% of the cases and partial gastrectomy
in 73%. In all patients, amylase activity in the drainage fluid was measured on day 2. If initial measurement was abnormal,
subsequent measurements were performed in alternated days until normalization. Pancreatic fistula was defined as amylase levels
greater than 600. In 25 of these patients (mean age 53 years, 16 males), the pancreatic capsule was histologically analyzed
for metastasis.
Results Pancreatic fistula was diagnosed in eight (10%) patients. The mean amylase level was 5,863. Normalization of amylase levels
was achieved within 7 days in all patients. No patient developed clinical signs of fistula besides abnormal amylase levels
in the drainage fluid, such as intra-abdominal abscesses. Pancreatic fistula was associated to younger age (p = 0.03) but not to gender (p = 0.1), tumor location (p = 0.6), and type of gastrectomy (p = 0.8). Metastasis to the pancreatic capsule was not identified.
Conclusion In conclusion, resection of the pancreatic capsule must be discouraged due to subclinical pancreatic fistula in a significant
number of the cases and absence of metastasis.
Presented as poster at the Digestive Disease Week, May 17–22, 2008, San Diego, CA, USA. 相似文献