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Determinants of Survival following Hepatic Resection for Metastatic Colorectal Cancer 总被引:13,自引:1,他引:12
Efthimios A. Bakalakos Julian A. Kim Donn C. Young Edward W. Martin Jr. 《World journal of surgery》1998,22(4):399-405
p
= 0.0001), resected versus nonresected (
p
< 0.0001), and tumor-free surgical margins versus positive margins (
p
= 0.001). Surprisingly, the disease-free interval and the original stage of the primary tumor did not predict survival (
p
= not significant). Other factors that had no influence on survival were type of resection, size and number of liver metastases,
ABO blood group, and the number of perioperative blood transfusions. For those patients who underwent resection of unilobar
metastases with tumor-free margins, the 5-year survival rate was 29% with a median survival of 35 months and eight survivors
> 7 years. In addition, one patient with bilobar disease had survival > 7 years and five patients who had resection of hepatic
metastases and extrahepatic cancer simultaneously had survival > 3 years. Our data support the concept that patients with
unilobar metastatic disease who undergo surgical resection with tumor-free surgical margins can be afforded a significant
opportunity at long-term survival with acceptable morbidity, mortality, and hospital stay. Also, certain patients with bilobar
or extrahepatic disease (or both) who undergo complete resection can enjoy a long-term survival. In these subgroups of patients
resection should be considered on an individual basis. 相似文献
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Sakamoto Y Yamamoto J Yoshimoto M Kasumi F Kosuge T Kokudo N Makuuchi M 《World journal of surgery》2005,29(4):524-527
Liver metastasis of breast cancer is considered a generalized disease, and surgical treatment is rarely discussed. Thirty-four patients who underwent 35 hepatectomies for liver metastases of breast cancer between 1985 and 2003 were analyzed. The median interval between the breast surgery and relapse in the liver was 1.9 years (0–20 years). The liver was the first site of recurrence in 25 patients. Fifteen clinicopathologic factors were evaluated using univariate and multivariate analyses to predict survival after hepatic resection. No patients died because of the surgery. The median survival was 36 months (1 month to 20 years). The overall and disease-free 5-year survival rates after hepatectomy for breast metastases were 21% and 16%, respectively. Four patients survived more than 5 years. The presence of extrahepatic recurrence prior to hepatectomy was the only significant prognostic factor according to the analyses, and the 5-year survival rate of patients without extrahepatic disease was 31%. No patient who had hilar lymph node metastasis survived more than 5 years. In the absence of extrahepatic recurrence, surgical resection of liver metastasis from breast cancer can offer an acceptable prognosis and should not be avoided in selected patients. 相似文献
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Sulaiman Nanji MD PhD Sean Cleary MD MSc Paul Ryan MD Maha Guindi MD Subani Selvarajah MD Paul Grieg MD Ian McGilvary MD PhD Bryce Taylor MD Alice Wei MD MSc Carol-Anne Moulton MD PhD Steven Gallinger MD MSc 《Annals of surgical oncology》2013,20(1):295-304
Background
Hepatic metastasis from colorectal cancer (CRC) is best managed with a multimodal approach; however, the optimal timing of liver resection in relation to administration of perioperative chemotherapy remains unclear. Our strategy has been to offer up-front liver resection for patients with resectable hepatic metastases, followed by post–liver resection chemotherapy. We report the outcomes of patients based on this surgical approach.Methods
A retrospective review of all patients undergoing liver resection for CRC metastases over a 5-year period (2002–2007) was performed. Associations between clinicopathologic factors and survival were evaluated by the Cox proportional hazard method.Results
A total of 320 patients underwent 336 liver resections. Median follow-up was 40 (range 8–80) months. The majority (n = 195, 60.9 %) had metachronous disease, and most patients (n = 286, 85 %) had a major hepatectomy (>3 segments). Thirty-six patients (11 %) received preoperative chemotherapy, predominantly for downstaging unresectable disease. Ninety-day mortality was 2.1 %, and perioperative morbidity occurred in 68 patients (20.2 %). Actual disease-free survival at 3 and 5 years was 46.2 % and 42 %, respectively. Actual overall survival (OS) at 3 and 5 years was 63.7 % and 55 %, respectively. Multivariate analysis identified four factors that were independently associated with differences in OS (hazard ratio; 95 % confidence interval): size of metastasis >6 cm (2.2; 1.3–3.5), positive lymph node status of the primary CRC (N1 (2.0; 1.0–3.8), N2 (2.4; 1.2–4.9)), synchronous disease (2.1; 1.3–3.5), and treatment with chemotherapy after liver resection (0.42; 0.23–0.75).Conclusions
Up-front surgery for patients with resectable CRC liver metastases, followed by chemotherapy, can lead to favorable OS. 相似文献5.
Arru M Aldrighetti L Castoldi R Di Palo S Orsenigo E Stella M Pulitanò C Gavazzi F Ferla G Di Carlo V Staudacher C 《World journal of surgery》2008,32(1):93-103
Background The aim of this study was to analyze the prognostic factors associated with long-term outcome after liver resection for colorectal
metastases. The retrospective analysis included 297 liver resections for colorectal metastases.
Methods The variables considered included disease stage, differentiation grade, site and nodal metastasis of the primary tumor, number
and diameter of the lesions, time from primary cancer to metastasis, preoperative carcinoembryonic antigen (CEA) level, adjuvant
chemotherapy, type of resection, intraoperative ultrasonography and portal clamping use, blood loss, transfusions, complications,
hospitalization, surgical margins status, and a clinical risk score (MSKCC-CRS).
Results The univariate analysis revealed a significant difference (p < 0.05) in overall 5-year survival rates depending on the differentiation grade, preoperative CEA >5 and >200 ng/ml, diameter
of the lesion >5 cm, time from primary tumor to metastases >12 months, MSKCC-CRS >2. The multivariate analysis showed three
independent negative prognostic factors: G3 or G4 grade, CEA >5 ng/ml, and high MSKCC-CRS.
Conclusions No single prognostic factor proved to be associated with a sufficiently disappointing outcome to exclude patients from liver
resection. However, in the presence of some prognostic factors (G3–G4 differentiation, preoperative CEA >5 ng/ml, high MSKCC-CRS),
enrollment of patients in trials exploring new adjuvant treatments is suggested to improve the outcome after surgery. 相似文献
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Seong-Heum Park Jong-Han Kim Joong-Min Park Sung-Soo Park Seung-Joo Kim Chong-Suk Kim Young-Jae Mok 《World journal of surgery》2009,33(2):303-311
Introduction The value of nonpalliative resection in metastatic gastric cancer has not been clearly defined.
Methods The survival and incidence of subsequent palliative interventions in 72 patients with metastatic gastric cancer who underwent
nonpalliative resection were retrospectively compared with those of 56 patients that did not undergo resection.
Results The median survival of patients who underwent resection was greater than that of patients who did not (12.0 months versus
4.8 months; p = 0.000). However, more patients in the resection group had a good performance status, no neighboring organ invasion, and
only one metastatic site, and this might have caused the survival difference. Adjuvant chemotherapy was the only independent
predictor of survival after resection. Incidences of subsequent palliative procedures were not significantly different in
the two study groups (43.1% in resection group versus 39.3% in the nonresection group; p = 0.668). However, the mean interval between operation and the first procedure was significantly different in the two groups
(287.3 days in the resection group versus 164.1 days in the nonresection group; p = 0.032).
Conclusions The survival of the patients that underwent nonpalliative resection was poor, and nonpalliative gastrectomy did not decrease
requirements for subsequent palliative procedures. Only a few patients with a favorable response to adjuvant chemotherapy
survived longer after resection and benefited from a longer symptom-free period until the subsequent palliative procedures
were required. Nonpalliative resection should be reserved for selected patients based on performance status, resection feasibilities
and metastatic tumor loads, and adjuvant chemotherapy should be combined as part of multimodality therapy. 相似文献
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胃间质瘤的手术治疗 总被引:6,自引:0,他引:6
目的探讨胃间质瘤的手术治疗方法及临床病理特点。方法回顾性分析经手术治疗的78例胃间质瘤患者的临床和病理资料,其中男34例,女44例。手术完全切除76例,其中胃楔形切除39例,远端胃大部切除术17例,近端胃大部切除术20例;姑息性切除2例。结果肿瘤平均直径5.5cm,其中<5cm者39例,5~10cm者27例,>10cm者12例。病变位于胃窦部12例,胃体部30例,胃底部36例。胃周淋巴结转移2例(2.6%)。免疫组化结果:CD117阳性74例(94.9%),CD34阳性61例(78.2%),SMA阳性29例(37.2%),Desmin阳性8例(10.3%),S-100阳性8例(10.3%)。72例(92.3%)获随访,平均56.1(3~168)个月,术后5年生存率为70.3%,术后复发转移11例(15.3%),术后复发转移者再次手术治疗6例,再次手术切除可延长患者生命。结论胃间质瘤的治疗以手术为主,术中应注意完整切除和防止肿瘤破裂。 相似文献
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Raphael Araujo MD Mithat Gonen PhD Peter Allen MD Leslie Blumgart MD Ronald DeMatteo MD Yuman Fong MD Nancy Kemeny MD William Jarnagin MD Michael D’Angelica MD 《Annals of surgical oncology》2013,20(13):4312-4321
Background
Additional chemotherapy in patients with resectable colorectal liver metastases (CRLM) likely improves outcomes. Whether to administer chemotherapy as perioperative or adjuvant therapy remains controversial. We analyzed outcomes between these two treatment strategies.Methods
Patients were identified from a prospective CRLM database and studied retrospectively. Patients with extrahepatic disease or initially unresectable CRLM were excluded. Only patients receiving oxaliplatin- and/or irinotecan-containing chemotherapy regimens were included. Univariate and Cox regression models were developed for recurrence and death.Results
Between 1998 and 2007, 236 patients (57.4 %) in the adjuvant group and 175 patients (42.6 %) in the perioperative group were compared. The perioperative group was younger and had more tumors, shorter disease-free intervals, and higher clinical risk scores (CRS), but had smaller tumors. The overall survival was similar between the groups (perioperative 72.9 months vs. adjuvant 71.5 months; p = 0.48). When the comparison was adjusted for other clinicopathologic factors and CRS, the differences remained insignificant. On univariate analysis, there was a significant difference in recurrence-free survival between the groups (perioperative 17.2 months vs. adjuvant 27.4 months, p = 0.036). However, when the recurrence-free survival was adjusted for other clinicopathologic factors and the CRS, differences were not significant.Conclusions
The timing of additional chemotherapy for resectable CRLM is not associated with outcomes. Trials comparing adjuvant and perioperative chemotherapy would have to be powered for small differences in outcome. 相似文献10.
Takakura Y Okajima M Kanemitsu Y Kuroda S Egi H Hinoi T Tashiro H Ohdan H 《World journal of surgery》2011,35(10):2275-2282
Background
Two nomograms are available for predicting patient survival after hepatic resection for metastatic colorectal cancer (CRC). However, they have not been externally validated using other databases, and so their universal applicability has not been established. We aimed to examine the validity of these nomograms for predicting patient survival after hepatic resection for metastatic CRC in different institutions. 相似文献11.
En Bloc Aortic Resection for Bulky Metastatic Germ Cell Tumors 总被引:2,自引:0,他引:2
Rosemary Kelly Donald Skinner Albert E. Yellin Fred A. Weaver 《The Journal of urology》1995,153(6):1849-1851
Between 1989 and 1993, 97 patients with stages B3 and/or C nonseminomatous germ cell tumors of the testes underwent induction chemotherapy followed by retroperitoneal lymph node dissection. Of these patients 6 (ages 22 to 41 years) had gross extension of tumor into the aortic adventitia at operation, which necessitated en bloc aortic and, on 3 occasions, iliac artery resection for complete tumor removal. Aortic continuity was restored by a woven Dacron tube or bifurcated graft. All grafts were covered with omentum. There were no postoperative vascular complications. Pathological study of the residual retroperitoneal disease demonstrated that 2 patients had mature teratoma only, 2 had mature teratoma with occasional nests of immature teratoma and 2 had residual yolk sac, embryonal or choriocarcinoma elements. The latter 3 patients underwent postoperative salvage chemotherapy with varying combinations of bleomycin, etoposide, ifosfamide and cisplatin. At 4 to 55 months 4 patients were disease-free, while 2 died of metastatic disease. No problems related to the aortic reconstruction have occurred. This small experience demonstrates that, if necessary, complete surgical en bloc extirpation of bulky metastatic germ cell tumors and the aorta/iliac artery can be performed safely with a satisfactory long-term outcome. 相似文献
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Gold JS Jaques DP Bentrem DJ Shah MA Tang LH Brennan MF Coit DG 《Annals of surgical oncology》2007,14(2):365-372
Background Metastatic gastric cancer has a dismal prognosis. We identified a subset of patients where surgical resection with therapeutic
intent was undertaken in the setting of known metastatic disease.
Methods Review of a prospectively maintained database of gastric cancer patients at a single institution over a 19-year period was
performed.
Results Thirty-seven patients with metastatic disease known prior to resection with therapeutic intent were identified out of 3384
patients with gastric cancer (1%). Twelve patients had positive peritoneal cytology as the only evidence of metastasis, 21
had gross metastasis limited to peritoneal surfaces, one had peritoneal and ovarian metastasis, one had liver metastasis,
one had retropancreatic lymph node metastasis, and one had a malignant pleural effusion. Thirty-six patients (97%) received
chemotherapy prior to resection, and 30 (81%) received postoperative chemotherapy. The median time from diagnosis to resection
was 4.5 months (range 1–22) in patients receiving preoperative chemotherapy. Median survival was 12 months after resection
with no three-year survivors. Predictors of worse prognosis were cytologic or pathologic evidence of persistent metastatic
disease at the time of resection or at laparoscopy within six weeks of resection (P < .01), N3 disease (P = .03), and total gastrectomy or additional organ resection (P = .04). Metastatic disease as evidenced by cytology only was not associated with improved prognosis.
Conclusions Highly selected patients with metastatic gastric cancer undergoing surgical resection with therapeutic intent have a relatively
poor prognosis. Persistent detectable metastatic disease after preoperative chemotherapy portends a particularly poor prognosis. 相似文献
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Chen F Sonobe M Sato K Fujinaga T Shoji T Sakai H Miyahara R Bando T Okubo K Hirata T Date H 《World journal of surgery》2008,32(8):1657-1662
BACKGROUND: Pulmonary metastasectomy has become the standard therapy for various metastatic malignancies to the lungs; however, little data have been available about lung metastasectomy for head and neck cancers. To confirm a role for resection of pulmonary metastases for such tumors, we reviewed our institutional experience. METHODS: Between 1991 and 2007, 20 patients with pulmonary metastases from head and neck cancers underwent complete pulmonary resection. All patients had obtained or had obtainable locoregional control of their primary head and neck cancers. Various perioperative variables were investigated retrospectively to analyze the prognostic factors for overall survival and disease-free survival after metastasectomy. RESULTS: Of the 20 patients, 10 (50%) had squamous cell carcinoma, 7 (35%) had adenoid cystic carcinoma, and 3 had miscellaneous carcinomas. The median disease-free interval from the time of treatment of the head and neck primary cancers to the development of pulmonary metastases was 27 months. Overall survival rate after metastasectomy was 59.4% at 5 years and 47.5% at 10 years, respectively. Disease-free survival rate was 25.0% at 5 years after pulmonary resection. A disease-free interval equal to or longer than 12 months was a significantly favorable prognostic factor for both overall survival and disease-free survival (p = 0.02 and 0.01, respectively). Patients with squamous cell carcinoma and male sex showed a worse overall survival (p = 0.04 and 0.03, respectively). CONCLUSION: The current practice of pulmonary metastasectomy for head and neck cancers in our institution was well justified. A disease-free interval equal to or longer than 12 months, nonsquamous cell carcinoma, and female sex might be relevant to a better prognosis. 相似文献
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Background This study was done to evaluate the prognostic factors that may affect the survival of patients with recurrent hepatic metastasis
after curative resection of gastric cancer.
Methods We reviewed the medical records of 73 patients with recurrent hepatic metastasis after surgical treatment of gastric cancer
from January 1995 to December 2005. Prognostic factors were classified into three groups: primary tumor factors, recurrent
hepatic factors, and treatment factors. The prognostic values of these factors were assessed using univariate and multivariate
analyses by the log-rank test in the Kaplan-Meier method and Cox’s proportional hazard model.
Results The overall median survival rate of the 73 study patients was 20.0 months [95% confidence interval (CI) 15.4–24.6 months].
The median survival rate after diagnosis of recurrent hepatic metastasis was 5 months (95% CI 3.5–6.5 months). Univariate
analysis showed that the favorable prognostic factors were stage I and II among the primary tumor factors, no extrahepatic
metastasis and unilobar distribution among the recurrent hepatic factors, and radiofrequency ablation (RFA) ± chemotherapy
among the treatment factors when operative treatment had been excluded. The independent favorable prognostic factors revealed
by the multivariate analysis were no extrahepatic metastasis and RFA ± chemotherapy. The median survival rate of patients
who had two favorable prognostic factors was 27 months (95% CI 0–66.38 months).
Conclusions Improvement in the survival rate can be expected with RFA ± chemotherapy for patients with recurrent gastric cancer in the
liver without extrahepatic metastasis. 相似文献
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Julio Sokolich Christos Galanopoulos Ernest Dunn Jeffrey D. Linder D. Rohan Jeyarajah 《JSLS, Journal of the Society of Laparoendoscopic Surgeons》2009,13(2):165-169
Objective:
Laparoscopic resection of large gastric gastrointestinal stromal tumors (GIST) has been controversial. This generally has been limited to small lesions. We hypothesize that laparoscopic mobilization and resection using, in some cases, extracorporeal anastomosis of the gastrointestinal (GI) tract is an oncologically safe alternative to open surgery even when tumors are large.Methods:
Four patients underwent a laparoscopic approach for gastric GIST tumors >2 cm at Methodist Dallas Medical Center over a 6-month period. Patient demographics, operative findings, postoperative course, and pathologic characteristics were examined.Results:
The mean age in this patient group was 58 years (range, 36 to 77). Gastrointestinal bleeding and dyspepsia were the most common symptoms. Seventy-five percent of the patients were females. Mean tumor size was 10 cm (range, 2.5 to 20) with distribution in the stomach as follows: 75% greater curvature and 25% antrum. Tumors were removed by wedge, sleeve, and partial gastrectomies. Two of these tumors showed a high grade and the other 2 a moderate grade of differentiation. The number of mitoses was <5/50 HPF in all the tumors. No intraoperative spillage occurred in any patients, even with the largest tumor (20 cm). Importantly, all tumors were excised with a negative gross and microscopic margin. Average length of stay was 4 days. No patients required reoperation, and there were no complications postoperatively.Conclusion:
Minimally invasive assisted approaches may be an option to treat large GIST tumors. Obeying principles of minimal touch, no spillage, and obtaining a negative margin, a safe operation with a laparoscopic approach is feasible, even in giant tumors. The large size of diagnosed GIST tumors should not preclude a minimally invasive approach. 相似文献18.
Sarah York Boostrom Liana Tsikitis Vassiliki David M. Nagorney Bruce G. Wolff Heidi K. Chua Scott Harmsen David W. Larson 《Journal of gastrointestinal surgery》2011,15(9):1583-1588
Background
The objectives were to determine the feasibility of combined rectal and hepatic resections and analyze the disease-free survival and overall survival. 相似文献19.
Hongbo Wei Jiafeng Fang Tufeng Chen Zongheng Zheng Bo Wei Yong Huang Jianglong Huang Haozhong Xu 《JSLS, Journal of the Society of Laparoendoscopic Surgeons》2014,18(2):323-332
Laparoscopy-assisted surgery for either rectal or gastric cancer has been increasingly performed. However, simultaneous laparoscopy-assisted resection for synchronous rectal and gastric cancer is rarely reported in the literature. In our study, 3 cases of patients who received simultaneous laparoscopy-assisted resection for synchronous rectal and gastric cancer were recorded. The results showed that all 3 patients recovered well, with only 253 minutes of mean operation time, 57 mL of intraoperative blood loss, 5 cm of assisted operation incision, 4 days to resume oral intake, 12 days'' postoperative hospital stay, and no complication or mortality. No recurrence or metastasis was found within the follow-up period of 22 months. When performed by surgeons with plentiful experience in laparoscopic technology, simultaneous laparoscopy-assisted resection for synchronous rectal and gastric cancer is safe and feasible, with the benefits of minimal trauma, fast recovery, and better cosmetic results, compared with open surgery. 相似文献
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John M. Creasy Eran Sadot Bas Groot Koerkamp Joanne F. Chou Mithat Gonen Nancy E. Kemeny Leonard B. Saltz Vinod P. Balachandran T. Peter Kingham Ronald P. DeMatteo Peter J. Allen William R. Jarnagin Michael I. D’Angelica 《Annals of surgical oncology》2018,25(2):431-438