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1.
Wim P. Ceelen MD PhD FACS Yves Van Nieuwenhove MD PhD Simon Van Belle MD PhD Hannelore Denys MD PhD Piet Pattyn MD PhD 《Annals of surgical oncology》2012,19(7):2352-2359
Background
Limited data are available on the use of cytoreductive surgery with hyperthermic intraperitoneal chemoperfusion (HIPEC) in patients with recurrent stage III ovarian cancer.Methods
Patients with recurrent, heavily pretreated ovarian cancer were enrolled onto a phase II multimodal protocol consisting of extensive cytoreduction followed by HIPEC.Results
Forty-two women were treated from October 2002 until January 2009. Chemoperfusion was performed with cisplatin in 59% and oxaliplatin in 41% of patients. A macroscopically complete resection was achieved in 50% of patients. No mortality occurred, and the major morbidity rate was 21%. After a mean follow-up of 21?months, median overall survival (OS) was 37?months (95% confidence interval 12.2?C61.8) and median progression-free survival was 13?months (95% confidence interval 6.9?C19.1). In univariate analysis, OS was influenced by completeness of cytoreduction, type of chemoperfusion drug, nodal status, and tumor grade. In a Cox regression model, only completeness of cytoreduction (hazard ratio 0.06?C0.8, P?=?.022) and tumor grade (hazard ratio 1.23?C12.6, P?=?.021) were independent predictors of OS.Conclusions
In selected patients with heavily pretreated recurrent ovarian cancer, cytoreduction combined with HIPEC may provide a meaningful OS with acceptable morbidity. Optimal results are achieved in patients with a macroscopically complete resection and biologically favorable disease. 相似文献2.
Ogura K Fujiwara T Beppu Y Chuman H Yoshida A Kawano H Kawai A 《Archives of orthopaedic and trauma surgery》2012,132(10):1379-1386
Background
Extraskeletal myxoid chondrosarcoma (EMC) is a rare soft tissue sarcoma. Although it has been regarded as a low-grade sarcoma unassociated with tumor-related death, a recent study has suggested an insidious nature with a high propensity for relapse during a long disease course. The aim of this study was to clarify the long-term clinical features of EMC treated at a single referral center using state-of-the-art techniques.Methods
A retrospective review of 23 consecutive patients (10 males, 13 females; mean age 58?years) treated between 1979 and 2008 (mean follow-up; 109?months) was performed.Results
Surgery for the primary tumor was performed in 22 patients, and 7 cases recurred locally due to inadequate resection. Eleven patients had metastatic disease, either at diagnosis (3) or developing later (8). The 5/10-year overall survival rates were 91/84?%, and the 5/10-year local recurrence-free and metastasis-free survival rates for patients with localized disease were 89/62 and 89/61?%, respectively. Larger tumor size (>10?cm) and metastases at diagnosis were significant negative prognostic factors. Four patients received ifosfamide-based chemotherapy with no objective response. There was no local recurrence in three patients who underwent R1 resection followed by adjuvant radiotherapy. Clinical palliation and retarded progression of the metastatic disease were achieved in three patients who underwent radiotherapy.Conclusions
EMC is indolent but has a high propensity for relapse over 5?years of follow-up. Definitive initial surgery and careful monitoring for a prolonged period are important. Radiotherapy seems beneficial in an adjuvant setting and as palliative therapy for metastatic disease. 相似文献3.
Bickenbach KA Gonen M Tang LH O'Reilly E Goodman K Brennan MF D'Angelica MI Dematteo RP Fong Y Jarnagin WR Allen PJ 《Annals of surgical oncology》2012,19(5):1663-1669
Background
Patients with locally unresectable pancreatic cancer (AJCC stage III) have a median survival of 10?C14?months. The objective of this study was to evaluate outcome of initially unresectable patients who respond to multimodality therapy and undergo resection.Methods
Using a prospectively collected database, patients were identified who were initially unresectable because of vascular invasion and had sufficient response to nonoperative treatment to undergo resection. Overall survival (OS) was compared with a matched group of patients who were initially resectable. Case matching was performed using a previously validated pancreatic cancer nomogram.Results
A total of 36 patients with initial stage III disease were identified who underwent resection after treatment with either systemic therapy or chemoradiation. Initial unresectability was determined by operative exploration (n?=?15, 42%) or by cross-sectional imaging (n?=?21, 58%). Resection consisted of pancreaticoduodenectomy (n?=?31, 86%), distal pancreatectomy (n?=?4, 11%), and total pancreatectomy (n?=?1, 3%). Pathology revealed T3 lesions in 26 patients (73%), node positivity in 6 patients (16%), and a negative margin in 30 patients (83%). The median OS in this series was 25?months from resection and 30?months since treatment initiation. There was no difference in OS from time of resection between the initial stage III patients and those who presented with resectable disease (P?=?.35).Conclusions
In this study, patients who were able to undergo resection following treatment of initial stage III pancreatic cancer experienced survival similar to those who were initially resectable. Resection is indicated in this highly select group of patients. 相似文献4.
Zaydfudim V Smoot RL Clark CJ Kendrick ML Que FG Farnell MB Nagorney DM 《Journal of gastrointestinal surgery》2012,16(8):1516-1523
Introduction
We investigated the role of operative therapy in non-cirrhotic patients who developed metastatic hepatocellular carcinoma (HCC).Methods
This retrospective cohort study included consecutive non-cirrhotic patients with metastatic HCC after a prior hepatectomy treated between 1990 and 2009. Patients were stratified by operative therapy (resection, ablation, transcatheter therapy). Kaplan?CMeier analyses with log-rank comparisons tested effects of operative therapy on overall survival (OS) and progression-free survival (PFS).Results
Of 195 non-cirrhotic patients treated for HCC during the study period, 98 [median age 65, interquartile range (IQR) 53?C71; 55?% male] subsequently developed metastatic HCC (55 intrahepatic only). Median time to development of metastases after the index operation was 10?months (IQR 5?C20?months); median number of metastases was 3 (IQR 2?C7). Half of these patients (n?=?50) underwent operative treatment of metastases; 20 (40?%) underwent metastasectomy, 18 (36?%) ablation, and 12 (24?%) transcatheter therapy. Operative therapy was associated with improved OS (p?0.001). Resection or ablation was associated with improved PFS and OS compared to transcatheter therapy (all p????0.006). Nine patients (seven resection, two ablation) are disease free at a median of 50?months (IQR 24?C80?months) posttreatment.Conclusions
Resection and ablation are associated with an improved PFS and long-term OS and should be considered in select patients with metastatic HCC. 相似文献5.
C Colombo U Ronellenfitsch Z Yuxin P Rutkowski R Miceli E Bylina P Hohenberger CP Raut A Gronchi 《Annals of surgical oncology》2012,19(11):3361-3367
Background
The duodenum is a rare site of primary gastrointestinal stromal tumor (GIST). Overall (OS) and disease-free survival (DFS) after limited resection (LR) versus pancreaticoduodenectomy (PD) were studied.Methods
All patients who underwent surgery for primary, localized duodenal GIST between 2000 and 2011 were identified from four prospective institutional databases. OS and DFS were calculated by Kaplan?CMeier method. Univariate analysis was performed.Results
Eighty-four patients (median follow-up 42?months) underwent LR (n?=?56, 67?%) or PD (n?=?28, 33?%). Patients in the PD group had a larger median tumor size (7?cm vs. 5?cm, p?=?0.024) and higher mitotic count (39?% vs. 19?% >5/50 high-power fields, p?=?0.05). Complications were observed in five patients (9?%) in the LR group and ten patients (36?%) in the PD group. OS and DFS for the entire cohort were 89?% and 64?% at 5?years, respectively. No difference in outcome between LR and PD were observed. Eleven patients were treated with preoperative IM. A major RECIST response was obtained in nine (80?%), whereas two had stable disease. Twenty-three patients received postoperative Imatinib (IM). A trend toward a better OS in IM-treated patients could be detected only in the high-risk group.Conclusions
Type of duodenal resection does not impact outcome. The choice should be determined by duodenal site of origin and tumor size. IM may be considered in cases at high risk of recurrence; in neoadjuvant setting, IM might facilitate resection and possibly increase the chance of preserving normal biliary and pancreatic anatomy. 相似文献6.
John T. Mullen MD Thomas F. DeLaney MD Wendy K. Kobayashi BA Jackie Szymonifka BA Beow Y. Yeap ScD Yen-Lin Chen MD Andrew E. Rosenberg MD David C. Harmon MD Edwin Choy MD PhD Sam S. Yoon MD Kevin A. Raskin MD G. Petur Nielsen MD Francis J. Hornicek MD PhD 《Annals of surgical oncology》2012,19(13):4028-4035
Background
Desmoid tumors are rare and exhibit a highly unpredictable natural history. We sought to analyze prognostic factors associated with recurrence in a large single-institution study of patients with desmoid tumors.Methods
We performed a retrospective review of 177 patients with desmoid tumor who underwent macroscopically complete surgical resection, with or without the addition of radiotherapy (RT) or systemic therapy, from 1970 to 2009. We examined patterns of presentation, all known risk factors for recurrence, and their association with recurrence-free survival (RFS).Results
Twenty-two patients (12?%) had intra-abdominal desmoid tumors, and 155 (88?%) had extra-abdominal tumors. Patterns of presentation included primary (n?=?133, 75?%) and locally recurrent (n?=?44, 25?%) disease. Treatment was surgery alone in 125 patients (71?%), surgery and RT in 36 (20?%), and surgery and systemic therapy with or without RT in 20 (11?%). Median follow-up was 40?months. Overall, the local relapse rate was 29?%, and 10-year RFS was 60?%. R0 resection status was the only predictor of freedom from local recurrence on multivariate analysis (odds ratio 0.32; 95?% confidence interval 0.15?C0.66; P?=?0.002). The selective use of adjuvant RT appeared to improve local control in patients with positive margins.Conclusions
For patients with desmoid tumors undergoing surgery, wide excision with negative margins should be the goal, but not at the expense of function, as fewer than half of patients with positive margins will experience recurrence. 相似文献7.
Irene Epelboym J. DiNorcia M. Winner M. K. Lee J. A. Lee B. A. Schrope J. A. Chabot J. D. Allendorf 《World journal of surgery》2014,38(5):1184-1195
Background
Neoadjuvant therapy and vascular resection may offer patients with locally advanced pancreatic cancer potential cure.Methods
We reviewed medical records of patients with ductal adenocarcinoma who underwent pancreaticoduodenectomy (PD) from 1992 through 2011. We identified patients who received neoadjuvant therapy (NA+) or required vascular resection (VR+) for locally advanced disease and compared outcomes to those who did not.Results
Of the 643 patients who were initially explored, 506 (143 NA+ and 363 NA? patients) ultimately underwent PD. There were no significant differences in R0 resection or morbidity. Mortality was higher in the NA+ versus NA? group (7.0 vs 3.0 %, p = 0.04). More NA+ patients underwent PD VR+ (p < 0.001). Among VR+ patients, neoadjuvant therapy resulted in significantly lower R1 resection. Among resected patients, survival of NA+ patients was significantly longer than both NA? patients (27.3 vs 19.7 months, p < 0.05) and patients abandoned because of locally advanced disease. Age, tumor grade, lymph node ratio, and R1 resection were independent predictors of poor survival.Conclusions
Neoadjuvant therapy and vascular resection offer patients with locally advanced pancreatic cancer the chance for cure with acceptable morbidity and mortality. These patients have improved survival over patients deemed locally inoperable by traditional criteria. 相似文献8.
Caitlin C. Murphy Arlene M. Correa Jaffer A. Ajani Ritsuko U. Komaki James W. Welsh Stephen G. Swisher Wayne L. Hofstetter 《Journal of gastrointestinal surgery》2013,17(8):1359-1369
Background
Experience with neoadjuvant chemoradiation (CXRT) has raised questions regarding the additional benefit of surgery after locally advanced esophageal adenocarcinoma patients achieve a clinical response to CXRT. We sought to quantify the value of surgery by comparing the overall (OS) and disease-free survival (DFS) of trimodality-eligible patients treated with definitive CXRT vs. CXRT followed by esophagectomy.Methods
We identified 143 clinical stage III esophageal adenocarcinoma patients that were eligible for trimodality therapy. All patients successfully completed neoadjuvant CXRT and were considered appropriate candidates for resection. Patients that were medically inoperable were excluded. Cox regression models were used to identify significant predictors of survival.Results
Among the 143 patients eligible for surgery after completing CXRT, 114 underwent resection and 29 did not. Poorly differentiated tumors (HR?=?2.041, 95% CI?=?1.235–3.373) and surgical resection (HR?=?0.504, 95% CI?=?0.283–0.899) were the only independent predictors of OS. Patients treated with surgery had a 50 and 54 % risk reduction in overall and cancer-specific mortality, respectively. Median OS (41.2 vs. 20.3 months, p?=?0.012) and DFS (21.5 vs. 11.4 months, p?=?0.007) were significantly improved with the addition of surgery compared to definitive CXRT.Conclusions
Surgery provides a significant survival benefit to trimodality-eligible esophageal adenocarcinoma patients with locally advanced disease. 相似文献9.
Nam P. Nguyen MD Misty Ceizyk CMD Fabio Almeida MD Alexander Chi MD Michael Betz MD Homayoun Modarresifar MD Thomas Sroka MD Deirdre Cohen MD Siyoung Jang PhD Dave Abraham CMD Michelle Stevie BS Lexie Smith-Raymond CMD Shane Krafft BS Vincent Vinh-Hung MD 《Annals of surgical oncology》2011,18(2):380-385
Background
Image-guided radiotherapy (IGRT) combines precise target visualization with optimal delivery of radiation dose to spare normal tissue from radiation and may potentially reduce side-effects and long-term treatment complications. We have assessed the effectiveness of IGRT for locally advanced rectal cancer.Methods
A retrospective review of 22 patients with locally advanced rectal cancer who underwent preoperative chemoradiation was conducted.Results
Nineteen patients (median age, 69 years) underwent surgical resection after chemoradiation. All 19 patients achieved complete resection with negative margins. Seven patients (32%) had no residual tumor in the surgical specimen. One patient had grade 4 gastrointestinal toxicity and hematological toxicity probably related to inadvertent overdosing of capecitabine. The median survival for the whole group—patients who had pCR and those who did not have pCR—was 14, 17, and 15 months, respectively.Conclusions
Image-guided radiotherapy provided effective treatment for locally advanced rectal cancer with minimal toxicity and should be investigated in future prospective trials. 相似文献10.
Background
Reports on the risk factors of peritoneal recurrence (PR) after liver resection for hepatocellular carcinoma are lacking. We examined the risk factors of PR after hepatectomy and the outcome of resected PR at our institution.Methods
We retrospectively reviewed the data from 1,222 patients who underwent hepatectomies for hepatocellular carcinoma in Samsung Medical Center from January 2006 to August 2010. We identified patients with PR and studied the risk factors and outcomes of resected PR.Results
The rate of PR was 3.0% (n?=?36). The mean?±?SD age of patients was 54.0?±?10.2?years. Among those with PR, 23 patients (63.9%) had unresectable disease and 13 patients (36.1%) had resectable disease. Multivariate analysis found that tumor size >50?mm, presence of microvascular invasion, bile duct invasion, and positive margins were significant risk factors of PR after liver resection. The median overall survival (OS) for resectable PR was 33.0 (28.0?C61.6) months compared to 14.0 (6.8?C21.2) months for unresectable PR (P?=?0.009). Cox regression analysis demonstrated that resected PR [hazard ratio (HR) 0.042, P?=?0.001] and interval between hepatectomy and PR (>6months) (HR 0.195, P?=?0.016) were positive prognostic factors for OS, while alfa-fetoprotein >200?ng/dl at detection of PR (HR 11.321, P?=?0.015) and serosal involvement of primary hepatocellular carcinoma (HR 25.616, P?=?0.007) were negative prognostic factors for OS.Conclusions
We found that tumor size >50?mm, presence of microvascular invasion, bile duct invasion, and positive resection margins were significant risk factors of PR after liver resection. Selected patients with resected PR had significantly better OS. 相似文献11.
Takemura N Saiura A Koga R Arita J Yoshioka R Ono Y Hiki N Sano T Yamamoto J Kokudo N Yamaguchi T 《Langenbeck's archives of surgery / Deutsche Gesellschaft fur Chirurgie》2012,397(6):951-957
Purpose
The indication for hepatectomy in cases of gastric cancer liver metastases (GLM) remains unclear and it remains controversial whether surgical resection is beneficial for GLM. The objective of this retrospective study was to clarify the indications for and benefit of hepatectomy for GLM.Methods
Seventy-three patients underwent hepatectomies for GLM from January 1993 to January 2011. Macroscopically complete (R0 or R1) resection was achieved in 64 patients. Among them, 32 patients underwent synchronous hepatectomy with gastrectomy and the remaining 32 patients underwent metachronous hepatectomy. Repeat hepatectomy was done in 14 patients for resectable intrahepatic recurrences. Clinicopathological factors were evaluated by univariate and multivariate analyses among patients who received macroscopically complete resection for those affecting survival.Results
The overall 1-, 3-, and 5-year survival rates after macroscopically complete (R0 or R1) liver resection (n?=?64) for GLM were 84, 50, and 37?%, respectively, with a median survival of 34?months. Univariate analysis identified serosal invasion of the primary gastric cancer and blood transfusions during surgery as poor prognosis indicators. By multivariate analysis, serosal invasion of the primary gastric cancer and larger hepatic tumor (>5?cm in diameter) were found to be independent indicators of poor prognosis.Conclusions
GLM patients with the maximum diameter of hepatic tumors of <5?cm and without serosal invasion of the primary gastric cancer are the best candidate for hepatectomy. 相似文献12.
Piotr Rutkowski MD PhD Alessandro Gronchi MD Peter Hohenberger MD PhD Sylvie Bonvalot MD PhD Patrick Schöffski MD MPH Sebastian Bauer MD PhD Elena Fumagalli MD Pawel Nyckowski MD PhD Buu-Phuc Nguyen MD Jan Martijn Kerst MD PhD Marco Fiore MD Elzbieta Bylina BSc Mathias Hoiczyk MD Annemieke Cats MD PhD Paolo G. Casali MD Axel Le Cesne MD Jürgen Treckmann MD PhD Eberhard Stoeckle MD Johannes. H. W. de Wilt MD PhD Stefan Sleijfer MD PhD Ronald Tielen MD Winette van der Graaf MD PhD Cornelis Verhoef MD PhD Frits van Coevorden MD PhD 《Annals of surgical oncology》2013,20(9):2937-2943
Background
Preoperative imatinib therapy of locally advanced GIST may facilitate resection and decrease morbidity of the procedure.Methods
We have pooled databases from 10 EORTC STBSG sarcoma centers and analyzed disease-free survival (DFS) and disease-specific survival (DSS) in 161 patients with locally advanced, nonmetastatic GISTs who received neoadjuvant imatinib. OS was calculated from start of imatinib therapy for locally advanced disease until death or last follow-up (FU) after resection of the GIST. DFS was calculated from date of resection to date of disease recurrence or last FU. Median FU time was 46 months.Results
The primary tumor was located in the stomach (55 %), followed by rectum (20 %), duodenum (10 %), ileum/jejunum/other (11 %), and esophagus (3 %). The tumor resection after preoperative imatinib (median time on therapy, 40 weeks) was R0 in 83 %. Only two patients have demonstrated disease progression during neoadjuvant therapy. Five-year DSS/DFS rates were 95/65 %, respectively, median OS was 104 months, and median DFS was not reached. There were 56 % of patients who continued imatinib after resection. Thirty-seven GIST recurrences were diagnosed (only 5 local relapses). The most common mutations affected exon 11 KIT (65 %). Poorer DFS was related to primary tumor location in small bowel and lack of postoperative therapy with imatinib.Conclusions
Our analysis comprising the largest group of GIST patients treated with neoadjuvant imatinib in routine practice indicates excellent long-term results of combined therapy in locally advanced GISTs. 相似文献13.
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14.
Eun Suk Park Young Hyun Cho Jeong Hoon Kim Sang Joon Kim Shin Kwang Khang Chang Jin Kim 《Acta neurochirurgica》2012,154(11):1961-1971
Background
Central neurocytomas (CN) are rare intraventricular tumors with benign clinical behavior that typically affect young adults. Although a favorable prognosis is generally expected after adequate management, there is no general consensus on the standard of therapy. We evaluated the efficacy and safety of radical surgery for the management of CN.Methods
Between 1996 and 2010, 12 patients with CN (eight males and four females; range, 18 to 62?years; mean age, 28.5?years) were surgically treated in our institution. The initial goal of therapy was complete resection through a frontal transcortical approach, and repeat surgery was done in cases of residual or recurrent disease. The mean follow-up period was 51.2?months (range, 14–149?months).Results
Complete resection was achieved in all patients either with primary (nine patients, 75?%) or second-look surgery (three patients, 25?%). No mortalities occurred and there were four surgery-related complications (two events of transient hemiparesis, one transient aphasia, and onepostoperative subdural hygroma). All patients were alive with normal activities of daily living at the last follow-up. Two patients (16.6?%) experienced a single recurrence at 26 and 66?months, one of whom underwent redo-surgery.Conclusion
For the management of CN, complete resection is feasible, effective, and safe. Repeat surgery may be a viable option in cases of residual or recurrent disease and the use of radiotherapy can be avoided in this young population. 相似文献15.
Yoshioka R Saiura A Koga R Arita J Takemura N Ono Y Yamamoto J Yamaguchi T 《World journal of surgery》2012,36(9):2187-2191
Background
The clinical implications of peritoneal lavage cytology (CY) status in patients with potentially resectable pancreatic cancer have not been established.Method
We retrospectively reviewed clinical data from 254 consecutive patients who underwent macroscopically curative resection for pancreatic cancer from February 2003 to December 2010 in our institution. Correlations between CY status and survival and clinicopathological findings were investigated.Results
Of the 254 patients, 20 were CY+ (7.9?%). There were no significant differences between CY+ and CY? patients in background data (age, sex, the level of preoperative tumor marker, and adjuvant chemotherapy). Patients with positive serosal invasion were more likely to be CY+ than those with negative serosal invasion (P?0.001) by univariate analysis. The median overall survival of CY+ patients and CY? patients was 23.8?months (95?% CI?=?17.6–29.8) and 26.5?months (95?% CI?=?20.7–32.3), respectively (P?=?0.302). The median recurrence-free survival of CY+ and CY? patients was 8.1?months (95?% CI?=?0.0–17.9) and 13.5?months (95?% CI?=?11.5–15.5), respectively (P?=?0.089).Conclusion
CY+ status without other distant metastasis does not necessarily preclude resection in patients with pancreatic cancer. 相似文献16.
17.
Jason W. Denbo MD W. Shannon Orr MD Yanan Wu MS Jianrong Wu PhD Catherine A. Billups MS Fariba Navid MD Bhaskar N. Rao MD Andrew M. Davidoff MD Matthew J. Krasin MD 《Annals of surgical oncology》2012,19(12):3809-3815
Background
Ewing sarcoma (ES) is the most common chest wall malignancy in adolescents. Current therapy incorporates chemotherapy to treat systemic disease and radiotherapy to assist with local control. We sought to evaluate the timing of surgery and role of adjuvant radiotherapy.Methods
We reviewed the St. Jude Children??s Research Hospital chest wall ES experience from 1979 to 2009. Patient demographics, tumor characteristics, treatment variables, and outcomes were analyzed with respect to timing of surgery and use of adjuvant radiotherapy.Results
Our cohort consisted of 36 patients with chest wall ES; median follow-up was 14.2?years, and 15-year estimate of overall survival was 66?%. In patients with localized disease, the timing of surgery (up-front vs. delayed) did not impact margin negativity or the use of adjuvant radiotherapy, but it did decrease the extent of chest wall resection. When considering radiotherapy in patients with localized disease, we found that patients who did not receive radiotherapy had smaller tumor size (median 6 vs. 10?cm) (p?=?0.04) and were more likely to have had negative margins (p?=?0.01) than patients who received adjuvant radiotherapy. One patient in each group developed a locoregional recurrence. The 15-year estimated of overall survival for patients who received adjuvant radiotherapy was 80 versus 100?% for those who did not.Conclusions
Delayed surgery decreased the extent of chest wall resection and helped define a patient population with favorable tumor biology. Patients with complete pathologic responses to chemotherapy, and those with tumors <8?cm and negative surgical margins may be spared adjuvant radiotherapy without any decrement in overall survival. 相似文献18.
Alan A. Thomay David M. Nagorney Steven J. Cohen Elin R. Sigurdson Mark J. Truty Barbara Burtness Michael J. Hall Yun Shin Chun 《Journal of gastrointestinal surgery》2014,18(1):69-74
Background
In colorectal cancer, the involvement of regional lymph nodes with metastasis is an established prognostic factor. The impact of the number of positive nodes on patient outcome with stage IV disease is not well defined.Methods
A retrospective review was performed of 1,421 patients at two tertiary referral centers with stage IV colorectal cancer who underwent primary tumor resection. Associations between regional nodes, lymph node ratio (LNR), and overall survival (OS) from date of diagnosis were analyzed.Results
The number of positive regional nodes and LNR correlated with multiple sites of metastases (p?<?0.001). Survival was significantly associated with the number of positive nodes and LNR, with a median OS of 43 months with negative nodes, compared to 20 months with ≥7 positive nodes (p?<?0.001). The number of regional nodal metastases correlated with OS among 400 patients undergoing resection of liver metastases (p?=?0.005) but lost prognostic significance in the subset of 223 patients who underwent hepatectomy with perioperative oxaliplatin- or irinotecan-based chemotherapy (p?=?0.48).Conclusions
In stage IV colorectal cancer, an increasing number of positive regional nodes and LNR correlate with multiple sites of metastases and poorer survival. The number of metastatic regional lymph nodes loses prognostic significance with modern chemotherapy in patients undergoing resection of liver metastases. 相似文献19.
Olofsson R Bergh P Berlin O Engström K Gunterberg B Hansson M Lindnér P Mattsson J 《Annals of surgical oncology》2012,19(6):1800-1807
Background
Isolated limb perfusion with tumor necrosis factor alpha and melphalan (TM-ILP) has proven to be a successful option in treating advanced soft tissue sarcomas (STS), where amputation otherwise is needed to achieve safe surgical margins.Methods
From 2000 to 2009, 54 patients with locally advanced STS, who all were candidates for amputation, were treated with totally 57 TM-ILP procedures and then followed prospectively. The median follow-up time was 30?months. Median tumor size was 10?cm, and 94% of the patients had high-grade tumors.Results
The clinical overall response after TM-ILP was 71% (including 21% CR), and 60% of the patients underwent resection of the tumor remnant after a median of 2?months. The histopathologic response rate in the resected specimens was 76%. Local recurrence/progress occurred in 37% of the patients after a median of 7?months. Thirteen patients finally underwent amputation after a median of 11?months, giving a long-term limb salvage of 76%.Conclusions
TM-ILP of advanced soft tissue sarcoma of the extremities makes limb-sparing surgery possible in a high proportion of patients. 相似文献20.
Siril G. Rogne Ane Konglund David Scheie Eirik Helseth Torstein R. Meling 《Acta neurochirurgica》2014,156(6):1053-1061