共查询到20条相似文献,搜索用时 11 毫秒
1.
Gruenberger T Jourdan JL Zhao J King J Morris DL 《Archives of surgery (Chicago, Ill. : 1960)》2000,135(11):1285-1290
HYPOTHESIS: Intraoperative echogenic appearance of liver metastases from colorectal cancer is a prognostic factor of outcome after curative treatment. DESIGN: Retrospective analysis of prospectively collected data. SETTING: Department of Surgery at a university hospital. PATIENTS: One hundred forty-three consecutive patients with hepatic metastases from colorectal cancer who underwent liver resection with curative intent between 1992 and 1998. INTERVENTION: Curative treatment was achieved by liver resection alone, liver resection plus edge cryotherapy, or liver resection plus cryotherapy to lesions not amenable to further resection. In patients with more than 2 lesions, a hepatic artery catheter was placed for regional chemotherapy. MAIN OUTCOME MEASURES: The echogenic appearance of the liver metastases was assessed by intraoperative ultrasound by a single person throughout the study using a 5-MHz ultrasound probe. The findings were prospectively entered into the database. RESULTS: Fifty-four percent of patients had hyperechoic metastases. This group had significantly longer overall (log rank, P<.001) and recurrence-free survival (log rank, P =.004) compared with patients who had hypoechoic metastases (36%). A significantly higher percentage of mucin-secreting tumors were found in the hypoechoic patient group (chi(2), P =.001). Dukes stage of the primary tumor (P =.02), echogenicity of the liver secondaries (P =.04), and diameter of the largest resected metastasis (P =.01) were independent prognostic factors for recurrence-free survival in the Cox regression model. CONCLUSION: These results support the hypothesis that echogenicity of liver metastases from colorectal cancer is an independent prognostic factor of outcome after curative resection. 相似文献
2.
The metastatic/examined lymph node ratio is an important prognostic factor after pancreaticoduodenectomy for pancreatic adenocarcinoma 总被引:9,自引:0,他引:9
Survival after curative resection for pancreatic adenocarcinoma remains poor; an important prognostic factor is lymph node (LN) status. Recent reports have established the number of LN examined as a separate prognostic factor in many malignancies. We retrospectively reviewed the charts of 128 patients undergoing pancreaticoduodenectomy (PD) for pancreatic cancer and obtained information such as overall survival (OS), disease-free survival (DFS), tumor characteristics, preoperative carbohydrate antigen (CA) 19-9, sex, and age. The ratio of metastatic to examined LN (LNR) was determined, and OS and DFS were analyzed in relation to the three groups: LNR = 0, LNR < 0.15, and LNR > 0.15. The median number of LN collected was 17. There were 46 N0 patients (median = 12) and 83 N1 patients (median = 19). The number of LN harvested had no impact on OS or DFS in the N0 or N1 patient populations. When LNR was examined as a continuous variable, it had a borderline impact on OS (P = 0.068). Examination of LNR by three groups showed an impact on OS (P = 0.037) and DFS (P = 0.013). After curative PD for pancreatic cancer, the ratio of metastatic to examined lymph nodes is an important prognostic factor and should be evaluated in stratification schemes for future clinical trials investigating adjuvant treatments. 相似文献
3.
PURPOSE: Gleason grade and tumor stage are well established prognostic factors in prostate cancer. Histological demonstration of tumor in lymphovascular spaces has been associated with poor prognosis in many tumor types but it is not included in current prostate cancer grading and staging schemes. Whether lymphovascular invasion is an independent prognostic factor for disease progression in prostate cancer is uncertain. We retrospectively investigated lymphovascular invasion as a predictive factor for biochemical failure and cancer specific survival following radical prostatectomy. MATERIALS AND METHODS: The records of 504 patients with prostatic adenocarcinoma undergoing radical prostatectomy were reviewed for lymphovascular invasion. Clinical followup data were available on 459 cases. Mean followup was 44 months (range 1.5 to 144). Multivariate analysis was performed using the Cox model. RESULTS: Lymphovascular invasion was identified in 106 cases (21%). Univariate analysis showed a significant association between lymphovascular invasion and higher preoperative serum prostate specific antigen (PSA), advanced pathological stage, higher Gleason score, positive surgical margins, extraprostatic extension, seminal vesicle invasion, lymph node metastasis and perineural invasion (each p <0.001). No association was observed between lymphovascular invasion and patient age at surgery, prostate weight or high grade prostatic intraepithelial neoplasia. Lymphovascular invasion was an independent predictor of PSA recurrence (HR 1.6, 95% CI 1.12 to 2.38, p = 0.01) and cancer specific survival (HR 2.75, 95% CI 1.04 to 2.28, p = 0.041) after controlling for tumor stage, surgical margins and Gleason grade on multivariate analysis. Five-year cancer specific survival was 90% in men with lymphovascular invasion compared to 98% in those without lymphovascular invasion (p <0.001). CONCLUSIONS: Lymphovascular invasion can be identified in approximately 20% of prostate cancer cases. Lymphovascular invasion is an independent risk factor for PSA recurrence and cancer death in patients with prostate cancer. 相似文献
4.
Postoperative morbidity and long-term survival after pancreaticoduodenectomy with superior mesenterico-portal vein resection 总被引:7,自引:0,他引:7
Hartwig Riediger M.D. Frank Makowiec M.D. Eva Fischer Ulrich Adam M.D. Ulrich T. Hopt M.D. 《Journal of gastrointestinal surgery》2006,10(8):1106-1115
The role of superior mesenteric-portal vein resection (SM-PVR) for vein invasion or tumor adherence during pancreatoduodenectomy
(PD) is still under debate. We investigated morbidity, mortality, and long-term survival in patients who underwent PD with
or without SM-PVR. Between July 1994 and December 2004, 222 PD (78% pylorus preserving, 19% Whipple, and 3% total pancreatectomy)
were performed for malignant disease. Fifty-three patients (24%) had PD with SM-PVR. Sixty-eight percent of the venous resections
were performed as wedge excisions and 32% as segmental resections. Long-term survival was analyzed in 165 patients with pancreatic
(n=110), ampullary (n=33), or distal bile (n=22) duct cancer using univariate (log-rank) and multivariate (Cox regression)
methods. In patients undergoing PD with SM-PVR and conclusive histologic examination of the resected vein specimen (n=42),
60% had true tumor involvement of the venous wall, whereas 40% had no proven tumor infiltration. In the complete study group,
negative resection margins were obtained in 69% of patients with SM-PVR and in 79% of patients without SM-PVR (P=0.09). Median duration of surgery was 500 minutes (SM-PVR) versus 440 minutes (no SM-PVR; P<0.001). Volume of intraoperatively transfused blood was 600 ml (median) in both groups. Postoperative surgical complications/mortality
occurred in 23%/3.8% (SM-PVR) versus 35%/4.1% (no SM-PVR); P=0.09/0.9. Analysis of long-term survival in all 165 patients included 41 with SM-PVR. Five-year survival rates were 15% in
cancer of the pancreatic head, 22% in ampullary cancer, and 24% in distal bile duct cancer (P=0.02). Long-term survival was not influenced by the need for SM-PVR in any of the different tumor entities. In multivariate
analysis, a positive resection margin (P<0.01, relative risk [RR]: 1.8, 95% confidence interval [CI]: 1.2–2.7), a histologically undifferentiated tumor (P=0.01, RR: 1.7, 95% CI: 1.1–2.5), and the tumor entity (P<0.01) were significant predictors of survival. Univariate survival analysis of the 110 patients with cancer of the pancreatic
head revealed that a histologically undifferentiated tumor (P=0.05) and positive resection margins (P=0.02) were associated with a poorer survival. In multivariate analysis, the resection margin (P=0.02, RR: 5.1, 95% CI: 1.1–2.8) and a histologically undifferentiated tumor (P=0.05, RR: 3.8, 95% CI: 1.0–2.5) significantly influenced survival. After PD, perioperative morbidity and long-term survival
in patients with SM-PVR were similar to those of patients without vein resection. In case of tumor adherence or infiltration,
combined resection of the pancreatic head and the vein should always be considered in the absence of other contraindications
for resection.
Initial results were presented at the Forty-Fourth Annual Meeting of The Society for Surgery of the Alimentary Tract, Orlando,
Florida, May 18–21, 2003 (poster). 相似文献
5.
6.
Ramiro Manuel Fernandez-Placencia Paola Montenegro Melvy Guerrero Mariana Serrano Emperatriz Ortega Mercedes Bravo Lourdes Huanca St phane Bertani Juan Manuel Trejo Patricia Webb Jenny Malca-Vasquez Luis Taxa Alberto Lachos-Davila Juan Celis-Zapata Carlos Luque-Vasquez Eduardo Payet Eloy Ruiz Francisco Berrospi 《World journal of gastrointestinal surgery》2022,14(1):24-35
7.
Interferon-based adjuvant chemoradiation therapy after pancreaticoduodenectomy for pancreatic adenocarcinoma 总被引:19,自引:0,他引:19
BACKGROUND: Patients with cancer who undergo pancreaticoduodenectomy (PD) followed by radiation and 5-fluorouracil (5-FU) therapy have experienced median overall survival from 18 to 24 months and an actuarial 2-year overall survival from 34% to 48%. We previously reported an 84% 2-year survival using a novel adjuvant chemoradiation protocol that included alpha interferon. This report describes the continued observations regarding this methodology with longer follow-up and more than twice the number of patients as the original report. METHODS: From July 1995 to May 2002, 43 patients with adenocarcinomas in the pancreatic head underwent PD at our institution. The mean age was 62 years (range 29 to 77) and 60% were men. Final pathologic findings were stage I (2%), II (12%), III (72%), and IVa (14%) while 84% had positive lymph nodes (average number of nodes positive was 3.2 nodes, (range 0 to 13). Tumor extended through the capsule of the surgical specimen in 70%. These patients then received our investigational protocol consisting of external-beam irradiation at a dose of 4,500 to 5,400 cGy (25 fractions over 5 weeks) and three-drug chemotherapy: continuous infusion 5-FU (200 mg/m(2) daily, days 1 to 35), weekly intravenous bolus cisplatin (30 mg/m(2) daily, days 1,8,15,22,29), and subcutaneous alpha, interferon (3 x 10(6) units, days 1 to 35). This chemoradiation was followed by continuous infusion 5-FU (200 mg/m(2) daily, weeks 9 to 14 and 17 to 22). Chemoradiation was generally initiated between 6 and 8 weeks after surgery. RESULTS: All patients completed radiation therapy. There were no deaths due to chemoradiation but 42% were hospitalized during chemoradiation, virtually all due to gastrointestinal toxicity. With a mean follow-up time of 31.9 months, 67% of the patients are alive. Therefore, the median survivorship has not been reached. Actuarial overall survival for the 1-, 2-, and 5-year periods was 95% (confidence interval [CI] = 91% to 98%), 64% (CI = 56% to 72%), and 55% (CI = 46% to 65%), respectively. CONCLUSIONS: This follow-up report further suggests overall survival may be improved for patients with adenocarcinoma in the pancreatic head using an adjuvant interferon-based chemoradiation protocol. These results are obtained despite a high incidence of node involvement and advanced tumor stage. From this limited patient series, the actuarial 2-year and 5-year overall survival rates suggest a potential for improved long-term survival. Further study of this regimen in a multiinstitutional setting is needed. 相似文献
8.
Anastomotic leakage is predictive of diminished survival after potentially curative resection for colorectal cancer 总被引:21,自引:0,他引:21
下载免费PDF全文
![点击此处可从《Annals of surgery》网站下载免费的PDF全文](/ch/ext_images/free.gif)
Walker KG Bell SW Rickard MJ Mehanna D Dent OF Chapuis PH Bokey EL 《Annals of surgery》2004,240(2):255-259
OBJECTIVE: The aim of this study was to determine whether anastomotic leakage has an independent association with overall survival and cancer-specific survival. SUMMARY BACKGROUND DATA: There are many known prognostic indicators following surgery for colorectal cancer (CRC). However, the impact of anastomotic leakage has not been adequately assessed. METHODS: Consecutive patients undergoing resection between 1971 and 1999 were recorded prospectively in the Concord Hospital CRC database. Total anastomotic leakage was defined as any leak, whether local, general, or radiologically diagnosed. Patients were followed until death or to December 31, 2002. The association between anastomotic leakage and both overall survival and cancer-specific survival was examined by proportional hazards regression with adjustment for other patient and tumor characteristics influencing survival. Confidence intervals (CI) were set at the 95% level. RESULTS: From an initial 2980 patients, 1722 remained after exclusions. The total leak rate was 5.1% (CI 4.1-6.2%). In patients with a leak, the 5-year overall survival rate was 44.3% (CI 33.5-54.6%) compared to 64.0% (CI 61.5-66.3%) in those without leak. In proportional hazards regression-after adjustment for age, gender, urgent resection, site, size, stage, grade, venous invasion, apical node metastasis and serosal surface involvement-anastomotic leakage had an independent negative association with overall survival (hazard ratio [HR] 1.6, CI 1.2-2.0) and cancer-specific survival (HR 1.8, CI 1.2-2.6). CONCLUSION: Apart from its immediate clinical consequences, anastomotic leakage also has an independent negative association with survival. 相似文献
9.
10.
11.
12.
The rate of colorectal tumors causing large bowel obstruction is still high (about 16%). In our experience, 93 out of 985 patients (9.4%) affected by colorectal cancer required surgery because of large bowel obstruction. The comparative analysis between 64 (68.8%) obstructed and 738 (82.7%) non-obstructed radically resected patients showed that sex and age of patients, tumor site, tumor diameter, parietal infiltration, grading, lymphnode involvement, distant metastases, and staging were not significantly different. Post-operative mortality rates (1.6% vs. 0.5%) and morbidity rates (15.6% vs. 15.6%) were not significantly different as well. On the contrary, survival rate was different. Patients submitted to radical resections had a far poorer prognosis as compared with non-obstructed radically resected ones: the five-year survival was 41.2% and 78.9% respectively. Radically resected obstructed patients showed an higher and earlier ráte of local and distant recurrence with a disease-related death rate of 47.6% vs. 16.3% as compared with non-obstructed ones. The occlusive phenomenon by itself resulted to represent an independent unfavorable factor negatively affecting long term prognosis after radical resections. 相似文献
13.
黄秀芸|王向阳|杨瑜明|吴明浩|刘展 《中国普通外科杂志》2016,25(9):1247-1252
目的:探讨影响壶腹腺癌患者行胰十二指肠切除术预后相关因素。方法:回顾2007年1月—2014年12月期间接受胰十二指肠切除术治疗的壶腹腺癌患者的临床及病理资料,分析患者术后生存的影响因素。结果:全组患者术后1、3、5年生存率分别为87.5%、64.3%、54.5%。单因素分析显示,术前总胆红素、直接胆红素、CEA、CA19-9、CA242、肿瘤分化程度、肿瘤浸润深度、淋巴结转移、肿瘤分期、胰腺侵犯、神经侵犯、术后辅助治疗是影响壶腹腺癌患者术后生存的影响因素(均P0.05)。多因素分析显示,CEA、肿瘤浸润深度是影响壶腹腺癌患者术后生存的独立影响因素(均P0.05)。结论:壶腹腺癌患者行胰十二指肠切除术后的预后与多种因素相关,CEA、肿瘤浸润深度是评价壶腹腺癌患者预后最重要的指标。 相似文献
14.
Interferon-based adjuvant chemoradiation therapy improves survival after pancreaticoduodenectomy for pancreatic adenocarcinoma 总被引:12,自引:0,他引:12
BACKGROUND: Based on a 2-year survival of 43%, the Gastrointestinal Tumor Study Group (GITSG) recommended adjuvant 5-FU-based chemoradiation for resected patients with adenocarcinoma of the pancreatic head. Here we report improved survival over the GITSG protocol with a novel adjuvant chemoradiotherapy based on interferon-alpha (IFNalpha). METHODS: From July 1993 to September 1998, 33 patients with adenocarcinoma of the pancreatic head underwent pancreaticoduodenectomy (PD) and subsequently went on to adjuvant therapy (GITSG-type, n = 16) or IFNalpha-based (n = 17) typically given between 6 and 8 weeks after surgery. The latter protocol consisted of external-beam irradiation at a dose of 4,500 to 5,400 cGy (25 fractions per 5 weeks) and simultaneous three-drug chemotherapy consisting of (1) continuous infusion 5-FU (200 mg/m2 per day); (2) weekly intravenous bolus cisplatin (30 mg/m2 per day); and (3) IFNalpha (3 million units subcutaneously every other day) during the 5 weeks of radiation. This was then followed by two 6-week courses of continuous infusion 5-FU (200 mg/m2 per day, given weeks 9 to 14 and 17 to 22). Risk factors for recurrence and survival were compared for the two groups. RESULTS: A more advanced tumor stage was observed in the IFNalpha-treated patients (positive nodes and American Joint Committee on Cancer [AJCC] stage III = 76%) than the GITSG group (positive nodes and stage III = 44%, P = 0.052). The 2-year overall survival was superior in the IFNalpha cohort (84%) versus the GITSG group (54%). With a mean follow-up of 26 months in both cohorts, actuarial survival curves significantly favored the IFNalpha group (P = 0.04). CONCLUSIONS: With a limited number of patients, this phase II type trial suggests better survival in the interferon group as compared with the GITSG group even though the interferon group was associated with a more extensive tumor stage. The 2-year survival rate in the interferon group is the best published to date for resected pancreatic cancer. The interferon/cisplatin/5-FU-based adjuvant chemoradiation protocol appears to be a promising treatment for patients who have undergone PD for adenocarcinoma of the pancreatic head. 相似文献
15.
Thilo Welsch Luca Degrate Stefanie Zschäbitz Stefan Hofer Jens Werner Jan Schmidt 《Langenbeck's archives of surgery / Deutsche Gesellschaft fur Chirurgie》2011,396(3):353-362
Purpose
Pancreaticoduodenectomy (PD) is standard for patients with resectable pancreatic ductal adenocarcinoma (PDAC) in the pancreatic head, neck, and uncinate process, but it is associated with a relatively high morbidity. This study aimed to identify risk factors for extended postoperative intensive care unit (ICU) admission and assess the impact of ICU treatment on patient survival. 相似文献16.
RCAS1 expression as a prognostic factor after curative surgery for extrahepatic bile duct carcinoma 总被引:4,自引:0,他引:4
Suzuoki M Hida Y Miyamoto M Oshikiri T Hiraoka K Nakakubo Y Shinohara T Itoh T Okushiba S Kondo S Katoh H 《Annals of surgical oncology》2002,9(4):388-393
Background RCAS1 (receptor-binding cancer antigen expressed on SiSo cells) is a cancer cell-surface antigen and has been identified as
a prognostic factor in several cancers. It is thought that tumor cells escape from immune attack by expressing RCAS1, which
induces apoptosis in receptor-positive immune cells. We investigated the relationship between RCAS1 expression and clinicopathologic
features and clinical outcome in patients with extrahepatic bile duct carcinoma (EBDC) who underwent curative resection.
Methods RCAS1 expression was determined by immunohistochemistry in 60 patients with EBDC who underwent curative resection from 1992
to 1999. The patients were divided into two groups on the basis of the extent of RCAS1 expression: a low-expression group
(immunoreactivity in <25% of cells) and a high-expression group. Expression was correlated with clinicopathologic features
and prognosis.
Results RCAS1 was expressed in 52 (86.7%) of 60 tumors and at a high frequency in all histopathologic stages. High expression of RCAS1
was detected in 46 (76.7%) of 60 cases. No correlation existed between the pattern of RCAS1 expression and any clinicopathologic
feature, although high expression did correlate with poor prognosis. High RCAS1 expression was an independent negative predictor
for survival.
Conclusions RCAS1 expression predicts poor outcome in resectable EBDC. 相似文献
17.
Pancreatic fistula (PF) after pancreaticoduodenectomy (PD) is still a severe complication and a challenging problem. The common risk factors are the soft pancreas and small pancreatic duct of the remnant pancreas. Those two risk factors were recognized during surgery. On the other hand, a preoperatively determined risk factor of PF is unclarified. We conducted a retrospective analysis of 203 patients consecutively treated by PD from April 2000 to October 2010. PF was defined according to the criteria of the International Study Group of Pancreatic Fistula. Clinical and pre- and intraoperative data were compared between PF and non-PF patients. The recommended cutoff value of body mass index (BMI) as 20 kg/m(2) was defined by receiver operating characteristic curve analysis. PF occurred in 53 (26.1%) of 203 patients. In univariate analysis, BMI and soft remnant pancreas were found to be risk factors of PF (P = 0.027, P = 0.005). In multivariate analysis, BMI and soft pancreas were also risk factors of PF (P = 0.040, P = 0.005). Patients with PF had a significantly longer hospital stay than non-PF patients (P = 0.005). High BMI and soft pancreas were significant risk factors for PF. 相似文献
18.
19.
20.
Blom RL Nieuwkerk PT van Heijl M Bindels P Klinkenbijl JH Sprangers MA van Berge Henegouwen MI 《Digestive surgery》2012,29(3):206-212
Background: Routine imaging (RI) as part of follow-up after potentially curative esophagectomy is currently not widely accepted. If detected recurrent disease could be adequately treated, it remains unclear whether patients would want to take part in a screening program. The aim of this study was to determine the extent to which patients who underwent esophagectomy prefer follow-up with or without RI. Methods: Patients who underwent esophagectomy for carcinoma without evidence of recurrent disease were included. An interview-administered questionnaire was used to assess fear of recurrence and elicit patient preferences for the frequency and duration of follow-up and hypothetical changes of survival chances (1-10%). Results: 45/54 eligible patients (83%) participated in this study. The majority of patients preferred follow-up with RI (67%) even if screening would not provide a survival benefit; this proportion increased up to 93% if the proposed chances of survival improved. Younger patients and patients with a lower histopathological tumor stage were more likely to desire follow-up with RI. Conclusion: Most patients who underwent esophagectomy preferred RI as part of follow-up over outpatient clinic visits only, even if such screening would not provide a survival benefit. Further research is needed to determine the most accurate screening modality and most efficient follow-up interval. 相似文献