Prognosis in gastric cancer; a study of 5-year survivors

Of 377 patients with gastric carcinoma 115 or 30.8 per cent survived resection; twenty-eight, 7.4 per cent of the 377, survived five years.Fifty per cent of the five year survivors had had symptoms of over a year's duration as compared with 31 per cent of the initial group. The symptoms were essentially identical in type. Palpable tumor masses were present in 40 per cent of the original group as compared with 26.6 per cent of the survivor group.Nine of the survivors had type I (Borrmann) carcinoma, seventeen had type II and four had type III; there were no five-year survivors in the Borrmann type IV group.Metastases were present in 23 per cent of the five-year survivors, five with lymph node involvement, one with mesenteric involvement and a seventh with spread to the transverse colon.Eighty per cent of the five-year survivors were restored to useful life.     

Carcinoma of the splenic flexure

Summary There were 50 primary cases of carcinoma of the splenic flexure at Memorial Hospital in the period from 1950 to 1966. Of the 50 patients, 31 were men and 19 were women. Curative resection was performed in 38 cases. palliative resection in nine, a bypass operation in one, and a transverse colostomy in one. The five-year survival of the patients without distant metastases (Dukes' A, B, and C) was significantly inferior when compared with that of the overall colonic-cancer group, 50 and 69.25 per cent, respectively. Splenectomy and distal pancreatectomy in resection of carcinoma of the splenic flexure did not seem to improve five-year survival. Pathologic study of the removed spleens and pancreases failed to reveal metastases. Read at the meeting of the American Proctologic Society, New York, New York, June 11 to 14, 1972.     

Radical mastectomy in the aged female.

Of 142 female patients over age 75 at The New York Hospital-Cornell Medical Center, 58 underwent radical mastectomy and 40 simple mastectomy for primary breast cancer. After five years, 19 per cent of the radical mastectomy group were cancer-free compared with 35 per cent of the simple mastectomy group. The gross five-year survival rates were 50 per cent and 47 per cent respectively. In the radical mastectomy group, when the axillary nodes did not show cancer at the time of operation, there have been no known recurrences and 70 per cent of the patients have survived at least five years. There was no surgical mortality. These findings support the view that until more controlled data are available, radical mastectomy is still the preferred therapy for primary breast cancer.     

Five-year results of abdominopelvic lymph node dissection for carcinoma of the rectum

Summary and Conclusions A series of 122 patients with adenocarcinoma of the rectum who had abdominopelvic lymph node dissection five or more years ago is presented. Metastases to abdominopelvic extramesenteric lymph nodes which would not have been removed by the standard types of resection of the rectum were found in 11 cases (9 per cent). There was 66 (54 per cent) five-year survivors. The survival rate for those classified according to Dukes’ method as A, B and C was 83, 58 and 40 per cent, respectively. Two patients of 11 having metastases to abdominopelvic extramesenteric lymph nodes which would not have been removed by the usual procedures for cancer of the rectum lived five or more years. Of 35 patients who died of residual or metastatic cancer, 22 (60 per cent) had residual pelvic malignant disease. Read at the meeting of the American Proctologic Society, June 29 to July 3, 1958, Los Angeles, California.     

Primary radiation therapy in the treatment of anal canal carcinoma

A retrospective analysis was undertaken of 51 patients with primary anal canal carcinoma who were treated by radiation therapy, with surgery being reserved for those with residual carcinoma. The five-year uncorrected survival rate was 59 per cent, and the corrected survival rate was 71 per cent. The primary tumor was controlled by radiation alone in 29 of 51 patients (57 per cent) and by subsequent radical surgery in eight of ten patients. Abnormal lymph nodes were controlled by radiation alone in eight of 11 patients. Only three of 29 patients required surgery for complications associated with radiation in the absence of persistent tumor. Seventy-seven per cent (23 of 30) of long-term survivors did not require colostomy and retained anal continence. It is concluded that modern radiation therapy techniques are well tolerated and are an effective method of treating carcinoma of the anal canal.     

Adenocarcinoma of the appendix

Twenty-two cases of appendiceal adenocarcinoma are reviewed. Correct diagnosis was not made preoperatively in any case, and in only 38 per cent of the cases was it made intraoperatively. Thirty-two per cent of the patients had second primary neoplasm, and in more than half of these cases, the neoplasms were most likely concurrent with the appendiceal tumors. The overall five-year survival rate of the 22 patients was 18.7 per cent, with a 43.4 per cent survival rate in the curative resection group. The grade of tumor differentiation was the only significant factor in determining curative resectability and prognosis.     

Surgical treatment of pulmonary tuberculosis in Greenland

Surgical treatment of pulmonary tuberculosis in Greenland. Follow-up of 1, 143 patients operated on for pulmonary tuberculosis at Queen Ingrid's Hospital, Godthåb, during the years 1954–1966. In particular the main group consisting of 785 resected patients is reviewed. Overall operative mortality was 1.0 per cent. At follow-up 2–12 years after surgery 104 (9 per cent) had died, and 1, 039 were in good health. Of the survivors 78 per cent were fully and 12 per cent partially fit for work while 1 per cent were unfit. Of the 1, 039 survivors 95 per cent were back at work within one year after surgery; 90 per cent had resumed their old occupation while only 6 per cent had changed occupation because of the tuberculosis. There was a close relationship between impaired work capacity and the nature and extent of the operation. By Greenland standards housing conditions of the survivors were satisfactory for 80, unsatisfactory for 5 and poor for 14 per cent.     

Surgical results in 657 patients with colorectal cancer

Six hundred fifty-seven patients with colorectal cancer who were operated upon at the Second Department of Surgery, Helsinki University Central Hospital during the period 1966 to 1975 had a 40.5 per cent crude five-year survival rate and 54.2 per cent relative (corrected) rate. The survival rates of patients with Dukes' A lesions were 80.7 per cent, Dukes' B, 61.6 per cent, Dukes' C, 40.4 per cent, and Dukes' D, 2.7 per cent. One hundred two patients (15.5 per cent) underwent emergency operations; 91 were occlusive cancers, eight were perforations and three were cancer bleedings. The operative mortality for the whole series was 6.5 per cent (4.7 per cent in elective and 16.7 per cent in emergency operations). A definite improvement of the five-year survival rates could be seen in both the colonic and rectal cancer series. This was due to earlier detection of the disease, reflecting a decreasing number of palliative operations. Patients at high risk for colorectal cancer (inflammatory bowel disease, inherited intestinal polyposis, cancer family syndrome, multiple colorectal cancers, and neoplastic polyps) might benefit from more effective cancer surveillance and prophylactic surgery to find and treat cancers in earlier stages, to prevent recurrences, and to facilitate follow-up. The controversial findings on postoperative adjuvant therapy presented in this study indicate the need for further controlled studies to define the patients who really benefit from it.     

An analysis of the outcome of 301 malignant colorectal tumors

The results of surgical treatment of 301 patients with malignant tumors of the colon and rectum presenting to two small district general hospitals in the years 1972 to 1977 were analyzed. Two hundred seventy-four patients (91 per cent) underwent surgery with an operative mortality of 8.7 per cent. Curative resections were performed in 58 per cent of the patients. The overall crude five-year survival rate was 32 per cent. The crude five-year survival rates for curative resection, palliative procedures, and inoperable patients were 47 per cent, 11 per cent, and 0 per cent, respectively. Survival rates were considerably improved in patients in the 40-to-50-year age group with 9 to 12 months' duration of symptoms, and in those with early unfixed, resected tumors. It was diminished in patients with bowel perforation presenting as an emergency, and in patients with two weeks or less duration of symptoms. Survival was not related to the site or grade of the tumor.     

Coexisting carcinoma with peridiverticulitis of the colon

Summary We have reported a series of 351 patients undergoing resection for diverticulitis, in 27 of whom a coexisting carcinoma in the same segment was found, an incidence of 7.7 per cent. In 13 instances cancer was not suspected preoperatively. Even by palpation of the isolated protected segment of involved bowel, we were unable to diagnose accurately the presence of the carcinoma, an error of 40.7 per cent. We believe that until more exacting methods of diagnosis are made available, and in view of the increase in life expectancy, as well as the increased incidence of cancer, where there is the slightest measure of doubt, the apparent diverticular segment should be removed as if it were frank cancer. We further plead for higher levels of suspicion and earlier surgical extirpation. Read at the meeting of the American Proctologic Society, New York, New York, June 11 to 14, 1972.     

Ovarian metastases from colorectal carcinoma

Summary Ovarian metastases are found in 3–4 per cent of female patients with carcinomas of the colon or rectum. They may be very large, like primary ovarian tumors. Ten women with ovarian metastases from colonic or rectal carcinoma were seen at Ochsner Foundation Hospital over an 11-year period. In four of these women ovarian metastases were found on physical examination, while in the other six they were found incidentally at surgery or necropsy. None of these tumors histologically resembled the classic Krukenberg tumor; all were hsitologically identifiable as metastases from carcinomas of the large intestine. Surgical resection was done in nine women. All are either dead of, or alive with, residual malignancy. Prophylactic oophorectomy should be considered for all postmenopausal women, and for premenopausal women with obvious ovarian tumors, extensive serosal involvement by the colonic or rectal lesion, or extensive metastases to regional lymph nodes. Read at the meeting of the American Proctologic Society, New York, New York, June 11 to 14, 1972. Department of Colon and Rectal Surgery. Department of Pathology.     

The Economics of Methadone Programs

The number of methadone programs in New York City has increased in recent years to a total of 161 treatment programs for ex-heroin addicts. Some of the economic implications of this are discussed. A follow-up study of 112 dropouts and 110 active patients of one of the largest methadone maintenance programs provides an opportunity to compare the sources of financial support for these persons. Of the dropouts who went to other programs, 78 per cent were on public assistance, and this is almost identical to the 79 per cent of active patients at the program sampled who were on public assistance. This is about twice as high as the proportion of drug-free dropouts who were on public assistance (38 per cent). Several interpretations are offered for these differences. The need for accurate monitoring and evaluation of drug-treatment facilities is emphasized because it is as important that the tax-payer not be short-changed as it is that the addict or ex-addict receives the kind of treatment that he or she needs to be able to lead a productive and autonomous life.     

Adenocarcinoma of the colon associated with ureterosigmoidostomy: Report of a case

Summary It has become apparent that patients with ureterosigmoidostomies have an increased susceptibility to tumors of the colon. These may have either gastrointestinal or urologic manifestations. Physicians following such patients must be ever alert for early evidence of these neoplasms. Read at the meeting of the American Proctologic Society, New York, New York, June 11 to 14, 1972.     

Long term follow-up after isolated aortic valve replacement

Between January 1982 and June 1989, 102 consecutive patients (25 women and 77 men) who had isolated aortic valve replacements were reviewed. The overall early operative mortality was 5%. The deaths were related mainly to pump failure and endocarditis. The early operative mortality in younger patients (less than 70 years old) was 3.5% and in the elderly (70 or older) 11%. The overall late mortality was 4%. All of the survivors except three (follow-up by telephone) were seen in follow-up by cardiologists. The mean follow-up was 40 +/- 26 months (range four to 89). Eighty-seven per cent of all patients or 92% of the survivors in the younger population did well following the operation. In the elderly patients, the results were less favorable (P less than 0.025). The overall cumulative survival was 92% at one year and 89% at five years. The actuarial event-free percentage of survivors was 86% at one year and 74% at five years. Aortic valve replacement can be accomplished in symptomatic patients with an acceptable operative mortality. Long term follow-up of these patients showed functional improvement and low mortality.     

Total rectal prolapse and total genital prolapse: A series of 17 cases

Summary The concomitant occurrence total genital prolapse and total rectal prolapse (isochronous) was not rare in our series (5 of 55 female patients with total rectal prolapse, an incidence of 9.27 per cent). In 12 of the 55 cases, an incidence of 21.81 per cent, both disorders occurred, but at different times, total genital prolapse preceding total rectal prolapse that occurred later despite perineal repair and hysterectomy. In four of the 12 heterochronous cases, prolapse of the vaginal vault was present concomitant (isochronous) with total rectal prolapse. It seems that the association of total genital prolapse and total rectal prolapse occurs mainly in women 65 years old or older. Of our five patients, three (60 per cent) were in their 80′ s. (The two patients of Lapeyrere and Grezes-Rueff were 84 and 88 years old). Parity does not seem to affect the occurrence of total rectal prolapse. In our five cases, the rectal prolapses were surgically corrected first (rectosigmoidectomy by the perineal route), and three to four weeks later, vaginal hysterectomy (four patients) or ample cervical amputation (patient 1) plus a perineal repair was performed. For rectosigmoidectomy, the perineal approach is convenient, using epidural anesthesia. (We have done a couple of cases with local anesthesia, with or without hyaluronidase.) Read at the meeting of the American Proctologic Society, New York, New York, June 11 to 14, 1972     

Five and ten year follow-up study of rheumatic patients; role of climate and environment

1. (1) Five- and ten-year studies were completed on 102 and 48 expatients of the National Children's Cardiac Hospital, Miami, Florida, to determine whether or not the lives of these subjects were influenced by a period of convalescent care in this tropical area.

2. (2) Data were available on 92 of the five-year group, and 41 of the ten-year patients. In the total 133, the death rate was less than 7 per cent.

3. (3) Of the 124 survivors on whom we have information, 16 per cent had recurrences.

4. (4) Heart damage, more than minimal, was observed in only 31 per cent of the 124 survivors.

5. (5) The death rate, frequency of recurrences, and heart damage, all compare very favorably with similar reports from other centers.

     

Evaluation of the latex-agglutination test for the diagnosis of invasive amebiasis

Summary A new test for the diagnosis of invasive amebiasis is evaluated. There were 96 positive results in 100 proved cases of both hepatic abscesses and intestinal amebiasis; there were 5 per cent false-positive results in the control group of 200 cases. The authors recommend the test as an aid to the clinical study of the patient, especially when the differential diagnosis is difficult to establish. Read at the meeting of the American Proctologic Society, New York, New York, June 11 to 14, 1972.     

Incidence, prevalence and characteristics of radiation-induced thyroid tumors

A population of 5,266 persons were known to be at risk for the development of thyroid neoplasms as a result of prior head and neck irradiation for benign conditions received at our institution. We contacted 2,578 (49.0 per cent) of these persons of whom we examined 1,476 (28.0 per cent) and received follow-up data on 713 (13.5 per cent). Prior to the onset of our recall program, 209 persons had had thyroid surgery (9.4 per cent of those with adequate follow-up data). The incidence of thyroid operations after the initial radiation treatment was low for 10 years and then increased continuously for at least 25 years. The incidence of carcinoma found at operations performed before the recall program and after was similar (37.1 per cent before versus 36.2 per cent after). This high percentage, which was not changed by the follow-up and examination program, supports the conclusion that the probability of finding thyroid cancer in a nodular gland is increased in irradiated patients. No risk factors were found in irradiated subjects that distinguished between malignant and benign disease. Of 50 patients who were examined and who had a history of prior thyroid surgery, 18 (36 per cent) had evidence of new thyroid tumors. In this limited group, thyroid suppressive therapy appeared to prevent recurrences. However, a larger trial to assess the value of thyroid suppression is still warranted. One subject is known to have died of thyroid cancer.     

Rare long-term survivors of pancreatic adenocarcinoma without curative resection

Long-term outcome data in pancreatic adenocarcinoma are predominantly based on surgical series, as resection is currently considered essential for long-term survival. In contrast, five-year survival in non-resected patients has rarely been reported. In this report, we examined the incidence and natural history of ≥ 5-year survivors with non-resected pancreatic adenocarcinoma. All patients with pancreatic adenocarcinoma who received oncologic therapy alone without surgery at our institution between 1995 and 2009 were identified. Non-resected ≥ 5-year survivors represented 2% (11/544) of all non-resected patients undergoing treatment for pancreatic adenocarcinoma, and 11% (11/98) of ≥ 5-year survivors. Nine patients had localized tumor and 2 metastatic disease at initial diagnosis. Disease progression occurred in 6 patients, and the local tumor bed was the most common site of progression. Six patients suffered from significant morbidities including recurrent cholangitis, second malignancy, malnutrition and bowel perforation. A rare subset of patients with pancreatic cancer achieve long-term survival without resection. Despite prolonged survival, morbidities unrelated to the primary cancer were frequently encountered and a close follow-up is warranted in these patients. Factors such as tumor biology and host immunity may play a key role in disease progression and survival.     

Prognosis in unstable angina.

A retrospective study was made of 158 patients with unstable angina admitted to a coronary care unit over a 4-year period. Twenty patients (13 per cent) had myocardial infarcts while in hospital, and of these 3 died; three others died without preceding evidence of myocardial infarction. There was thus an acute mortality rate of 4 per cent. Patients with persisting angina after the first 24 hours and those without a previous history of myocardial ischaemia were more likely to develop a myocardial infarct or to die in hospital. Follow-up information, ranging from 3 to 7 years, was available in 144 of 152 hospital survivors. Patients older than 60 years (P less than 0-05), with cardiomegaly (P less than 0-01) and with pulmonary venous congestion (P less than 0-05) were found to have significantly increased long-term mortality. Long-term mortality was also found to rise with increasing coronary prognostic index. The average mortality rate for the whole group of hospital survivors was about 5 per cent per annum. Of the 111 patients who were alive at follow-up, 19 (17%) had had a myocardial infarct after leaving hospital, and a similar number had moderate or severe angina.