Gastric carcinoma: 30-year review

The records of 1030 patients with gastric carcinoma seen between 1941 and 1970 were analysed. A 10-year follow-up was available for 1024. The overall operability and resectability rates were 80.9% and 53.5% respectively, and in the two decades 1951 to 1960 and 1961 to 1970, the rates increased significantly, as did the subtotal gastrectomy rate of 46.9%. Subtotal resection for cure was done in 59.5%, and for palliation in 40.5%. Fifty-six patients underwent a total gastrectomy. There was no significant increase in consecutive decades in either overall 5-year survival or survival following subtotal gastrectomy. The 5- and 10-year survival rates of 15.1% and 6.6%. Of the 5-year survivors, 54% had no lymphnode involvement and 35.2% had nodes positive for tumour spread. Gastroesophagectomy was associated with a high morbidity and extremely low survival. Of 56 patients having a total gastrectomy, 37 lived 1 year or more while only 5 survived 5 or more years. Linitis plastica occurred with equal frequency in men and women. Operability and resectability rates were lower and there was a 90.6% 1-year death rate.     

Testicular torsion in Bristol: a 25-year review

To identify changes in incidence, presentation, management and outcome, 670 patients with torsion of the spermatic cord presenting in Bristol between 1960 and 1984 have been reviewed. Among the susceptible population of 150,000, the annual incidence of torsion has increased fourfold from 11.2 cases between 1960 and 1964 to 42.8 cases between 1980 and 1984. Throughout this period greater than 90 per cent of patients have been managed by general surgeons. Patients aged between 12-18 years comprised 62 per cent but 20 per cent were 21 years or older. Torsion was commoner in the cold months, 24 per cent of cases occurring during December and January (chi 2 = 30.26, P less than 0.01). When acute torsion was relieved within 12 h of the onset of symptoms only 4 per cent of affected testes were considered non-viable, but beyond this time 75 per cent of patients received orchidectomy. Overall, 238 of 624 (38 per cent) acutely twisted testes were found to be infarcted at operation, and a further 35 patients (6 per cent) had marked testicular atrophy on review 3 months later. The testicular salvage rate has steadily improved from 45 per cent in the years 1960-64 to 67 per cent in 1980-84. Much of the increased incidence of testicular torsion is likely to reflect a greater awareness of the condition by general practitioners. It has been more than matched by an improvement in testicular salvage rate because of earlier referral.     

Gastric carcinoma. A 25-year experience

The case records of 101 patients operated on for adenocarcinoma of the stomach at one hospital over a 25-year period were reviewed. Generally, the patients had advanced disease (80% had Stage III or Stage IV tumors) at the time of treatment. Curative procedures were possible in only 46 patients and yielded a five-year survival rate of 16.7 per cent. The overall operative mortality rate was 25 per cent, although in the last decade that rate decreased to 15 per cent. Good palliation in the early months was achieved with both subtotal gastric resection and bypass gastrojejunostomy. Because of patient selection, however, the palliation provided by bypass was of shorter duration (mean less than six months). The main reason for these disappointing results was the advanced stage of the cancer at the time of diagnosis and treatment. The prognosis for patients with gastric cancer clearly correlates with the stage of the disease at the time of operation. Surgical resection provides the most effective relief of symptoms and offers the only hope of cure. The importance of diagnosing gastric cancer early when the tumor is still confined to the stomach wall is emphasized and recommendations for achieving this goal are discussed.     

Malacoplakia: a 25-year experience with a review of the literature

Our experience with 9 cases of genitourinary malacoplakia is reviewed. The bladder was involved in 4 patients, ureter in 2, prostate in 1, testis in 1 and a combination of prostate, bladder, rectum and pelvic adnexae in 1. The female-to-male ratio was 2:1. Escherichia coli was present in 7 of 8 available urine cultures. Of 9 patients 2 had associated immunocompromised conditions. A variety of therapeutic approaches were chosen, depending mainly on location and extent of disease. These varying combinations of medical and surgical therapies produced resolution of disease in 8 of 9 patients. Generally, upper tract involvement requires surgical intervention, while most cases of lower tract involvement can be managed with antibiotics and endoscopic resection. Rare cases of extensive lower tract malacoplakia may require extirpation for cure.     

肝门部胆管癌外科治疗25年的历程

1989年,国内首次报道肝门部胆管癌以来,该病的治疗作为跨世纪的热点问题已逐渐深入.但是,存在的争议仍然较多,距最后解决问题仍有差距.1 命名及范围与分类习惯上胆道系统分为肝内、外胆管系统,以左、右肝管的汇合点作为分界线.然而,从解剖学上位于肝管汇合以上的胆管,部分仍位于肝实质之外,而临床上又无清楚的划分肝内、外胆管的标志.     

肝门部胆管癌外科治疗25年的历程

Hilar cholangiocarcinoma has received great attention in the past 25 years because of its rising prevalence. However, the results of surgical treatment of hilar cholangiocar-cinoma are still unsatisfactory. A series of studies on cholangio-carcinoma, both clinical and experimental, were conducted in the Research Institute of Hepatobiliary Surgery of PLA. Detailed clinicopathological research revealed the characteristics of nerve involvement and metastasis of bile duct cancer, which may be responsible for the high recurrence after surgical removal. Hepa-titis C virus may be one of the causal factors of bile duct cancer in China. Clinically, of the 402 patients with hilar cholangiocarcinoma, 51. 5% of the resections were found to be R0. The 5-year survival rate was 33. 3% and the morality rate was 0.3%. For those high-risk patients with jaundice, when resec-tion of the hepatic artery was found to be necessary, an arterial-portal venous shunt was constructed with satisfactory results. However, the best approach to treat hilar cholangiocarcinoma still needs further investigation.     

肝门部胆管癌外科治疗25年的历程

1989年,国内首次报道肝门部胆管癌以来,该病的治疗作为跨世纪的热点问题已逐渐深入.但是,存在的争议仍然较多,距最后解决问题仍有差距.1 命名及范围与分类习惯上胆道系统分为肝内、外胆管系统,以左、右肝管的汇合点作为分界线.然而,从解剖学上位于肝管汇合以上的胆管,部分仍位于肝实质之外,而临床上又无清楚的划分肝内、外胆管的标志.     

Gastric cancer: a review of 400 consecutive cases

Four hundred out of 422 patients with primary gastric cancer seen from 1965 to 1979 underwent surgical treatment and were studied retrospectively. Fifty-eight percent underwent curative procedures. The five year survival rate was 19.14%. Subtotal and total gastrectomy gave survival rates of 35.8% and 9% respectively (p less than 0.05). Postoperative mortality (24.2%) was influenced by both the type of procedure performed (p less than 0.001) and the stage of the neoplasis (p less than 0.001). This study confirms the influence of staging on short, intermediate and long term survival and demonstrates the importance of the early diagnosis of gastric cancer in carrying out effective surgical treatment.     

Omphalocele: a 25-year experience

Between 1958 and 1983, 92 neonates with omphalocele were admitted to Ste-Justine Hospital. The male to female ratio was 3:2. Birth weight ranged from 1,450 to 5,100 g (mean 2,786 g). Associated anomalies, apart from malrotation, were present in 45%. They were cardiovascular (18.4%), vesico-intestinal fissure or bladder exstrophy (11.9%), Beckwith Wiedeman (6.5%), and chromosomal abnormalities (7.5%). Seven patients were not treated. Topical applications were used in seven cases (1 survivor). In 65%, primary closure was achieved; the mortality rate was 20% with a mean hospital stay of 17.5 days. Silastic was used in 12 cases with a mortality of 5/12 and a mean hospital stay of 82.1 days. The mean number of reductions was 6.7. Omphalocele rupture did not influence mortality. Prior to 1974 the mortality rate was 50%. Since 1974 it has decreased to 31.5%. The advent of total parenteral nutrition (TPN) was an important factor in decreasing the mortality. Prior to 1974, 23 patients survived, only one with a major associated anomaly (Fallot). After 1973, 35 survived, 13 having a major associated anomaly. Overall mortality was 9% when no other major malformations were present. A retrospective study of 92 cases of omphalocele over a 25-year period reveals an overall mortality rate of 37%. Death was associated almost exclusively with additional congenital anomalies. Birthweight in itself was not a determining prognostic factor. With the advent of TPN and a better knowledge of the mechanical ventilation of the neonate the results are better and involve the survival of a greater number of patients with serious associated malformations.     

Wilms' tumor: a 25-year review of the role of preoperative chemotherapy

PURPOSE: This 25-year population based, single institution review was conducted to investigate the impact of preoperative chemotherapy on surgical and histological staging in patients with Wilms' tumors. RESULTS: Forty-nine patients under the age of 15 years were identified from case notes to have had histologically verified Wilms' tumors over the 25-year period from January 1972 to December 1996. Twenty-six patients were treated initially with preoperative chemotherapy, 23 with immediate surgery. Eleven had treatment randomized within the UKCCSG WT9101 trial (UKWT3), and the remainder received initial treatment according to unit policy. Surgical stages in the two groups (preoperative chemotherapy and immediate surgery) were respectively, stage 1:14(28.5%) and 11 (22.5%), stage II: one (2%) and eight (16.3%), stage III: 11 (22.5%) and four (8.2%). Seven patients had clinical stage IV disease at presentation. Histology results were favorable in 45 patients and unfavorable in four. All patients received chemotherapy during treatment, whereas 25 (51%) also received radiotherapy. No significant difference was evident in the two groups with respect to treatment-related morbidity. Five patients relapsed, three of whom died within the period of review, but a fourth has since died. CONCLUSIONS: This study suggests that the use of preoperative chemotherapy does not put the patient at increased risk of postoperative morbidity or reduced survival. The distribution of surgical stages suggests that limited tumor downstaging may have occurred as a result of preoperative chemotherapy.     

25-year prostate cancer control and survival outcomes: a 40-year radical prostatectomy single institution series

PURPOSE: We report on 25-year cancer control and survival outcomes after radical prostatectomy in a single center series of patients treated during a 40-year period. MATERIALS AND METHODS: Between 1954 and 1994, 787 consecutive patients underwent radical prostatectomy at Virginia Mason Medical Center in Seattle, Washington. Kaplan-Meier 25-year probabilities of prostate cancer specific, overall, prostate specific antigen progression-free, local and distant progression-free survival were determined. Multivariate Cox regression models addressed prostate cancer specific mortality. RESULTS: Prostate cancer specific survival, overall survival, prostate specific antigen progression-free survival, local and distant progression-free survival ranged from 99.0% to 81.5%, 93.5% to 19.3%, 84.8% to 54.5%, 95.3% to 87.8% and 95.9% to 78.2%, respectively. In univariate analyses pathological stage, surgical margin status, pathological Gleason sum, delivery of hormonal therapy and radiotherapy represented statistically significant predictors of prostate cancer specific mortality (all p < or =0.001). In multivariate analyses only Gleason sum (p = 0.03) and delivery of hormonal therapy (p < 0.001) remained significant. CONCLUSIONS: This is one of the most mature radical prostatectomy series. It demonstrates that long-term biochemical cancer control outcomes after radical prostatectomy might be suboptimal. However, local and distant control outcomes are excellent, and cancer specific mortality is minimal even 25 years after surgery.     

Congenital anomalies: a 25-year overview

Expansion of the discipline of hand surgery and heightened interest in congenital problems have resulted in major advances in the treatment of congenital hand anomalies over the past 25 years. Increased experience with congenital anomalies of the hand has expanded the hand surgeon's knowledge of patterns and relationships between different anomalies resulting in new methods of classification and more logical approaches to treatment. The principles of treatment of the more common anomalies, such as syndactyly, established by prior generations of hand surgeons have been refined in details of technique. New technologies, such as distraction lengthening and free vascularized transfers, have allowed the surgeon to treat new problems and old problems in new ways. In spite of our successes, much remains to challenge hand surgeons in this new millennium, especially in the construction of joints and the expanding field of fetal surgery.     

Surgical management of infected abdominal aortic grafts: review of a 25-year experience

Eighty-four patients with infected abdominal aortic grafts managed from 1961 through February 1985 were reviewed. Thirty-three patients had associated aortoenteric fistula formation. Twenty-eight infections (33%) and 13 aortoenteric fistulas (39%) originated at The Cleveland Clinic, yielding an incidence of aortic graft infection of 0.77% (28 of 3652 grafts) and aortoenteric fistula formation of 0.36% (13 of 3652 grafts) at this center. Staphylococcus organisms alone or in combination with other organisms were isolated from 34% of the series. Management consisted of graft removal and extra-anatomic bypass in 54 patients (64%), graft removal alone in 14 (17%) patients, partial graft removal and extra-anatomic bypass in seven (8%) patients, and miscellaneous operations in nine (11%) patients. Twenty-three patients (27%) required major amputations, nine of which were bilateral. Life-table analysis yielded 30-day and 1-year survival rates of 72% and 42%, respectively. Thirty-day survival of the aortoenteric fistula subset (49%) was less than that (86%) of the nonaortoenteric fistula subset (p = 0.003). One-year survival of patients treated since 1980 (54%) was superior to that of patients treated before 1980 (31%, p = 0.035). No difference in operative or 1-year survival was demonstrated between the group treated with extra-anatomic bypass and subsequent graft removal and another in which both procedures were performed simultaneously, although the staged group experienced substantially fewer (p = 0.04) amputations (7%) than the combined group (41%).     

Small bowel cancer: A 30-year review

Background: Small bowel cancer is a relatively rare tumor with an incidence of 2,700 new cases and 900 deaths per year. The influence of stage on survival has been reported only once previously. Patterns of recurrence are unreported. Methods: All cases of small bowel cancer treated at our hospital over a 30-year period (1960–1989) were reviewed. Results: The site of most cancers was the duodenum (46%), followed in frequency by the jejunum (33%) and the ileum (21%). Adenocarcinoma was the most common histology (63%), followed in frequency by lymphoma (15%), leiomyosarcoma (13%), carcinoid tumors (6%), and miscellaneous (3%). Analysis of stage distribution by site showed a decrease in stages I and II with more distal locations. Associated cancers occurred in 11%, but none were seen in the group with carcinoid tumors. Actuarial 10-year survival rates were 24% for those with adenocarcinoma (all stages) 75% for stage I, 25% for those with stage II, and 0% for stage III. A subgroup of 10 patients who underwent a pancreaticoduodenectomy (one stage I, seven stage II, two stage III) had a 30% 10-year survival rate. Those patients with lymphoma had a 12% 10-year survival rate, and those with leiomyosarcoma had a 20% 10-year survival rate. A 100% 10-year survival rate was observed in those with carcinoid tumors. Peritoneal carcinomatosis was the most common failure pattern (33%), followed in frequency by local recurrence in 23% and abdominal wall recurrence in 15%. Conclusions: A correlation exists between the pathologic stage and the survival rate for adenocarcinoma. The most common recurrence pattern for adenocarcinoma was carcinomatosis, followed in frequency by abdominal wall recurrence. Leiomyosarcoma preferentially metastasizes to the liver. The results of this study were presented at the 46th Annual Cancer Symposium of The Society of Surgical Oncology, Los Angeles, California, March 18–21, 1993.     

Idiopathic granulomatous mastitis: a 25-year experience

BACKGROUND: Idiopathic granulomatous mastitis (IGM) is a rare, benign, chronic inflammatory condition of the breast that can mimic inflammatory breast cancer and periductal mastitis (PDM). Eighteen patients with a histopathologic diagnosis of IGM, seen over a period of 25 years, were retrospectively reviewed and compared with 133 patients with PDM and 100 normal patients. STUDY DESIGN: The unit's pathology database and clinic letters for this time period were used to identify patients who had presented with IGM. A retrospective review of the notes was used to extract reproductive factors, cigarette smoking habits, and ethnicities that were recorded at presentation. These were compared with data from a similar group of patients with PDM and a control group. RESULTS: All IGM patients were women. Median age was 36 years (range 18 to 67 years) compared with 52 years (range 20 to 77 years) for PDM patients (p < 0.001). Seventeen percent of IGM patients were smokers at the time of presentation, as compared with 60% of PDM patients (p < 0.001). Although parity was similar for all groups, 10 IGM patients (56%) had given birth in the last 5 years, compared with 6 (5%) PDM patients (p < 0.001) and 20 (20%) in the control group (p=0.0194). Two IGM patients had recurrences after pregnancy. The course of IGM varied from 11 to 105 weeks and was not affected by any treatment modalities. CONCLUSIONS: IGM patients are younger, have given birth more recently, and are less likely to be Caucasian as compared with PDM patients. IGM is not related to smoking and can recur. Treatment should be supportive.     

A single-institution 25-year review of true parathyroid cysts

Background Parathyroid cysts (PCs) are rare, and their origin is a subject of debate. They have been described as either functional, causing hyperparathyroidism, or non-functional in eucalcaemic patients. Patients and methods We have performed a 25-year departmental review of PCs. Features studied included the clinical presentation and intra-operative findings, and a histological review was performed. Cases of cystic degeneration of parathyroid adenomas and pseudocystic change were excluded. Results Over 25 years, 22,009 thyroidectomies and 2,505 parathyroidectomies were performed in our department. Amongst these, 38 non-functional PCs were documented in 37 patients. The mode of presentation included incidental findings on routine chest x-ray, compressive symptoms or an asymptomatic palpable neck mass. Aspiration was the initial treatment in 14 patients and was curative in 10 of these. Four out of 14 patients underwent surgical procedures for recurrence of the cyst that occurred 6 to 48 months after aspiration. In 27 patients, surgery was performed and all identified PCs were localized in the inferior parathyroid glands. Histologically, the cyst wall consisted in associations of lymphoid, muscular, thymic, salivary, adipose and mesenchymal tissues. Conclusions PCs are rare but should be included within the differential diagnosis of a neck lump. True PCs are non-functional. Pathological and immunohistochemical findings are suggestive of a branchial origin. Fine-needle aspiration may be curative and is diagnostic due to the characteristic appearance of the fluid and high PTH levels on assay.