Carinal resection for bronchogenic carcinoma

The purpose of this study was to evaluate the results of carinal resection for bronchogenic carcinoma in our institute. From 1981 to 1999, 24 carinal resection were performed for squamous cell carcinoma (n = 19), adenoid cystic carcinoma (n = 2), small cell carcinoma (n = 1), adenocarcinoma (n = 1), and mucoepidermoid carcinoma (n = 1). Nineteen underwent sleeve pneumonectomy, 2 had carinal resection without lung resection, 2 had carinal resection with right middle and lower lobectomy, and 1 had wedge pneumonectomy. In the patients with sleeve or wedge pneumonectomy, there were 5 operative death and 3 patients had survived for more than 3 years. Two patients with low-grade malignant tumors underwent carinal resection without lung resection and survived more than 10 years. We believe that limited carinal resection for low-grade malignant tumors are safe and valuable procedure. Careful selection of patients with sleeve or wedge pneumonectomy is mandatory.     

Superior vena cava reconstruction combined with resection of mediastinal-pulmonary malignant tumors

From 1988 to 1997, we experienced 5 cases of the superior vena cava (SVC) replacement with expanded polytetrafluoroethylene (ePTFE) grafts combined with resection of mediastinal or pulmonary malignant tumors. Two patients had lung cancer and three had invasive thymoma. Resection and reconstruction of the superior vena cava (SVC) were performed by application of a bypass graft between the innominate vein and the right atrium in two cases and a temporary bypass using a heparin-coated tube in three cases. Except in one patient who died of acute respiratory failure, no complication or occlusive symptom were observed postoperatively. Two patients remain healthy for 5 years 4 months and 2 years 7 months after operation. Three died 9 years, 5 months, and 110 days after operation respectively. In conclusion, ePTFE graft replacement or patch angioplasty of the SVC should be part of planning and execution of radical excision with curative intent of mediastinal or pulmonary malignant tumors.     

The difficult approach to neoplastic superior vena cava syndrome: surgical option

AIM: Superior vena cava syndrome is a dramatic event that can be cured in specialized centers. METHODS: Between 1989 and 1995 6 patients with superior vena cava syndrome underwent surgical treatment for thoracic tumors. In all cases the vena was restricted by a neoplastic sleeve. A median sternotomy was performed in all cases. Two patients received an associated right anterolateral thoracotomy to obtain good surgical exposure for tumor resection and grafting. A 12 mm diameter polytetrafluoroethylene graft was inserted in all cases. The tumor resection was radical in 4 cases (2 thymic carcinomas, 2 malignant germ cell tumors) and palliative in 2 (1 non-small cell lung cancer and 1 mediastinal fibrosis). RESULTS: We had no in-hospital mortality. All patients had immediate relief of obstruction after by-pass. Three patients were alive without disease at the end of follow-up (40-96 mo), one patient died of postoperative complications after 4 mo, 2 patients died of disease after 4 and 12 mo. CONCLUSION: PTFE by-pass graft for treatment of the obstructed SVC relieves SVC syndrome and has good medium term patency.     

原发性心脏肿瘤232例临床分析

目的 总结原发性心脏肿瘤的临床特征及治疗结果。方法回顾性分析232例原发性心脏肿瘤患者的临床资料。良性肿瘤218例（94．0％）,其中左房黏液瘤200例（86．2％）;恶性肿瘤14例（6．0％）。临床表现为心悸、气短202例（87．1％）。230例手术,其中完整切除223例,局部切除2例（左心室恶性间皮瘤）,5例（均为恶性肿瘤）仅行活检。瘤体为实性的5例同期行二尖瓣置换术,1例肺动脉瓣黏液瘤行肺动脉瓣置换术,5例行经股动脉取瘤栓术。结果术前死亡2例。术中死亡3例。术后随访6个月～24年185例（81．5％）,其中良性肿瘤174例、恶性肿瘤11例;死亡21例,其中良性肿瘤10例（因良性肿瘤死亡6例,其他原因死亡4例）,恶性肿瘤11例,3例复发（良性1例、恶性2例）,其余恢复良好。结论原发性心脏肿瘤中左房黏液瘤最常见,最常见的临床表现是心悸、气短。一经确诊应尽早手术,良性肿瘤手术效果好,恶性肿瘤预后差。     

Abdominosacral Approach for Retrorectal Tumors

The relative rarity and anatomical position of retrorectal tumors may lead to difficulty in diagnosis and surgical treatment. The clinical features and management of 20 such tumors (chordoma 8, neurilemmoma 3, teratoma 3, hemangiopericytoma 1, chondrosarcoma 1, osteosarcoma 1, dermoid 1, lipoma 1, and undifferentiated sarcoma 1) have therefore been reviewed. Low back or sacral pain was present in 18 patients and, although all tumors were palpable on rectal examination, pain had been present for a median of 12 months before diagnosis. Mean tumor size was 9.4 cm (range: 2.5-17 cm). Sacral bone destruction was demonstrated radiographically in all chordomas and three sarcomas, but in none of the benign tumors. Three patients had undergone previous partial removal of their tumors. Surgical resection was carried out using a combined abdominal and transsacral approach in 13, a transsacral approach in the right lateral position in four and transabdominally in three. There was one operative death following secondary operation for chbrdoma. Four of 12 patients with malignant tumors are alive and well at seven months to eight years. One died of a myocardial infarct without recurrence at 11 years. For small benign tumors, the right lateral position permits maximal flexibility for resection either by the transsacral, transabdominal or a combined approach. For bulky or malignant tumors, a combined abdominal transsacral approach in the right lateral position permits vascular control and provides good exposure for protection of vital structures and wide resection.     

腹腔镜胆囊切除术遗漏恶性肿瘤的防治分析

目的探讨腹腔镜胆囊切除术漏诊恶性肿瘤的原因及其预防措施。方法回顾性分析2005年5月至2011年5月我院LC手术中6例漏诊恶性肿瘤的临床资料,并对之进行随访。结果 1859例LC共发生遗漏恶性肿瘤6例,包括右半结肠癌、胃癌各2例,胰腺癌、肝癌各1例,除2例右半结肠癌行根治性切除外,另外4例已不能行根治性手术。结论术前注意鉴别患者的症状,术中注意观察胆囊的病理改变及腹腔内有无异常情况,重视术后恢复时间长的老年患者可预防腹腔镜胆囊切除术遗漏恶性肿瘤。     

Nonfunctioning adrenal tumors. Dilemmas in management

A retrospective study conducted from 1975-1987 at Vanderbilt University Medical Center and affiliated hospitals identified 28 patients, ranging in age from 22 to 74 years, who were noted to have "nonfunctioning" adrenocortical tumors. Eighteen (64%) were men, and ten (36%) were women. A left adrenal mass was present in 16 (57%) patients, a right in 11 (39%) patients, and one (4%) patient had bilateral adrenal enlargements. Nineteen patients underwent an adrenalectomy. Ten were found to have adrenocortical adenomas, ranging is size from 2.5-4.0 cm in greatest diameter. Three were adrenocortical carcinomas (3.0, 5.5, and 8.0 cm). A necrotic mass (14.0 cm) was found in one patient. Two patients had myelolipoma, one had ganglioneuroma, and one had a suspected primary melanoma. Five patients were not operated upon and were followed by serial computed tomographic scans for variable periods; two died of unrelated cardiac problems, and one was lost to follow-up. Three patients underwent biopsy with benign pathology. The data indicate a high incidence of adenoma and carcinoma in patients with nonfunctioning adrenal tumors that measure more than 3.0 cm in diameter. These tumors have the potential to progress to malignant degeneration without any recognizable clinical or endocrine abnormalities. The authors thus conclude that all patients with "nonfunctioning" adrenal tumors that are larger than 3.0 cm in diameter should undergo surgical exploration and excision.     

Neuroblastoma with intraspinal (dumbbell) extension

Twenty-three patients with neurogenic tumors having extradural extension (dumbbell tumors) were treated over a 30-year period. Three had ganglioneuroma, 6 had ganglioneuroblastoma, and 14 had neuroblastoma. Nineteen patients with malignant tumors had symptoms of spinal-cord compression; three patients with ganglioneuroma and one with a malignant tumor had no neurologic symptoms. Delays in diagnosis were frequent ranging from 6 weeks to 3 years in 10 patients. Sixteen patients had abnormal x-rays of the spine. All patients with malignant tumors had positive myelograms. Three patients with ganglioneuroma and 13 with malignant tumors are alive and free of disease. Seven patients with malignant tumors died: five with stage IV and 1 with stage III tumors from disease, and 1 with stage II tumor during laminectomy. Age and stage were important prognostic factors; location was not. Treatment consisted of excision and radiation or radiation only. Patients receiving lower-dose (less than 2000 rad) radiation did as well as those receiving much larger doses. Morbidity in patients with malignant tumors was high; 4 have spinal deformity (3 severe) and 8 of 13 surviving patients have residual neurologic deficits. Earlier diagnosis, a surgical approach which does not introduce morbidity, and low-dose radiation in younger patients are important factors in reducing morbidity.     

Aggressive surgery for metastatic liver neuroendocrine tumors

BACKGROUND: Neuroendocrine tumors of the gastrointestinal tract (carcinoids, pancreatic endocrine tumors) have low malignant potential but can decrease survival rates if they spread to the liver (LNET). METHODS: The records of 16 patients with LNET primarily from gastrointestinal carcinoids treated surgically were retrospectively reviewed. RESULTS: There were 12 women and 4 men. Median age was 56 years (range 25 to 75). Thirteen (81%) had a carcinoid tumor and 5 had gastrinoma. Two patients with multiple endocrine neoplasia type 1 had both a gastric carcinoid and a jejunal gastrinoma. Eight patients (50%) had the carcinoid syndrome. Each patient had all identifiable LNET either resected or ablated. Ten patients had liver wedge resections, 1 right trisegmentectomy, 5 left hepatic lobectomies, and 2 radiofrequency ablations. Thirteen (81%) patients had concomitant bowel resections. Two patients had concomitant total gastrectomies to remove stomach primaries. The final patient had an extraintestinal pelvic primary or a liver primary. There were no operative deaths, and all 8 (100%) patients with the carcinoid syndrome had amelioration of symptoms. The 5-year actuarial survival rate was 82% with a median follow-up of 32 months. CONCLUSIONS: This study demonstrates that liver and concomitant extrahepatic surgery can be performed safely in patients with liver metastases because of carcinoids or pancreatic endocrine tumors. It results in excellent long-term survival and amelioration of symptoms. Surgery should be the first-line therapy for patients with LNET.     

Morbidity profile and functional outcome of modified facial translocation approaches for skull base tumors

The primary objective of this study was to evaluate morbidity associated with facial translocation approaches for skull base and results of various technical modifications. Forty consecutive patients who underwent facial translocation approaches for accessing skull base tumors from July 2005 to June 2010 were included in this study. There were 25 patients who underwent standard facial translocation, 4 patients medial mini, and 11 patients underwent extended facial translocation. Thirteen patients had benign disease and 27 patients had malignant disease. Resection was R0 in 36 and R1 in 4 patients. Most patients had acceptable cosmetic results. None of the patients had problems related to occlusion or speech and swallowing. The commonest complication observed was nasal crusting in 16 patients. Grade 2 trismus and exposure of mini plate was seen in three patients. Two patients developed necrosis of translocated bone. Three patients developed palatal fistula before modification of palatal incision. Facial translocation provides a satisfactory access for adequate clearance of skull base tumors with satisfactory aesthetic and functional results. With modifications of the surgical technique and implementation of new surgical tools, the morbidity of facial translocation approaches will continue to decrease.     

新型复合重建技术重建髋臼周围肿瘤切除后骨缺损

目的 评价新型复合重建技术对髋臼周围肿瘤切除后骨缺损的重建效果.方法 2001年3月至2007年3月,对23例髋臼周围肿瘤患者行切除复合重建,其中男性16例,女性7例,平均年龄43岁(16～78岁).肿瘤类型:原发性恶性骨与软组织肿瘤17例,其中软骨肉瘤7例、成骨肉瘤4例、尤文肉瘤2例、恶性纤维组织细胞瘤2例、恶性神经鞘瘤1例、滑膜肉瘤1例;骨巨细胞瘤2例;侵袭性骨母细胞瘤1例;转移瘤3例,其中甲状腺癌1例、乳腺癌l例、卵巢癌1例.术后对肿瘤控制和功能结果进行评定.结果 原发性恶性骨盆肿瘤中Ⅰ A期1例,Ⅰ B期5例,ⅡA期3例,ⅡB期8例,3例良性骨肿瘤均为Ⅲ期,原发瘤患者平均随访时间36.8个月(9～73个月);3例转移瘤患者生存期9.6～36.6个月.肿瘤局部复发4例,肺转移5例,死亡5例,术后无深部感染和皮肤坏死.深静脉血栓2例;坐骨神经不全损伤1例,股骨头假体脱位2例,螺钉松动3例,肢体短缩3例,其中植入物相关并发症发生率为21.7%,术后6个月MSTS功能评分平均为68%;随访5年以上的6例患者MSTs功能评分平均为62%.结论 新型复合重建技术可有效重建髋臼周围肿瘤切除后骨缺损同时可以较好恢复髋关节功能,术后并发症少.     

膀胱憩室癌5例报告

目的：探讨膀胱憩室癌的临床特征，提高其诊治水平。方法：对5例膀胱憩室癌患者均行CT和膀胱镜检查确诊。3例行根治性膀胱全切、尿流改道手术．2例行膀胱部分切除术。结果：病理诊断移行细胞癌2例，鳞状细胞癌2例，恶性神经鞘瘤1例。3例于术后2个月内死亡，均为非移行性细胞癌；另外2例术后随访10个月，无局部复发和远处转移。结论：CT和膀胱镜检查是确诊膀胱憩室癌的重要方法；膀胱憩室癌的临床分期不同，预后明显不同，非移行细胞癌病理类型有早期浸润行为．预后差。     

原发性纵隔肿瘤的诊断和外科治疗(附39例报告)

目的探讨原发性纵隔肿瘤的临床特征和诊疗方法。方法回顾性分析我院2002年1月至2007年10月39例原发性纵隔肿瘤外科诊治的临床资料。结果手术完整切除30例,姑息性切除9例。全组无手术死亡,术后32例获随访,随访3个月-5年。良性肿瘤患者术后均预后良好,恶性肿瘤出现远处转移2例,共3例在术后因肿瘤复发及其并发症而死亡。结论原发性纵隔肿瘤不论是良性还是恶性,只要无明确手术禁忌证均应及早手术,术后综合治疗是影响预后的重要因素。     

Clinico-pathological study of meningiomas in childhood--with special reference to malignant meningiomas

Six cases of meningiomas which accounted for 3.6% out of 167 intracranial tumors in children were studied with clinico-pathological method. Four meningiomas located in the convexity, two meningiomas developed within the lateral ventricle. CT scan with contrast material showed homogeneous enhanced tumors in four cases. Heterogeneous enhanced tumors were observed in two malignant meningiomas. There was evidence of recurrence in three cases. Two of in these cases were malignant meningiomas. Three patients received postoperative radiotherapy. One case of malignant meningiomas died seven years after the first operation. Five cases are still alive. Macroscopically three cases had cyst formation. Four convexity meningiomas were attached to the dura matter. Three malignant meningiomas were ill-defined and invaded the normal brain tissue. One case of malignant meningiomas invaded the skull. Six meningiomas were classified histologically into two fibrous, one transitional and three malignant meningiomas according to the World Health Organization (WHO) classification of brain tumors. All cases were examined for glial fibrillary acidic protein (GFAP) using the immunohistochemical method. Two cases of malignant meningiomas demonstrated the positive reaction to GFAP. Four cases were negative. These findings suggest that malignant meningiomas grow invasively into the surrounding normal brain tissue.     

Surgical treatment of primary cardiac tumors]

Twenty patients with primary cardiac tumors were operated on during the past ten years. The age of 15 female and 5 male patients ranged from 17 to 73 years. Eighteen patients had myxomas, 16 of which located in the left atrium and 2 in the right atrium. Systemic embolism occurred in 8 patients, subsequently caused cerebral infarction in 4, ischemia of extremities in 2, myocardial infarction in 1 and pulmonary infarction in 1. Emergency operation was performed in 5 patients because of severe congestive heart failure. In all cases, removal of myxoma was performed together with the excision of the wall to which the pedicle attached with the use of cardiopulmonary bypass. One patient with pulmonary infarction underwent resection of the infarcted lung simultaneously. Only one patient with severe heart failure died of pulmonary insufficiency one month after the operation. Another patient with cerebral infarction underwent clipping of cerebral aneurysm which appeared later in the infarcted area. The 17 patients including the latter patient showed a good recovery and no local recurrence during the follow-up period of 1 to 120 months. Two patients had malignant tumors, which were malignant fibrous histiocytoma of the left atrium and leiomyosarcoma of the pulmonary artery, respectively. Both of these rare tumors were resected noncuratively and led to the death because of their local recurrence with distant metastasis, though they received adjuvant chemotherapy. The symptoms, complications, diagnoses, surgical treatment and outcome of the primary cardiac tumors are reviewed in this study.     

Surgical treatment of primary tumors of the heart

The article discusses the experience in surgical treatment of tumors of the heart in 34 patients in clinics of cardiosurgery at the Riga Medical Institute and the Institute of Cardiology and Cardiovascular Surgery of Havana (Cuba). Twenty-five patients underwent operations for benign tumors of the heart (16 myxomas, 2 leiomyomas, 2 fibromas, 1 lipoma, 1 angiofibroma, 2 coelomic cysts) under extracorporeal circulation, with 4% lethality. No recurrences were encountered in follow-up periods of 5 months to 14 years. Nine patients had malignant tumors; the tumor was removed successfully in 3 of them, even with resection and prosthetic replacement of the outflow tract of the right ventricle. Only 3 of the patients (33%) who were operated on had a follow-up period of more than 1 year.     

Benign and malignant ovarian tumors in children and adolescents: A review of 63 cases

Sixty-three patients (15 months to 17 years of age) with ovarian tumors were seen. Fifty-six patients had germ cell tumors and 7 epithelial tumors, 6 patients had bilateral tumors, 47 patients had teratomas (41 benign, 3 with embryonic tissue, and 3 malignant), 6 germinomas, 1 endodermal sinus tumor, and 2 mixed germ cell tumors. Of the patients with epithelial tumors, six had cystadenomas and one cystadenocarcinoma. Abdominal pain was the most common symptom, and an abdominal mass the most common sign. A calcification on abdominal films was seen in 29 patients with benign teratoma. At surgery, the opposite ovary was bivalved or biopsied in 31 patients with benign tumors. Two patients had teratomas burried in the ovarian tissue. Among 47 patients with benign tumors, 37 have remained well after the operation and 10 were lost to follow-up. Two girls with embryonic teratoma are well 71 and 19 months after diagnosis but the third died with embryonal carcinoma. Of the 13 patients with malignant tumors, 8 are alive disease free $\text{4}\text{1}\text{2}$ to 17 years after diagnosis, 4 are dead, and 1 is lost to follow-up (disease free 15 months after diagnosis).     

A clinical study of six surgically treated patients with malignant tumors arising from chronic pleuritis and pyothorax

During the clinical course of chronic pleuritis and pyothorax, we frequently have found abnormal clinical signs such as increased abnormal chest shadows, subjective symptoms, such as chest pain and bloody sputum, and the appearance of atypical cells in the pleural effusion. It is very difficult and important to diagnose differentially worsening of chronic inflammation and occurrence of malignant tumors. We have surgically treated six patients with malignant tumors arising from chronic pleuritis and pyothorax, who had the above abnormal signs. All of them were made, and their average age was fifty three years. Two patients exhibited increased abnormal chest shadows, 5 had subjective symptoms (5 with chest pain, 2 with bloody sputum and 2 with fever), and 1 had atypical cells in the pleural effusion. Two patients had suffered from chronic pleuritis, who both had received artificial pneumothorax therapy for pulmonary tuberculosis, and the other 4 patients had suffered from chronic pyothorax, with mean duration of thirty years. The pathological diagnoses were 2 cases each of malignant pleural mesothelioma, squamous cell carcinoma, and malignant fibrous histiocytoma. The two patients with squamous cell carcinoma had pleurocutaneous and bronchopleural fistula. The operative methods were tumor resections with pleuropneumonectomy performed in 2 patients and pneumonectomy in 1. Absolute non-curative operation was performed in 1 patient, and postoperative radiotherapy in 3 patients. All patients died of tumor recurrence, although five of them underwent reoperation, chemotherapy and radiotherapy. Their duration of survival ranged from 3 to 15 months with a mean of 9 months after appearance of malignant tumor signs.(ABSTRACT TRUNCATED AT 250 WORDS)     

Intracranial hemangiopericytoma: Radiology,surgery, radiotherapy,and outcome in 21 patients

At operation, 21 meningeal intracranial hemangiopericytomas resembled meningiomas, but differed histologically. They were frequently attached to sinuses, occipitally located, bled profusely at operation, and had a higher risk of recurrence and metastasis. Specific preoperative diagnosis is possible: computed tomography scan showed a meningiomalike tumor, which on the angiogram looked malignant and highly vascular. Two tumors showed a malignant growth pattern on computed tomography scan, “mushrooming.” After a radical removal, three patients have lived for more than 10 years without recurrence; two of them were irradiated postoperatively. Three recurrent tumors were treated with radiotherapy only; one responded favorably.     

Cardiac tumors: clinical experience and surgical results in 74 patients

A series of 75 cardiac tumors in 74 patients were operated on at La Pitie Hospital between 1972 and 1989. There were 73 primary and 2 metastatic tumors. Among the benign neoplasms, 58 were myxomas; seven of the nine malignant tumors were primary heart tumors. The mean age of the patients was 48 years (range, 9 to 75 years); 46 patients were female and 28 male. Fifty-seven percent of the patients had congestive heart failure, 13% had chest pain, 17% had neurological symptoms, and only 1 patient was totally asymptomatic. The cardiac tumors were incidental findings in 3 patients. Complete resection was carried out in 66 benign lesions and only four of the malignant tumors. All patients survived operation, although 4 died in the early postoperative period. Long-term results were excellent in patients with benign lesions, and no recurrences were found. In patients with malignant tumors, surgical procedures were only palliative and aimed at prolonging life; hence, prognosis remained unchanged.