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1.
Genevieve B. Melton William C. Lavely Heather A. Jacene Richard D. Schulick Michael A. Choti Richard L. Wahl Susan L. Gearhart 《Journal of gastrointestinal surgery》2007,11(8):961-969
Purpose Efficacy of F-18 fluorodeoxyglucose positron emission tomography combined with computed tomography (FDG-PET/CT) for determining
neoadjuvant therapy response in rectal cancer is not well established. We sought to evaluate serial FDG-PET/CT for assessing
tumor down-staging, percentage residual tumor, and complete response or microscopic disease with rectal cancer neoadjuvant
therapy.
Methods Patients with rectal cancer undergoing neoadjuvant therapy, definitive surgical resection, and FDG-PET/CT before and 4–6 weeks
after neoadjuvant treatment were included. Tumors were evaluated pretreatment and on final pathology for size and stage. FDG-PET/CT
parameters assessed were visual response score (VRS), standardized uptake value (SUV), PET-derived tumor volume (PETvol),
CT-derived tumor volume (CTvol), and total lesion glycolysis (δTLG).
Results Twenty-one rectal cancer patients over 3 years underwent neoadjuvant treatment, serial FDG-PET/CT, and resection. Complete
response or microscopic disease (n = 7, 33%) was associated with higher ΔCTvol (AUC = 0.82, p = 0.004) and ΔSUV (AUC = 0.79, p = 0.01). Tumor down-staging (n = 14, 67%) was associated with greater ΔPETvol (AUC = 0.82, p < 0.001) and ΔSUV (AUC = 0.82, p < 0.001). Pathologic lymph node disease (n = 7, 33%) correlated with ΔCTvol (AUC = 0.75, p = 0.03) and ΔPETvol (AUC = 0.70, p = 0.08).
Conclusion FDG-PET/CT parameters were best for assessing tumor down-staging and percentage of residual tumor after neoadjuvant treatment
of rectal cancer and can potentially assist in treatment planning.
This work was presented in the plenary session of the 47th Annual Meeting of the Society for Surgery of the Alimentary Tract
at the Digestive Disease Week in Los Angeles, CA on 24 May 2006. 相似文献
2.
John D. Allendorf Margaret Lauerman Aliye Bill Mary DiGiorgi Nicole Goetz Efsevia Vakiani Helen Remotti Beth Schrope William Sherman Michael Hall Robert L. Fine John A. Chabot 《Journal of gastrointestinal surgery》2008,12(1):91-100
Abstract
Background We evaluated the feasibility and efficacy of neoadjuvant chemotherapy and radiation for patients with locally unresectable
pancreatic cancer.
Materials and Methods From October 2000 to August 2006, 245 patients with pancreatic adenocarcinoma underwent surgical exploration at our institution.
Of these, 78 patients (32%) had undergone neoadjuvant therapy for initially unresectable disease, whereas the remaining patients
(serving as the control group) were explored at presentation (n = 167). All neoadjuvant patients received gemcitabine-based chemotherapy, often in conjunction with docetaxal and capecitabine
in a regimen called GTX (81%). Seventy-five percent of neoadjuvant patients also received preoperative abdominal radiation
(5,040 rad).
Results Neoadjuvant patients were younger than control-group patients (60.8 vs 66.2 years, respectively, p < 0.002). Seventy-six percent of neoadjuvant patients were resected as compared to 83% of control patients (NS). Concomitant
vascular resection was required in 76% of neoadjuvant patients but only 20% of NS (p < 0.01). Complications were more frequent in the neoadjuvant group (44.1 vs 30.9%, p < 0.05), and mortality was higher (10.2 vs 2.9%, p < 0.03). Among the neoadjuvant patients, all but one of the deaths were in patients that underwent arterial reconstruction.
Mortality for patients undergoing a standard pancreatectomy without vascular resection was 0.8% in this series. Of patients
resected, negative margins were achieved in 84.7% of neoadjuvant patients and 72.7% of NS. Within the cohort of neoadjuvant
patients, radiation significantly increased the complication rate (13.3 vs 54.6%, p < 0.006), but did not affect median survival (512 vs 729 days, NS). Median survival for patients who received neoadjuvant
therapy (503 days) was longer than NS that were found to be unresectable at surgery (192 days, p < 0.001) and equivalent to NS that were resected (498 days).
Conclusions Resection rate, margin status, and median survivals were equivalent when neoadjuvant patients were compared to patients considered
resectable by traditional criteria, demonstrating equal efficacy. Surgical resection with venous reconstruction following
neoadjuvant therapy for patients with locally advanced pancreatic cancer can be performed with acceptable morbidity and mortality.
This approach extended the boundaries of surgical resection and greatly increased median survival for the “inoperable” patient
with advanced pancreatic cancer.
This work was presented at the American Hepato-Pancreato-Biliary Association Conference in Las Vegas, NV, April 2007. 相似文献
3.
Eddie K. Abdalla Dario Ribero Timothy M. Pawlik Daria Zorzi Steven A. Curley Andrea Muratore Axel Andres Gilles Mentha Lorenzo Capussotti Jean-Nicolas Vauthey 《Journal of gastrointestinal surgery》2007,11(1):66-72
Purpose: To examine clinical features and outcome of patients who underwent hepatic resection for colorectal liver metastases (LM)
involving the caudate lobe.
Patients and Methods: Consecutive patients who underwent hepatic resection for LM from May 1990 to September 2004 were analyzed from a multicenter
database. Demographics, operative data, pathologic margin status, recurrence, and survival were analyzed.
Results: Of 580 patients, 40 (7%) had LM involving the caudate. Six had isolated caudate LM and 34 had LM involving the caudate plus
one or more other hepatic segments. Patients with caudate LM were more likely to have synchronous primary colorectal cancer
(63% vs. 36%; P = 0.01), multiple LM (70% vs. 51%; P = 0.02) and required extended hepatic resection more often than patients with non-caudate LM (60% vs. 18%; P < 0.001). Only four patients with caudate LM underwent a vascular resection; three at first operation, one after recurrence
of a resected caudate tumor. All had primary repair (vena cava, n = 3; portal vein, n = 1). Perioperative complications (43% vs. 28%) and 60-day operative mortality (0% vs. 1%) were similar (caudate vs. non-caudate
LM, both P > 0.05). Pathological margins were positive in 15 (38%) patients with caudate LM and in 43 (8%) with non-caudate LM (P < 0.001). At a median follow-up of 40 months, 25 (64%) patients with caudate LM recurred compared with 219 (40%) patients
with non-caudate LM (P = 0.01). Patients with caudate LM were more likely to have intrahepatic disease as a component of recurrence (caudate: 51%
vs. non-caudate: 25%; P = 0.001). No patient recurred on the vena cava or portal vein. Patients with caudate LM had shorter 5-year disease-free and
overall survival than patients with non-caudate LM (disease-free: 24% vs. 44%; P = 0.02; overall: 41% vs. 58%; P = 0.02).
Conclusions: Patients who undergo hepatic resection for caudate LM often present with multiple hepatic tumors and tumors in proximity to
the major hepatic veins. Extended hepatectomy is required in the majority, although vascular resection is not frequently necessary;
when performed, primary repair is usually possible. Despite resection in this population of patients with multiple and bilateral
tumors, and despite close-margin and positive-margin resection in a significant proportion, recurrence on the portal vein
or vena cava was not observed, and long-term survival is accomplished (41% 5-year overall survival).
These data were presented at the American Hepato-Pancreato-Biliary Association 2006 Annual Meeting, Miami, Florida, March
12, 2006. 相似文献
4.
P. Teyton J. P. Metges A. Atmani V. Jestin-Le Tallec A. Volant D. Visvikis J. P. Bail O. Pradier P. Lozac’h Catherine Cheze Le Rest 《Journal of gastrointestinal surgery》2009,13(3):451-458
Introduction Although the prognosis of patients with esophageal cancer has been improved by extended dissection, the incidence of recurrence
still remains high. In esophageal cancer, positron emission tomography (PET) using 18F-fluorodeoxyglucose (FDG) already demonstrated to be useful for initial staging and monitoring response to therapy. This
prospective study compared the ability of FDG-PET and conventional imaging to detect early recurrence of esophageal cancer
after initial surgery in asymptomatic patients.
Materials and Methods Between October 2003 and September 2006, 41 patients with esophageal cancer were included in a prospective study after initial
radical esophagectomy. FDG-PET, thoracoabdominal computed tomography (CT), abdominal ultrasonography, and endoscopy were performed
every 6 months after initial treatment.
Results and Discussion Twenty-three patients had recurrent disease (56%), mostly within the first 6 months after surgery (70%). Despite two false-positive
scans due to postoperative changes, FDG-PET was more accurate than CT (91% vs. 81%, p = 0.02) for the detection of recurrence with a sensitivity of 100% (vs. 65%), a specificity of 85% (vs. 91%), and a negative
predictive value of 100% on a patient-by-patient-based analysis. For the detection of locoregional recurrence, FDG-PET was
more accurate than CT (96.2% vs. 88.9%). FDG-PET was also more accurate than CT for the detection of distant metastases (92.5%
vs. 84.9%), especially when involving either bones (100%) or liver (98.1%). A lower sensitivity of FDG-PET (57%) for the early
detection of small lung metastases did not affect patient management (accuracy = 92.5%).
Conclusion FDG-PET appears to be very useful for the systematic follow-up of asymptomatic patients after esophagectomy with an initial
scan performed 6 months after surgery.
Presented at the Forty-sixth Annual Meeting of The European Society of Nuclear Medicine, Athens, Greece, September 30–October
4, 2006 (oral presentation). 相似文献
5.
Timothy M. Pawlik Kelly Olino Ana Luiza Gleisner Michael Torbenson Richard Schulick Michael A. Choti 《Journal of gastrointestinal surgery》2007,11(7):860-868
Some investigators have suggested that preoperative chemotherapy for hepatic colorectal metastases may cause hepatic injury
and increase perioperative morbidity and mortality. The objective of the current study was to examine whether treatment with
preoperative chemotherapy was associated with hepatic injury of the nontumorous liver and whether such injury, if present,
was associated with increased morbidity or mortality after hepatic resection. Two-hundred and twelve eligible patients who
underwent hepatic resection for colorectal liver metastases between January 1999 and December 2005 were identified. Data on
demographics, clinicopathologic characteristics, and preoperative chemotherapy details were collected and analyzed. The majority
of patients received preoperative chemotherapy (n = 153; 72.2%). Chemotherapy consisted of fluoropyrimidine-based regimens: 5-FU monotherapy, 31.6%; irinotecan, 25.9%; and
oxaliplatin, 14.6%. Among those patients who received chemotherapy, the type of chemotherapy regimen predicted distinct patterns
of liver injury. Oxaliplatin was associated with increased likelihood of grade 3 sinusoidal dilatation (p = 0.017). Steatosis >30% was associated with irinotecan (27.3%) compared with no chemotherapy, 5-FU monotherapy, and oxaliplatin
(all p < 0.05). Irinotecan also was associated with steatohepatitis, as two of the three patients with steatohepatitis had received
irinotecan preoperatively. Overall, the perioperative complication rate was similar between the no-chemotherapy group (30.5%)
and the chemotherapy group (35.3%) (p = 0.79). Preoperative chemotherapy was also not associated with 60-day mortality. In patients with hepatic colorectal metastases,
preoperative chemotherapy is associated with hepatic injury in about 20 to 30% of patients. Furthermore, the type of hepatic
injury after preoperative chemotherapy was regimen-specific.
Presented at the American Hepato-Pancreato-Biliary Association 2006 Annual Meeting, March 11, Miami, Florida. 相似文献
6.
Radiofrequency Ablation vs. Resection for Hepatic Colorectal Metastasis: Therapeutically Equivalent?
Nathaniel P. Reuter Charles E. Woodall Charles R. Scoggins Kelly M. McMasters Robert C. G. Martin 《Journal of gastrointestinal surgery》2009,13(3):486-491
Introduction The role of ablation for hepatic colorectal metastases (HCM) continues to evolve as ablation technology changes and systemic
chemotherapy improves. Our aim was to evaluate the therapeutic efficacy of radiofrequency ablation (RFA) of HCM compared to
surgical resection.
Methods A retrospective review of our 1,105 patient prospective hepatic database from August 1995 to July 2007 identified 192 patients
with only hepatic resection or only ablation for HCM.
Results Patients who underwent RFA were similar to resection patients based on a similar Fong score (1.8 vs. 2.1 p = 0.28), presence of extrahepatic disease (15% vs. 9% p = 0.19), mean number of hepatic lesions (2.8 vs. 2.1 p = 0.14), and prior chemotherapy (67% vs. 60% p = 0.33). Median time to recurrence was shorter with ablation than resection (12.2 vs. 31.1 months; p < 0.001). Recurrence at the ablation–resection site was more common with ablation than resection occurring 17% vs. 2% (p ≤ 0.001) of the time, respectively. Distant recurrence in the liver was also more common with ablation occurring in 33% of
patients vs. 14% for resection (p = 0.002).
Conclusions Surgical resection is associated with a lower chance of recurrence and a longer disease-free interval than RFA and should
remain the treatment of choice in resectable HCM. 相似文献
7.
Marcus C. B. Tan David C. Linehan William G. Hawkins Barry A. Siegel Steven M. Strasberg 《Journal of gastrointestinal surgery》2007,11(9):1112-1119
Dramatic responses are being observed in colorectal cancer liver metastases treated with newer chemotherapeutic regimens.
These have been associated with normalization of [18F]fluoro-2-deoxy-d-glucose (FDG) uptake (complete metabolic response) on follow-up Positron Emission Tomography with [18F]fluoro-2-deoxy-d-glucose (FDG-PET) scans in some patients. It is unclear how often complete metabolic response is indicative of complete tumor
destruction. We analyzed a subset of patients who had neoadjuvant chemotherapy for hepatic metastases from colorectal adenocarcinoma.
Inclusion criteria were: (1) FDG-avid hepatic lesions before initiation of chemotherapy; (2) complete metabolic response of
the same lesions after chemotherapy; and (3) histopathologic examination of hepatic lesions. Complete pathologic response
was defined as no histologically identifiable viable tumor. Fourteen patients fit the inclusion criteria. All had synchronous,
hepatic-only colorectal metastases. On microscopic examination, complete pathologic response to the neoadjuvant regimen was
found in only 5 of 34 lesions (15%) and in only 3 of the 14 patients (21%). Seven lesions had complete metabolic response
and disappeared on computed tomography (CT); of these, six still contained viable tumor. We conclude that complete metabolic
response on FDG-PET after neoadjuvant chemotherapy is an unreliable indicator of complete pathologic response. Therefore,
currently, curative resection of liver metastases in these patients should not be deferred on the basis of FDG-PET findings.
Presented at the 2007 Annual Meeting of the American Hepato–Pancreato–Biliary Association, April 19–22, 2007, Las Vegas, Nevada. 相似文献
8.
David J. Gallagher MD Junting Zheng PhD Marinela Capanu PhD Dana Haviland Philip Paty MD Robert P. Dematteo MD Michael D’Angelica MD Yuman Fong MD William R. Jarnagin MD Peter J. Allen MD Nancy Kemeny MD 《Annals of surgical oncology》2009,16(7):1844-1851
Objective We investigated the relation between response to neoadjuvant chemotherapy and overall survival (OS) in patients with colorectal
liver metastases (CLM).
Background It has previously been reported that patients with synchronous CLM whose disease progresses while receiving neoadjuvant chemotherapy
or who do not receive neoadjuvant chemotherapy experience worse survival than patients whose disease responds to neoadjuvant
chemotherapy.
Methods By means of a prospectively maintained surgical database, between 1995 and 2003, we identified 111 patients with a synchronous
CLM who received neoadjuvant chemotherapy before hepatic resection. The disease of all 111 patients was deemed resectable,
and patients underwent hepatic resection with curative intent.
Results The median OS after liver resection was 62 months, with a median follow-up of 63 months. Median OS was similar between the
three study groups classified by response to neoadjuvant chemotherapy (complete or partial response, 58 months; stable disease,
65 months; and disease progression, 61 months; P = .98). By univariate analysis, carcinoembryonic antigen level after liver resection of <5 ng/dL, size of metastatic lesion
of ≤5 cm, lymph node–negative primary tumor, and disease-negative margins were associated with improved survival. Patients
in the disease progression group had more positive margins and metastases >5 cm in size than patients in the complete or partial
response group and the stable disease group. Patients whose tumor progressed but who received postoperative hepatic arterial
infusion had a trend toward improved survival compared with those who did not receive hepatic arterial infusion (70% vs. 50%
at 3 years, permutation log rank test P = .12).
Conclusions Response to neoadjuvant chemotherapy did not correlate with OS even after controlling for margins, stage of primary tumor,
and postoperative carcinoembryonic antigen level. Postoperative salvage treatment may have helped the survival of some patients. 相似文献
9.
Survival of Patients with Synchronous and Metachronous Colorectal Liver Metastases—is there a Difference? 总被引:1,自引:0,他引:1
Maximilian Bockhorn Andreja Frilling Nils R. Frühauf Jan Neuhaus Ernesto Molmenti Tanja Trarbach Massimo Malagó Hauke Lang Christoph E. Broelsch 《Journal of gastrointestinal surgery》2008,12(8):1399-1405
Background The aim of this study was to compare outcomes in patients with synchronous and metachronous colorectal liver metastases, with
special emphasis on prognostic determinants.
Study design We analyzed prospectively collected data on 101 patients with synchronous metastases (group A) who were treated surgically
during the time period from April 1998 to December 2006 in regard to overall and disease-free survival, impact of chemotherapy,
as well as several serum parameters. A group of patients with metachronous colorectal liver metastases (group B) was considered
for baseline comparison.
Results Twenty-three patients in group A received only an explorative laparotomy. Surgical treatment included right hepatectomy (n = 7), left hepatectomy (n = 5), right trisectionectomy (n = 10), left trisectionectomy (n = 1), left lateral resection (n = 11), and sectionectomy (n = 44). Thirty-day mortality was 3%. Morbidity was observed in 10% of the patients. One-, 3-, and 5-year overall survival
rates for synchronous metastases were 86%, 68%, and 47%, respectively. The corresponding rates for metachronous metastases
were 94%, 68%, and 39% (p > 0.05). Disease free survival was 74%, 42%, and 33% in group A versus 84%, 62%, and 13% in group B (p = 0.28). There was no difference in survival between patients receiving neoadjuvant chemotherapy and no chemotherapy (p > 0.05). Out of all serum parameters, carcinoembryonic antigen levels were a negative predictor for overall and disease-free
survival only.
Conclusions Patients with synchronous colorectal liver metastases had a similar 5-year overall and disease-free survival, which corresponds
to patients with metachronous metastases. The impact of neoadjuvant chemotherapy in patients with synchronous metastases needs
to be further clarified. 相似文献
10.
Seung Hyuk Baik Nam Kyu Kim Kang Young Lee Seung Kook Sohn Chang Hwan Cho 《Journal of gastrointestinal surgery》2008,12(1):176-182
The anal sphincter preservation rate (ASPR) according to tumor level and neoadjuvant chemoradiotherpy (CRT) has not been fully
evaluated. Therefore, the aim of this study was to evaluate the correlation between the tumor level, neoadjuvant CRT, and
the ASPR in rectal cancer patients. We studied 544 patients (tumor level, 0–6 cm) who underwent curative resection for rectal
cancer between 1991 and 2005. Patients were divided six into groups according to tumor level over 1-cm intervals, and the
ASPR was evaluated in patients with and without neoadjuvant CRT according to tumor level. Sphincter preservation surgery was
performed in 191 patients, and 86 patents underwent neoadjuvant CRT. The overall ASPR was 43.0% (37/86) in patients with neoadjuvant
CRT and 33.6% (154/458) in patients without neoadjuvant CRT (P = 0.094). In an analysis according to tumor level, the ASPR was 0.0 vs 0.0% in ≤1 cm, 0.0 vs 2.1% in 1 ≤ 2 cm (P = 0.589), 11.8 vs 16.8% in 2 ≤ 3 cm (P = 0.599), 55.6 vs 20.2% in 3 ≤ 4 cm (P = 0.001), 57.7 vs 45.9% in 4 ≤ 5 cm (P = 0.227), and 66.7 vs 69.5% in 5 ≤ 6 cm (P = 0.827). Neoadjuvant CRT did not increase the ASPR in tumor level within ≤6 cm. However, for the tumor level (3 ≤ 4 cm),
neoadjuvant CRT significantly increased the ASPR.
Presented at the 20th Annual meeting of International Society for Digestive Surgery in Rome, Italy, November 29–December 2,
2006 (oral presentation in Grassi Prize Session). 相似文献
11.
Michelle L. DeOliveira Timothy M. Pawlik Ana L. Gleisner Lia Assumpcaom Gaspar J. Lopes-Filho Michael A. Choti 《Journal of gastrointestinal surgery》2007,11(8):970-976
Survival after resection of colorectal liver metastases has traditionally been associated with clinicopathologic factors.
We sought to investigate whether echogenicity of colorectal liver metastasis as assessed by intraoperative ultrasound (IOUS)
was a prognostic factor after hepatic resection. Prospective data on tumor IOUS appearance were collected in 84 patients who
underwent hepatic resection for colorectal liver metastasis. Images were digitally recorded, blindly reviewed, and scored
for echogenicity (hypo-, iso-, or hyperechoic). The median tumor number was 1 and the median tumor size was 5.0 cm. At the
time of surgery, the IOUS appearance of the colorectal liver metastases were hypoechoic in 35 (41.7%) patients, isoechoic
in 37 (44.0%) patients, and hyperechoic in 12 (14.3%) patients. Traditional clinicopathologic prognostic factors were similarly
distributed among the three echogenicity groups (all p > 0.05). Patients with a hypoechoic lesion had a significantly shorter median survival (30.2 months) compared with patients
who had either an isoechoic (53.2 months) or hyperechoic (42.3 months) lesion (p = 0.005). The 5-year survival after hepatic resection of colorectal liver metastasis was also associated with the echogenic
appearance of the lesion (hypoechoic 14.4 vs isoechoic 37.4 vs hyperechoic 46.2%) (p < 0.05). Intraoperative ultrasound echogenicity should be considered a prognostic factor after hepatic resection of metastatic
colorectal cancer.
This study was presented at the 47th annual meeting of The Society for Surgery of the Alimentary Tract, Los Angeles, CA, USA,
22 May 2006. 相似文献
12.
P. Vogel U. Bolder M. N. Scherer H.-J. Schlitt K.-W. Jauch 《Langenbeck's archives of surgery / Deutsche Gesellschaft fur Chirurgie》2009,394(2):331-337
Background/Aims Soft tissue sarcomas (STS) are rare tumors. General treatment is difficult while multimodality treatment strategies are more
and more common. In these strategies, surgical resection of the primary tumor is essential to achieve local control of the
tumor. In certain cases, complex resections (CR) including multivisceral and/or vascular resection are needed to achieve resection
with tumor-free margins. In this study, we evaluated retrospectively the overall prognosis, morbidity, and mortality of patients
treated for STS at our university hospital.
Patients/Methods Between 1992 and 2000, 24 of 154 patients with STS received multivisceral resection and four of 154 underwent vascular resection.
To determine the influence of CR on overall prognosis, we compared n = 19 patients after CR with a matched control group after simple tumor resection (SR). To determine surgical morbidity and
mortality the whole study group was used (n = 154, SR n = 126, CR n = 28).
Results The median follow up for all patients was 6.89 years (mean 5.64 years SD 4.3) with no difference between the groups (CR vs
SR: 5.4 SD 4.8 vs 5.9 SD 3.9 years; p = 0.711). Patients receiving CR had a similar overall prognosis (mean survival 9.9 years), morbidity (10.7%) and mortality (0%) compared
to patients with SR (mean survival 8.5 years; morbidity 10.3%; mortality 3.96%).
Conclusions Multivisceral resection and/or vascular resection with tumor-free margins can be achieved with the same overall prognosis,
same morbidity and mortality as SR. This has to be taken into account when evaluating the treatment strategy in patients with
STS. 相似文献
13.
Srinevas K. Reddy Gloria Broadwater Donna Niedzwiecki Andrew S. Barbas Herbert I. Hurwitz Johanna C. Bendell Michael A. Morse Bryan M. Clary 《Journal of gastrointestinal surgery》2009,13(1):74-84
Background Few studies identifying variables associated with prognosis after resection of colorectal liver metastases (CLM) account for
treatment with multiagent chemotherapy (fluoropyrmidines with irinotecan, oxaliplatin, bevacizumab, and/or cetuximab). The
objective of this retrospective study was to determine the effect of multiagent chemotherapy on long-term survival after resection
of CLM.
Methods Demographics, clinicopathologic tumor characteristics, treatments, and long-term outcomes were reviewed.
Results From 1996 to 2006, 230 patients underwent resection of CLM. Treatment strategies before and after resection included fluoropyrimidine
monotherapy (n = 34 and n = 39), multiagent chemotherapy (n = 81 and n = 73), and observation (n = 115 and n = 118). Prehepatectomy treatment strategy was not associated with overall survival. Actuarial 4-year survival was 63%, 39%,
and 40% for patients treated with multiagent chemotherapy, fluoropyrimidine monotherapy, and observation after hepatectomy,
p = 0.06. Posthepatectomy multiagent chemotherapy (p = 0.04, HR 0.52 [0.27–1.03]), duration of posthepatectomy chemotherapy treatment of 2 months or longer (p = 0.05, HR 0.49 [0.25–0.99]), carcino-embryonic antigen level >10 ng/mL (p = 0.03, HR 2.09, 95% CI [1.32–3.32]), and node positive primary tumor (p = 0.002, HR 1.79 [1.06–3.02]) were associated with overall survival in multivariate analysis.
Conclusions The association of posthepatectomy multiagent chemotherapy with overall survival in this retrospective study indicates the
need for prospective randomized trials comparing multiagent chemotherapy and fluoropyrimidine monotherapy for CLM. 相似文献
14.
Karoui M Koubaa W Delbaldo C Charachon A Laurent A Piedbois P Cherqui D Tran Van Nhieu J 《Annals of surgical oncology》2008,15(12):3440-3446
Background This study characterizes the histological effect of chemotherapy (CT) on primary colonic tumors.
Methods Between 2000 and 2006, 38 patients with stage IV colon cancer underwent resection of the primary, after chemotherapy (CT group,
n = 16) or without preoperative CT (control group, n = 22). For all primary tumors, histological analysis included: fibrosis, acellular necrosis, acellular mucin pools, lymphoplasmacytic
infiltration, and changes at tumor surface. Tumor regression grade (TRG) was determined by the amount of residual tumor cells
and was graded from 1 to 5.
Results No patient had complete histological response. Major histological tumor regression (TRG2) was observed in 70% of patients
treated by CT and none of the not treated patients (P < 0.0001). Fibrosis, acellular necrosis, and surface changes were significantly increased in the CT group. TRG in the primary
was comparable to the TRG in the corresponding liver metastases for 7/9 patients who underwent both colonic and hepatic resection
after CT.
Conclusion CT induces major histological response in 70% of colon cancers. Response to CT in the primary and the corresponding liver
metastases are correlated. These results support a policy of initial CT management for stage IV colon cancer and may warrant
future studies of neoadjuvant CT in locally advanced colon carcinomas. 相似文献
15.
Yun Shin Chun Jean-Nicolas Vauthey Dario Ribero Matteo Donadon John T. Mullen Cathy Eng David C. Madoff David Z. Chang Linus Ho Scott Kopetz Steven H. Wei Steven A. Curley Eddie K. Abdalla 《Journal of gastrointestinal surgery》2007,11(11):1498-1505
Background
Two-stage hepatectomy has been proposed for patients with bilateral colorectal liver metastases (CLM). The aim of this study
was to compare the outcome of patients with CLM treated with preoperative chemotherapy followed by one- or two-stage hepatectomy.
Methods
From a prospective database, 214 consecutive patients who received preoperative systemic chemotherapy (fluoropyrimidine with
irinotecan or oxaliplatin) followed by planned one- or two-stage hepatectomy were retrospectively analyzed (1998–2006). In
patients undergoing two-stage procedures, minor hepatectomy (wedge or segmental resection[s]) was systematically performed
before major (more than three segments), second-stage hepatectomy. Preoperative portal vein embolization (PVE) was performed
if indicated.
Results
One- (group I) and two-stage(group II) hepatectomies were performed in 184 and 21 patients, respectively. Median number of
metastases in groups I and II were two (range 1–20) and seven (range 2–20). All patients in group II had bilateral disease
vs 39% in group I. Major hepatectomy was performed in all patients in group II and 79% in group I. PVE was performed in 18
group I and 12 group II patients without increase in morbidity. For group I, group II first stage, and group II second stage,
respectively, morbidity (24%, 24%, 43%), median hospital stay (7 days, 6 days, 6.5 days) and 30 days postoperative mortality
(2%, 0%, 0%) were not significantly different (P = NS). Median follow-up was 25 months; median survival has not been reached. One- and 3-year overall and disease-free survival
rates from the time of hepatic resection were 95% and 75%, 63% and 39%, respectively in group I; 95% and 86%, 70% and 51%,
respectively in group II (P = NS).
Conclusions
Two-stage hepatectomy with preoperative chemotherapy results in comparable morbidity and survival rates as one-stage hepatectomy.
This approach enables selection and treatment of patients with multiple, bilateral CLM who will benefit from aggressive surgery
with good outcomes.
Presented at the Society for Surgery of the Alimentary Tract 48th Annual Meeting, May 2007, Washington, DC. 相似文献
16.
Finkelstein SE Grigsby PW Siegel BA Dehdashti F Moley JF Hall BL 《Annals of surgical oncology》2008,15(1):286-292
Background Whole-body 131I scintigraphy (WBS) and serial thyroglobulin measurement (Tg) are standard methods for detecting thyroid cancer recurrence
after total/near total thyroidectomy and 131I ablation. Some patients develop elevated Tg (Tg-positive) or there is clinical suspicion of recurrence, but WBS are negative
(WBS-negative). This may reflect non-iodine-avid recurrence or metastasis. In 2002, the Centers for Medicare and Medicaid
Services (CMS) approved positron emission tomography with [18F]fluorodeoxyglucose (FDG-PET) for Tg-positive/WBS-negative patients with follicular-cell-origin thyroid cancer. Limited data
are available regarding the performance of combined FDG-PET/computed tomography (FDG-PET/CT) for detecting recurrent thyroid
cancer in WBS-neg patients.
Methods This retrospective review of prospectively collected data analyzed 65 patients who had FDG-PET/CT for suspected thyroid cancer
recurrence (April 1998–August 2006). Patients were WBS-negative but were suspected to have recurrence based on Tg levels or
clinical grounds. Suspected FDG-PET/CT abnormalities were reported as benign or malignant. Lesions were ultimately declared
benign or malignant by surgical pathology or clinical outcome (disease progression).
Results Of 65 patients who underwent FDG-PET/CT, 47 had positive FDG-PET/CT. Of the positive FDG-PET/CT, 43 studies were true positives,
with 21 (49%) confirmed pathologically by surgical resection. The four false positives (3/4 confirmed pathologically) included
an infundibular cyst, an inflamed supraclavicular cyst, pneumonitis, and degenerative disc disease. Of the 18 FDG-PET/CT studies
that were negative, 17 were true negatives and one was a false negative (metastatic papillary carcinoma). Thus, FDG-PET/CT
demonstrated a patient-based sensitivity of 98%, specificity of 81%, positive predictive value of 91%, and negative predictive
value of 94%.
Conclusions FDG-PET/CT is useful for detecting thyroid cancer recurrence in WBS-negative patients, and can assist decision making. 相似文献
17.
Improved Staging With Pretreatment Positron Emission Tomography/Computed Tomography in Low Rectal Cancer 总被引:9,自引:1,他引:8
Gearhart SL Frassica D Rosen R Choti M Schulick R Wahl R 《Annals of surgical oncology》2006,13(3):397-404
Background 18F-Fluorodeoxyglucose (FDG)-positron emission tomography (PET) and computed tomography (CT) are widely accepted in the evaluation
for metastatic or recurrent rectal cancer. Only spiral CT and transrectal ultrasonography (TRUS) are routinely used in the
initial evaluation of primary rectal cancer. We wished to determine whether PET/CT could provide additional information in
patients undergoing standard evaluation for primary rectal cancer.
Methods Thirty-seven patients (mean age, 58 years; range, 26–90 years) with a previously untreated rectal cancer underwent TRUS or
magnetic resonance imaging, spiral CT, and FDG-PET/CT. The tumor location (low, ≤6 cm; mid, 7–10 cm; or high, ≥10 cm) and
carcinoembryonic antigen level were recorded. Discordant findings between spiral CT and FDG-PET/CT were confirmed by histological
analysis or imaging follow-up.
Results FDG-PET/CT identified discordant findings in 14 patients (38%), and this resulted in upstaging of 7 patients (50%) and downstaging
of 3 patients (21%). Although node-positive disease on TRUS/magnetic resonance imaging was associated with discordant FDG-PET/CT
findings, this was not statistically significant. Discordant PET/CT findings were significantly more common in patients with
a low rectal cancer than in those with mid or high rectal cancer (13 vs. 1; P = .0027). The most common discordant finding was lymph node metastasis (n = 7; 50%). Histological confirmation of discordant
FDG-PET/CT findings was performed in seven patients, and in no case did FDG-PET/CT prove to be inaccurate. Discordant PET/CT
findings resulted in a deviation in the proposed treatment plan in 27% of patients (n = 10).
Conclusions FDG-PET/CT frequently yields additional staging information in patients with low rectal cancer. Improved accuracy of pretreatment
imaging with FDG-PET/CT will allow for more appropriate stage-specific therapy.
Presented at the Annual Meeting of the Society of Surgical Oncology, Atlanta, Georgia, March 3–6, 2005. 相似文献
18.
Thomas A. Aloia René Adam Didier Samuel Daniel Azoulay Denis Castaing 《Journal of gastrointestinal surgery》2007,11(10):1328-1332
Introduction For liver transplant candidates with hepatocellular carcinoma (HCC), the ability of neoadjuvant transarterial chemoembolization
(TACE) to improve outcomes remains unproven. The objective of our study was to determine if there was a specific time interval
where neoadjuvant TACE would decrease the number of HCC patients removed from the pretransplant waitlist.
Materials and Methods A decision model was developed to simulate a randomized trial of neoadjuvant treatment with TACE vs. no TACE in 600 virtual
patients with HCC and cirrhosis. Transition probabilities for TACE morbidity (1 ± 1%), TACE response rates (30 ± 20%), and
disease progression (7 ± 7% per month) were assigned by systematic review of the literature (18 reports). Sensitivity analyses
were performed to determine time thresholds where TACE would decrease the number of delisted patients.
Results TACE treatment had statistical benefit at waitlist time breakpoints of 4 and 9 months (P < 0.05). When waitlist times were less than 4 months, waitlist attrition was similar (20% vs. 34%, P = 0.08). When waitlist times exceed 9 months, waitlist dropout rates re-equilibrated (33% vs. 46%, P = 0.06). Review of the current literature determined that only those studies reporting on patients with waitlist times between
4 and 9 months found a benefit to neoadjuvant TACE.
Conclusions This analysis indicates that the benefit of neoadjuvant TACE may be limited to those patients transplanted from 4 to 9 months
from first TACE. These data may help transplant programs to tailor TACE treatments based on predicted waitlist times to achieve
optimal resource utilization and improved organ allocation efficiency.
Presented at the 7th World Congress of the International Hepato Pancreato Biliary Association Meeting, September 6, 2006,
Edinburgh, Scotland. 相似文献
19.
Endoscopic Ultrasound and Computed Tomography Predictors of Pancreatic Cancer Resectability 总被引:1,自引:0,他引:1
Philip Q. Bao J. Chad Johnson Elizabeth H. Lindsey David A. Schwartz Ron C. Arildsen Ewa Grzeszczak Alexander A. Parikh Nipun B. Merchant 《Journal of gastrointestinal surgery》2008,12(1):10-16
Introduction This study investigates the ability of endoscopic ultrasound (EUS) and computed tomography (CT) to predict a margin negative
(R0) resection and the need for venous resection in patients undergoing pancreaticoduodenectomy (PD).
Methods Patients with pancreatic head adenocarcinoma undergoing surgery with intent to resect during the last 5 years were identified.
EUS and CT data on vascular involvement were collected. Preoperative imaging was compared to intraoperative findings and final
pathology. Contingency table analysis using Fisher’s exact test identified imaging features of EUS and CT associated with
unresectability and positive margins.
Results Seventy-six patients met study criteria. Forty-seven (62%) underwent potentially curative PD. The R0 resection rate was 70%.
There were 16 unresectable patients because of locally advanced disease. Venous involvement >180° and arterial involvement
>90° by CT had 100% positive predictive value for failure to achieve R0 resection (p < .01). If patients with prestudy biliary stents were excluded, EUS venous abutment or invasion also predicted R0 failure
(p = .02). Combined but not individual EUS and CT findings were predictive of need for vein resection.
Conclusions Pancreas protocol CT imaging appears to be a better predictor of resectability compared to EUS. EUS accuracy is affected by
the presence of biliary stents.
This article was presented at SSAT, Washington DC, May 2007. 相似文献
20.
Dong Do You Hyung Geun Lee Jin Seok Heo Seong Ho Choi Dong Wook Choi 《Journal of gastrointestinal surgery》2009,13(9):1699-1706
Background The aim of this study was to determine prognostic factors for survival after resection of pancreatic adenocarcinoma (PC) and
to compare outcomes after surgery alone versus surgery plus adjuvant therapy.
Methods We performed a retrospective review of 219 patients who underwent pancreaticoduodenectomy for PC with curative intent between
1995 and 2007. Data were collected prospectively. Postoperative adjuvant chemoradiation therapy (CRT) consisted of fluorouracil
or gemcitabine-based chemotherapy; the median radiation dose was 45 Gy.
Results The 3- and 5-year overall survival (OS) rates were 24.3% and 14.2%, respectively. Median OS was 14.0 months [95% confidence
interval (CI), 12–16 months]. Patients with metastatic lymph nodes experienced improved median survival (16 vs 10 months;
P < 0.001) and 3-year OS (3-year OS 28% vs 8%) after adjuvant CRT compared with those who had no CRT. Patients who underwent
non-curative resection had the same effect (median OS, 13 vs 8 months; P = 0.037). Lymph node metastasis and non-curative resection showed no significance on multivariate analysis. Poor differentiation
[risk ratio (RR) = 2.10; P < 0.001] and tumor size >3 cm (RR = 1.57; P = 0.018) were found to be adverse prognostic factors; adjuvant CRT had borderline significance (RR = 0.70; P = 0.087).
Conclusions Adjuvant CRT benefited a subset of patients with resected PC, particularly those with lymph node metastasis and those undergoing
non-curative resection. Multivariate analysis demonstrated that patients with tumors larger than 3 cm and poor differentiation
had poor prognosis. 相似文献