Survival in patients with superior pulmonary sulcus tumors.

We report our experience with 21 patients with superior sulcus tumors. Demographic features and survival were analyzed according to the stage of disease. Eleven patients had stage IIIA disease, 2 had stage IIIB disease and 8 had stage IV disease. Only 4 (19%) were amenable to surgery at the time of diagnosis and only 1 underwent combined preoperative radiotherapy and surgery. The majority of our patients were nonresectable at the time of diagnosis because of extensive disease or coexisting medical conditions. Overall, the probability of survival approached zero at 1 year. This poor survival is a reflection of nonresectability in the majority of our patients, which may be unique to our patient population.     

Contemporary management of superior pulmonary sulcus (Pancoast) lung tumors

For more than three decades following the initial report by Shaw et al. in 1961, the standard treatment of Pancoast lung tumors consisted of induction radiotherapy followed by en bloc resection through a posterolateral thoracotomy. Overall 5-year survival rates with this regime were typically 30 to 40%, with poor prognosis in patients with positive mediastinal lymph nodes, T4 involvement, or incomplete resection. During the past decade, advancements in surgical technique and adjuvant therapy have improved the safety and completeness of resection as well as the probability of long-term survival. Alternative surgical approaches have been developed to facilitate more complete resection of tumors involving subclavian vessels and brachial plexus, and aggressive vertebral body resection has been performed in conjunction with neurosurgeons. Arguably the most important advance in the treatment of Pancoast tumors has been the recognition that induction chemoradiation substantially improves both the rate of complete resection and medium-term survival.     

Interdisciplinary treatment of glioblastoma: Analysis of prognostic factors and treatment results in unselected patients

Aim of the present study was to investigate survival rates of unselected patients with glioblastoma after multimodal treatment and estimation of prognostic factors. Data of 189 patients (118 men; 71 women; median age: 59 years) with histologically confirmed glioblastoma treated from 1999 to 2009 were analyzed retrospectively. Complete tumor resection was performed in 99 patients (52%), subtotal excision in 65 patients (34%), and stereotactic biopsy in 25 patients (13%). In 135 patients (71%), residual tumors were detectable in post-surgical imaging. All patients underwent three-dimensional conformal radiotherapy of the tumor region in shrinking-field technique to a?total dose of 60 Gy. Beginning in 2002, 124 patients (66%) received concomitant temozolomide (TMZ) treatment, 76 patients among them were additionally treated with adjuvant TMZ. After disease progression, 74 patients underwent salvage therapy (salvage chemotherapy, n=61; local therapy, n=30). Actuarial 1- and 2- year progression-free survival (PFS) rates were 32% and 7%, overall survival (OS) rates were 54% and 22%, respectively. Without TMZ, 1- and 2- year OS rates were 47% and 11%, with concomitant TMZ 57% and 28%, and with concomitant and adjuvant TMZ 72% and 44%. In multivariate Cox proportional hazards regression models, age (p<0.001), extent of resection (p?=?0.001), and TMZ (p?相似文献   

Surgical outcome and prognostic factors after treatment of osteoradionecrosis of the jaws

Purpose

This prospective study attempts to identify prognostic factors for outcome in patients Classes 2 and 3 osteoradionecrosis (ORN) treated using individualized methods.

Methods

From 2005 to 2010, patients with Classes 2 and 3 osteoradionecrosis of the jaws were treated by the same surgical team using standard protocols. The patients were evaluated prospectively and followed up for a minimum of 12 months after completion of treatment. Two examinations were performed at least six months apart.

Results

A total of 94 patients were assessed. Local debridement was performed in 33 patients (35.1 %), a rim resection with the application of a reconstruction plate was performed in 35 patients (37.2 %), and continuity resection in 26 patients (27.7 %). Postoperative wound infections locally or at the neck were detected in 69 patients (70.2 %), failure to eradicate radionecrosis occurred in 50 patients (53.2 %). The location of the primary tumor (p = 0.023) and radiation dose (p = 0.049), were associated with a significant risk of development of ORN. Prognostic factors for failure of treatment were the extent of initial osteoradionecrosis (p = 0.049) surgical treatment (p < 0.0001), number of debridements (p < 0.0001), type of microvascular free flap with (p < 0.0001), and grossly infected ORN (p < 0.0001).

Conclusions

Several factors affect the outcome of treatment of ORN. We confirm many of the intuitive factors influence outcome of treatment and add evidence that complete removal of affected bone and watertight well vascularized coverage is the most useful treatment strategy.     

Laparoscopic Nissen fundoplication: results and prognostic factors

Introduction: Laparoscopic Nissen fundoplication is the technique of choice in the surgical treatment of gastroesophageal reflux disease. Aims: To review the cases of laparoscopic Nissen fundoplication carried out at our hospital and to analyze the prognostic factors that influenced surgical outcome. Material and methods: A total of 226 patients that underwent laparoscopic Nissen fundoplication within the time frame of 1996 to 2010 were retrospectively reviewed. Surgical results and prognostic factors were evaluated in 182 patients that had a follow-up longer than one year. Results: The Nissen-Rossetti technique was carried out in 219 patients, without short gastric vessel division, and the "floppy"-Nissen technique was performed on seven patients. Intraoperative complication rate was 3.1%, conversion rate was 6.6%, and postoperative complication rate was 4%. Mortality was 0. After surgery, 19% of patients presented with dysphagia that was persistent in only 3.5%. Of the 182 patients with a follow-up longer than one year, 166 (91.2%) were satisfied with the surgical results. In the univariate analysis, esophagitis (OR=0.59) was a protective factor, while a DeMeester score >50 (OR=1.97) and medical treatment resistance (OR=1.75) were risk factors. In the multivariate analysis a DeMeester score >50 (OR=4.24) was the only independent prognostic factor associated with poor outcome. Conclusions: Our results with laparoscopic Nissen fundoplication are comparable to those found in the medical literature, with a high degree of patient satisfaction. Esophagitis is associated with good outcome, while massive reflux and medical treatment resistance are negative prognostic factors.     

High relapse-free survival after preoperative and intraoperative radiotherapy and resection for sulcus superior tumors

STUDY OBJECTIVES: Relapse-free survival in patients with sulcus superior tumors. DESIGN: Prospective registration study. SETTING: Department of surgical oncology of a university hospital. PATIENTS: Twenty-one patients treated with preoperative radiotherapy (46 Gy), lobectomy and chest-wall resection, and intraoperative radiotherapy (10 Gy). RESULTS: After a median follow-up of 18 months, 18 patients (85%) were free from locoregional relapse, while 8 patients were still alive. CONCLUSIONS: The results show that this protocol can achieve excellent local tumor control and can even be used for palliative treatment.     

Surgical treatment and prognostic factors in TS1 carcinoma of the pancreas

After classifying 72 resected ductal carcinomas of the pancreas on the basis of tumor size (TS) into the following categories: TS1 (≦2.0cm,n=9), TS2 (>2.0cm, ≦4.0cm,n=37), and TS3,4 (>4.0cm,n=26), we investigated both clinicopathological and biological factors, and assessed their relation to long-term outcome. The 5-year survival rate was 44.4% in the TS1 patients, 9.0% in the TS2 patients, and 4.5% in the TS3,4 patients, being significantly higher in the TS1 patients. Six patients survived for more than 5 years, including 2 TS1 patients with conclusive stage I disease, and their clinicopathological and/or biological factors were negative. Most of the 72 patients, however, were not only very advanced macro-microscopically but their biological malignant potential was also high. These patients with advanced disease, especially those with noncurative resection (curability C), had a poor outcome. The TS1 patients, on the other hand, were characterized by a better outcome than the TS2 and TS3,4 patients after curable resection combined with N2 lymph node dissection, even when the tumor extension was the same. Thus, survivals of more than 5 years can be expected in TS1 patients with stage I, or in patients with stage III or IV, if the histological factors and/or biological factors are negative. All patients who died of early recurrence after resection had some positive histological and biological factors. Liver metastasis was especially frequent when two or more biological factors were positive. Therefore, in advanced TS1 patients (stage III or IV), radical resection should be performed, followed by adjuvant chemotherapy.     

Non-small-cell superior sulcus tumor: results of en bloc resection in fifty-six patients - non-small-cell pancoast

BACKGROUND: Various multidisciplinary approaches are taken in the treatment of superior sulcus tumors. The purpose of this study was to determine the outcome, long-term results, and factors associated with prolonged survival after administering different combined radiosurgical regimens in a single institution. METHODS: Between 1986 and 2000, 56 patients (43 men, 13 women) with superior sulcus tumor and histology of non-small-cell lung cancer underwent surgical resection. There were four treatment groups: I - preoperative radiation and operation (n = 15); II - preoperative radiation, operation and postoperative radiation (n = 22); III - operation and postoperative radiation (n = 10) and IV - no radiotherapy (n = 9). Survival was calculated by the Kaplan-Meier method and prognostic factors were assessed for significance by log-rank test and Cox regression analysis. RESULTS: The five-year survival rate after complete resection and N0/1 was 34 %. Of the prognostic factors analyzed, the histology, type of irradiation regimen and Horner's syndrome did not influence survival. Completeness of resection and mediastinal lymph node involvement clearly influences survival in univariate analysis. Age, sex and TNM classification were found to be independent significant prognostic factors for survival following resection. CONCLUSION: With superior sulcus tumors, every attempt should be made to resect the tumor completely by en bloc chest-wall resection with lobectomy and systematic hilar and mediastinal lymph node dissection. Mediastinal exploration by routine mediastinoscopy is recommended for identification of patients with advanced nodal involvement. Long-term survival may be relative to care taken in patient selection and extent of the resection performed. No significant difference in survival of patients with different irradiation regimens could be demonstrated in this study.     

Thyroid cancer: prognostic factors and treatment

Because most differentiated thyroid carcinomas have an excellent prognosis, some authors have claimed that these patients are suffering from over treatment. Grouping patient- and tumor-specific factors have been proposed for prognostic stratification, but no clinicopathologic staging was demonstrated to be useful at the present time. More recently, molecular genetic tools have been used to identify and understand how the primary tumor progresses and many molecular markers have been proposed in order to distinguish the subset of patients at risk of developing metastasis. Here we analyzed some of them, with emphasis on the expression of NIS, a determinant of prognosis since the functional integrity of the iodine transport is essential to assure an uptake of radioiodine high enough to detect and destroy any tumoral thyroid tissue. More recent observations on how some relevant molecular genetics aspects of thyroid cancer impact new potential therapeutic approaches are also discussed.     

Superior sulcus tumors: the role of imaging

Advances in the treatment of stage 0 to III superior sulcus tumors mandate greater accuracy in establishing tissue diagnosis, assessing tumor extent, and staging. Currently, this is best accomplished by a combination of PA chest radiography, MRI, and needle biopsy. MRI is superior to other single imaging modalities for the overall assessment of local tumor extent, bone invasion, mediastinal invasion, and perhaps in the future, determining radiosensitivity. In patients with superior sulcus tumors, evaluation of the brain, liver, and skeleton for metastases may be advisable prior to treatment with preoperative radiation and radical surgical resection.     

Gastrointestinal stromal tumors of the duodenum:Surgical management and survival results

AIM:To provide long-term survival results of operable duodenal gastrointestinal stromal tumors(DGISTs)in a tertiary center in China.METHODS:In this retrospective study,the pathological data of 28 patients with DGISTs who had been treated surgically at the Second Department of General Surgery,Sir Run Run Shaw Hospital(SRRSH)from June1998 to December 2006 were reviewed.All pathological slides were examined by a single pathologist to confirm the diagnosis.In patients whose diagnosis was not confirmed by immunohistochemistry at the time of resection,representative paraffin blocks were reassembled,and sections were studied using antibodies against CD117(c-kit),CD34,smooth muscle actin(SMA),vimentin,S-100,actin(HHF35),and desmin.Operative procedures were classified as wedge resection(WR,local resection with pure closure,without duodenal transection or anastomosis),segmental resection[SR,duodenal transection with Roux-Y or BillrothⅡgastrojejunostomy(G-J),end-to-end duodenoduodenostomy(D-D),end-to-end or end-to-side duodenojejunostomy(D-J)],and pancreaticoduodenectomy(PD,Whipple operation with pancreatojejunostomy).R0 resection was pursued in all cases,and at least R1 resection was achieved.Regional lymphadenectomy was not performed.Clinical manifestations,surgery,medical treatment and follow-up data were retrospectively analyzed.Related studies in the literature were reviewed.RESULTS:There were 12 males and 16 females patients,with a median age of 53 years(20-76 years).Their major complaints were"gastrointestinal bleeding"(57.2%)and"nonspecific discomfort"(32.1%).About14.3%,60.7%,17.9%,and 7.1%of the tumors originated in the first to fourth portion,respectively,with a median size of 5.8 cm(1.6-20 cm).Treatment was by WR in 5 cases(17.9%),SR in 13 cases(46.4%),and by PD in 10 cases(35.7%).The morbidity and mortality rates were 35.7%and 3.6%,respectively.The median post-operative stay was 14.5 d(5-47 d).During a follow-up of 61(23-164)mo,the 2-year and 5-year relapse-free survival was 83.3%and 50%,respectively.Eighty-f     

右心肿瘤的外科治疗

目的　总结 2 7例右心肿瘤外科治疗经验。方法　右房原发肿瘤 18例 ,转移性肿瘤 3例 ,右室原发肿瘤 6例 ;恶性肿瘤 10例 ,占 3 7%。结果　手术死亡 1例。 1例因术中出血 ,肿瘤未能完全切除。 3例转移性肿瘤仅做解除梗阻手术。 2例肿瘤切除同时进行三尖瓣置换术。结论　 ( 1)术中应注意插管方法 ,防止瘤体脱落 ,必要时采用深低温停循环方法 ;( 2 )切除瘤体时应注意心脏功能和结构的完整性。     

脊柱转移瘤的外科处理(附22例报告)

目的 脊柱转移瘤可引起顽固性疼痛及脊髓压迫，探讨其外科治疗的临床效果。方法 回顾性分析1995～2003年手术治疗22例脊柱转移瘤患者的临床资料。结果 术后22例疼痛均得到缓解。14例有神经功能损害者术后麻痹症状得到不同程度的改善；8例术前膀胱或(和)直肠功能受损的患者中，术后除2例变化不明显外。余6例膀胱与直肠功能明显改善；术前4例Frankel A级患者，1例无变化，2例术后恢复至C级，1例恢复至D级；6例C级患者中3例恢复至D级，3例恢复至E级，4例D级患者全部恢复至E级。结论 积极的手术治疗可以缓解疼痛、解除压迫、重建脊柱的稳定性，进而改善患者的生活质量。     

胰腺内分泌肿瘤的外科治疗

目的 提高对胰腺内分泌肿瘤的认知和诊疗水平.方法 回顾性分析1968 ～ 2005年收治的78例胰腺内分泌肿瘤患者的临床资料.结果 胰岛素瘤49例,均为良性,其中40例行单纯肿瘤摘除术(2例在腹腔镜下完成),2例在摘除的同时行胰腺空肠Roux-en-Y吻合术,7例行胰体尾切除术;胰高血糖素瘤4例,均有肝转移,行原发病灶及部分转移灶切除术;胰多肽瘤21例,恶性8例,手术切除16例,其余5例因肿瘤无法切除而放弃手术;舒血管肠肽瘤1例和胰腺类癌3例,均为恶性,行外科手术.术后均获得满意的疗效.结论 手术切除是胰腺内分泌肿瘤最为理想的治疗方法.术前定性诊断尤为重要,关键是提高对这类肿瘤的认知水平.对胰岛素瘤不强求术前定位诊断,应慎用有创性诊断方法,术中胰腺探查是定位的关键.其他内分泌肿瘤术前多可依影像学检查定位诊断.手术方式根据肿瘤生长部位而定.姑息性切除手术亦可明显缓解症状.即便是恶性肿瘤,其预后亦明显好于胰腺外分泌肿瘤.     

肠系膜上动脉血栓手术实施及介入治疗

目的 观察肠系膜上动脉血栓手术的实施过程以及介入治疗效果. 方法 对我院2005年1月至2013年12月收治21例肠系膜上动脉血栓患者的诊断及临床治疗过程进行回顾性分析. 结果 21例患者中有19例有明显的易感因素,早期症状与体征不相符.21例患者经动脉造影术显示肠系膜上动脉主干血栓17例,回肠动脉血栓2例,肠系膜下动脉血栓2例.所有患者手术均进行顺利,住院10～14 d,平均11d.经介入手术治疗后,腹痛症状得到明显缓解.术后随访12～36个月,未有复发情况出现. 结论 肠系膜动脉血栓确诊困难,需早期诊断并及时进行介入治疗.