Intensive surgical and chemotherapeutic management of advanced ovarian cancer.

We have presented the background and rationale for initiating a program of intensive surgical and chemotherapeutic management of advanced ovarian cancer. Our goal of excising all tumor masses larger than 1.5 cm in diameter has been explained and our operative approach described. The necessity for nutritional support has been emphasized. Preliminary results among patients with Stage III disease treated by optimal operation and Adriamycin-cyclophosphamide chemotherapy are encouraging. Aggressive operations have been unsuccessful when employed as secondary treatment. The single most important contraindication to extensive operation is the inability to initiate effective chemotherapy in the postoperative period.     

Surgical treatment of advanced (p-stage III.IV) lung cancer less than 2.0 cm in size

We treated surgically 567 patients with primary lung cancer from June 1975 to December 1989. There were nine patients with advanced (p-stage III.IV) lung cancer less than 2.0 cm in size. The five year survival rate was 50.8%. The histological diagnosis was adenocarcinoma in 6, squamous cell carcinoma in 3. A curative resection was performed in seven of nine patients. Six patients had one level metastasis of mediastinal lymph node. Three patients in whom relative curative resection was performed at surgery later developed regional recurrence. However, distant metastasis was not evident in all but one of nine patients. In conclusion surgical resection is considered to be significant in patients with advanced (p-stage III.IV) lung cancer less than 2.0 cm in size.     

外科手术在晚期胃癌治疗中的价值与合理选择

迄今,晚期胃癌的临床研究进展甚微,有关外科手术治疗的价值亦存在较大争议。临床上,应明确晚期胃癌的概念并细化其分期,充分认识根治手术、减瘤手术、姑息手术和探查手术的价值;应基于多学科协作团队精确评估晚期胃癌病人病情,重视转化治疗的应用,并根据治疗目的合理选择外科手术治疗。     

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目的 通过研究进展期胃近侧癌淋巴结转移情况及相关因素,阐述合理的手术治疗。方法 复习１９８２～１９９８年根治性全胃切除的胃近侧癌手术的１６８例,分析淋巴结的转移及有关预后。结果 淋巴结转移率为７４．４％。肿瘤的大小、Ｂｏｒｒｍａｎｎ分型及病理分型和浸润深度均与淋巴结转移相关（Ｐ〈０．０１）。肿瘤侵及肌层,浆膜及浆膜外淋巴结转移率分别为３５．７％、８１％和１００％。肿瘤侵及肌层Ｎｏ⑤、⑥淋巴结转移分     

Interest in intestinal resection for treatment of advanced ovarian cancer

AIM OF THE STUDY: Digestive surgery is often necessary for surgical management of advanced ovarian carcinoma. PATIENTS AND METHODS: In a series of 62 patients with stage III ovarian carcinoma, postoperative morbidity and mortality, overall survival after 5 years and disease-free survival after 2 years were studied and corelated with several patients criteria (age, stage of the disease, residual disease, type of surgery, CA125 normalisation delay, postoperative complications and hospital stay). Patients were divided into two groups according to the surgical treatment. The first group (n = 17) included patients treated by gynecologic and digestive surgery, the second group (n = 45) included patients treated by gynecologic surgery only. All patients were proposed for chemotherapy included platyn salt. Mean age was 60 years (range: 20-83). The stage of the cancer was stage IIIa in 7 cases, stage IIIb in ten and stage IIIc in 45. RESULTS: Postoperative mortality was 3.5% (2/62). Postoperative morbidity was 26% (13/62). No statistical differences were noted for hospital stay, general morbidity, surgical morbidity when a gastric resection or a colon resections or a splenectomy were performed. Overall survival at 5 years was 56%. Residual disease less than 2 cm3 is the only prognostic factor for overall survival (56% vs 23% [P = 0.03]) and disease-free survival (86% vs 46% [P = 0.02]). CONCLUSION: This study including 62 patients confirmed the prognostic significance of extensive cytoreductive surgery for treatment in advanced ovarian epithelial cancer without increasing the postoperative morbidy and mortality.     

Prognosis and treatment of advanced breast cancer from the surgical viewpoint

Twenty-four patients with advanced mammary carcinoma (stage T4) were treated between 1983-1986 at the Department of Surgery of the University of Bochum, Marienhospital Herne 1. The primary surgical treatment was supported in 18 cases by an ablatio modified from Patey, the ablatio simplex were performed on 4 patients; while a thoracical-epigastric flap was applied to one patient. Because of the high percentage (16.6%) of advanced breast cancer on all our breast cancer patients, we feel obliged to show the survival time of different under-groups by an interdisciplinary making follow up examination. So we believe to give a better and more different statement on the prognosis of the advanced breast cancer.     

日本晚期胃癌外科治疗效果分析

日本胃癌协会（JGCA）统计1991年在日本顶级胃癌治疗中心8851例原发性胃癌、7935例行胃癌切除术的患者的临床资料。联合脏器切除2394例、手术治疗合并腹膜及肝转移748例，两年生存率分别为62．0％和17．3％。晚期胃癌可以取得较好的外科治疗效果。     

机器人手术系统在卵巢癌治疗中的应用进展

卵巢癌是一种威胁女性健康的恶性肿瘤,恶性程度高,病死率居妇科肿瘤之首,手术是其主要的治疗方式。随着科技的进步,研究者在腹腔镜手术原理的基础上,开发了更加精准的达芬奇机器人手术系统,其具有微创、精细、灵活、滤抖等诸多优点,并引领着妇科手术迈向精准医疗的新征程。作为一种新兴的手术方式,机器人手术在卵巢癌的治疗与应用中存在诸多争议。本研究主要针对卵巢癌治疗的现状与争议进行深入剖析,对比分析机器人、腹腔镜及开腹手术治疗卵巢癌的手术疗效,并对机器人手术的发展及应用进行展望。     

Study of surgical treatment of advanced small lung cancer

We analyzed 15 patients with small but advanced primary lung cancer operated from 1965 to 1988. The size of tumors were less than 2.0 cm in largest dimension and their pathological stages III A, III B and IV. The histological types were adenocarcinoma in 13 cases and squamous cell carcinoma in 2 cases. Nine patients (69%) had elevated levels of preoperative serum CEA. The prognosis of patients with intrapulmonary metastases was better than that of those with pleural dissemination. In adenocarcinoma patients with mediastinal lymph node metastases, the survival rate of cases with small cancer less than 2.0 cm in diameter was higher than those with large cancer more than 5.0 cm in diameter.     

进展期胃癌外科综合治疗的发展趋势

在我国,胃癌仍然是死亡率最高的恶性肿瘤之一,根治性手术是治愈进展期胃癌的唯一手段;D2胃癌根治术作为治疗进展期胃癌的标准术式已被普遍接受.几项临床试验已证实与D2根治术相比,扩大手术范围并未使患者术后生存率有更多的获益.为改善进展期胃癌患者的预后,必须强调开展术前TNM分期,以便临床医生根据肿瘤的状况选择合适的治疗方案.外科综合治疗包括合理应用围手术期化疗、放疗与分子靶向治疗等是治疗进展期胃癌的最佳选择.在本文中,作者介绍了近年来国内外文献报告的有关进展期胃癌外科综合治疗的发展与趋势,供读者借鉴.     

Phase III randomised study of zoladex versus stilboestrol in the treatment of advanced prostate cancer.

An open randomised Phase III trial was conducted of the depot GnRH analogue goserelin (Zoladex) versus stilboestrol (3 mg/day) in patients with advanced or metastatic prostate cancer. The study included 250 patients and the median follow-up was 43 months. In the Zoladex arm the time to first response was achieved earlier and more patients reported an improvement in symptoms. There was no statistically significant difference between the Zoladex and the stilboestrol arms with regard to survival and time to treatment failure. A major reason for treatment failure was the preponderance of adverse events in patients receiving stilboestrol. It is suggested that stilboestrol should no longer be used for prostate cancer when equally effective alternative treatments are available.     

胃癌外科治疗的纷争与解决办法胃癌外科治疗纷争、对策及新进展

陈峻青教授 :胃癌外科治疗有几个“老问题”一直是学者们从多方面不断探讨的重要问题。意见有共识 ,亦有相悖。方法有的可行 ,有的难行。下面我就胃癌外科治疗的几个实际问题及其可行性对策予以叙述。1　胃癌合理的胃切除范围及对策研究胃癌的合理切除范围 ,首先应深刻理解不同病期、不同类型胃癌的生物学行为有明显差异 ,癌在胃壁内浸润范围与方式差别亦甚大。因此 ,不可能获得一个简单的、统一的适应全部胃癌的癌缘外切除距离的数据。1 1　癌缘外切除距离的研究概况过去 ,不少学者力图寻得一个明确的、统一的切除数据。但因研究方法不同、…     

Morbidity of surgical treatment for advanced cancer of the breast after irradiation

The authors reviewed the medical files of 100 patients with locally advanced breast cancer (stage III), treated in the department of surgery of the Institut Jules-Bordet between 1974 and 1988. All patients received preoperative radiotherapy (average total dose of 45 Grays). This preoperative irradiation was associated with chemotherapy in 74% of patients. All patients subsequently underwent surgery and a modified radical mastectomy was performed in 92% of cases. Our data analysis reveals an incidence of 25% of local wound infections, 34% of delayed wound healing, 63% of seroma formation and 22% of lymphoedema of the upper limb. The local postoperative morbidity appears to be increased in patients preoperatively irradiated. This indicates that preoperative chemotherapy may be preferable in these patients to minimise the local postoperative morbidity and its impact on the quality of life.     

Results of the surgical treatment of patients with advanced small lung cancer

From 1970 to 1988, 603 patients with non-small cell lung cancer were operated in our department. Among them, patients with small lung cancer (diameter less than 3 cm) with advanced disease were analyzed. There were 19 patients with mediastinal node metastasis, 2 with contralateral or supra-clavicular node metastasis, 3 with distant organ metastasis and one with pleural dissemination. In T1N2 group, adenocarcinoma was predominant in 17 patients and only 2 with squamous cell carcinoma. Sixteen patients underwent curative lobectomy with mediastinal node dissection. In T1N3 group, lobectomy and mediastinal and cervical node dissection were carried out. In T 1M1 group, 3 patients had lobectomy and removal of metastatic lesions, separately or simultaneously. One patient with pleural dissemination had segmentectomy and extirpation of disseminated foci. There were no operative deaths or hospital deaths in this series. Survival of the patients with T1N2 with curative resection was 93.8% in one year, 38.2% in 3 years and 22.9% in 5 years after operation. Among them, patients with intraoperative diagnosis of negative mediastinal node had relatively well survival. However, patients with N3, D+, or M1 had poor prognosis.     

T4 advanced lung cancer: results of surgical treatment and indications of surgical resection

A total of 1,289 patients with primary lung cancer were surgically treated at our hospital from January 1953 to December 1985. Surgical treatment for T4 lung cancer was studied in 93 patients who had pulmonary resections. The relationships between histologic type, stage, method of resection, curability, nodal involvement, pleural involvement, site of invasion, pleural metastasis, pleural effusion, combination therapy, and the survival rate were analyzed. The survival rate of 93 patients with T4 lung cancer was 17% at 3 years and 7% at 5 years. Three-year survival rate of 39 patients with adenocarcinoma, 34 patients with squamous cell carcinoma, and 9 patients with large cell carcinoma was 7%, 23%, and 14%, respectively. Two-year survival rate of 6 patients with small cell carcinoma was 17%. Four-year survival rate of 14 patients who had complete resection was 33%. On the other hand, four-year survival rate of 77 patients who had incomplete resection was 7%. Three-year survival rate of 6 patients with N0 disease, and 19 patients with N1 disease, 46 patients with N2 disease, and 22 patients with NX disease was 40%, 39%, 0%, and 15%, respectively. Two patients, who had partial resection of the left atrium because carcinoma made an invasion upon it, had survived more than 5 years. All patients with esophageal invasion or tracheal invasion had died within a year. Indications of surgical resection for patients with T4 lung cancer should be limited to patients with N0 and N1 disease. Radical pulmonary resection can be performed in patients who are expected to have complete resection.