Laparoscopy and laparoscopic ultrasonography in staging carcinoma of the gastric cardia.

OBJECTIVE: To investigate the role of diagnostic laparoscopy and laparoscopic ultrasonography in the staging of carcinoma of the gastric cardia that is involving the distal oesophagus. DESIGN: Retrospective consecutive case series. SETTING: Tertiary care centre, The Netherlands. SUBJECTS: 48 patients (34 men and 14 women, median age 63 years, range 39-84) who presented with tumours of the gastric cardia that involved the distal oesophagus and in whom non-invasive staging had not shown unresectable locoregional disease or distant metastases. INTERVENTIONS: In addition to laparoscopy and laparoscopic ultrasonography, biopsy of all suspected lesions outside the area of potential resection. MAIN OUTCOME MEASURES: Number of patients in whom the findings obviated the need for exploratory laparotomy. RESULTS: There were no complications related to the laparoscopy. The investigation showed distant metastases (which were histologically verified) in 11 patients (23%, 95% confidence interval (CI) 16 to 30). These patients had non-operative palliation. Seven were identified by laparoscopy, and laparoscopic ultrasonography showed the other four. In three patients whose distant metastases had already been identified by laparoscopy, ultrasonography was omitted. Three additional patients had suspect lesions, but these were not confirmed histologically. However, these lesions were shown to be cancerous at laparotomy. One additional patient had an intra-abdominal metastasis which was missed by laparoscopy with ultrasonography. CONCLUSIONS: Laparoscopy with ultrasonography safely detected metastases that had not been shown by conventional staging investigations in 23% of 48 patients with carcinoma of the gastric cardia. The investigation should therefore be added to the standard staging procedures in patients with carcinoma of the gastric cardia that is involving the distal oesophagus.     

Human chorionic gonadotropin in gastric carcinoma. A useful marker for bone metastasis

Twenty patients with bone metastases from gastric carcinoma resected during the 13 years from 1974 through 1987 were investigated in relation to the serum and tissue carcinoembryonic antigen (CEA), alpha-fetoprotein (AFP) and human chorionic gonadotropin (hCG). The incidence of bone metastases was 2.1% (20/933). The serum AFP, CEA and hCG positive rates were found to be 14.3, 42.9 and 69.2% for patients with bone metastases and 18.3, 19.4 and 14.1% for those without bone metastases, respectively. In addition, the tissue AFP, CEA and hCG positive rates were 11.1, 100 and 77.8% for such patients with bone metastases, and 8.0, 80.8 and 21.1% for those without bone metastases. Only the serum and tissue hCG positive rate was significantly higher for the patients with bone metastases than those without bone metastases. The bone metastatic lesions were investigated for tissue hCG in four cases, and found to be positive in all the four bone lesions. In four of the patients with metachronous bone metastases, serum hCG levels were elevated before or at the time when bone metastases were diagnosed. Furthermore, serum hCG levels fell in response to chemotherapy or tumor resection. On the contrary, the serum AFP or CEA levels did not correlate with the clinical course in patients with bone metastases. These results indicate that the measurement of the tissue and serum hCG in patients with gastric carcinomas could be of extreme value in the search for bone metastases and the serum hCG level could be a useful marker for the prediction of bone metastases in gastric carcinoma.     

Outcome of hepatic resection for metastatic gastric cancer

The role of hepatic resection for metastatic gastric cancer is less well defined due to the tendency of gastric cancer to widely metastasize. The purpose of this study is to examine the beneficial effect of hepatic resection in patients with metastatic gastric cancer. The clinicopathologic features and long-term results of 11 patients who underwent hepatic resection for metastatic gastric cancer from January 1988 to December 1996 at Seoul National University Hospital were analyzed retrospectively. All resected hepatic metastases were solitary lesions. Among eight patients with synchronous hepatic metastases, one patient with early gastric cancer and lymph node metastases (T1N2M1) remained alive for 8 years 6 months after hepatic resection without recurrence. Among three patients with metachronous hepatic metastases, two patients with advanced gastric cancer and lymph node metastases (T3N2MO, T2N1MO at the initial operation, respectively) survived 8 years 6 months and 3 years after hepatic resection, respectively. Median survival times of synchronous and metachronous hepatic metastases were 13.0 and 74.3 months, respectively. In solitary hepatic metastatic lesions from gastric cancer, surgical resection should be considered as one of the treatment options.     

Early gastric cancer – excellent prognosis after curative resection in 87 patients irrespective of submucosal infiltration, lymph-node metastases or tumor size

BACKGROUND AND AIMS: Despite a decreasing incidence of primary gastric carcinoma over the last decade, the incidence of early gastric cancer has remained unchanged. Some aspects of the surgical treatment (e.g., extent of resection, lymphadenectomy) are still controversially discussed in the literature. PATIENTS/METHODS: Between May 1986 and July 1999, 87 patients were operated upon due to primary early gastric adenocarcinoma. All patients data were analyzed retrospectively. RESULTS: Of 626 patients with primary gastric carcinoma, 87 (13.9%) had an early carcinoma (54 men, 33 women; median age 61 years). In all patients, curative (R0-) gastrectomy could be performed, total in 62 patients (71.4%) and subtotal in 25 patients (28.6%). Postoperative morbidity was 23% and mortality 4.5%. Mucosal tumors were found in 34 (39.1%) and submucosal in 53 (60.9%) patients. Multicentricity was present in eight cases (9.1%). Twelve patients (13.8%) had lymph-node metastases. The 5-year survival rate was 88.8%. The submucosal infiltration, the lymph-node infiltration, the histological type, and the tumor size had no statistically significant impact on prognosis. CONCLUSION: Radical resection of early gastric cancer cured most of the patients, irrespective of lymph-node metastases or tumor size. Multicentricity, increasing incidence of proximal cancers, and low mortality suggest that total gastrectomy may be indicated. Patients with early gastric cancer may benefit from D2-lymphadenectomy, but this has to be assessed in further randomized studies, in particular for those with small mucosal tumors.     

Hepatic resections: an eight year experience at a community hospital

Between April 1979 and March 1987 24 patients underwent 26 hepatic resections. Colorectal liver metastases constituted the largest group (n = 18), followed by hepatocellular carcinoma (n = 2), Echinococcal liver cyst (n = 1), cholangiocarcinoma (n = 1), and leiomyosarcoma (n = 1). The mean age was 41.8 +/- 14.6 years (range: 23-69 years). Fifteen women and nine men comprised the group. The operative morbidity was 21 per cent, the 30-day operative mortality was 8 per cent (two deaths). Both operative deaths occurred in patients with colorectal liver metastases. The 18 patients with colorectal liver metastases included ten women and eight men. The mean age was 59.1 +/- 6.5 years (range: 46-69 years). There were seven synchronous and 11 metachronous liver metastases. Carcinoembryonic antigen (CEA) was found elevated in 14 of the original primary colonic carcinomas, and in all but one patient with metachronous liver metastases. The mean time from colorectal carcinoma resection to occurrence of metachronous metastases was 17.1 +/- 5.8 months. To date, 10 patients have had recurrences of liver metastases after hepatic resection for colorectal liver metastases. The mean time of recurrence was 12.6 +/- 11.9 months. The size of the metastases was 3.8 +/- 3.2 cm (range: 0.2-17 cm). The mean number of lesions present was 1.5 +/- 1.0. The 1 year and 2 year actuarial survival rates were 87.5 and 43.8 per cent respectively. The longest survivor is alive 54 months after his hepatic resection for colorectal liver metastases and remains to this date disease free.(ABSTRACT TRUNCATED AT 250 WORDS)     

Results of pulmonary resection for metastatic lung tumors

The results of pulmonary resection for metastatic pulmonary lesions in our institution are reviewed. Over the period of ten years 43 patients underwent 46 thoracotomies with a 5 years survival rate of 40.8%. The most significant predictors of survival were type of primary tumor, number of lesions removed and disease-free interval, while there were no statistically significant difference in survival rates between partial resection and lobectomy. Recurrence in the early postoperative period was often observed in the patients with bilateral pulmonary metastases and their 5 years survival rate was as low as 21.9%. Though multiple lung metastases is not contraindication for pulmonary resection, we should be prudent to operate for those patients with multiple lung metastases. Our results suggest that the patient with solitary lesion, long disease-free interval and no metastases to mediastinal lymph nodes is the best candidate for resection of the metastatic pulmonary lesions.     

Therapeutic video-assisted thoracoscopic surgical resection of colorectal pulmonary metastases

Objective: Careful patient selection is vital when video-assisted thoracoscopic surgical (VATS) therapeutic pulmonary metastasectomy of colorectal carcinoma is considered. Complete resection of all metastatic disease remains a vital concept. We reviewed our VATS experience for therapeutic metastasectomy of peripheral colorectal pulmonary metastases. Methods: Over 90 months, therapeutic VATS metastasectomy was accomplished upon 80 patients with colorectal metastases. Thin cut computed tomography (CT) was central in identifying lesions. The mean interval from primary carcinoma to VATS resection was 41 months (1–156 months; median, 33). A solitary lesion was resected in 60 patients and multiple (2–7) lesions resected in 20 patients. Statistics were obtained using the Student's t-test. Results: No operative mortality or major postoperative complications occurred. The hospital stay was 4.5±2.2 days (range, 1–13). All lesions were resected by VATS, with four conversions to thoracotomy to improve the margins. The mean survival of patients with one lesion was 34.8 months compared with 26.5 months for patients with multiple lesions (P=0.37). The mean survival was 20.5 months when metastases occurred <3 years vs. 28.1 months for >3 years from primary carcinoma resection (P=0.20). Twenty-five (31%) patients are disease free; with a mean interval of 38.7 (3–84; median, 35) months. Sixty-nine percent (55/80) of patients developed a recurrence: 6/80 (8%) local; 19/80 (24%) regional (same hemithorax away from resection); and 30/80 (38%) distant. The overall survival at 1 year was 81.2%, 48.4% at 3 years and 30.8% at 5 years. Conclusions: Therapeutic VATS resection of colorectal metastases appears efficacious. Preoperative CT can identify peripheral colorectal metastases amenable to VATS. Conversion to thoracotomy is indicated when none of the lesions identified by CT are found or when clear surgical margins are jeopardized.     

Surgical resection of liver metastases of gastric cancer: an analysis of a 17-year experience with 22 patients

BACKGROUND: The justification for surgical resection of liver metastases from gastric cancer remains controversial. METHODS: Twenty-two patients who underwent 26 hepatectomies for liver metastases of gastric cancer between 1985 and 2001 were analyzed. Fifteen clinicopathologic factors were evaluated with univariate and multivariate analyses for survival after hepatic resection. RESULTS: The overall 1-year, 3-year, and 5-year survival rates after hepatectomy for gastric metastases were 73%, 38%, and 38%, respectively. Five patients survived for more than 3 years without recurrence, 3 of whom had synchronous metastases resected at the time of gastrectomy. The best results after surgical resection for liver metastases of gastric cancer were obtained with solitary metastases less than 5 cm in size. The number of liver metastases (solitary or multiple) was the only significant prognostic factor according to both univariate and multivariate analyses. CONCLUSION: Surgical resection for liver metastases of gastric cancer may be beneficial for patients with a solitary metastasis, whether it is synchronous or metachronous.     

The radical treatment of gastric carcinoma

AIM: The aim of this paper is to review and assess the selective principles for a radical treatment of gastric carcinoma with respect to resection type as well as the role of lymphadenectomy. METHODS: From 1994 to 1999, we operated 222 patients affected by gastric adenocarcinoma at the 1st Surgical Clinic Institute in Padua. Out of the whole group, 138 patients (62.1%) underwent radical surgical treatment (75 patients with total gastrectomy, extended in 30 cases, and 63 patients by means of gastric resection). RESULTS: The overall survival rate at a median follow-up of 4 years was 58% for the patients treated with total gastrectomy, and 77% in case of distal gastric resection; 97% of patients with early gastric cancer are alive at a median follow-up of 3 years. CONCLUSION: Whenever it is feasible, subtotal gastrectomy could ensure a radical treatment of gastric carcinoma with low morbidity and mortality rate. The survival rate of such patients was 77%. Prognosis of early gastric cancer is excellent. Patients with IV stage tumors surgically treated had a poor outcome, and they should be susceptible of a multidisciplinary palliative approach.     

Resection of brain metastases from non-small-cell lung carcinoma. Results of therapy. Memorial Sloan-Kettering Cancer Center Thoracic Surgical Staff.

The treatment of patients with a solitary brain metastasis has been evolving, with most centers recommending resection in patients with good performance status. To evaluate the results of resection of brain metastases from non-small-cell lung cancer, we reviewed our 16-year experience with 185 consecutive patients undergoing resection of brain metastases from 1974 to 1989, inclusive. There were 89 men and 96 women; ages ranged from 34 to 75 years (median 54). Sixty-five (35%) had synchronous and 120 (65%) metachronous brain metastases. Discounting the brain metastasis, 68 patients (37%) had stage I, 13 (7%) stage II, 62 (33%) stage IIIA, 30 (16%) stage IIIB, and 12 (6%) stage IV carcinoma. There was no significant difference in age, locoregional stage (TN), or histologic features in patients with synchronous versus metachronous lesions. The overall survival rates (n = 185) were as follows: 1 year, 55%; 2 years, 27%; 3 years, 18%; 5 years, 13%; and 10 years, 7% (median 14 months). There was no significant difference in survival between patients with synchronous and metachronous lesions. To evaluate the impact of locoregional stage and treatment of the primary site, we analyzed only those patients with synchronous brain metastases. Multivariate analysis demonstrated that locoregional stage had no significant effect on survival (p = 0.97), but complete resection of the primary disease significantly prolonged survival (p = 0.002). Therefore complete resection, and not stage, of the locoregional primary lesion is the primary determinant of survival in patients undergoing resection of brain metastases from non-small-cell lung cancer.     

Multivisceral resections of extracolorectal lesions in familial adenomatous polyposis

AIMS: 1/ To report our experience with multivisceral resections in familial adenomatous polyposis (FAP) for extracolorectal lesions in a cohort of nine patients. 2/ Discuss the long term results of an agressive surgery. PATIENTS AND METHODS: Nine patients (7 males and 2 females) were operated at the University Hospital of Nimes (N=4) and Nantes (N=5). The median age at the first operation was 29 years (range 18-43). A genetic study was performed in six patients and confirmed the mutation on APC gene (exon 11, 13 and 15). All the patients were operated through a classic laparotomy. RESULTS: All patients have underwent a mean of three operations (range 2-5). Eight patients have had initially a total colectomy and 4 underwent subsequent proctectomy. Seven patients had pancreaticoduodenectomy for extensive duodenal adenomas and/or carcinoma. Three had one or multiple small bowel resections for development of carcinoma and one had partial gastric resection for large adenovillous tumor. The median follow up was 25 years (range 15-37) since the first operation. Three patients were died: one of gastric cancer with hepatic metastases, one of peritoneal carcinosis after ileal resection and one of astrocytoma. CONCLUSION: With regard to these nine observations, the authors underline the possibility of multivisceral resection in FAP. Despite a major digestive mutilation, it permits a long survival with acceptable quality of life. The prognosis depends on the aggressiveness of the duodenal or jejunoileal lesions more than of the colorectal tumors if found at the first resection.     

Bronchogenic carcinoma: a study of patients treated at Capital Hospital, Peking, China

From 1961 to 1972, 123 patients with lung cancer underwent operations at Capital Hospital, Peking, China. Ninety-six patients had resectable lesions and 27 did not, a resectability rate of 78%. Four patients (4.2%) died immediately postoperatively. Complications occurred in 8 (8.3%) patients. Five-year survival in this group of 92 survivors was 26 (28.3%). Ten-year survival among 49 patients was 10 (20.4%). Among the 92 five-year survivors, 41.2% had squamous cell carcinoma, 25% had adenocarcinoma, and 16% had undifferentiated carcinoma. Patients with squamous cell carcinoma had a much longer survival than the others. Six factors appear to influence survival after resection: cell type, presence of lymph node metastases, presence of tumor emboli in blood vessels, sex, age, and location. Men about 50 years of age, with a peripherally located squamous cell tumor and with no tumor emboli or lymph node metastases, have a good chance of surviving a pulmonary resection for ten years.     

Surgeon's role in the management of solitary renal cell carcinoma metastases occurring subsequent to initial curative nephrectomy: An institutional review

Background: Solitary metastases from a primary renal cell carcinoma (RCC) occur in <10% of patients with metastatic RCC. To date, the benefit of surgically resecting such apparently solitary lesions has not been well documented. Materials and Methods: Forty-one patients (25 men, 16 women) with metastatic renal cell carcinoma treated by surgical excision of solitary metastases (1970–1990) were retrospectively reviewed. They comprised 9% of patients with metastatic hypernephroma seen during this period. All patients had undergone previous curative nephrectomy with a median disease-free interval of 27 months. Patients with skeletal, spinal cord, and lymph node metastases were excluded. Results: Mevtastases were intrathoracic (n=20), intracranial (n=7), and intraabdominal or in the extrapleural chest wall soft tissue (n=10). Three patients had metastases to the thyroid gland and one had a solitary metastasis to an index finger. Median follow-up was 3.2 years. Complete resection was possible in 36 patients (88%) with a single lesion excised in 23 of these 36 patients (64%). There was no operative mortality. Predicted survival from the date of complete resection of metastases was 77%, 59%, and 31% at 1, 3, and 5 years, respectively, with a median survival of 3.4 years. One patient is alive without evidence of recurrent tumor 93 months from the first of 12 complete surgical resections. Varying adjuvant therapy was used in 50% of the patients. An increased histological tumor grade of the metastatic lesion relative to the original RCC was the only significant prognostic indicator identified. Disease-free interval and number of resected lesions were not significantly associated with patient survival. Conclusion: A small fraction of renal cell carcinoma patients are candidates for potentially curative surgical resection of solitary metastatic lesions. Excision of such lesions may contribute to prolonged survival in selected instances. 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.     

Esophageal carcinoma is frequently accompanied with early gastric carcinoma.

A review of data on 360 patients with esophageal squamous cell carcinoma who underwent esophageal resection revealed 14 cases (3.9%) and 16 lesions with synchronous gastric carcinomas. Among the 16 lesions, there were 14 (87.5%) early gastric carcinomas and two advanced carcinomas. Of the 14 early gastric carcinomas, two were minute (less than 5 mm in the largest diameter) early gastric carcinomas and four small (6-10 mm in the largest diameter). These gastric carcinomas were in a relatively early stage. The six early gastric carcinomas were not detected preoperatively. However, a thorough observation of the gastric mucosa could not be done in four of those due to stenosis which had developed as a result of the esophageal carcinoma. Therefore, intraoperative gastric observation should be done in cases in which the findings of the preoperative endoscopic examination of the stomach are inadequate and the upper gastrointestinal series reveal certain gastric abnormalities.     

Results of surgical treatment of early gastric cancer in 113 patients

From 1961 to 1978, 113 patients with early gastric cancer were treated surgically at Erlangen University. The lesions were located in the lower 1/3 of the stomach in 47% of the patients, in the corpus and fundus in 46%, and in the gastric stump after resection in 7%. Surgical techniques included subtotal distal resection, proximal resection, total gastrectomy, local excision and polypectomy, and their use depended on the circumstances. The tumors were classified as intestinal type carcinoma in 71% of patients and diffuse type carcinoma in 29%. The 5-year survival rates calculated by the actuarial method were 74% (observed) and 87% (age corrected). Tumors in the lower 1/3 of the stomach had a better prognosis than tumors of other regions. Tumors limited to the mucosa had a higher 5-year survival rate than those with invasion of the submucosa. In Europe, as in Japan, early gastric cancer has a much better prognosis than all other forms of gastric cancer.Presented at the XXVIIIth Congress of the Société Internationale de Chirurgie, San Francisco, California, U.S.A., September 2–8, 1979.     

Resection of multifocal non-small cell lung cancer when the bronchioloalveolar subtype is involved

OBJECTIVE: Bronchioloalveolar lung cancer is commonly multifocal and can also present with other non-small cell types. The staging and treatment of multifocal non-small cell cancer are controversial. We evaluated the current staging of multifocal bronchioloalveolar carcinoma and the therapeutic effectiveness of resection when this tumor type is involved. METHODS: We reviewed our experience between 1992 and 2000 with complete pulmonary resections for bronchioloalveolar carcinoma. Kaplan-Meier survival curves were calculated from the dates of pulmonary resection. RESULTS: Among 73 patients with bronchioloalveolar carcinoma, 14 patients, 7 male and 7 female with a mean age of 65 years (51-87 years), had multifocal lesions without lymph node metastases. Follow-up was 100% for a median of 5 years (range 2.6-8.5 years). Tumor distribution was unilateral in 9 patients and bilateral in 5 patients. The multifocal nature of the disease was discovered intraoperatively in 4 patients. Nine patients had 2 lesions, 4 patients had 3 lesions, and 1 patient had innumerable discrete foci in a single lobe. Operative mortality was 0. Postoperatively, 10 patients were staged pIIIB or pIV on the basis of multiple foci of similar morphology; 4 patients had some differences in histology (implying multiple stage 1 primaries). The median survival time to death from cancer was 14 months (141 days-5.6 years). The overall 5-year survival after resection of multifocal bronchioloalveolar carcinoma was 64%. Unilateral or bilateral distribution had no impact on survival. CONCLUSIONS: The current staging system is not prognostic for multifocal bronchioloalveolar carcinoma without lymph node metastases. Complete resection of multifocal non-small cell lung cancer when bronchioloalveolar carcinoma is a component may achieve survivals similar to that of stage I and II unifocal non-small cell lung cancer. When bronchioloalveolar carcinoma is believed to be one of the cell types in multifocal disease without lymph node metastases, consideration should be given to surgical resection.     

伴肝转移的Ⅳ期胃癌手术方式的合理选择

目的探讨不同手术方式对伴肝转移的Ⅳ期胃癌患者的临床疗效。方法回顾性分析1993-2004年间102例伴肝转移的Ⅳ期胃癌病例的手术方式,评价不同术式对预后的影响。结果肝转移H1的胃癌病例行姑息切除后半年、1年和2年的生存率分别为69%、44%和6%,与改道手术、开腹探查术者的生存率比较,差异有统计学意义(P=0.009)。肝转移H2的胃癌病例姑息切除术后半年、1年和2年的生存率分别为56%、13%和6%,与改道手术、开腹探查术者的生存率比较,差异无统计学意义(P=0.068)。肝转移H3的胃癌病例行姑息切除半年、1年和2年的生存率分别为25%、13%和0,与改道手术、开腹探查术者的生存率比较,差异无统计学意义(P=0.157)。有或无腹膜转移的病例,其术后生存率比较,差异亦无统计学意义(P=0.132)。结论肝转移H1的胃癌患者,无论伴与不伴腹膜转移,均应尽量行姑息性切除手术。肝转移H2、H3的Ⅳ期胃癌患者行切除性手术无益于预后。     

Surgical treatment of hepatic and pulmonary metastases from colon cancer

BACKGROUND: Surgical resection of isolated hepatic or pulmonary metastases secondary to colorectal cancer has been shown to yield acceptable long-term survival. However, results are inconclusive for surgical resection of both hepatic and pulmonary metastases. METHODS: We reviewed the records of all patients who underwent surgical resection of both hepatic and pulmonary metastases from colorectal cancer between 1980 and 1998. RESULTS: A total of 58 patients underwent resection of both hepatic and pulmonary metastases secondary to colorectal cancer. All patients had local control of their primary cancer before metastasectomy. There were no operative deaths. Morbidity occurred in 12% of patients. Follow-up was complete in all patients, with a median duration of 62 months (range, 6 to 201 months). The 5- and 10-year survivals were 30% and 16%, respectively. A premetastasectomy carcinoembryonic antigen level greater than 5 ng/mL increased the risk of early death (p = 0.029). Neither the number of pulmonary lesions nor the time interval between the primary surgery and the metastasectomy had a significant impact on survival (p = 0.67). At 5 years, 55% of patients were free of disease. Four patients had lymph node involvement at the time of pulmonary resection and all 4 patients died within 22 months of their pulmonary metastasectomy. CONCLUSIONS: Resection of both hepatic and pulmonary metastases secondary to colorectal cancer in highly selected patients is safe and results in long-term survival. Thoracic lymph node involvement and elevated carcinoembryonic antigen levels before pulmonary metastasectomy are associated with reduced survival.     

骨盆转移瘤外科治疗的疗效评估

目的 总结不同类型骨盆转移瘤,特别是髋臼周围转移瘤的治疗经验.方法 1997年7月至2005年7月,共收治88例骨盆转移瘤患者,其中男性48例,女性40例,平均年龄54岁.其中乳腺癌23例,肺癌15例,肾癌13例,甲状腺癌3例,膀胱癌2例,前列腺癌3例,肝癌3例,胃肠道癌7例,妇科肿瘤3例,其他肿瘤3例,不明来源转移瘤13例;32例为骨盆孤立性转移灶,56例为多发性骨转移.单纯累及Ⅰ区18例患者,累及Ⅱ区50例,单纯累及Ⅲ区及Ⅳ区的各10例.肿瘤切除方法:行刮除术72例,整块切除16例.重建方式包括骨水泥填充或骨水泥结合斯氏针、钉棒系统内固定重建29例;重建髋关节50例;单纯肿瘤局部切除5例;4例患者因肿瘤巨大及严重疼痛行半盆截肢.结果 88例骨盆转移瘤患者中29例失随访,59例患者随访时间6～24个月,平均13个月.术前疼痛评分平均7.2分,手术治疗后86例(97.8%)有不同程度疼痛缓解和行走能力恢复,术后疼痛评分平均3.5分.保肢病例Enneking功能评分平均19.2分,涉及髋臼区的平均评分16.4分,非髋臼区患者23.5分.随访59例患者中,11例出现局部复发,平均复发时间为术后5.6个月.主要并发症包括,8例伤口感染、2例多器官功能衰竭、1例严重肺栓塞、2例假体脱位.结论 对于骨盆转移癌导致严重疼痛和行走困难的患者,外科治疗可以缓解症状.手术目的是缓解疼痛,力求恢复和维持髋关节的活动度和稳定性.手术方式以刮除后骨水泥填充为主.对于单发、预后较好的骨转移病灶,可行广泛切除.     

Patients with penile carcinoma benefit from immediate resection of clinically occult lymph node metastases

PURPOSE: In this retrospective study we compared the clinical outcome of early vs delayed excision of lymph node metastases in patients with penile squamous cell carcinoma. MATERIALS AND METHODS: A total of 40 patients with a T2-3 penile carcinoma with lymph node metastases were included in this study. All patients initially presented with bilateral impalpable lymph nodes. In 20 patients (50%) metastases were removed when they became clinically apparent during meticulous followup (median interval 6 months, range 1 to 24). There were 20 patients (50%) who underwent resection of inguinal metastases detected on dynamic sentinel node biopsy before they became palpable. The histopathological characteristics of the tumors and lymph nodes were reevaluated. RESULTS: The 2 populations were similar in terms of patient age, T-stage, pathological tumor grade, vascular invasion and infiltration depth. Disease specific 3-year survival of patients with positive lymph nodes detected during surveillance was 35% and in those who underwent early resection, 84% (log rank p = 0.0017). In multivariate analysis early resection of occult inguinal metastases detected on dynamic sentinel node biopsy was an independent prognostic factor for disease specific survival (p = 0.006). CONCLUSIONS: Early resection of lymph node metastases in patients with penile carcinoma improves survival.