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1.
Gabriela M. Vargas Kristin M. Sheffield Abhishek D. Parmar Yimei Han Aakash Gajjar Kimberly M. Brown Taylor S. Riall 《Journal of gastrointestinal surgery》2014,18(2):369-377
Introduction
Trends in the use of modern chemotherapeutic regimens, primary tumor resection, and the timing of chemotherapy and resection in older patients with stage IV colorectal cancer have not been evaluated.Methods
We used Cancer Registry- and Medicare-linked data (2000–2009) to describe time trends in resection of the primary tumor and receipt of chemotherapy in patients ≥66 presenting with stage IV colorectal cancer (N?=?16,168).Results
The mean age was 77.8?±?7.3 years; 53.8 % were women and 82.9 % were white. Primary cancer sites were colon in 83.4 % and rectum in 16.6 %. Resection of the primary tumor decreased from 64.6 to 57.1 % (P?<?0.0001) from 2001 to 2009. Systemic chemotherapy was given to 45.1 % of the patients. While the use of chemotherapy was stable over time (P?=?0.48), the use of modern regimens containing oxaliplatin or irinotecan increased from 40.9 to 75.4 % (P?<?0.0001). Bevacizumab use increased from 0.10 to 54.2 % (P?<?0.0001). Survival improved by 4 % per year even after controlling for treatment and tumor location (HR?=?0.96, 95 % CI 0.95–0.97).Conclusions
Survival in older patients with stage IV disease is improving over time. Surgical resection is still performed in the majority of patients. Resection rates decreased while modern chemotherapy was rapidly adopted perhaps suggesting a shift in practice patterns. 相似文献2.
Sae Byeol Choi Hyung Joon Han Chung Yun Kim Wan Bae Kim Tae-Jin Song Sung Ock Suh Young Chul Kim Sang Yong Choi 《Journal of gastrointestinal surgery》2010,14(4):668-678
Background
Depth of tumor invasion is an important prognostic factor for gallbladder cancer. The aim of this study was to investigate the clinicopathological prognostic factors of T2 gallbladder cancer.Methods
We retrospectively reviewed the clinicopathological data and survival for 83 patients with T2 gallbladder cancers who underwent surgical resection between January 1995 and December 2007.Results
The overall survival rates were 48.9% at 3 years and 29.3% at 5 years. Univariate analysis revealed that R0 resection (P?<?0.001), extended surgery (P?=?0.028), lymph node dissection (P?=?0.024), non-infiltrative tumors (P?=?0.001), well differentiation (P?=?0.001), absence of lymphatic (P?=?0.025), perineural (P?=?0.001), and vascular (P?=?0.025) invasion, absence of lymph node metastasis (P?=?0.001), negative resection margin (P?=?0.016), and stage (P?=?0.002) were significantly better predictors for survival. A significant difference in survival between Rx and R1 was not found. R0 resection, lymph node dissection, well differentiation, and absence of perineural and vascular invasion were significantly independent prognostic factors for overall survival. Recurrence occurred in 48 patients (57.8%). Age older than 65 years, R0 resection, non-infiltrative tumors, and good differentiation were significant independent predictors of disease-free survival by multivariate analysis.Conclusions
For T2 tumors, radical surgery including lymph node dissection should be performed to achieve R0 resection. Tumors with infiltrative types and suspicious lymph node metastasis in the intraoperative findings were candidates for aggressive surgical management to improve patient survival. 相似文献3.
Background
Reports on the risk factors of peritoneal recurrence (PR) after liver resection for hepatocellular carcinoma are lacking. We examined the risk factors of PR after hepatectomy and the outcome of resected PR at our institution.Methods
We retrospectively reviewed the data from 1,222 patients who underwent hepatectomies for hepatocellular carcinoma in Samsung Medical Center from January 2006 to August 2010. We identified patients with PR and studied the risk factors and outcomes of resected PR.Results
The rate of PR was 3.0% (n?=?36). The mean?±?SD age of patients was 54.0?±?10.2?years. Among those with PR, 23 patients (63.9%) had unresectable disease and 13 patients (36.1%) had resectable disease. Multivariate analysis found that tumor size >50?mm, presence of microvascular invasion, bile duct invasion, and positive margins were significant risk factors of PR after liver resection. The median overall survival (OS) for resectable PR was 33.0 (28.0?C61.6) months compared to 14.0 (6.8?C21.2) months for unresectable PR (P?=?0.009). Cox regression analysis demonstrated that resected PR [hazard ratio (HR) 0.042, P?=?0.001] and interval between hepatectomy and PR (>6months) (HR 0.195, P?=?0.016) were positive prognostic factors for OS, while alfa-fetoprotein >200?ng/dl at detection of PR (HR 11.321, P?=?0.015) and serosal involvement of primary hepatocellular carcinoma (HR 25.616, P?=?0.007) were negative prognostic factors for OS.Conclusions
We found that tumor size >50?mm, presence of microvascular invasion, bile duct invasion, and positive resection margins were significant risk factors of PR after liver resection. Selected patients with resected PR had significantly better OS. 相似文献4.
Thomas Beez Sevgi Sarikaya-Seiwert Hans-Jakob Steiger Daniel Hänggi 《Acta neurochirurgica》2014,156(3):597-604
Background
5-aminolevulinic acid (5-ALA) can be used as an adjunct for the surgery of adult malignant glioma and improves the rate of gross total resection and patient survival. So far, only three casuistic reports of fluorescence-guided surgery used in children have been published. We report our pilot series of 16 pediatric brain tumors treated with 5-ALA.Methods
Sixteen patients (mean age 9 years, range 1–16 years) received a standardized 5-ALA dose according to the published protocol after informed parental consent. The fluorescence status (positive versus negative) in correlation with histology as well as blood samples and adverse clinical symptoms were recorded.Results
Histology revealed pilocytic astrocytoma (n?=?7), classical medulloblastoma (n?=?4), anaplastic astrocytoma (n?=?1), glioblastoma (n?=?3) and anaplastic ependymoma (n?=?1). Positive fluorescence was observed in cases of anaplastic astrocytoma, glioblastoma, and medulloblastoma, respectively. Significant increases were registered for alanine aminotransferase (14.92?±?1.106 U/l vs. 37.70?±?3.795 U/l, P?=?0.0020) and gamma glutamyl transpeptidase (12.69?±?1.638 U/l vs. 39.29?±?6.342 U/l, P?=?0.0156), correlated with young age. No further adverse reactions were evident.Conclusion
Positive fluorescence was observed in two high-grade gliomas and one medulloblastoma after oral administration of 5-ALA. Thus, 5-ALA appears capable of inducing fluorescence in pediatric high-grade tumors. Adverse reactions observed in children were similar to those reported for adults, although very young children might be at increased risk. Further studies are required to elucidate pharmacokinetic and pharmacodynamic properties of 5-ALA in children and to assess its prognostic role in the resection of pediatric brain tumors. 相似文献5.
Jan Franko Wentao Feng Linwah Yip Elizabeth Genovese A. James Moser 《Journal of gastrointestinal surgery》2010,14(3):541-548
Objective
Pancreatic neuroendocrine cancer is a rare, indolent malignancy with no effective systemic therapy currently available. This population-based analysis evaluated the hypothesis that long-term survival benefit is greater with aggressive, rather than limited, surgical therapy.Methods
Non-functional pancreatic neuroendocrine carcinoma (NF-pNEC) cases diagnosed from 1973 to 2004 were retrieved from the SEER database.Results
A total of 2,158 patients with NF-pNEC were identified, representing 2% of all pancreatic malignancies. The annual incidence increased from 1.4 to 3.0 per million during the study period. On average, tumors measured 59?±?35 mm (median 50), and age at diagnosis was 59?±?15 years; 29% of patients were younger than 50. Nodal (44%) and systemic metastases (60%) were common. Overall the 5-, 10-, and 20-year survival rates were 33%, 17%, and 10%, respectively. Removal of the primary tumor significantly prolonged survival in the entire cohort (median 1.2 vs. 8.4 years; p?<?0.001) and among those with metastases (median 1.0 vs. 4.8 years; p?<?0.001). No survival difference was seen between enucleation and resection of the primary tumor (median 10.2 versus 9.2 years, p?=?0.456).Conclusion
This study suggests that surgical therapy improves survival among patients with localized, as well as metastatic, NF-pNEC. Enucleation may be oncologically equivalent to resection. 相似文献6.
Sabha Ganai Vivek N. Prachand Mitchell C. Posner John C. Alverdy Eugene Choi Mustafa Hussain Irving Waxman Marco G. Patti Kevin K. Roggin 《Journal of gastrointestinal surgery》2013,17(2):244-256
Background
While laparoscopy has become integral to the performance of foregut surgery, its optimal use in resection of gastric submucosal neoplasms, including gastrointestinal stromal tumors (GISTs), remains uncertain. Concern exists for technical feasibility related to tumor size and location, as well as oncologic outcome.Methods
From 2002 to 2012, 106 patients underwent resection for gastric submucosal neoplasms, comprising 79 laparoscopic and 27 open resections. Median follow-up was 15 months.Results
Patients were 62?±?14 years and 56 % male. Mean tumor size was 5.5?±?4.3 cm, with 76 % being GISTs. A total of 8 (10 %) conversions occurred in the laparoscopic cohort. On multivariate analysis, conversion was predicted by size greater than 8 cm, while recurrence was predicted by mitotic index (p?<?0.05). Laparoscopic resection resulted in better perioperative outcomes, with less morbidity, operative time, blood loss, and length of stay (p?<?0.05). No significant difference was seen in survival, with 90 % and 81 % alive 3 years after laparoscopic and open resection, respectively (HR 0.4; 95 % CI 0.1–1.3; p?=?0.13).Conclusions
Laparoscopic resection is feasible and effective in the management of gastric submucosal neoplasms, including GISTs. Caution should be reserved for tumors greater than 8 cm. Oncologic outcome appears to be predicted by tumor biology as opposed to surgical approach. 相似文献7.
Salem I. Noureldine Nicole R. Jackson Ralph P. Tufano Emad Kandil 《Langenbeck's archives of surgery / Deutsche Gesellschaft fur Chirurgie》2013,398(8):1069-1074
Purpose
This study seeks to explore the efficacy of robotic thyroidectomy in treating a North American population with differentiated thyroid cancer (DTC) as compared with the conventional cervical approach.Methods
A retrospective analysis of our prospectively collected thyroid surgery database was performed. We included all consecutive patients that underwent thyroidectomy for the treatment of well-differentiated thyroid cancer, performed by a single surgeon.Results
Twenty-four robotic transaxillary and 35 conventional thyroidectomy procedures were performed. Average size of the tumor was 1.1?±?0.2 cm in the robotic group and 1.7?±?0.3 cm in the cervical group (p?=?0.16). Average total operative time for the robotic group was 133?±?65.4 and 119.7?±?22.5 min in the cervical group (p?=?0.34). No robotic cases required conversion. One patient required reoperation for recurrent disease at 24 months follow-up. Both groups had similar blood loss (p?=?0.37) and all margins were negative for malignancy on permanent pathology. All patients were discharged home within 24 h. Postoperative stimulated thyroglobulin levels were similar for the two groups (p?=?0.82).Conclusions
Our experience with robotic transaxillary thyroidectomy confirms this technique is feasible. It is possible to achieve a safe and effective oncologic result in a select group of North American patients with DTC. 相似文献8.
Edwin O. Onkendi Nimesh D. Naik Jordan K. Rosedahl Scott W. Harmsen Christopher J. Gostout Todd H. Baron Sr. Michael G. Sarr Florencia G. Que 《Journal of gastrointestinal surgery》2014,18(9):1588-1596
Background
Data comparing operative and endoscopic resection of adenomas of the ampulla of Vater are limited. Our aims were to evaluate and compare the long-term results and outcomes of endoscopic and operative resections of benign tumors of the ampulla of Vater as well as to determine which features of benign periampullary neoplasms would predict recurrence or failure of endoscopic therapy and therefore need for operative treatment.Methods
Retrospective review of all patients treated for adenomas of ampulla of Vater at our institution from 1994 to 2009.Results
Over a 15-year span, 180 patients (mean age 59 years) were treated for benign adenomas of the ampulla of Vater with a mean follow-up of 4.4 years. Obstructive jaundice was more common in the operative resection group (p?=?0.006). The adenomas were tubular in 83 patients (44 %), tubulovillous in 77 (45 %) and villous in 20 (11 %). Endoscopic resection alone was performed in 130 patients (78 %). Operative resection was performed in 50 patients (28 %), with pancreatoduodenectomy in 40, transduodenal local resection in 9, and pancreas-sparing total duodenectomy in 1. Nine patients who underwent endoscopic resection initially were endoscopic treatment failures. Fifty-eight percent of endoscopically treated patients required one endoscopic resection, while 58 (42 %) required two or more endoscopic resections (range 2–8). Patients who underwent operative resection had larger tumors with a mean size of 3.7?±?2.8 versus 1.8?±?1.5 cm in those treated by endoscopic resection (p?0.001) or intraductal extension (p?=?0.02). Intraductal extension and ulceration had no effect on recurrence if completely resected endoscopically (p?=?0.41 and p?=?0.98, respectively). Postoperative complications occurred in 58 % of patients, and post-endoscopic complications in 29 % (p?0.001). Endoscopic resection was associated with a greater than fivefold risk of recurrence than operative resection (p?=?0.006); 4 % of recurrences had invasive carcinomas. When comparing patients who underwent local resections only (endoscopic and operative), there was no difference in the recurrence rate between endoscopic resection and operative transduodenal resection (32 versus 33 %; p?=?0.49). The need for two or more endoscopic resections for complete tumor removal was associated with 13-fold greater risk of recurrence (p?0.001).Conclusion
There is no significant difference between endoscopic and local operative resections of benign adenomas of ampulla of Vater; recurrences are more common when two or more endoscopic resections are required for complete tumor removal. Appropriate adenomas for endoscopic resection included tumors <3.6 cm that do not extend far enough intraductally (on EUS) to preclude an endoscopic snare ampullectomy. 相似文献9.
Reese W. Randle Shuja Ahmed Naeem A. Newman Clancy J. Clark 《Journal of gastrointestinal surgery》2014,18(2):354-362
Background
Previous case series report that neuroendocrine tumors (NETs) of the ampulla of Vater have worse overall survival (OS) than NETs in the duodenum. We aimed to compare the OS of patients with ampullary NETs to patients with duodenal NETs.Methods
This retrospective comparative cohort study used the Surveillance, Epidemiology, and End Results (SEER) registry from 1988 to 2009. OS was evaluated using Kaplan–Meier estimates and Cox proportional hazard regression.Results
Ampullary NETs (n?=?120) were larger (median size 18 vs. 10 mm, p?<?0.001), higher grade (poorly and undifferentiated tumor 42 % vs. 12 %, p?<?0.001), higher SEER historic stage (distant metastasis 16 % vs. 7 %, p?<?0.001), and more often resected (78 % vs. 60 %, p?<?0.001) than duodenal NETs (n?=?1,360). Median OS was significantly worse for patients with ampullary NETs than with duodenal NETs (98 vs. 143 months, p?=?0.037). Local resection was performed for 50.5 % of the resected ampullary NETs and resulted in similar OS compared to locally resected duodenal NETs (HR 1.37, 95 % CI 0.76–2.48, p?=?0.291).Conclusions
While ampullary NETs are more advanced at presentation and have worse OS than duodenal NETs, long-term survival is possible with proximal small bowel NETs. For locally resected NETs, OS is similar between ampullary and duodenal NETs. 相似文献10.
Constantinos Nastos Konstantinos Kalimeris Nikolaos Papoutsidakis George Defterevos Agathi Pafiti Helen Kalogeropoulou Loukia Zerva Tzortzis Nomikos Georgia Kostopanagiotou Vasillios Smyrniotis Nikolaos Arkadopoulos 《Journal of gastrointestinal surgery》2011,15(5):809-817
Background
This study aims to evaluate whether injury of gut mucosa in a porcine model of post-hepatectomy liver dysfunction can be prevented using antioxidant treatment with desferrioxamine.Methods
Post-hepatectomy liver failure was induced in pigs combining major (70%) liver resection and ischemia/reperfusion injury. An ischemic period of 150 minutes, was followed by reperfusion for 24 h. Animals were randomly divided into a control group (n?=?6) and a desferrioxamine group (DFX, n?=?6). DFX animals were treated with continuous IV infusion of desferrioxamine 100 mg/kg. Intestinal mucosal injury (IMI), bacterial and endotoxin translocation (BT) were evaluated in all animals. Intestinal mucosa was also evaluated for oxidative markers.Results
DFX animals had significantly lower IMI score (3.3?±?1.2 vs. 1.8?±?0.9, p?<?0.05), decreased BT in the portal circulation at 0 and 12 h of reperfusion (p?=?0.007 and p?=?0.008, respectively), decreased portal endotoxin levels at 6 (p?=?0.006) and 24 h (p?=?0.004), decreased systemic endotoxin levels (p?=?0.01) at 24 h compared to controls. Also, 24 h post-reperfusion mucosal malondialdehyde and protein carbonyls were decreased in DFX animals compared to controls (4.1?±?1.2 vs. 2.5?±?1.2, p?=?0.05 and 0.5?±?0.1 vs. 0.4?±?0.1, p?=?0.04 respectively).Conclusion
Desferrioxamine seems to attenuate mucosal injury from post-hepatectomy liver dysfunction possibly through blockage of iron-catalyzed oxidative reactions. 相似文献11.
Jiajia Luo Cornelia Betschart Luyun Chen James A. Ashton-Miller John O. L. DeLancey 《International urogynecology journal》2014,25(2):197-203
Introduction and hypothesis
A method was developed using 3D stress magnetic resonance imaging (MRI) and was piloted to test hypotheses concerning changes in apical ligament lengths and lines of action from rest to maximal Valsalva.Methods
Ten women with (cases) and ten without (controls) pelvic organ prolapse (POP) were selected from an ongoing case–control study. Supine, multiplanar stress MRI was performed at rest and at maximal Valsalva and was imported into 3D Slicer v. 3.4.1 and aligned. The 3D reconstructions of the uterus and vagina, cardinal ligament (CL), deep uterosacral ligament (USLd), and pelvic bones were created. Ligament length and orientation were then measured.Results
Adequate ligament representations were possible in all 20 study participants. When cases were compared with controls, the curve length of the CL at rest was 71 ±16 mm vs. 59?±?9 mm (p?=?0.051), and the USLd was 38?±?16 mm vs. 36?±?11 mm (p?=?0.797). Similarly, the increase in CL length from rest to strain was 30?±?16 mm vs. 15?±?9 mm (p?=?0.033), and USLd was 15?±?12 mm vs. 7?±?4 mm (p?=?0.094). Likewise, the change in USLd angle was significantly different from CL (p?<?0.001).Conclusions
This technique allows quantification of 3D geometry at rest and at strain. In our pilot sample, at maximal Valsalva, CL elongation was greater in cases than controls, whereas USLd was not; CL also exhibited greater changes in ligament length, and USLd exhibited greater changes in ligament inclination angle. 相似文献12.
Oncologically Safe Distal Resection Margins in Rectal Cancer Patients Treated with Chemoradiotherapy
Jae Young Kwak Chan Wook Kim Seok-Byung Lim Chang Sik Yu Tae Won Kim Jong Hoon Kim Se Jin Jang Jin Cheon Kim 《Journal of gastrointestinal surgery》2012,16(10):1947-1954
Introduction
Although current guidelines recommend distal resection margins (DRM) of 2?C5?cm in rectal cancer operation, smaller margins may be safe. We therefore assessed the impact of distal margins on outcomes in patients with rectal cancer treated with neoadjuvant chemoradiotherapy (CRT) followed by radical resection or resection followed by adjuvant CRT.Materials and methods
This study involved 376 patients who underwent sphincter-saving resection for rectal adenocarcinoma and pre- or postoperative CRT between 2000 and 2006. DRMs were measured on pinned fixed specimens. We excluded patients who did not complete planned CRT and those with stage IV disease. A retrospective cross-sectional analysis was performed.Results
No significant differences in local recurrence (9.8 versus 7.3?%; P?=?0.324) and systemic recurrence (16.4 versus 18.7?%; P?=?0.731) were observed in patients with DRMs of ??5 and >5?mm, respectively. Moreover, in each DRM category, there were no differences in local and systemic recurrence rates between patients who received pre- or postoperative CRT. DRM did not affect overall survival (P?=?0.880) or 5-year survival rate (80.3 versus76.8?%; P?=?0.340).Conclusion
A distal margin of at least 5?mm with negative resection margin on frozen section does not reduce oncological safety in rectal cancer patients who receive pre- or postoperative CRT. 相似文献13.
Sae Byeol Choi Hyung Joon Han Wan Bae Kim Tae Jin Song Sung Ock Suh Sang Yong Choi 《Langenbeck's archives of surgery / Deutsche Gesellschaft fur Chirurgie》2013,398(8):1137-1144
Purpose
Resection of the extrahepatic bile duct is not performed uniformly in gallbladder cancer. The study investigated the clinical significance of resection of extrahepatic bile duct (EHBD) in T2 and T3 gallbladder cancer.Methods
Between 2000 and 2010, 71 T2 or T3 gallbladder cancer patients who underwent R0 resection at Korea University Medical Center were included. Clinicopathological data were reviewed retrospectively. Survival analysis and comparison between EHBD resection and non-resection groups were performed.Results
The 32 men and 39 women had 49 T2 tumors and 22 T3 tumors. The overall survival rate was 67.8 % at 3 years and 47.2 % at 5 years. In multivariate analysis for overall survival, lymphovascular invasion and lymph node metastasis were significant independent predictors. Comparing the patients according to EHBD resection, the EHBD resection group demonstrated significantly longer hospital stay, longer operative time, more transfusion requirement, more extensive liver resection, and less treatment of neoadjuvant therapy. Significantly higher proportions of perineural invasion and lymph node metastasis were noted in the EHBD resection group. There were no statistically significant differences in survival between the EHBD resection and non-resection groups.Conclusions
Resection of extrahepatic bile duct was not always necessary in T2 and T3 cancers. However, the patients who undergo resection of extrahepatic bile duct tended to have more aggressive tumor characteristics and undergo more aggressive surgical approach. To enhance overall survival for the patients with T2 and T3 gallbladder cancers, surgeons should try to perform R0 resection including EHBD resection. 相似文献14.
Vilma Dzenkeviciūte Zaneta Petrulioniene Virginijus Sapoka Sigita Aidietiene Lina Abaraviciute 《Obesity surgery》2014,24(11):1961-1968
Background
Herein, we investigate the anthropometric, biochemical and left ventricle (LV) geometry changes following the laparoscopic adjustable gastric banding (LAGB) operation in morbidly obese individuals.Methods
Eighty-three morbidly obese participants (mean age, 46.1?±?11.5 years; 30.1 % men), scheduled for elective LAGB were examined before and 12 months after the surgery. LV geometry and diastolic function were investigated by 2-dimensional echocardiography, whereas laboratory tests assessed the glycaemic, serum lipid and inflammatory marker profiles.Results
Twelve months after the operation, body mass index (BMI) decreased from 46.9?±?7.2 kg/m2 to 40.1?±?8.2 kg/m2 (p?0.05), which was associated with the significant improvements in glycaemic control, inflammatory state, LV end-diastolic diameter (53.6?±?4.6 mm vs. 52.9?±?4.1 mm, p?0.05), LV mass (223.6?±?61.3 vs. 215.4?±?52.7 g, p?0.05) and LV mass index (53.9?±?14.1 g/m2.7 vs. 52.0?±?12.3 g/m2.7, p?0.05). However, no overall improvements in LV geometry or the prevalence of LV hypertrophy subtypes were recorded 12 months after the LAGB. The reduction in LV end-diastolic diameter (ß?=?0.56, p?=?0.0001) and BMI (ß?=?0.26, p?=?0.015) were both associated with diminished LV mass. Additionally, a statistically significant correlation between LV mass and changes in BMI (R?=?0.29, p?=?0.007), waist circumference (R?=?0.32, p?=?0.004), LV end-diastolic diameter (R?=?0.63, p?=?0.0001) and E-wave deceleration time (R?=??0.24, p?=?0.03) were observed within our study population.Conclusions
LV mass decreases 12 months after LAGB surgery, but no improvements in LV geometry and function occur. The regression of LV mass is better predicted by weight loss than by reduction in blood pressure or changes in metabolic parameters. 相似文献15.
Alexander Fritzkarl Hagel Andreas Naegel Annette Simone Lindner Hermann Kessler Klaus Matzel Wolfgang Dauth Markus Friedrich Neurath Martin Raithel 《Journal of gastrointestinal surgery》2012,16(11):2132-2138
Background
Perforation of the gastrointestinal tract may cause various complications and may require emergency surgery, even in patients with significant comorbidities.Methods
Seventeen consecutive patients with indication for surgery due to a visible gastrointestinal perforation were treated with OTSC application. In this study, cause of perforation, estimated size, location, rate of perforation closure, outcome and complications were reported.Results
In 11 of 17 patients (64.7?%), OTSC application resulted in permanent closure of perforations, thus avoiding surgery. All 11 successful cases had smaller perforation lengths (5.5?±?1.9?mm, p?<?0.02), widths (3.7?±?0.9?mm) or area (21.1?±?9.1?mm2), had vital margins of perforations and 1.1?±?0.3 OTSC per patient were necessary. The six unsuccessful cases (35.3?%) showed larger perforation lengths (13.4?±?8.8?mm, p?<?0.02), widths (5?±?4.5?mm) and area (97.6?±?149?mm2), had necrotic or soft inflammatory margins and significantly more OTSC (2.3?±?0.5, p?=?0.018) were tried.Conclusions
OTSC application yields a high rate of endoscopic perforation closure in patients with macroscopic gastrointestinal perforation, even in an emergency setting, representing an alternative to surgery, especially when the size of the lesion is not too large and when vital or solid perforation margins are expected. 相似文献16.
Kai Liao Huaizhi Wang MD PhD Qilong Chen MD PhD Zheng Wu MD PhD Leida Zhang MD PhD 《Journal of gastrointestinal surgery》2014,18(8):1452-1461
Background
The use of prosthetic grafts for superior mesenteric-portal vein reconstruction (SMPVR) after pancreaticoduodenectomy (PD) with venous resection remains controversial. We evaluated the effectiveness and safety of using polytetrafluoroethylene (PTFE) interposition grafts for SMPVR after PD.Methods
We identified 76 patients who underwent PD with segmental vein resection for pancreatic head and periampullary neoplasms at three centers between January 2007 and June 2012. The venous reconstruction technique depended on the length of venous involvement. Forty-two and 34 patients underwent SMPVR with primary anastomosis and SMPVR with PTFE interposition grafts, respectively. The postoperative morbidity, mortality, and patency were compared. For the patients with pancreatic ductal adenocarcinoma (n?=?65), survival was compared between the SMPVR with primary anastomosis (n?=?36) and SMPVR with PTFE interposition graft groups (n?=?29).Results
Patients undergoing SMPVR with PTFE grafts had larger tumor sizes (3.4?±?0.9 cm, 2.9?±?0.9 cm, P?=?0.016), longer operative durations (492.9?±?107.5 min, 408.8?±?78.8 min, P?<?0.001), and greater blood loss (986.8?±?884.5 ml, 616.7?±?485.5 ml, P?=?0.040) compared to those undergoing SMPVR with primary anastomosis. However, 30-day postoperative morbidity and mortality did not differ (29.4 and 2.9 %, respectively, for PTFE grafts and 33.3 and 7.1 %, respectively, for primary anastomosis). There were no cases of graft infection. The estimated cumulative patency of SMPVR 6 and 12 months after surgery did not differ (87.9 and 83.5 % after PTFE grafts, respectively, and 94.4 and 86.4 % after primary anastomosis, respectively). For patients who underwent surgery for pancreatic ductal adenocarcinoma, there were no significant differences in the median survival time (11 vs. 12 months) or the 1-, 2-, and 3-year survival rates (35.7, 12.5, and 4.2 vs. 36.4, 17.3, and 8.7 %, respectively) for the PTFE and primary anastomosis groups.Conclusions
PTFE grafts could provide a safe and effective option for venous reconstruction after PD in patients with segmental vein resection. 相似文献17.
Philippe Schucht Sonja Knittel Johannes Slotboom Kathleen Seidel Michael Murek Astrid Jilch Andreas Raabe Jürgen Beck 《Acta neurochirurgica》2014,156(2):305-312
Background
The technique of 5-aminolevulinic acid (5-ALA) tumor fluorescence is increasingly used to improve visualization of tumor tissue and thereby to increase the rate of patients with gross total resections. In this study, we measured the resection volumes in patients who underwent 5-ALA-guided surgery for non-eloquent glioblastoma and compared them with the preoperative tumor volume.Methods
We selected 13 patients who had received a complete resection according to intraoperative 5-ALA induced fluorescence and CRET according to post-operative T1 contrast-enhanced MRI. The volumes of pre-operative contrast enhancing tissue, post-operative resection cavity and resected tissue were determined through shift-corrected volumetric analysis.Results
The mean resection cavity (29 cm3) was marginally smaller than the pre-operative contrast-enhancing tumor (39 cm3, p?=?0.32). However, the mean overall resection volume (84 cm3) was significantly larger than the pre-operative contrast-enhancing tumor (39 cm3, p?=?0.0087). This yields a mean volume of resected 5-ALA positive, but radiological non-enhancing tissue of 45 cm3. The mean calculated rim of resected tissue surpassed pre-operative tumor diameter by 6 mm (range 0–10 mm).Conclusions
Results of the current study imply that (i) the resection cavity underestimates the volume of resected tissue and (ii) 5-ALA complete resections go significantly beyond the volume of pre-operative contrast-enhancing tumor bulk on MRI, indicating that 5-ALA also stains MRI non-enhancing tumor tissue. Use of 5-ALA may thus enable extension of coalescent tumor resection beyond radiologically evident tumor. The impact of this more extended resection method on time to progression and overall survival has not been determined, and potentially puts adjacent and functionally intact tissue at risk. 相似文献18.
Yaojun Zhang Adam E. Frampton Patrizia Cohen Charis Kyriakides Jan J. Bong Nagy A. Habib Duncan R. C. Spalding Raida Ahmad Long R. Jiao 《Journal of gastrointestinal surgery》2012,16(10):1875-1882
Background
Microscopic tumor involvement (R1) in different surgical resection margins after pancreaticoduodenectomy (PD) for pancreatic ductal adenocarcinoma (PDAC) has been debated.Methods
Clinico-pathological data for 258 patients who underwent PD between 2001 and 2010 were retrieved from a prospective database. The rates of R1 resection in the circumferential resection margin (pancreatic transection, medial, posterior, and anterior surfaces) and their prognostic influence on survival were assessed.Results
For PDAC, the R1 rate was 57.1?% (48/84) for any margin, 31.0?% (26/84) for anterior surface, 42.9?% (36/84) for posterior surface, 29.8?% (25/84) for medial margin, and 7.1?% (3/84) for pancreatic transection margin. Overall and disease-free survival for R1 resections were significantly worse than those for R0 resection (17.2 vs. 28.7?months, P?=?0.007 and 12.3 vs. 21.0?months, P?=?0.019, respectively). For individual margins, only medial positivity had a significant impact on survival (13.8 vs. 28.0?months, P?<?0.001), as opposed to involvement in the anterior (19.7 vs. 23.3?months, P?=?0.187) or posterior margin (17.5 vs. 24.2?months, P?=?0.104). Multivariate analysis demonstrated R0 medial margin was an independent prognostic factor (P?=?0.002, HR?=?0.381; 95?% CI 0.207?C0.701).Conclusion
The medial surgical resection margin is the most important after PD for PDAC, and an R1 resection here predicts poor survival. 相似文献19.
Yun-Hsuan Lee Chia-Yang Hsu Yi-Hsiang Huang Chien-Wei Su Han-Chieh Lin Cheng-Yuan Hsia Teh-Ia Huo 《Journal of gastrointestinal surgery》2013,17(4):730-738
Background/Aims
Serum α-fetoprotein (AFP) and total tumor volume (TTV) are important factors linked with post-operative tumor recurrence in hepatocellular carcinoma (HCC) patients. We investigated the role of a new prognostic marker, AFP-to-TTV ratio, in predicting HCC recurrence.Methods
A total of 655 HCC patients undergoing resection were analyzed.Results
In the multivariate logistic model, serum AFP level [odds ratio (OR) 32.459, p?=?0.012] and TTV (OR 0.006, p?=?0.01) were independently associated with a higher AFT/TTV ratio. The 1-, 3-, and 5-year tumor recurrence rates were 29 %, 55 %, and 68 %, respectively. In the Cox proportional hazards model, alcoholism (hazard ratio [HR], 1.354, p?=?0.028), international normalized ratio of prothrombin time ≥1.01 (HR, 1.349, p?<?0.001), multiple nodules (HR, 1.381, p?=?0.004), main tumor diameter ≥4?cm (HR, 1.535, p?=?0.001), macrovascular invasion (HR, 1.362, p?=?0.016), and AFP/TTV ratio ≥1.5 (HR, 1.49, p?<?0.001) were independently associated with tumor recurrence. In subgroup analysis, a higher AFP/TTV ratio was significantly associated with tumor recurrence in patients characterized by macrovascular invasion, TTV?≥?40 cm3, or main tumor diameter ≥4cm (all p?=?0.001).Conclusion
The AFP/TTV ratio, a newly proposed marker for predicting post-operative tumor recurrence in HCC, is a feasible surrogate and may be useful in selecting super-high-risk patients for tumor recurrence. 相似文献20.
Evan S. Glazer Ping Liu Eddie K. Abdalla Jean-Nicolas Vauthey Steven A. Curley 《Journal of gastrointestinal surgery》2012,16(9):1666-1671