Showing papers on "Surgical oncology published in 1985"
TL;DR: From 1969 to 1983, 53 adult patients with head and neck soft tissue sarcomas were evaluated and treated by the Division of Surgical Oncology at the University of Illinois, and it is apparent that aggressive therapy of such tumors can provide good long‐term results.
Abstract: From 1969 to 1983, 53 adult patients with head and neck soft tissue sarcomas were evaluated and treated by the Division of Surgical Oncology at the University of Illinois The most common anatomic location was the neck (36%), and these patients had the highest 5-year disease-free survival rate (67%) Fibrosarcoma was the most common histologic type (26%); patients with aggressive fibromatosis had the longest mean survival time (93 months) The mean overall survival time was 587 months, and the disease-free 2-year, 5-year, and 10-year survival rates were 68%, 54%, and 28%, respectively Wide excision was the treatment of choice, with adjuvant radiotherapy or chemotherapy, or both, used in selected patients In all of the long-term survivors, the tumors were either well-differentiated or less than or equal to 50 cm in diameter It is apparent that aggressive therapy of such tumors can provide good long-term results
88 citations
TL;DR: The approach will be to assimilate current knowledge of tumor progression and to evaluate its relative importance in clinical oncology.
Abstract: Cl in ica l problems Despite dramatic advances in the management of cancer, cure is often elusive because the vast tumor burden at diagnosis imparts increasing difficulties for treating all the neoplastic cells. As tumors increase in size there is an associated disruption of surrounding normal tissues and thus, a greater challenge to remove neoplastic tissue while sparing normal tissues. With tumor growth also comes the increasing probabil i ty that therapy-resistant populations will emerge. Finally, there is an increasing chance that at diagnosis tumor cells have already detached and spread from the larger tumors. The formation and control of metastases represent the major clinical problem facing the oncologist. Development of metastatic potential is the culmination of complex and poorly understood changes in tumor cells termed tumor progression. Progression begins with the initiation steps in carcinogenesis (figure 1). Later, promot ion occurs through either singleor mult i -s tep mechanism to convert a pr imed normal cell(s) to a t ransformed cell(s). F rom transformation, the tumor grows and the cells eventually progress from a benign to a malignant state. Cellular and biochemical changes that characterize individual stages in tumor growth and progression are important markers of the neoplastic state; however, their roles in cancer t reatment have not been carefully examined. The impact of tumor progression on cancer t reatment will be the subject of this review. The approach will be to assimilate current knowledge of tumor progression and to evaluate its relative importance in clinical oncology.
67 citations
46 citations
32 citations
TL;DR: There was no increase in recurrences when the stapler was used, even though lower lesions were treated, and the rates of local recurrence in cancer of the rectum treated by low anterior resection using theStapling device or hand-sewn.
Abstract: A retrospective study was done comparing the rates of local recurrence in cancer of the rectum treated by low anterior resection using the stapling device or hand-sewn. It was found that there was no increase in recurrences when the stapler was used, even though lower lesions were treated.
29 citations
TL;DR: Three patients with colonic necrosis associated with extensive retroperitoneal suppuration following acute pancreatitis are reported, emphasizing the need for an aggressive surgical approach and multiple operations.
Abstract: Colonic necrosis is a rare complication of peripancreatic sepsis following acute pancreatitis. Three patients with colonic necrosis associated with extensive retroperitoneal suppuration are reported. The pathogenesis of this syndrome may be explained by the tendency of pancreatic abscesses to extend widely in the retroperitoneum. Management is discussed, emphasizing the need for an aggressive surgical approach and multiple operations.
22 citations
21 citations
TL;DR: Gallstone ileus is a distinctly unusual cause of colonic obstruction and two patients, with associated biliary-colonic fistulas, are described.
Abstract: Gallstone ileus is a distinctly unusual cause of colonic obstruction. Two patients, with associated biliary-colonic fistulas, are described. The clinical features and approximate management of this entity are discussed.
19 citations
TL;DR: The authors have examined the survival rate of patients with colorectal cancer treated by potentially curative surgery with regard to the appearance of postoperative fever and/or septic complications and demonstrate that these factors do not significantly influence the long-term prognosis.
Abstract: The authors have examined the survival rate of 111 patients with colorectal cancer (Dukes' A, B, and C stages) treated by potentially curative surgery In particular, the survival has been evaluated with regard to the appearance of postoperative fever and/or septic complications The preliminary results demonstrate that these factors do not significantly influence the long-term prognosis
19 citations
TL;DR: While digital rectal examination is an important, effective method of diagnosing rectal cancer, the positive rate is one tenth that of rectoscopy and it cannot be used for mass screening because the examining finger cannot tolerate such constant use and is too short to discover higher tumors.
Abstract: From September 15, 1977, to April 15, 1978, 450, 477 persons over the age of 7 years were screened for schistosomiasis; a subgroup of 198,950 over 30 years were screened for colorectal cancer Seventy-five malignant colorectal tumors were discovered in the latter group, a positive rate of 3769 per 100,000 (seven were colonic cancers, 14 rectal cancers, 20 polyps with cancerous change, and 34 carcinoids) Of this group, 2701 had various types of polyps and 5242 had definitive diagnostic schistosomiasis History, physical examination, and an occult blood test are simple, useful methods for detecting late colorectal cancer but are of no value in preventive screening of early cases While digital rectal examination is an important, effective method of diagnosing rectal cancer, the positive rate is one tenth that of rectoscopy It cannot be used for mass screening because the examining finger cannot tolerate such constant use and is too short to discover higher tumors The sequence of colorectal cancerous change found in our center was from normal intestinal epithelium to tumorigenic polyps or colorectal ulcer, to polyps with anaplastic change, to polyps with local cancerous change, to adenocarcinoma Cancer was seen more frequently in villous and adenomatous polyps; these are called precancerous stages of colorectal cancer No relationship between schistosomiasis and colorectal cancer was found
14 citations
TL;DR: Since the 1950's the treatment of breast cancer has changed substantially and related surgery has become less disfiguring without either impairing survival or increasing recurrences.
Abstract: Since the 1950's the treatment of breast cancer has changed substantially. This related surgery has become less disfiguring without either impairing survival or increasing recurrences. Adjuvant chemotherapy has also contributed.
TL;DR: Volvulus of the splenic flexure is a rare cause of large-bowel obstruction and Resection with or without primary anastomosis is the procedure of choice to prevent recurrence.
Abstract: Volvulus of the splenic flexure is a rare cause of large-bowel obstruction. Three cases are presented and the features of 17 previously reported cases reviewed. Resection with or without primary anastomosis is the procedure of choice to prevent recurrence.
TL;DR: Skin metastasis from colorectal carcinoma without evidence of visceral metastases is exceedingly rare, however, it must be considered when-ever a new skin growth appears in a patient with a history of carcinoma.
Abstract: Skin metastasis from colorectal carcinoma without evidence of visceral metastases is exceedingly rare. However, it must be considered when-ever a new skin growth appears in a patient with a history of carcinoma. A diagnostic biopsy is mandatory as the appearance of these metastases is not distinctive.
TL;DR: A 52-year old man underwent successful surgical removal of renal cell carcinoma with inferior vena caval and right atrial involvement, under cardio-pulmonary bypass, and is doing well, with no evidence of metastasis.
Abstract: A 52-year old man underwent successful surgical removal of renal cell carcinoma with inferior vena caval and right atrial involvement, under cardio-pulmonary bypass. The postoperative progress was uneventful and at this writing he is doing well, with no evidence of metastasis.
TL;DR: Though two gastric cancer xenografts exhibited synergistic effects in combination of γ-interferon with Mitomycin C, antagonistic effects, which was not found inCombined effect was defined as synergism and antagonism was defined when the survival fraction of drug combination was larger than the larger one observed in either interferon or Mitomyin C alone.
Abstract: Using the human tumor clonogenic assay technique, the effects of Mitomycin C plus either α-interferon or γ-interferon were studied against five human tumor xenografts serially transplanted into nude mice (three gastric and two colon cancers). When the survival fraction found with the drug combination was smaller than the multiplication of survival fractions with either drug alone, the combined effect was defined as synergism. Similarly, antagonistic effect was defined when the survival fraction of drug combination was larger than the larger one observed in either interferon or Mitomycin C alone. Four out of five human tumor xenografts (three gastric and one colon cancers) showed synergistic effects in combination of α-interferon with Mitomycin C. Though two gastric cancer xenografts exhibited synergistic effects in combination of γ-interferon with Mitomycin C, antagonistic effects, which was not found in combination of α-interferon with Mitomycin C, were observed in one gastric cancer and one colon cancer xenografts.
TL;DR: 1. Sodium bicarbonate attenuates pain on skin infiltration with lidocaine, with or without epinephrine, and 2. Chemical stability of bupivacaine and epinphrine in pH-adjusted solutions.
Abstract: 1. Okamura RK, Reisner LS, Kalichman MW. Effects of pH-adjusted lidocaine solutions on the compound action potential in intact rat sciatic nerves. Anesthesiology 1987;37(3A),A281. 2. McLeskey CH. pH of local anesthetic solutions. Anesth Analg 1980;59:892-3. 3. Moore DC. The pH of local anesthetic solutions. Anesth Anal 1981 ;60:833-4. 4. Parnass SM; Baughman VL, Miletich D J, Albrecht RF. The effects of pH on the oxidation rate of epinephrine. Anesthesiology 1987;37(3A),A280. 5. Bonhomme L, Benhamou D, Martre H, Preaux N. Chemical stability of bupivacaine and epinephrine in pH-adjusted solutions. Anesthesiology 1987;37(3A),A279. 6. McKay W, Morris R, Mushlin T. Sodium bicarbonate attenuates pain on skin infiltration with lidocaine, with or without epinephrine. Anesth Analg 1987;66:572-4.
Journal Article•
TL;DR: Relatively good agreement of in vitro/in vivo correlations was seen with an overall of 25/32 correct predictions in GI and other tumours, and predictivity was particularly good for loco-regional chemotherapy.
Abstract: Based on the concept of a combined modality cancer treatment in surgical oncology, the use of the human tumour colony assay for routine chemosensitivity testing and prospective treatment planning was investigated in 204 surgical biopsies of primary human solid tumours. The majority of the tumours (135/204) were of gastro-intestinal (GI) origin. Sufficient growth for drug testing occurred in 29-67% of all tumours depending on the tumour type, with a mean of 36% in GI-carcinomas. Chemosensitivity testing in vitro against standard anti-cancer agents correlated well with clinical experience, 5-FU and FUDR being the most active drugs (27% respectively 24% sensitive tumours in vitro) in GI-carcinomas. Relatively good agreement of in vitro/in vivo correlations was seen with an overall of 25/32 correct predictions in GI and other tumours. Predictivity was particularly good for loco-regional chemotherapy. Nevertheless, the limited in vitro growth rate of gastro-intestinal tumour specimens and their chemoresistance restrict the use of this method-in particular with respect to individual treatment planning.
TL;DR: Results show that the hypothesis that PAA plays at least a temporary role in the nidation process of tumor cells with metastatic potential is supported, suggesting a preferential localization of PAA on the surface of cells which metastasized.
Abstract: The ability of tumor cells to colonize remote sites has been correlated with their transient production of fibrinolytic enzymes, capable of degrading some of the host's defense mechanisms [1,3]. One of the enzyme complexes inculpated in this process are the plasminogen activators (PAA) [2]. We have studied the MT/W449-A rat mammary\" adenocarcinoma as a model. This tumor, originally induced by DES in female W/F rats, can be maintained by trochar injection into the thigh muscle. The model metastasizes spontaneously to the lungs and forms large and multiple loci. Explants from the primary growth and from the lung metastases were teased, digested into single cell suspensions and cultured in RPMI 1640 medium with antibiotics and 15 per cent FBS. Confluent cell cultures were resuspended after gentle trypsinization; when reinjected subcutaneously, solid tumors grew at the injection site. The histopathology of the original tumors, the loci and the implants remained consistent. The doubling times of the cell cultures were calculated; the growth rate of the cell line derived from the lung foci was significantly faster (23 versus 31 h on day 3). In both the solid primaries and lung loci as well as in their cell cultures, PAA was determined with the chromogen $2251 KABI [4] in the cvtosol (100000g supernatant) and the pellet. Our results show that while the PAA levels in the cytosol of both the primary and the secondary growth were similar, the PAA activity in the pellet containing the cell membrane fraction from the lung loci was significantly (P < 0\"01) higher, suggesting a preferential localization of PAA on the surface of cells which metastasized (84\"0 + 19\"2 versus 154\"4___ 38'4 Ploug units/mg protein). This observation supports the hypothesis that PAA plays at least a temporary role in the nidation process of tumor cells with metastatic potential. (Supported by a grant from KABI Peptide Research, M61ndal, Sweden.)
TL;DR: Endorectal ileal pull-through is an attractive alternative to leaving a permanent ileostomy in children with ulcerative colitis and familial polyposis and results are encouraging and support the more frequent use of this alternative.
Abstract: The marked reluctance to leaving a permanent ileostomy in a child is understandable; too often, however, before surgical therapy is accepted, the patient is permitted to decline to a hopeless state from which restoration is virtually impossible without operation. Endorectal ileal pull-through provides an attractive alternative. From 1972 to 1982 at Children's Hospital, G. Gaslini Institute, Genoa, nine patients with ulcerative colitis and eight patients with familial polyposis received this operation. Results are encouraging and support the more frequent use of this alternative.
TL;DR: This work has shown that finding the lesion on preoperative angiograms does not guarantee intraoperative identification, especially if the anatomy is distorted due to adhesions from previous operations or if the lesions is in the small bowel.
Abstract: THE BEST DIAGNOSTIC TEST for identifying bleeding vascular ectasias is arteriography. Since Margulis et al. 1 used operative angiography to identify a \"vascular malformation\" of the cecum, the number of vascular ectasias reported has increased. In fact, in the 1980s, vascular ectasia is recognized as probably the pr ime cause of massive colonic bleeding in the elderly. Finding the lesion on preoperative angiograms does not guarantee intraoperative identification, especially if the anatomy is distorted due to adhesions from previous operations or if the lesion is in the small bowel. Previous attempts at intraoperative localization have met with mixed results. Heretofore, intraoperative angiography has been accomplished using the transfemoral approach requiring operating in the angiography suite or transporting the patient with catheter in place to the operat ing room. Both of these options
01 Jan 1985
TL;DR: It is proposed that the minute gastric carcinoid should be defined as a tumor not exceeding 5 mm in size with the invasion limited to the mucosa or submucosa with radical gastrectomy performed even for the minute carcinoid tumor because of its multicentricity and invasiveness.
Abstract: Two cases of minute carcinoid tumor of the stomach were reported and 167 cases of gastric carcinoid in Japan up to December 1984 were reviewed. In Case 1, two carcinoid tumors of the body were found as sessile polyps of 4.2 and 4.8 mm in diameter, respectively, the latter having been detected two years previously. Case 2 had 60 polypoid lesions on the body and the fundus, ranging from 1.0 to 4.5 mm in diameter. In both cases the tumor invasion was limited to the mucosa and submucosa, although many micronests were found around the polypoid lesions. Among 167 cases of gastric carcinoid in Japan, 12 were 5 mm or less in size and 12 were 6 to 10 mm in size. In the former cases, there was no metastasis while in the latter, metastasis to the lymph nodes was found in 25.0%. We propose that the minute gastric carcinoid should be defined as a tumor not exceeding 5 mm in size with the invasion limited to the mucosa or submucosa. In addition, we emphasized that radical gastrectomy should be performed even for the minute carcinoid tumor because of its multicentricity and invasiveness.
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TL;DR: The patient may serve as a case to support the hypothesis that familial adenomatosis coli is a systemic or generalized disease with tumorigenicity that is not restricted to the colon and rectum, and that a total colectomy with ileostomy is not always entirely curative.
Abstract: A rare case of embryonal carcinoma of the testis associated with familial adenomatosis coli is reported. The patient may serve as a case to support the hypothesis that familial adenomatosis coli is a systemic or generalized disease with tumorigenicity that is not restricted to the colon and rectum, and that a total colectomy with ileostomy is not always entirely curative.
TL;DR: With the addition of these two excellent papers, multicentricity, synchronousness, and careful long-term follow-up, as well as complete preoperative colonic investigation, are stressed once again.
Abstract: To the Editor:--I was most interested in and encouraged by two of the articles in a recent issue of your Journal. The articles, \"Mult iple Pr imary Malignant T u m o r s Involving the Large Bowel,\" by Drs. Shah and Alfsen (Diseases o[ the Colon ~z Rec tum 1984;27:798-80% and \"Survival of 727 Patients with Single Carcinomas of the Large Bowel,\" by Mr. Umpleby and co-authors (Diseases of the Colon 6\" Rec tum 1984;27:803-10), represent an area that I have had a particular interest in for many years, as well as having made contributions to the mass of literature on this fascinating subject.t, 2 1 certainly agree with the authors of both articles with specific reference to the conclusions they have drawn; however, I think they do not go far enough. Without question, almost all published data, to date, continue to support the notion that early, aggressive surgery gives the patient the best chance for long-term survival. With the addition of these two excellent papers, multicentricity, synchronousness, and careful long-term follow-up, as well as complete preoperative colonic investigation, are stressed once again. These suggestions have been recorded in the literature since 19801 and 1982, z and in many preceding years. Yet, many practitioners view this information as some new revelation in treating this most common problem. Once and for all, allow me to update an individual surgeon's fanatic
TL;DR: The case for surgery can best be developed by encouraging special training and expertise in the field of surgical oncology, as one element in the provision of a surgical service for cancer patients.
Abstract: The past thirty years has seen a profound change in emphasis and direction in the management of cancer. In many countries this has been away from traditional surgical management towards specialists trained primarily in medical oncology or radiotherapy. This trend has occurred despite the fact that surgery is still by far the most effective method of treatment of most common cancers. The effectiveness of sound cancer surgery and the importance of local disease control as an element in improving cure rates and palliation needs to be emphasised so that patients are not denied optimal treatment. The case for surgery can best be developed by encouraging special training and expertise in the field of surgical oncology, as one element in the provision of a surgical service for cancer patients.