Showing papers on "Surgical oncology published in 1997"
TL;DR: The greatest complication to successful cure of cancer is metastasis, and patients diagnosed with metastatic disease invariably have poor prognoses, highlighting how important it is to understand metastasis if treatment of patients with advanced disease is to improve.
Abstract: At the time of diagnosis, tumors are already complex mixtures of cells despite having arisen from single cells. One of the earliest detectable changes in transformed cells is a greater genetic instability than their normal counterparts [1–8]. Even before they become tumorigenic, transformed cells (anchorageindependent, not contact-inhibited, and immortal) display genomic instability that is apparently the driving force for further progression. Genetic instability is particularly important for generation of heterogeneity within tumors [2,4,9–11]. A heterogenous population is then subjected to selective pressures that cause evolution toward increasingly malignant characteristics (i.e. invasion and metastasis). In addition to these types of intrinsic cellular changes, tumor cells exist in a complex milieu, exchanging signals with other tumor cell subpopulations and host cells. Heppner likens this to ‘tumor cell societies’ [12]. The sum of signals received by tumor cells, coupled with intrinsic properties, determines their individual behaviors as well as the overall tumor’s behavior. Metastasis is the ultimate step in the multistage process of tumor progression [13–21]. Subsets of neoplastic cells are able to form distinct tumor colonies from the primary tumor. Development of metastasis requires tumor cells to complete a complex cascade of events. First, malignant cells invade adjacent tissues and penetrate into the lymphatic and/or circulatory systems. Cells then detach from the primary tumor mass and disseminate. During transport, tumor cells can travel individually or as emboli composed of tumor cells (homotypic) or tumor cells and host cells (heterotypic). At the secondary site, tumor cells or emboli either arrest due to physical limitations (e.g. too large to traverse a capillary lumen) or bind to specific molecules in particular organs or tissues. Once there, tumor cells must then proliferate either in the vasculature or extravasate into surrounding tissue [22,23]. To form macroscopic metastases, cells must then recruit a vascular supply [19,24–31]. Fewer than 0.1% of cells that enter the vasculature survive to form clinically detectable macroscopic metastases [32]. At which step(s) of the metastatic cascade circulating tumor cells commonly succumb is debatable [22,23,33,34]. The greatest complication to successful cure of cancer is metastasis. During the past half-century, the proportion of patients surviving long-term has increased significantly [35]; however, patients diagnosed with metastatic disease invariably have poor prognoses. A majority die within 5 years. In contrast, when tumors are detected before they have spread, cure rates approach 100%. Unfortunately, 60–70% of patients have occult metastatic disease at the time of diagnosis [36]. Development of recurrence (whether local or distant) is also a bad sign. These statistics highlight how important it is to understand metastasis if treatment of patients with advanced disease is to improve.
208 citations
TL;DR: While the data are preliminary and initial follow-up is limited, early results suggest that sentinel lymph node mapping and excision may be a useful adjunct in the treatment of MCC.
Abstract: Background: Merkel cell carcinoma (MCC) is an aggressive cutaneous tumor with a propensity for local recurrence, regional and distant metastases. There are no well-defined prognostic factors that predict behavior of this tumor, nor are treatment guidelines well established.
138 citations
TL;DR: Careful follow-up evaluating local recurrence, nodal spread, and pulmonary metastases is warranted in patients with epithelioid sarcoma prospectively followed between July 1982 and July 1995.
Abstract: Background: Epithelioid sarcoma is a rare histologic subtype of sarcoma. The clinical behavior and prognostic factors influencing survival in this disease are examined.
105 citations
TL;DR: Tumor size clinically serves as a simple predictor of tumor progression and survival of patients in gastric carcinoma.
Abstract: Background: Tumor size can be measured easily before or during operation with no special tools, but its prognostic use in patients with gastric carcinoma is still unclear.
105 citations
TL;DR: Results are highly variable and must be individualized according to the site of the primary tumor, extent of spread, and general condition of the patient, and a prolongation of quality life can often be accomplished through aggressive medical and surgical therapies.
Abstract: BACKGROUND: Carcinoid or neuroendocrine tumors of the gastrointestinal tract, although characteristically indolent, are also quite heterogeneous both with respect to histologic and endocrine features and with respect to clinical presentation and behavior. PURPOSE: This study was undertaken to review and summarize the current literature on classification controversies, site-specific carcinoid presentation and behavior, and diagnostic and management strategies for primary and advanced carcinoid tumors and the carcinoid syndrome. RESULTS: For carcinoid tumors, oncologic results depend on the location of the primary tumor, extent of locoregional and metastatic disease, functioning status of the tumor, and the feasibility of complete surgical extirpation. Whereas favorable survival rates are typically observed for appendiceal and rectal primaries, less favorable rates are often observed for colonic and ileal tumors. A search for additional tumors is generally advised because multiple carcinoids and second neoplasms are not uncommon. Because of the indolent nature of the tumor and because these therapies have been shown to improve quality and quantity of life, otherwise fit patients with advanced carcinoid disease should be treated with aggressive medical and surgical therapies. Development of a malignant carcinoid syndrome indicates the presence of a functionally active carcinoid tumor and portends a poor prognosis. CONCLUSION: Gastrointestinal carcinoids, although malignant, behave differently from other carcinomas. Results are highly variable and must be individualized according to the site of the primary tumor, extent of spread, and general condition of the patient. A prolongation of quality life can often be accomplished through aggressive medical and surgical therapies.
103 citations
TL;DR: The data indicate that breast carcinoma in males is not biologically more aggressive than in females, and conflict with the conventional wisdom that breast cancer in men carries a worse prognosis than the disease in women.
Abstract: Background: Considerable debate exists concerning the prognosis of breast cancer in male patients compared with that in female patients. Some studies have observed worse prognosis for men; others suggested the higher mortality rates were primarily due to delayed diagnosis.
97 citations
TL;DR: Once individuals are diagnosed with melanoma, they are in a high-risk population for having other primary site melanomas diagnosed and should be placed in an intensive follow-up protocol consisting of a complete skin examination.
Abstract: Background: Once individuals are diagnosed with malignant melanoma, they are at an increased risk of developing another melanoma when compared with the normal population.
74 citations
TL;DR: It is suggested that adequate management of thyroid cancer with laryngotracheal invasion can be achieved with a more conservative surgical approach and adjuvant radiotherapy, reserving more radical resections for extensive primary lesions or locally recurrent disease.
Abstract: Background: Locally advanced thyroid cancer invading the tracheal cartilage represents a difficult treatment dilemma during thyroidectomy.
73 citations
TL;DR: The significance of local recurrence for the patient in terms of survival, using data derived from the study of extremity soft tissue sarcoma is reviewed.
Abstract: Local recurrence has long been seen as a technical surgical failure to be avoided at all costs. This paper reviews the significance of local recurrence for the patient in terms of survival, using data derived from the study of extremity soft tissue sarcoma.
63 citations
TL;DR: Black women with breast cancer experience shorter survival times than do white women, including a shorter survival time after disease recurrence, after adjustment for menopausal status and estrogen receptor level.
Abstract: Background: Breast cancer survival has been shown to be significantly less among black women than white women. The reason for this difference in survival is unclear.
48 citations
TL;DR: This document on the management of symptomatic breast cancer is the first of a series of guidelines to be proposed by ESSO and draws heavily on excellent documents already in existence from the British Association of Surgical Oncology and from the Danish Breast Cancer Co-Operative Group.
Abstract: The European Society of Surgical Oncology is actively involved in the promotion of a high standard of surgical oncology throughout Europe. Such an ambition involves recognition of Centres of Excellence in the management of cancer patients throughout Europe. These centres have a multi-disciplinary system involved in the total care of patients with cancer and are concerned with the delivery of care to the highest available standards. It is accepted that not all patients with cancer can, nor should, necessarily be treated in such highly specialized centres. Yet all cancer patients should be guaranteed a high standard of care. High surgical standards can be ensured if surgeons treating cancer are trained in specialist centres and, when in independent practice, follow established guidelines or protocols of treatment. In common with many national surgical oncology societies, the European Society of Surgical Oncology is in the process of establishing good practice guidelines in the treatment of solid tumours. This document on the management of symptomatic breast cancer is the first of a series of guidelines to be proposed by ESSO. It draws heavily on excellent documents already in existence from the British Association of Surgical Oncology and from the Danish Breast Cancer Co-Operative Group. It is hoped that this document will be sufficiently clear and purposeful to be of help to the individual surgeon and yet sufficiently flexible to allow it to be adopted in the different medical systems throughout Europe.
TL;DR: Leland McKittrick was born in Thorp, Wisconsin, the eldest son of a town physician and was reared to follow a similar path after graduating from the University of Wisconsin and Harvard Medical School in 1918.
Abstract: Leland McKittrick was born in Thorp, Wisconsin, the eldest son of a town physician. He was reared to follow a similar path after graduating from the University of Wisconsin in 1915 and Harvard Medical School in 1918. McKittrick began his surgical postgraduate training at the University of Minnesota before transferring to the Massachusetts General Hospital as a surgical house pupil on the so-called East Surgical Service. After 18 months in Boston, he began his association with one of the pre-eminent surgeons of the day, Daniel Fiske Jones.
TL;DR: The high overall reliability of cutaneous lymphoscintigraphy as demonstrated by long-term follow-up indicates that the information obtained by CL can be reliably used to guide intervention.
Abstract: Background: If cutaneous lymphoscintigraphy (CL) is accurate in predicting the draining lymph node basins at risk from primary axial melanomas, then regional metastases should only occur in those lymph node basins identified by CL.
TL;DR: Although IL cancers have demonstrated insidious behavior, their incidence of bilaterality is only slightly higher than other histologies and their rates of recurrence are low when properly evaluated and treated, and the risk to the opposite breast also appears to be low.
Abstract: Background: The purpose of this study was to evaluate the tumor biology with respect to bilaterality and recurrence rates for bilateral infiltrating lobular (IL) breast carcinoma in comparison with other histological types.
TL;DR: These data clearly demonstrated the effectiveness of preoperative HCR therapy for improving long-term results of patients with carcinoma of the rectum, especially those demonstrating an advanced stage of disease.
Abstract: PURPOSE: The aim of this study is to evaluate long-term results of preoperative hyperthermia combined with chemotherapy and irradiation (HCR therapy) in patients with carcinoma of the rectum. METHODS: Postoperative prognoses were compared among 36 patients with carcinoma of the rectum, who were given preoperative HCR therapy followed by surgery, and 52 patients undergoing surgery alone without any preoperative therapy. RESULTS: There were significant differences in the prognosis between patients given preoperative HCR therapy plus surgery and those having surgery alone, and five-year survival rates were 91.3 and 64 percent, respectively. Particularly, for patients with tumors invading beyond the muscularis propria and/or with positive lymph node metastasis, a significantly longer survival was obtained with HCR plus surgery than in surgery alone (86.5vs.50.9 percent and 92.9vs.51.7 percent, respectively). However, no significant differences were observed in the postoperative prognosis for cases with no lymph node metastasis and/or with tumors limited to the muscularis propria between these two groups. CONCLUSIONS: These data clearly demonstrated the effectiveness of preoperative HCR therapy for improving long-term results of patients with carcinoma of the rectum, especially those demonstrating an advanced stage of disease.
TL;DR: There is no statistically significant difference in the 5-year survival rates when multiple ASOS are resected; therefore, an aggressive surgical approach is warranted.
Abstract: Background: The purpose of this study was to determine the therapeutic benefit of multivisceral resection (MVR) in patients with locally advanced colorectal carcinomas.
TL;DR: The high incidence and late stage of rectal cancer detected while under surveillance after IRA supports excision of the entire colorectal mucosa as the treatment of choice for most patients with FAP.
Abstract: PURPOSE: This study was performed to determine the relationship among surgical treatment, colorectal cancer, and outcome in patients with familial adenomatous polyposis (FAP). METHODS: Records of 115 patients with FAP who underwent surgery at The Mount Sinai Medical Center between 1947 and 1994 were retrospectively reviewed. Patients without cancer were compared with those with colorectal cancer at initial surgery and with patients who developed rectal cancer following colectomy. RESULTS: Thirty-one patients (27 percent) had colorectal cancer at the time of initial surgery (colon = 24; rectal = 7). Another 11 patients (26 percent) developed rectal cancer after colectomy with ileorectal anastomosis (IRA). Mean age of patients with colorectal cancer at initial surgery was significantly higher than those without cancer (P < 0.01). Patients who developed rectal cancer after IRA were significantly older than patients with colorectal cancer at initial surgery (P < 0.01). All patients with rectal cancer after IRA had advanced disease with either nodal or distant metastases at the time of diagnosis. CONCLUSIONS: Colorectal cancer remains a major problem in the treatment of patients with FAP. Nearly one-fourth of these patients have colorectal cancer at initial operation, and one-fourth of patients with IRA develop rectal cancer after a mean follow-up of 13 years. Patients with rectal cancer following IRA are more likely to have advanced tumors than patients with colorectal cancer at initial operation. The high incidence and late stage of rectal cancer detected while under surveillance after IRA supports excision of the entire colorectal mucosa as the treatment of choice for most patients with FAP.
Journal Article•
TL;DR: Recommendations for postoperative follow-up of patients with colorectal carcinoma are provided to provide recommendations for postoperatively followed-up care.
Abstract: Objective
To provide recommendations for postoperative follow-up of patients with colorectal carcinoma.
TL;DR: RIGS technology offers a substantial benefit for patients undergoing surgery for recurrent colorectal cancer and a better chance of finding recurrent tumor intraoperatively in patients who have elevated CEA levels with no other CT findings.
Abstract: Background: Despite new adjuvant therapy, 50% of patients with colon cancer will have recurrent disease. This study investigated the use of a radiolabeled monoclonal antibody in locating occult tumor during surgery for recurrent colorectal cancer.
01 Jun 1997
TL;DR: The Society of Surgical Oncology surgical practice guidelines focus on the signs and symptoms of primary cancer, timely evaluation of the symptomatic patient, appropriate preoperative evaluation for extent of disease, and role of the surgeon in surgery.
Abstract: The Society of Surgical Oncology surgical practice guidelines focus on the signs and symptoms of primary cancer, timely evaluation of the symptomatic patient, appropriate preoperative evaluation for extent of disease, and role of the surgeon in
TL;DR: In this technique, the anesthetic solution is injected into the subdermal plane distal to the dentate line, which is sensitive, and works its way out to the perianal skin to anesthetize the anoderm.
Abstract: To the Edi tor-In the recent article by Sobrado and Habr-Gama, 1 the authors bend the needle like a hook, puncture the mucosa above the dentate line into the submucosa, and advance it distally. The anesthetic solution is then infused. In this technique, the anesthetic solution is injected into the subdermal plane distal to the dentate line, which is sensitive. Most of the pain in local anesthesia is not from the needle but from injection of the anesthetic agent. I tried this technique in 1980 and abandoned it, because it still caused considerable pain. Buffering the anesthetic solution with sodium bicarbonate with dilution of 1:1 will minimize the pain. The authors use the HillFerguson or Fansler anal speculum to start. If these are the large size, the patients must have been heavily sedated. In 1982, I described a technique that causes the least pain or no pain at all. 2 In this technique, the anesthetic solution, which consisted of 0.25 percent bupivacaine containing 1:200,000 epinephrine, is injected into the submucosa 2 m m above the dentate line via a small Vernon-David anoscope, which is 1.5 cm in diameter. A 27-gauge needle on a 3-ml syringe is used. This is performed in four quadrants. The wheal of the anesthetic solution is then milked across the dentate line into the subdermal plane be low the dentate line to anesthetize the anoderm. At this point, the entire anal canal is completely relaxed and can accommodate a large Hill-Ferguson speculum without any discomfort. Next, the injection is made 2 m m distal to the dentate line and works its way out to the perianal skin. I have found this technique to be the most satisfactory method. Patients who are not anxious or apprehensive do not require sedation. It can be used in the operating room and in the outpatient clinic or office.
TL;DR: The investigation of the diagnosis and operative methods for benign tumors of the lung, in which the surgical treatment was selected due to suspicious malignancy, included 22 patients with benign tumors.
Abstract: In the following report, we describe our investigation of the diagnosis and operative methods for benign tumors of the lung, in which the surgical treatment was selected due to suspicious malignancy. This study included 22 patients with benign tumors. The patients' mean age was 55 years old. The histological diagnosis was made postoperatively prior to 1985 and intraoperatively after 1986. Hamartoma was the most common of the benign tumors. In benign tumors, the preoperative diagnosis was almost the same as the postoperative one. Of the patients with benign tumors, 78% underwent lobectomy or segmentectomy prior to 1985, and none have undergone any invasive procedures since 1986. Malignant tumors are sometimes difficult to distinguish from benign tumors preoperatively. Therefore, intraoperative histological examinations are necessary in cases in which malignancy is suspected. In such cases, a smaller invasive procedure should be selected due to the possibility of the tumor being benign.
Journal Article•
TL;DR: Removal of all macroscopic tumor is possible in 79% of the patients with sarcoma disseminated in the abdominal cavity and intraperitoneal chemotherapy with cis-DDP after cytoreductive surgery resulted in a 5-year survival rate of only 7%.
Abstract: Background: There is no information in the literature concerning the use of cytoreductive surgery with intraperitoneal chemotherapy for sarcomas disseminated intraabdominally.
Journal Article•
TL;DR: The Society of Surgical Oncology surgical practice guidelines focus on the signs and symptoms of primary cancer, timely evaluation of the symptomatic patient, appropriate preoperative evaluation for extent of disease, and role of the surgeon in surgery.
Abstract: The Society of Surgical Oncology surgical practice guidelines focus on the signs and symptoms of primary cancer, timely evaluation of the symptomatic patient, appropriate preoperative evaluation for extent of disease, and role of the surgeon in
TL;DR: The clinical features, diagnosis, therapy, and prognosis of leiomyosarcoma of the breast are discussed here in the light of the previously published literature.
Abstract: Sarcomas of the breast are rare, accounting for about 1% of all malignant breast tumors. Leiomyosarcoma of the breast was an almost unknown tumor until some 20 years ago, and the few previously published cases lacked detailed information. Only 11 well-documented cases of leiomyosarcoma of the breast had been reported in the literature up to February 1992. The clinical features, diagnosis, therapy, and prognosis are discussed here in the light of the previously published literature.
TL;DR: BCS was not associated with poverty level of area of residence but continued to be lower for larger or node-positive cancers, and attitudes and practices of local physicians were hypothesized as being important in explaining variation in BCS use by town of residence.
Abstract: Background: Breast-conserving surgery (BCS) has been recommended for most early-stage primary breast cancers, but predictors may vary by time and geographic area.
TL;DR: A 54-year-old woman who developed a recurrence of carcinoma in a stapled colon stump 2 years after undergoing an anterior resection for carcinoma of the rectosigmoid colon is reported on.
Abstract: We report herein the case of a 54-year-old woman who developed a recurrence of carcinoma in a stapled colon stump 2 years after undergoing an anterior resection for carcinoma of the rectosigmoid colon. At this time an end to end anastomosis (EEA) stapler had been used to perform a side-to-end anastomosis. The implantation of cancer cells was thought to have caused the recurrence.
TL;DR: The implications ofMDM2 overexpression in human breast cancer from the literature as well as the preliminary results are summarized.
Abstract: The MDM2 protein, an oncogene product, is known to act by suppressing p53 function. Although gene amplification of MDM2 was frequently detected in human sarcomas, it was uncommon in the majority of epithelial tumors including breast cancer. However, recent reports have demonstrated that its translational activity is enhanced in a variety of carcinomas. In this report, we summarized the implications of MDM2 overexpression in human breast cancer from the literature as well as our preliminary results.