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Surgery for colorectal cancer  

Microsoft Academic Search

Colorectal cancer remains the second commonest cause of cancer death in North America and Western Europe. Surgery remains the mainstay of treatment. The aim of surgery should be to achieve cure and to avoid locoregional recurrence. The fixity of the primary tumour determines resectability, and the extent of spread determines ultimate survival. Patients with rectal cancer present a particular problem.

Sina Dorudi; Robert JC Steele; Colin S McArdle


Polaroid photographic referral for skin cancer--a potentially useful method of reducing time to surgery.  


A prospective trial was conducted on twenty-five patients referred by dermatologists during 1998 using a referral letter and an accompanying polaroid photograph for prospective plastic surgical management of skin cancers. Using the description and the photograph, suitable patients were given dates for operation without requiring a plastic surgery out-patient clinic appointment. This enabled, not only a saving in the cost of an out-patient appointment, but a significant reduction in waiting time to surgery. PMID:10461694

Khan, F; McGregor, J C



Radioimmunoguided surgery benefits for recurrent colorectal cancer  

Microsoft Academic Search

Background: Despite new adjuvant therapy, 50% of patients with colon cancer will have recurrent disease. This study investigated the\\u000a use of a radiolabeled monoclonal antibody in locating occult tumor during surgery for recurrent colorectal cancer.\\u000a \\u000a \\u000a Methods: Twenty-two patients with recurrent colorectal cancer underwent surgery using the radioimmunoguided surgery (RIGS) system.\\u000a All patients were subjected to abdominal and chest computed tomography

Schlomo Schneebaum; Joseph Papo; Moshe Graif; Mimi Baratz; Jack Baron; Yehuda Skornik



Surgery for colorectal cancer.  


Colorectal cancer remains the second commonest cause of cancer death in North America and Western Europe. Surgery remains the mainstay of treatment. The aim of surgery should be to achieve cure and to avoid locoregional recurrence. The fixity of the primary tumour determines resectability, and the extent of spread determines ultimate survival. Patients with rectal cancer present a particular problem. There is good evidence that lower local recurrence rates may be achieved both by improvements in surgical technique and the use of adjuvant radiotherapy. The importance of adequate treatment of the circumferential tumour margin cannot be over-emphasised; meticulous attention is required to ensure an adequate circumferential excision. The lowest incidences of locoregional recurrence are reported by surgeons who perform total mesorectal excision. Anorectal function, sexual and urinary dysfunction may occur after rectal excision. Both postoperative and pre-operative radiotherapy can reduce the incidence of local recurrence. However, in view of the low recurrence rates obtained with TME alone, the role of adjuvant radiotherapy requires further evaluation. Several aspects of the surgical management of colorectal cancer, for example, the role of transanal local excision of selected rectal cancers and laparoscopic surgery, the management of obstructed cases and the role of follow-up remain to be defined clearly. PMID:12421728

Dorudi, Sina; Steele, Robert J C; McArdle, Colin S



New Methods in Surgery.  

National Technical Information Service (NTIS)

Contents: The use of lasers in surgery (experimental study); Graphoanalytical method of determining the temperature field of the human head when producing craniocerebral hypothermia with a Kholod-2F machine.

S. D. Pletnev Z. V. Golbert L. A. Sapozhnikov O. A. Smirnov I. G. Meshcherinov



Approach to Rectal Cancer Surgery  

PubMed Central

Rectal cancer is a distinct subset of colorectal cancer where specialized disease-specific management of the primary tumor is required. There have been significant developments in rectal cancer surgery at all stages of disease in particular the introduction of local excision strategies for preinvasive and early cancers, standardized total mesorectal excision for resectable cancers incorporating preoperative short- or long-course chemoradiation to the multimodality sequencing of treatment. Laparoscopic surgery is also increasingly being adopted as the standard rectal cancer surgery approach following expertise of colorectal surgeons in minimally invasive surgery gained from laparoscopic colon resections. In locally advanced and metastatic disease, combining chemoradiation with radical surgery may achieve total eradication of disease and disease control in the pelvis. Evidence for resection of metastases to the liver and lung have been extensively reported in the literature. The role of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for peritoneal metastases is showing promise in achieving locoregional control of peritoneal dissemination. This paper summarizes the recent developments in approaches to rectal cancer surgery at all these time points of the disease natural history.

Chua, Terence C.; Chong, Chanel H.; Liauw, Winston; Morris, David L.



Novel Optical Methods for identification, Imaging, and Preservation of the Cavernous Nerves Responsible for Penile Erections during Prostate Cancer Surgery.  

National Technical Information Service (NTIS)

There is wide variability in sexual potency rates (9-86%) after prostate cancer surgery due to our limited understanding of the location of the cavernous nerves, which are responsible for erectile function. Advances in identification and preservation of t...

N. M. Fried



Paravertebral block for breast cancer surgery  

Microsoft Academic Search

Purpose  Major breast cancer surgery is associated with a high incidence of postoperative nausea, vomiting and pain. Regional anaesthesia,\\u000a with intraoperative sedation, would seem an ideal alternative to general anaesthesia for this type of surgery. We report our\\u000a initial experience using paravertebral blocks (PVB) to provide anaesthesia for major breast surgery.\\u000a \\u000a \\u000a \\u000a Methods  Twenty-five patients agreeing to have surgery performed under paravertebral blocks

R. Greengrass; F. O’Brien; K. Lyerly; D. Hardman; D. Gleason; Fran D’Ercole; S. Steele



Hallmarks in colorectal cancer surgery.  


Starting from the first attempts of artificial anus creation to the successful excision of the rectum for cancer, the lumbar colostomy and the creation of caecostomy and ileostomy, we present the major hallmarks in the history of colorectal cancer surgery. PMID:21229654

Karamanou, M; Matsaggas, A; Skarpas, G; Gkeneralis, G; Androutsos, G


Surgery for Testicular Cancer  


... therapy for testicular cancer Radiation therapy uses a beam of high-energy rays (such as gamma rays or x-rays) or particles (such as electrons, protons, or neutrons) to destroy cancer cells or slow ...


Method of localization and implantation of the lumpectomy site for high dose rate brachytherapy after conservative surgery for T1 and T2 breast cancer  

Microsoft Academic Search

Purpose: This article describes our technique of localization and implantation of the lumpectomy site of patients with T1 and T2 breast cancer. Our method was developed as part of our Phase I\\/II pilot study of high dose rate (HDR) brachytherapy alone after conservative surgery for early breast cancer.Methods and Materials: In March 1992, we started a pilot study of HDR

F. Perera; F. Chisela; J. Engel; V. Venkatesan



Lung Cancer Treatment: Surgery  


... and Giving Support For Health Professionals Get Involved Lung HelpLine Questions about your lung health? Ask an ... of suggested questions . A A A Share Print Lung Cancer Education Resource Lung Health Education Resources Lung ...


Nanorobots for Laparoscopic Cancer Surgery  

Microsoft Academic Search

This paper presents an innovative hardware architecture for medical nanorobots, using nanobioelectronics, clinical data, and wireless technologies, as embedded integrated system devices for molecular machine data transmission and control upload, and show how to use it in cancer surgery. The integration of medical nanorobotics and surgical teleoperation has the use of robotic laparoscopy concepts. To illustrate the proposed approach, we

Adriano Cavalcanti; Bijan Shirinzadeh; Declan Murphy; Julian A. Smith



Present status of endoscopic surgery in Japan: laparoscopic surgery and laparoscopic assisted surgery for gastric cancer  

NASA Astrophysics Data System (ADS)

In this report, I would like to explain the latest data from the 7th National Survey 2004, by the Japan Society for Endoscopic Surgery (1). Next, I will explain you the comment on laparoscopic gastric cancer operation, in particular. We perform the following 3 surgical procedures. (1) Intragastric method (2) Laparoscopic lesion lifting method (3) Laparoscopic assisted gastric resection Mastery of basic techniques and thorough understanding of topographic anatomy are the most important (2). Furthermore, it is necessary for a surgeon with experience of at least 50 cases of laparoscopic surgery to be involved in surgery as an assistant.

Hiki, Yoshiki; Kitano, Seigo



Lobar volume reduction surgery: a method of increasing the lung cancer resection rate in patients with emphysema  

PubMed Central

BACKGROUND—Guidelines on patient selection for lung cancer resection identify a predicted postoperative forced expiratory volume in 1second (ppoFEV1) of <40% as a predictor of high risk. Experience with lung volume reduction surgery suggests that ppoFEV1 may be underestimated in those with concomitant emphysema.?METHODS—Anatomical lobectomy was performed in 29 patients with a resectable lung cancer within a poorly perfused, hyperinflated emphysematous lobe identified by radionuclide perfusion scintigraphy and computed tomographic scanning. Perioperative changes in spirometric parameters at 3 months were compared in 14 patients (group A) of mean age 69 years (range 48-78) with ppoFEV1 <40% (mean (SD) 31.4 (7)%) and 15 patients (group B) with ppoFEV1 >40% (mean (SD) 47 (5)%). The correlation between predicted and actual postoperative FEV1 was also assessed.?RESULTS—In group B there was a significant perioperative reduction in FEV1 (p=0.01) but in group A FEV1 did not change significantly after lobectomy (p=0.87); mean difference in perioperative change between groups A and B 331 ml (95% CI 150 to 510). Despite the difference in ppoFEV1 between the groups, there was no difference in actual FEV1 at 3 months. In-hospital mortality was 14% in group A and zero in group B, but at a median follow up of 12 (range 6-40) months there was no difference in survival between the groups.?CONCLUSIONS—Selection for lung cancer resection in patients with emphysema using standard calculations of ppoFEV1 may be misleading. The effect of lobar volume reduction allows for an extension of the selection criteria.??

Edwards, J; Duthie, D; Waller, D



Curative Surgery for Local Pelvic Recurrence of Rectal Cancer  

Microsoft Academic Search

Background\\/Aims: Local pelvic recurrence of rectal cancer after radical resection has been associated with morbidity and cancer-related death. This study retrospectively evaluated outcome following curative resection for rectal cancer recurring after surgery on the basis of prognosis, type of procedure and perioperative morbidity. Methods: A total of 85 consecutive patients with local pelvic recurrence of rectal cancer were evaluated. Of

Norio Saito; Keiji Koda; Nobuhiro Takiguchi; Kenji Oda; Masato Ono; Masanori Sugito; Kiyotaka Kawashima; Masaaki Ito



Cancer Surgery in the Elderly  

PubMed Central

The proportions both of elderly patients in the world and of elderly patients with cancer are both increasing. In the evaluation of these patients, physiologic age, and not chronologic age, should be carefully considered in the decision-making process prior to both cancer screening and cancer treatment in an effort to avoid ageism. Many tools exist to help the practitioner determine the physiologic age of the patient, which allows for more appropriate and more individualized risk stratification, both in the pre- and postoperative periods as patients are evaluated for surgical treatments and monitored for surgical complications, respectively. During and after operations in the oncogeriatric populations, physiologic changes occuring that accompany aging include impaired stress response, increased senescence, and decreased immunity, all three of which impact the risk/benefit ratio associated with cancer surgery in the elderly.

Kowdley, Gopal C.; Merchant, Nishant; Richardson, James P.; Somerville, Justin; Gorospe, Myriam; Cunningham, Steven C.



Non-curative surgery for colorectal cancer: critical appraisal of outcomes  

Microsoft Academic Search

Background and aims The value of surgery for patients with incurable colorectal cancer is controversial. This study evaluated outcomes in patients undergoing non-curative surgery for colorectal cancer and aimed to identify patients who would benefit from palliative surgery. Patients and methods Demographics, tumour characteristics, operating details and outcomes were reviewed for 180 patients undergoing surgery for incurable colorectal cancer; palliative

WaiLun Law; WaiFun Chan; YeeMan Lee; KinWah Chu



Depression and conservative surgery for breast cancer  

PubMed Central

BACKGROUND: Depression is prevalent among women and associated with reduced quality of life, and therefore it is important to determine its incidence in adult women, especially in those with breast cancer. OBJECTIVE: To determine the occurrence of depression in women who underwent conservative surgery for breast cancer with or without breast reconstruction. METHODS: Seventy?five women aged between 18 and 65 years were enrolled. Patients had undergone conservative surgery for breast cancer with immediate breast reconstruction (n?=?25) or without breast reconstruction (n?=?25) at least one year before the study. The control group consisted of 25 women without cancer, but of similar age and educational level distribution as the other two groups. The Beck Depression Inventory was used to measure depression. The collected data were assessed using analysis of variance and the ?2 test. RESULTS: There were no significant differences between groups in age (p?=?0.72) or educational level (p?=?0.20). A smaller number of patients had undergone the menopause (p?=?0.02) in the control group than in other groups. There were no significant differences in occurrence of depression between groups (?2?=?9.97; p?=?0.126). CONCLUSION: Conservative surgery for breast cancer did not affect the occurrence of depression in women, regardless of whether breast reconstruction was performed.

de Medeiros, Mauriceia C L; Veiga, Daniela F; Neto, Miguel Sabino; Abla, Luis E F; Juliano, Yara; Ferreira, Lydia M



Increased Risk of Colorectal Cancer After Obesity Surgery.  


OBJECTIVE:: The purpose was to determine whether obesity surgery is associated with a long-term increased risk of colorectal cancer. BACKGROUND:: Long-term cancer risk after obesity surgery is not well characterized. Preliminary epidemiological observations and human tissue biomarker studies recently suggested an increased risk of colorectal cancer after obesity surgery. METHODS:: A nationwide retrospective register-based cohort study in Sweden was conducted in 1980-2009. The long-term risk of colorectal cancer in patients who underwent obesity surgery, and in an obese no surgery cohort, was compared with that of the age-, sex- and calendar year-matched general background population between 1980 and 2009. Obese individuals were stratified into an obesity surgery cohort and an obese no surgery cohort. The standardized incidence ratio (SIR), with 95% confidence interval (CI), was calculated. RESULTS:: Of 77,111 obese patients, 15,095 constituted the obesity surgery cohort and 62,016 constituted the obese no surgery cohort. In the obesity surgery cohort, we observed 70 patients with colorectal cancer, rendering an overall SIR of 1.60 (95% CI 1.25-2.02). The SIR for colorectal cancer increased with length of time after surgery, with a SIR of 2.00 (95% CI 1.48-2.64) after 10 years or more. In contrast, the overall SIR in the obese no surgery cohort (containing 373 colorectal cancers) was 1.26 (95% CI 1.14-1.40) and remained stable with increasing follow-up time. CONCLUSIONS:: Obesity surgery seems to be associated with an increased risk of colorectal cancer over time. These findings would prompt evaluation of colonoscopy surveillance for the increasingly large population who undergo obesity surgery. PMID:23470581

Derogar, Maryam; Hull, Mark A; Kant, Prashant; Ostlund, Magdalena; Lu, Yunxia; Lagergren, Jesper



Laparoscopic surgery for colorectal cancers: Current status  

PubMed Central

Laparoscopy was introduced more than 15 years ago into clinical practice. However, its role in colorectal surgery was not well established for want of better skills and technology. This coupled with high incidences of port site recurrences, prevented laparoscopic surgery from being incorporated into mainstream colorectal cancer surgery. A recent increase in the number of reports, retrospective analyses, randomized trials and multicentric trials has now provided sufficient data to support the role of laparoscopy in colorectal cancer surgery. We, thus, present a review of the published data on the feasibility, safety, short - and long-term outcomes following laparoscopic surgery for colorectal cancers. While the data available strongly favors the use of laparoscopic surgery in colonic cancer, larger well powered studies are required to prove or disprove its role in rectal cancer.

Shukla, Parul J; Barreto, George; Gupta, Piyush; Shrikhande, Shailesh V



Breast Conservation Surgery: Methods  

Microsoft Academic Search

Breast conservation therapy (BCT) has become the preferred treatment for early stage breast cancer in most women. Breast conserving\\u000a therapy is defined as the complete removal of a breast tumor (invasive breast cancer or duct carcinoma in situ) with a surrounding\\u000a margin of normal tissue performed in a cosmetically acceptable manner followed by irradiation therapy (Schwartz et al., 2006). Well-designed

Lloyd A. Mack; Robert L. Lindsay; Walley J. Temple


[Prophylactic surgery in common hereditary cancer syndromes].  


Preventive surgery is a mainstay of treatment for persons with genetic risk factors for cancer The indications of preventive surgery are based on a thorough risk assessment, clinical characteristics of the different hereditary cancer susceptibility syndromes, the types of mutation, and the possibility of watchful waiting for early cancer detection. Preventive surgery may either be recommended or represent one possible option. Bilateral prophylactic mastectomy can reduce the risk of breast cancer by up to 95% in BRCA1/BRCA2 mutation carriers. Bilateral prophylactic salpingo-oophorectomy is recommended for BRCA1/ BRCA2 carriers: women who undergo this preventive surgery have a reduced risk of ovarian cancer but also of breast cancer (around 50% for breast cancer). Patients with Lynch syndrome are at high risk of endometrial cancer, and prophylactic hysterectomy may be proposed to women for whom surgery is indicated for a uterine disorder (fibroma). Prophylactic surgery may be proposed to patients at risk of hereditary gastrointestinal malignancies, either on a case-by-case basis (Lynch syndrome) or more systematically for patients with the familial adenomatous polyposis syndrome or hereditary difuse gastric cancer Despite its efficacy, prophylactic surgery in a healthy individual, albeit at high risk of cancer, remains a difficult, multidisciplinary decision. Psychological support is needed to anticipate the possible physical psychological and social complications--and benefits. PMID:23815011

Noguès, Catherine; Mouret-Fourme, Emmanuelle



Dysphagia following head and neck cancer surgery  

Microsoft Academic Search

Surgical resection of head and neck cancer results in predictable patterns of dysphagia and aspiration due to disruption of the anatomic structures of swallowing. Common procedures undertaken in the treatment of head and neck cancer include tracheostomy, glossectomy, mandibulectomy, surgery on the palate, total and partial laryngectomy, reconstruction of the pharynx and cervical esophagus, and surgery of the skull base.

Michael B. Kronenberger; Arlen D. Meyers



[Informed consent for colorectal cancer surgery].  


There are two issues in informed consent for colorectal cancer surgery. One is the actual surgical technique. Recently intersphincteric resection (ISR) has been performed to avoid permanent colostomy, although it is not standard procedure. Regarding QOL score, Patients with colostomies do not necessarily have lower quality of life scores than patients who undergo sphincter-preserving surgery because of frequent bowel movements. Lateral lymphadenectomy for lower rectal cancer was standard procedure; however, its indications became limited due to urinary and sexual dysfunction. Preoperative radiotherapy is considered instead of lateral lymphadenectomy, as in the Western concept of the local recurrence of rectal cancer. Now laparoscopic surgery is accepted for stage I colon cancer according to the guidelines of the Japan Society for Cancer of the Colon and Rectum. The other issue is postoperative complications like anastomotic leakage, intestinal obstruction, etc. Frequent bowel movements and urinary and sexual dysfunction should also be explained before rectal cancer surgery. PMID:17304952

Yamaguchi, Shigeki; Morita, Hirofumi; Ishii, Masayuki; Saito, Shuji



Secondary cytoreductive surgery for recurrent epithelial ovarian cancer  

Microsoft Academic Search

OBJECTIVE:To review our experience with secondary cytoreductive surgery for recurrent epithelial ovarian cancer with regard to its feasibility, morbidity, mortality, patient selection, and survival.METHODS:Forty-six patients who underwent secondary cytoreductive surgery at the Royal Hospital for Women, Sydney, between July 1988 and October 1996 were retrospectively reviewed. The mean age at surgery was 50.3 years, and the median disease-free interval was

Eng-Hseon Tay; Peter T Grant; Val Gebski; Neville F Hacker



Quantitative computed tomography for the prediction of pulmonary function after lung cancer surgery: a simple method using simulation software  

Microsoft Academic Search

Objective: The prediction of pulmonary functional reserve is mandatory in therapeutic decision-making for patients with resectable lung cancer, especially those with underlying lung disease. Volumetric analysis in combination with densitometric analysis of the affected lung lobe or segment with quantitative computed tomography (CT) helps to identify residual pulmonary function, although the utility of this modality needs investigation. Methods: The subjects

Kazuhiro Ueda; Toshiki Tanaka; Tao-Sheng Li; Nobuyuki Tanaka; Kimikazu Hamano



Laparoscopic surgery for the cure of colorectal cancer  

Microsoft Academic Search

PURPOSE: The aim of this study was to assess the feasibility and safety of laparoscopic surgery for the cure of colorectal cancer with emphasis on oncologic follow-up in particular. METHODS: A study was performed of patients with colorectal cancer treated by laparoscopy in five German centers between May 1991 and September 1997. Surgical and pathologic data were recorded in an

T. H. K. Schiedeck; O. Schwandner; I. Baca; E. Baehrlehner; J. Konradt; F. Köckerling; A. Kuthe; C. Buerk; A. Herold; H.-P. Bruch



Predictors of Lymphedema Following Breast Cancer Surgery.  

National Technical Information Service (NTIS)

Surgery for breast cancer includes removal of the breast tumor along with axillary lymph nodes. Unfortunately, a relatively common side effect following axillary lymph node dissection (ALND) is upper-extremity lymphedema. The purpose of this study is to i...

K. K. Swenson



Progress in gastric cancer surgery in Japan and its limits of radicality  

Microsoft Academic Search

Radical surgery of gastric cancer has become more widely utilized in Japan. Topics explored in gastric cancer surgery include the extended lymph node dissection guided by the node staining method with India ink, left upper abdominal organs exenteration for advanced cancer of the upper stomach, and pancreaticoduodenectomy for advanced cancer of the lower stomach. Through the progress of surgical treatment

Keiichi Maruyama; Kenzo Okabayashi; Taira Kinoshita



New Technologies in Breast Cancer Surgery  

PubMed Central

Since breast-conserving surgery has become the gold standard for early breast cancer, the development of less radical or less burdensome technologies has been pressed for in order to preserve the patient from unnecessary harm through the operative procedure. Different technical approaches are under evaluation, and some of them are already being used in the clinical setting. The aim of this article is to present a perspective on future breast cancer surgery by shedding light on the current innovative and new techniques.

Thill, Marc; Baumann, Kristin



Secondary lymphoedema after breast cancer surgery: a survival analysis.  


This study explores the time of occurrence and risk factors of secondary lymphoedema after breast cancer surgery. A cross-sectional study of women with breast cancer (n = 230) recruited from Chongqing Breast Cancer Center from July 2009 to June 2010 provided data. A self-reported questionnaire was used to evaluate the lymphoedema by telephone interview at 6 monthly intervals between 12 and 24 months after breast cancer surgery. The Kaplan-Meier method and Cox proportional hazards regression were used to analyse the collected data. The mean time reported by women who had lymphoedema after breast cancer surgery was 18 months; body mass index and preoperative chemotherapy associated with lymphoedema development were identified in the present study. Given these findings, oncologists and nurses should provide sufficient knowledge to patients to recognize the symptoms, risk factors of lymphoedema and know-how to use interventions to prevent it. PMID:23181961

Huang, HuaPing; Zhou, JianRong; Zeng, Qing



Effect of Darbepoetin Alfa on Physical Function in Patients Undergoing Surgery for Colorectal Cancer  

Microsoft Academic Search

Objective: To study whether perioperative treatment with darbepoetin alfa (DA) improves physical performance following colorectal cancer surgery. Methods: Patients admitted for planned colorectal cancer surgery were randomized to receive either weekly placebo or DA 300 or 150 ?g depending on the hemoglobin (Hb) concentration. Patients were assessed 10 days before, as well as 7 and 30 days after surgery for

C. B. Norager; M. B. Jensen; M. R. Madsen; N. Qvist; S. Laurberg



Lung cancer surgery: an up to date  

PubMed Central

According to the International Agency for Research on Cancer (IARC) GLOBOCAN World Cancer Report, lung cancer affects more than 1 million people a year worldwide. In Greece according to the 2008 GLOBOCAN report, there were 6,667 cases recorded, 18% of the total incidence of all cancers in the population. Furthermore, there were 6,402 deaths due to lung cancer, 23.5% of all deaths due to cancer. Therefore, in our country, lung cancer is the most common and deadly form of cancer for the male population. The most important prognostic indicator in lung cancer is the extent of disease. The Union Internationale Contre le Cancer (UICC) and the American Joint Committee for Cancer Staging (AJCC) developed the tumour, node, and metastases (TNM) staging system which attempts to define those patients who might be suitable for radical surgery or radical radiotherapy, from the majority, who will only be suitable for palliative measures. Surgery has an important part for the therapy of patients with lung cancer. “Lobectomy is the gold standard treatment”. This statement may be challenged in cases of stage Ia cancer or in patients with limited pulmonary function. In these cases an anatomical segmentectomy with lymph node dissection is an acceptable alternative. Chest wall invasion is not a contraindication to resection. En-bloc rib resection and reconstruction is the treatment of choice. N2 disease represents both a spectrum of disease and the interface between surgical and non-surgical treatment of lung cancer Evidence from trials suggests that multizone or unresectable N2 disease should be treated primarily by chemoradiotherapy. There may be a role for surgery if N2 is downstaged to N0 and lobectomy is possible, but pneumonectomy is avoidable. Small cell lung cancer (SCLC) is considered a systemic disease at diagnosis, because the potential for hematogenous and lymphogenic metastases is very high. The efficacy of surgical intervention for SCLC is not clear. Lung cancer resection can be performed using several surgical techniques. Video-assisted thoracoscopic surgery (VATS) lobectomy is a safe, efficient, well accepted and widespread technique among thoracic surgeons. The 5-year survival rate following complete resection of lung cancer is stage dependent. Incomplete resection rarely is useful and cures the patient.

Baltayiannis, Nikolaos; Chandrinos, Michail; Anagnostopoulos, Dimitrios; Tsakiridis, Kosmas; Mpakas, Andreas; Machairiotis, Nikolaos; Katsikogiannis, Nikolaos; Kougioumtzi, Ioanna; Courcoutsakis, Nikolaos; Zarogoulidis, Konstantinos



[Postoperative inconveniences after breast cancer surgery].  


The most common postoperative inconveniences after breast cancer surgery are pain, nausea and vomiting, which contribute to reduced patient satisfaction, prolonged hospital stays and delayed courses of rehabilitation. This article summarizes the literature regarding available procedure-specific evidence for prophylactic nausea, vomiting and pain treatment supported by transferable evidence from similar types of surgery. We propose a prophylactic combination of Dexametason, Ondansteron, Paracetamol, Celecoxib, Gabapentin and Detromethorphan as future treatment. PMID:18534168

Gärtner, Rune; Callesen, Torben; Kroman, Niels; Kehlet, Henrik



Avoiding complications in esophageal cancer surgery.  


Modern handling of esophageal cancer patients is based on a multidisciplinary concept, but surgery remains the primary curative treatment modality. Improvements in the perioperative care have reduced the overall morbidity and mortality, but 2-7% of the patients may still die within 30 days as a direct consequence of complications related to the esophagectomy procedure. Primarily based on results from randomized studies published after 2000 this review describes some of the factors that may contribute to the development of postoperative complications following esophageal cancer surgery as well as studies intended to finding ways of reducing the complication rate. PMID:24019042

Bau Mortensen, M



[Resection margins in conservative breast cancer surgery].  


Conservative breast cancer surgery is facing a new problem: the potential tumour involvement of resection margins. This eventuality has been closely and negatively associated with disease-free survival. Various factors may influence the likelihood of margins being affected, mostly related to the characteristics of the tumour, patient or surgical technique. In the last decade, many studies have attempted to find predictive factors for margin involvement. However, it is currently the new techniques used in the study of margins and tumour localisation that are significantly reducing reoperations in conservative breast cancer surgery. PMID:23611356

Medina Fernández, Francisco Javier; Ayllón Terán, María Dolores; Lombardo Galera, María Sagrario; Rioja Torres, Pilar; Bascuñana Estudillo, Guillermo; Rufián Peña, Sebastián



Surgery for nonsmall cell lung cancer.  


Surgery remains the best curative option in patients with early stage lung cancer (stage I and II). Developments in minimally invasive techniques now allow surgeons to perform lung resections on elderly patients, patients with poor pulmonary function or significant cardiopulmonary comorbidities. New techniques, such as stereotactic radiotherapy and ablative procedures, are being evaluated in early-stage lung cancer and may represent an alternative to surgery in patients unfit for lung resection. Perioperative mortality rates have dropped significantly at most institutions in the past two decades and complications are managed more efficiently. Progress in imaging and staging techniques have helped cut futile thoracotomy rates and offer patients the most adequate treatment options. Large randomised trials have helped clarify the role of neoadjuvant, induction and adjuvant chemotherapy, as well as radiotherapy. Surgery remains an essential step in the multimodality therapy of selected patients with advanced-stage lung cancer (stage III and IV). Interventional and endoscopic techniques have reduced the role of surgery in the diagnosis and staging of nonsmall cell lung cancer, but surgery remains an important tool in the palliation of advanced-stage lung cancer. Large national/international surgical databases have been developed and predictive risk-models for surgical mortality/morbidity published by learned surgical societies. Nonetheless, lung cancer overall survival rates remain deceptively low and it is hoped that early detection/screening, better understanding of tumour biology and development of biomarkers, and development of efficient targeted therapies will help improve the prognosis of lung cancer patients in the next decade. PMID:23997065

Lang-Lazdunski, Loïc



Prophylactic Mastectomy: Surgery to Reduce Breast Cancer Risk  


... noncommercial use only. Prophylactic mastectomy: Surgery to reduce breast cancer risk By Mayo Clinic staff Original Article: http:// ... address Sign up Prophylactic mastectomy: Surgery to reduce breast cancer risk Prophylactic mastectomy may reduce your risk of ...


Surgery and radiotherapy in vulvar cancer  

Microsoft Academic Search

The majority of patients with vulvar cancer have squamous cell carcinomas (SCC). The cornerstone of the treatment is surgery. Radical vulvectomy with “en bloc” inguinofemoral lymphadenectomy has led to a favorable prognosis but with impressive morbidity. Nowadays, treatment is more individualized with wide local excision with uni- or bilateral inguinofemoral lymphadenectomy via separate incisions as the standard treatment for early

J. A. de Hullu



Perioperative Chemotherapy versus Surgery Alone for Resectable Gastroesophageal Cancer  

Microsoft Academic Search

Background A regimen of epirubicin, cisplatin, and infused fluorouracil (ECF) improves sur- vival among patients with incurable locally advanced or metastatic gastric adeno- carcinoma. We assessed whether the addition of a perioperative regimen of ECF to surgery improves outcomes among patients with potentially curable gastric cancer. Methods We randomly assigned patients with resectable adenocarcinoma of the stomach, esophagogastric junction, or

David Cunningham; William H. Allum; Sally P. Stenning; Jeremy N. Thompson; Marianne Nicolson; J. Howard Scarffe; Fiona J. Lofts; Stephen J. Falk; Timothy J. Iveson; David B. Smith; Ruth E. Langley; Monica Verma; Simon Weeden; Yu Jo Chua



Effect of lung cancer surgery on quality of life  

PubMed Central

Background: Health related quality of life (HRQOL) after surgery is important, although very limited data are available on the QOL after lung cancer surgery. Methods: The effect of surgery on HRQOL was assessed in a prospective study of 110 patients undergoing potentially curative lung cancer surgery at Papworth Hospital, 30% of whom had borderline lung function as judged by forced expiratory volume in 1 second. All patients completed the EORTC QLQ-C30 and LC13 lung cancer module before surgery and again at 1, 3 and 6 months postoperatively. Results: On average, patients had high levels of functioning and low levels of symptoms. Global QOL had deteriorated significantly 1 month after surgery (p = 0.001) but had returned to preoperative levels by 3 months (p = 0.93). Symptoms had worsened significantly at 1 month after surgery but had returned to baseline levels by 6 months. Low values on the preoperative HRQOL scales were not significantly associated with poor surgical outcome. However, patients with low preoperative HRQOL functioning scales and high preoperative symptom scores were more likely to have poor postoperative (6 months) QOL. The only lung function measurement to show a marginally statistically significant association with quality of life at 6 months after surgery was percentage predicted carbon monoxide transfer factor (TLCO). Conclusion: Although surgery had short term negative effects on quality of life, by 6 months HRQOL had returned to preoperative values. Patients with low HRQOL functioning scales, high preoperative symptom scores, and preoperative percentage predicted TLCO may be associated with worse postoperative HRQOL.

Win, T; Sharples, L; Wells, F; Ritchie, A; Munday, H; Laroche, C



Breast-conserving surgery in breast cancer.  


The breast cancer treatment is based nowadays on new surgical options: breast-conserving surgery, which applies at least for the first and second stage cancer, with radical intention. We have been practicing breast-conserving surgery for the last 16 years and we have performed 303 breast conserving operations from a total of 673. We recorded 12 local recurrences (3,96%) and 2 deaths due to cancer progression. Our protocol includes removal of the primary tumor with enough surrounding tissue to ensure negative margins of the resectable specimen, associated with axillary lymph-node dissection and postoperative breast irradiation. Our oncologist indicated chemotherapy on different postoperative conditions: tumor size, axillary lymph node involvement, patient's age, etc. The purpose of this paper is to emphasize our modest experience, nevertheless to draw the attention on important results, obtained by long-term monitoring of the patients who underwent breast-conserving surgery, in a two prospective protocols, and demonstrate the importance and applicability of breast conserving therapy. The conclusion of this study is that breast-conserving surgery followed by breast irradiation is reliable, as the results are similar with radical mastectomies; the main objective is to obtain a good cosmetic result, which depends on tumor size / breast size. PMID:23116836

Tenea Cojan, T S; Vidrighin, C D; Ciobanu, M; Paun, I; Teodorescu, M; Mogos, G; Tenovici, M; Florescu, M; Mogos, D


Surgery for inoperable breast cancer.  


Neoadjuvant chemotherapy has the potential to convert inoperable breast cancer into operable disease; however, patients may remain inoperable by the classic criteria after neoadjuvant chemotherapy. In such cases, palliative surgical therapy to promote comfort and hygiene and to control wound breakdown may need to be considered. This report documents this clinical scenario in a patient with a large exophytic breast cancer who had a partial response with neoadjuvant chemotherapy and required an extended radical mastectomy with extensive reconstruction for coverage. The decision to undertake such a surgical procedure is complicated when the patient's life expectancy may be extremely limited and both patient and treatment team must carefully weigh the risks and potential benefits of a highly complex but technically feasible operation. PMID:11918881

Kuerer, Henry M; Beahm, Elisabeth K; Swisher, Stephen G; Ross, Merrick I



Irradiation and surgery for selected cancers  

SciTech Connect

Combinations of radiation therapy with surgery originated when the surgeon thought he had transected cancer. Unrealistic expectations, however, plagued these combinations until it was appreciated that the dose required to eradicate a given cancerous mass varied primarily with its volume and the associated oxygen tension of its cells. This helped to establish the rationale for combining irradiation and surgery and enabled the radiation therapist to more closely tailor dose needs to each specific clinical problem. Tailoring of dose remains crude. Our greatest errors continue to be attributable to poor definition of tumor extent and the underestimation of residual tumor volume. We need more precise information from the surgeon and pathologist along with greater knowledge of patterns of spread. To the degree that such added information becomes available, we have the means to increase loco-regional control rates.

Moss, W.T.



Functional outcome following restorative rectal cancer surgery.  


The trend towards preoperative adjuvant and neoadjuvant therapies in selected patients with rectal cancer has led to increases in sphincter preservation with a limited understanding of the factors governing unsatisfactory functional outcomes. Data would suggest the need for a more selective use of standard radiotherapeutic fields in low- to intermediate-risk cases where there appears to be limited survival or locoregional recurrence benefit and where there is under-reported toxicity. This article discusses the complex factors which impact on functional outcome following open rectal cancer surgery particularly when it is accompanied by adjuvant therapy. PMID:19780324

Zbar, A P; Kennedy, P J; Singh, V



Smoking as a risk factor for wound healing and infection in breast cancer surgery  

Microsoft Academic Search

Aim: Clinical studies suggest that smoking is associated with wound necrosis after breast cancer surgery. However, the significance of smoking as a risk factor for wound infection, skin flap necrosis, and epidermolysis when adjusting for other potential risk factors remains to be studied.Methods: From June 1994 through August 1996, 425 patients underwent breast cancer surgery as simple mastectomy, modified radical

L. T. Sørensen; J. Hørby; E. Friis; B. Pilsgaard; T. Jørgensen



Predictive factors for detecting colorectal carcinomas in surveillance colonoscopy after colorectal cancer surgery  

Microsoft Academic Search

PURPOSE: The aim of this study was to identify the high-risk groups for metachronous colorectal carcinoma among patients who undergo colorectal cancer surgery. METHODS: Three hundred forty-one patients undergoing colorectal cancer surgery who had undergone surveillance colonoscopy at least twice during a period of more than three years were analyzed. A metachronous colorectal carcinoma was defined as a new colorectal

Kazutomo Togashi; Fumio Konishi; Akihito Ozawa; Tomoyuki Sato; Kazuhisa Shito; Hiroshi Kashiwagi; Masaki Okada; Hideo Nagai



Laparoscopic resection of colon Cancer: Consensus of the European Association of Endoscopic Surgery (EAES)  

Microsoft Academic Search

Background: The European Association of Endoscopic Surgery (EAES) initiated a consensus development conference on the laparoscopic resection of colon cancer during the annual congress in Lisbon, Portugal, in June 2002. Methods: Asystematic review of the current literature was combined with the opinions, of experts in the field of colon cancer surgery to formulate evidence-based statements and recommendations on the laparoscopic

R. Veldkamp; M. Gholghesaei; H. J. Bonjer; D. W. Meijer; M. Buunen; J. Jeekel; B. Anderberg; M. A. Cuesta; A. Cuschierl; A. Fingerhut; J. W. Fleshman; P. J. Guillou; E. Haglind; J. Himpens; C. A. Jacobi; J. J. Jakimowicz; F. Koeckerling; A. M. Lacy; E. Lezoche; J. R. Monson; M. Morino; E. Neugebauer; S. D. Wexner; R. L. Whelan



Cancer Incidence and Mortality After Gastric Bypass Surgery  

Microsoft Academic Search

Despite weight loss recommendations to prevent cancer, cancer outcome studies after intentional weight loss are limited. Recently, reduced cancer mortality following bariatric surgery has been reported. This study tested whether reduced cancer mortality following gastric bypass was due to decreased incidence. Cancer incidence and mortality data through 2007 from the Utah Cancer Registry (UCR) were compared between 6,596 Utah patients

Ted D. Adams; Antoinette M. Stroup; Richard E. Gress; Kenneth F. Adams; Eugenia E. Calle; Sherman C. Smith; R. Chad Halverson; Steven C. Simper; Paul N. Hopkins; Steven C. Hunt



Postoperative myocardial injury after major head and neck cancer surgery  

PubMed Central

Background Head and neck cancer patients often have multiple risk factors for coronary artery disease. Yet, little is known about the incidence of postoperative myocardial injury after major head and neck cancer surgery and its clinical relevance. The aim of the study was to determine the risk of postoperative myocardial injury in patients undergoing major head and neck cancer surgery. Methods Retrospective cohort study of all patients who underwent major head and neck cancer surgery (n=378) at a single major academic center from April 2003 to July 2008. Peak postoperative troponin I (TnI) concentration was the primary outcome. Results Of 378 patients, who underwent major head and neck cancer surgery, 57 patients (15%) developed an elevated TnI; 90% of which occurred within the first 24 hours after surgery. Pre-existing renal insufficiency (unadjusted OR [OR]: 4.60, 95% CI 1.53–13.82), coronary artery disease (OR: 2.33, 95% CI 1.21–4.50), peripheral vascular disease (OR: 2.83, 95%CI 1.31–6.14), hypertension (OR: 2.22, 95% CI 1.20–4.12), and previous combined chemotherapy and radiation (OR: 2.68, 95% CI 1.04–6.91) were associated with elevated postoperative TnI. Patients with elevated TnI had a significantly longer length of stay in the hospital (8.5 vs. 10.1 days; p= 0.014) and ICU (3 vs. 4.5 days; p= 0.001) and an 8-fold increased risk of death at 60 days after surgery (adjusted OR: 8.01, 95% CI 2.03 – 31.56). At one year, patients with an abnormal postoperative TnI were twice as likely to die (OR 1.93; 95% CI 1.02 – 3.63). Conclusions Patients who undergo major head and neck cancer surgery are at significant risk for postoperative myocardial injury which is a strong predictor of 60-day mortality after surgery. Monitoring of myocardial injury during the first postoperative days as well as optimizing preventive cardiac care may be helpful to reduce postoperative mortality.

Nagele, Peter; Rao, Lesley K.; Penta, Mrudula; Kallogjeri, Dorina; Spitznagel, Edward L.; Cavallone, Laura F.; Nussenbaum, Brian; Piccirillo, Jay F.



Surgery Choices for Women With DCIS or Breast Cancer

For women diagnosed with DCIS or breast cancer that can be removed with surgery. This guide explains types of breast surgery, such as breast-sparing surgery and mastectomy, and helps women decide which surgery is the best choice for them.


Chemotherapy Before Surgery May Increase Survival in Stomach Cancer

Chemotherapy given before surgery for cancer of the lower esophagus and stomach increased the number of patients surviving for five years compared to surgery alone, according to findings presented at the 2007 ASCO meeting in Chicago.


Risk quantification for pulmonary complications after lung cancer surgery  

Microsoft Academic Search

Purpose  The purpose of this study was to identify the risk factors for postoperative pulmonary complications and to develop a scoring\\u000a system to predict the surgical outcomes in lung cancer patients.\\u000a \\u000a \\u000a \\u000a \\u000a Methods  Clinical data were collected from January 1990 to March 2007 for 1713 patients who underwent lung cancer surgery at Chiba\\u000a University Hospital. Between January 1990 and December 2000, 1032 evaluation

Yasuo Sekine; Hidemi Suzuki; Takahiro Nakajima; Kazuhiro Yasufuku; Shigetoshi Yoshida



Inguinal hernia developed after radical retropubic surgery for prostate cancer  

PubMed Central

Purpose In this retrospective study, we aimed to compare the clinical characteristics of inguinal hernia developed after radical retropubic surgery for prostate cancer to the hernia without previous radical prostatectomy. Methods Twenty-three patients (group A) who had radical retropubic surgery for prostate cancer underwent laparoscopic or open tension-free inguinal hernia repair from March 2007 to February 2011. Nine hundred and forty patients (group B) without previous radical retropubic surgery received laparoscopic or tension-free open hernia operation. Results Group A was older than group B (mean ± standard deviation, 69.6 ± 7.2 vs. 54.1 ± 16.1; P < 0.001). Right side (73.9%) and indirect type (91.3%) in group A were more prevalent than in group B (51.5% and 69.4%, respectively) with statistic significance (P = 0.020 and P = 0.023). The rate of laparoscopic surgery in group B (n = 862, 91.7%) was higher than in group A (n = 14, 64.3%, P < 0.001). In comparing perioperative variables between the two groups, operative time (49.4 ± 23.5 minutes) and hospital stay (1.9 ± 0.7 days) in group A were longer than in group B (38.9 ± 16.9, 1.1 ± 0.2; P = 0.046 and P < 0.001, respectively) and pain score at 7 days in group A was higher than in group B (3.1 ± 0.7 vs. 2.3 ± 1.0, P < 0.001). Postoperative recurrence rate was not significantly different between the two groups. Conclusion Inguinal hernia following radical retropubic surgery for prostate cancer was predominantly right side and indirect type with statistic significance compared to hernias without previous radical prostatectomy.

Jeong, Gyu Young; Kim, Seung Han; Lee, Dong Keun



[Splenectomy in cytoreductive surgery in ovarian cancer].  


During the course of surgery for the treatment of ovarian cancer, splenectomy is rarely performed since this tumour rarely infiltrates the parenchyma although it spreads around the spleen. Surgery is significant if surgical efforts successfully reduce tumour volume to less than one centimetre in diameter. Perisplenic involvement is frequent, even if not always massive and infiltrating, in relation both to biological aggressiveness and clinical and instrumental diagnostic delay. Between January '81 and December '91 a total of 16 splenectomies were performed during the course of surgery relating to 311 (5.1%) patients suffering from mullerian ovarian carcinoma at the 3rd and 4th stage. Of these, 7 were performed during the first operation and 9 during the course of a second-look. The mean age of patients was 56 with a range of 33-71 years. Massive hilar infiltration was found in 14 cases, in 7 together with contemporary capsular infiltration. Parenchymal infiltration was present in 3 cases; one splenectomy was performed following an iatrogenic complication during the mobilization of the left colic flexure, necessary for the creation of the colon-rectal anastomosis. Splenectomy was always well tolerated in an overall assessment of surgery and was without severe local complications. The most frequent complications were pleural (7/16) with reactive effusion and bronchopulmonary with basal dystelectasia (3 cases) and bronchopneumonic foci (4 cases). A silent hematoma in a splenic site was revealed using ultrasonography in 3 cases but resolved spontaneously without requiring drainage.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:8469360

Scarabelli, C; Campagnutta, E; Zarrelli, A; De Piero, G; Volpe, R; Coran, F


Accelerated Partial Breast Irradiation After Conservative Surgery for Breast Cancer  

PubMed Central

Objective: To critically review the theoretical and actual risks and benefits of accelerated partial breast irradiation (APBI) after breast-conserving surgery. Summary Background Data: Because of rapid evolution of radiation therapy techniques related to brachytherapy and three-dimensional conformal radiation therapy, APBI has very recently come to the forefront as a potential local treatment option for women with breast cancer. This review aims to give an overview of the biologic rationale for APBI techniques, and benefits and limitations of APBI techniques. Methods: The authors reviewed the currently available published world medical literature on breast-conserving surgery with and without postoperative irradiation; all studies involving partial breast irradiation, including brachytherapy, for breast cancer; and currently accruing and planned APBI trials. The focus of this review was the early results of treatment in terms of toxicity, complications, cosmesis, and local control. Results: On average, approximately 3% of patients treated with breast-conserving surgery will have an in-breast local recurrence away from the original lumpectomy site with or without postoperative standard whole-breast irradiation. The results of phase I-II studies involving approximately 500 patients treated with APBI after breast-conserving surgery have been published. Although many of the studies have limited long-term follow-up and potential selection bias, early results suggest that toxicity, cosmesis, and local control are comparable to outcomes seen after breast-conserving surgery followed by standard whole-breast irradiation. Conclusions: Recent advances in radiation delivery and published series of partial breast irradiation support large randomized trials comparing APBI with standard whole-breast irradiation after breast-conserving surgery.

Kuerer, Henry M.; Julian, Thomas B.; Strom, Eric A.; Lyerly, H Kim; Giuliano, Armando E.; Mamounas, Eleftherios P.; Vicini, Frank A.



Minimally Invasive Surgery for Colorectal Cancer: Past, Present, and Future  

PubMed Central

A rapid progression from conventional open surgery to minimally invasive approaches in the surgical management of colorectal cancer has occurred over the last 2 decades. Initial concerns that this new approach was oncologically inferior to open surgery were ultimately refuted when several prospective randomized trials concluded that laparoscopic colectomy could achieve similar oncologic outcomes to open surgery. On the contrary, level 1 data has not yet matured regarding the oncologic safety of minimally invasive approaches for rectal cancer. We review the published literature pertaining to the evolution of minimally invasive techniques used to treat colorectal cancer surgery, including barriers to adoption, and the prospects for future advances related to innovative techniques.

Holder-Murray, J.; Dozois, E. J.



High-dose chemoradiotherapy followed by surgery versus surgery alone in esophageal cancer: a retrospective cohort study  

Microsoft Academic Search

BACKGROUND: We aimed to assess whether high-dose preoperative chemoradiotherapy (CRT) improves outcome in esophageal cancer patients compared to surgery alone and to define possible prognostic factors for overall survival. METHODS: Hundred-and-seven patients with disease stage IIA - III were treated with either surgery alone (n = 45) or high-dose preoperative CRT (n = 62). The data were collected retrospectively. Sixty-seven

Meysan Hurmuzlu; Kjell Øvrebø; Odd R Monge; Rune Smaaland; Tore Wentzel-Larsen; Asgaut Viste



A Y-shaped vinyl hood that creates pneumoperitoneum in laparoscopic rectal cancer surgery (Y-hood method.): a new technique for laparoscopic low anterior resection  

Microsoft Academic Search

Background  Many studies have focused on laparoscopic techniques for the treatment of colon cancer, but such work is more limited for\\u000a the treatment of rectal cancer, largely because of concerns for safety issues. This report presents an effective method of\\u000a anal lavage and excision in laparoscopic low anterior resection.\\u000a \\u000a \\u000a \\u000a Methods  The authors developed clamp forceps for intestinal lavage and a Y-shaped vinyl

Shoichi Fujii; Mitsuyoshi Ota; Shigeru Yamagishi; Chikara Kunisaki; Shunichi Osada; Hirokazu Suwa; Yasushi Ichikawa; Hiroshi Shimada



Robot-assisted laparoscopic radical prostatectomy after previous cancer surgery  

Microsoft Academic Search

Robot-assisted laparoscopic radical prostatectomy has become a frequently used alternative treatment option in the management\\u000a of prostate cancer. As more operations are performed, more challenging patient conditions are encountered, for example those\\u000a with previous abdominal cancer surgery. We present our experience of robot-assisted laparoscopic radical prostatectomy (RALP)\\u000a in patients with previous cancer surgery. Seven patients with a history of previous

Kwang Hyun Kim; Enrique Ian S. Lorenzo; Wooju Jeong; Cheol Kyu Oh; Ho Song Yu; Koon Ho Rha



Thyroid cancer: surgery for the primary tumor.  


Surgery is the mainstay of therapy for most patients who present with thyroid cancer. The surgeon must select an appropriate procedure based upon pre operative factors such as tumor histology, extent of primary disease, the presence of regional or distant metastases, associated disease in the contralateral thyroid lobe and the potential for post operative adjuvant therapy. Preservation of the vital structures in the central neck, including the recurrent and superior laryngeal nerves and the parathyroid glands is critical as is the maintenance of absolute hemostasis. In this review article we describe the management of Well Differentiated Thyroid Cancer (WDTC) presenting as a solitary nodule, WDTC in a background of multinodular disease and the management of WDTC presenting as advanced local disease. We go onto discuss the impact that regional and distant metastases have on the choice of surgical approach. The focus of this article is WDTC, however the principles of management of the primary in medullary and anaplastic carcinoma are also discussed. PMID:23623837

Nixon, I J; Ganly, I; Shah, J P



The unsatisfactory margin in breast cancer surgery  

Microsoft Academic Search

Background: Surgical margin involvement with breast cancer usually results in obligatory reexcision or mastectomy. While unalterable occult host and pathologic factors may interfere with margin clearance during the initial excision, it is possible that alterations in surgical technique might increase the likelihood of obtaining satisfactory margins.Methods: Two hundred and thirty-five patients who were candidates for breast conservation therapy were identified

Han H Luu; Christopher N Otis; William P Reed; Jane L Garb; James L Frank



Breast surgery in stage IV breast cancer: impact of staging and patient selection on overall survival  

Microsoft Academic Search

Purpose Retrospective analyses suggest patients with stage IV breast cancer who undergo breast surgery have improved survival. We\\u000a sought to determine whether surgery and other clinical and staging factors affected overall survival. Methods We performed a review of our prospectively maintained database of patients who presented with stage IV breast cancer between\\u000a 1998 and 2005. We compared survival between women

Andrea C. Bafford; Harold J. Burstein; Christina R. Barkley; Barbara L. Smith; Stuart Lipsitz; James D. Iglehart; Eric P. Winer; Mehra Golshan



Long-term Outcomes of Laparoscopic Surgery for Colorectal Cancer  

PubMed Central

Purpose The long-term results of a laparoscopic resection for colorectal cancer have been reported in several studies, but reports on the results of laparoscopic surgery for rectal cancer are limited. We investigated the long-term outcomes, including the five-year overall survival, disease-free survival and recurrence rate, after a laparoscopic resection for colorectal cancer. Methods Using prospectively collected data on 303 patients with colorectal cancer who underwent a laparoscopic resection between January 2001, and December 2003, we analyzed sex, age, stage, complications, hospital stay, mean operation time and blood loss. The overall survival rate, disease-free survival rate and recurrence rate were investigated for 271 patients who could be followed for more than three years. Results Tumor-node-metastasis (TNM) stage I cancer was present in 55 patients (18.1%), stage II in 116 patients (38.3%), stage III in 110 patients (36.3%), and stage IV in 22 patients (7.3%). The mean operative time was 200 minutes (range, 100 to 535 minutes), and the mean blood loss was 97 mL (range, 20 to 1,200 mL). The mean hospital stay was 11 days and the mean follow-up period was 54 months. The mean numbers of resected lymph nodes were 26 and 21 in the colon and the rectum, respectively, and the mean distal margins were 10 and 3 cm. The overall morbidity rate was 26.1%. The local recurrence rates were 2.2% and 4.4% in the colon and the rectum, respectively, and the distant recurrence rates were 7.8% and 22.5%. The five-year overall survival rates were 86.1% in the colon (stage I, 100%; stage II, 97.6%; stage III, 77.5%; stage IV, 16.7%) and 68.8% in the rectum (stage I, 90.2%; stage II, 84.0%; stage III, 57.6; stage IV, 13.3%). The five-year disease-free survival rates were 89.8% in the colon (stage I, 100%; stage II, 97.7%; stage III, 74.2%) and 74.5% in the rectum (stage I, 90.0%; stage II, 83.9%; stage III, 59.2%). Conclusion Laparoscopic surgery for colorectal cancer is a good alternative method to open surgery with tolerable oncologic long-term results.

Lee, Jeong-Eun; Yoo, Sang-hwa; Jeong, Geu-Young; Kim, Sung-Han; Chung, Choon-Sik; Lee, Dong-Gun; Kim, Seon Hahn



Impact of intraoperative lung-protective interventions in patients undergoing lung cancer surgery  

Microsoft Academic Search

INTRODUCTION: In lung cancer surgery, large tidal volume and elevated inspiratory pressure are known risk factors of acute lung (ALI). Mechanical ventilation with low tidal volume has been shown to attenuate lung injuries in critically ill patients. In the current study, we assessed the impact of a protective lung ventilation (PLV) protocol in patients undergoing lung cancer resection. METHODS: We

Marc Licker; John Diaper; Yann Villiger; Anastase Spiliopoulos; Virginie Licker; John Robert; Jean-Marie Tschopp



Intraoperative Cerenkov Imaging for Guiding Breast Cancer Surgery and Assessing Tumor Margins.  

National Technical Information Service (NTIS)

Breast-conserving surgery is standard treatment for breast cancer. However, to be effective, the surgery must remove all malignant tissue. Currently, a significant fraction of BCS patients require additional re- excision surgery to remove residual cancer....

G. Pratx



Cancer-Surgery Complications Rise While Death Risk Drops  


... please enable JavaScript. Cancer-Surgery Complications Rise While Death Risk Drops Decade-long study covered 2.5 ... undergoing these procedures," Sammon said. Despite the falling death rates, more needs to be done to prevent ...


Patients With Esophageal Cancer May Be Able to Avoid Surgery

Patients with esophageal cancer lived just as long after receiving chemoradiation therapy alone as did those whose chemoradiation therapy was followed by surgery, according to the April 1, 2007, Journal of Clinical Oncology.


Venous Thromboembolism in Cancer Patients Undergoing Major Surgery  

Microsoft Academic Search

Background  Cancer patients undergoing major abdominal or pelvic surgery are at considerable risk of venous thromboembolism (VTE). The\\u000a genesis of thromboses in malignancy is complicated, and reflects the interaction and derangement of multiple molecular pathways.\\u000a Furthermore, the nature and location of the cancer, as well as the type surgery involved, are thought to affect the level\\u000a of VTE risk. These considerations

Nicolas H. Osborne; Thomas W. Wakefield; Peter K. Henke



[Laparoscopic surgery for gastric cancer: indications and limitations].  


Gastric cancer has been successfully treated by both endoscopic and open surgery, while early-stage gastric cancer with some risk of lymph node metastasis is managed with laparoscopic surgery. The principle of treatment of gastric cancer is to perform a complete resection of the lesion with safe and appropriate procedures based on disease stage. Three types of laparoscopic surgery have been reported: laparoscopy-assisted distal gastrectomy (LADG); laparoscopic local resection with the use of aT-fastener; and intragastric mucosal resection. In local resection, there is a possibility that past of the lesion or lymph node metastases may remain. D2 lymph node dissection requires a longer operative time and technical difficulties causing postoperative complications may be encountered. At present, LADG is the preferred choice of treatment in patients with early-stage gastric cancers due to the acceptable length of surgery and simple lymph node harvesting. For the wider application of minimally invasive surgery, numerous advances in operative procedures, including hand-assisted surgery and sentinel node navigation surgery, are required, along with technical developments for more accurate diagnosis to offer ideal treatment for each stage of gastric cancer. PMID:11681000

Kitano, S; Yasuda, K; Shiraishi, N; Adachi, Y



The impact of obesity on outcomes of laparoscopic surgery for colorectal cancer in Asians  

Microsoft Academic Search

Background  The influence of obesity on surgical outcomes after laparoscopic colorectal surgery in Asian patients is unclear. The aim\\u000a of this study was to evaluate the feasibility and safety of laparoscopic surgery in obese Asian patients with colorectal cancer.\\u000a \\u000a \\u000a \\u000a \\u000a Methods  We retrospectively reviewed the prospectively collected data on 984 consecutive patients who underwent laparoscopic surgery\\u000a for colorectal cancer between May 2001 and

Ji Won Park; Seok-Byung Lim; Hyo Seong Choi; Seung-Yong Jeong; Jae Hwan Oh



Pre-Surgery Psychological Factors Predict Pain, Nausea and Fatigue One Week Following Breast Cancer Surgery  

PubMed Central

Prior to scheduled surgery, breast cancer surgical patients frequently experience high levels of distress and expect a variety of post-surgery symptoms. Previous literature has supported the view that pre-surgery distress and response expectancies are predictive of post-surgery outcomes. However, the contributions of distress and response expectancies to post-surgical side effect outcomes have rarely been examined together within the same study. Furthermore, studies on the effects of response expectancies in the surgical setting have typically focused on the immediate post-surgical setting rather than the longer term. The purpose of the present study was to test the contribution of pre-surgery distress and response expectancies to common post-surgery side effects (pain, nausea, fatigue). Female patients (n=101) undergoing breast cancer surgery were recruited to a prospective study. Results indicated that pre-surgery distress uniquely contributed to patients’ post-surgery pain severity (P<0.05) and fatigue (P<0.003) one week following surgery. Response expectancies uniquely contributed to pain severity (P<0.001), nausea (P<0.012) and fatigue (P<0.010) one week following surgery. Sobel tests indicated that response expectancies partially mediated the effects of distress on pain severity (P<0.03) and fatigue (P<0.03). Response expectancies also mediated the effects of age on pain severity, nausea and fatigue. Results highlight the contribution of pre-surgery psychological factors to post-surgery side effects, the importance of including both emotional and cognitive factors within studies as predictors of post-surgery side effects, and suggest pre-surgical clinical targets for improving patients’ postoperative experiences of side effects.

Montgomery, Guy H.; Schnur, Julie B.; Erblich, Joel; Diefenbach, Michael A.; Bovbjerg, Dana H.



Sarcoma - Adult Soft Tissue Cancer: Surgery  


... see if cancer is growing in the edges ( margins ) of the specimen. If cancer cells are present ... the tissue removed is said to have positive margins. This means that cancer cells may have been ...


The quality of research synthesis in surgery: the case of laparoscopic surgery for colorectal cancer  

PubMed Central

Background Several systematic reviews and meta-analyses populate the literature on the effectiveness of laparoscopic surgery for colorectal cancer. The utility of this body of work is unclear. The objective of this study was to synthesize all such systematic reviews in terms of clinical effectiveness, to appraise their quality, and to determine whether areas of duplication exist across reviews. Methods Systematic reviews comparing laparoscopic and open surgery for colorectal cancer were identified using a comprehensive search protocol (1991 to 2008). The primary outcome was overall survival. The methodological quality of reviews was appraised using the Assessment of Multiple Systematic Reviews (AMSTAR) instrument. Abstraction and quality appraisal was carried out by two independent reviewers. Reviews were synthesized, and outcomes were compared qualitatively. A citation analysis was carried out using simple matrices to assess the comprehensiveness of each review. Results In total, 27 reviews were included; 13 reviews included only randomized controlled trials. Rectal cancer was addressed exclusively by four reviews. There was significant overlap between review purposes, populations and, outcomes. The mean AMSTAR score (out of 11) was 5.8 (95% CI: 4.6 to 7.0). Overall survival was evaluated by ten reviews, none of which found a significant difference. Three reviews provided a selective meta-analysis of time-to-event data. Previously published systematic reviews were poorly and highly selectively referenced (mean citation ratio 0.16, 95% CI: 0.093 to 0.22). Previously published trials were not comprehensively identified and cited (mean citation ratio 0.56, 95% CI: 0.46 to 0.65). Conclusions Numerous overlapping systematic reviews of laparoscopic and open surgery for colorectal cancer exist in the literature. Despite variable methods and quality, survival outcomes are congruent across reviews. A duplication of research efforts appears to exist in the literature. Further systematic reviews or meta-analyses are unlikely to be justified without specifying a significantly different research objective. This works lends support to the registration and updating of systematic reviews.



[Comparison of robotic surgery documentary in gynecological cancer].  


Robotic surgery is a surgical technique recently introduced, with major expansion and acceptance among the medical community is currently performed in over 1,000 hospitals around the world and in the management of gynecological cancer are being developed comprehensive programs for implementation. The objectives of this paper are to review the scientific literature on robotic surgery and its application in gynecological cancer to verify its safety, feasibility and efficacy when compared with laparoscopic surgery or surgery classical major surgical complications, infections are more common in traditional radical surgery compared with laparoscopic or robotic surgery and with these new techniques surgical and staying hospital are lesser than the former however, the disadvantages are the limited number of robot systems, their high cost and applies only in specialized centers that have with equipment and skilled surgeons. In conclusion robotic surgery represents a major scientific breakthrough and surgical management of gynecological cancer with better results to other types of conventional surgery and is likely in the coming years is become its worldwide. PMID:23336154

Vargas-Hernández, Víctor Manuel


[Oncoplastic surgery for the treatment of breast cancer].  


Surgery is still the gold standard in breast cancer. Also if the elective treatment, thanks to the adjuvant therapy, ha became more conservative than once was, breast surgery remains, in the mind of the woman affected by breast cancer, a demolitive surgery. The collaboration bet-ween the breast surgeon and the plastic surgeon has to be closer than it is, in order to obtain the total asportation of the tumor and an esthetic result that limits the psychological trauma to the woman. Oncoplastic surgery is the answer to these human and medical necessities, giving the correct approaches about breast volume, tumor volume, radicality of the treatment and esthetic outcome. This review will focus on different oncoplastic approaches, to help improving both the esthetic outcome of breast cancer resection and the likelihood of surgeons obtaining wide surgical margins in preparation for breast-conserving radiotherapy. PMID:19749675

Colombo, G; Dellacasa, I; Ruvolo, V; Ottonello, M; Bormioli, M; Meszaros, P



A method using vestibulo-sulcoplasty combining a split-thickness skin graft and a palatal keratinized mucosa graft for peri-implant tissue secondary to oral cancer surgery.  


Twelve patients presented with oral submucosal fibrosis and loss of keratinized gingiva in a compromised vestibule of a severely deficient mandibular edentulous ridge secondary to oral cancer surgery. They received implant rehabilitation with a total of 49 fixtures without major bone graft augmentation. To overcome vestibular compromise, soft tissue management consisting of simultaneous vestibulo-sulcoplasty, split-thickness skin graft (STSG), and palatal keratinized mucosa graft (KMG) was performed as a second stage when healing abutment was transferred to replace the cover screw of the dental implant. Postoperative follow-up of all patients consisted of clinical and radiographic examinations for an average of 4 years, revealing good stability of implant fixtures with a 91.8% success rate and generally healthy peri-implant tissue, the latter with an average sulcus depth of 2.9 +/- 0.6 mm. Satisfactory results were also demonstrated regarding improved morphology of the vestibule, cosmetics, and prosthetic functionality. Vestibulo-sulcoplasty combining STSG and palatal KMG offers a stable and convenient method for rebuilding peri-implant tissue without need for bone grafting in selected patients who have compromised atrophic ridges secondary to cancer surgery. PMID:16145846

Kao, Shou-Yen; Lui, Man-tin; Fong, Jenny; Wu, Dmsc Che-wei; Wu, Cheng-Hsien; Tu, Hsi-Feng; Hung, Kai-Feng; Yeung, Tze-Cheung



Does surgery modify growth kinetics of breast cancer micrometastases?  

Microsoft Academic Search

Surgery should be considered as a major perturbing factor for metastasis development in laboratory animals. The different time distribution of mortality for 1173 patients undergoing mastectomy in comparison with 250 untreated patients suggests that primary tumour removal could result in changes of the metastatic process even for breast cancer. © 2001 Cancer Research Campaign http:\\/\\/

R Demicheli; P Valagussa; G Bonadonna



[Minimal-invasive surgery for lung cancer - strategies and limits].  


Minimal invasive surgical procedures, also known as keyhole surgery, have gained in importance in the last years and have become the standard of care in experienced hands for most surgical procedures. Despite initial concerns with respect to the radicalness of the approach it is nowadays also established in oncologic surgery. Minimal invasive procedures aim at minimizing the operative trauma and associated inflammatory reactions to achieve faster convalescence after surgery. In addition to obvious cosmetic advantages minimal invasive surgery has been shown to be associated with fewer postoperative pain and shorter postoperative rehabilitation and faster reintegration into everyday as well as working life. With 15% of all cancer diagnoses and 29% of all cancer-associated causes of death, lung cancer is the most frequent malignancy in the general public and hence the treatment of lung cancer is a main focus of thoracic surgery. Within the scope of modern multimodal treatment concepts radical surgical resection of lung cancer is essential and the main pillar of curative treatment. In early stage lung cancer the current standard of care is a thoracoscopic lobectomy with mediastinal lymphadenectomy. The expertise of specialized centers allows for curative minimal-invasive treatment in a large number of patients, particularly of patients of advanced age or with limited pulmonary function. PMID:22753289

Schneiter, D; Weder, W



Chronic preoperative pain and psychological robustness predict acute postoperative pain outcomes after surgery for breast cancer  

PubMed Central

Background: Few epidemiological studies have prospectively investigated preoperative and surgical risk factors for acute postoperative pain after surgery for breast cancer. We investigated demographic, psychological, pain-related and surgical risk factors in women undergoing resectional surgery for breast cancer. Methods: Primary outcomes were pain severity, at rest (PAR) and movement-evoked pain (MEP), in the first postoperative week. Results: In 338 women undergoing surgery, those with chronic preoperative pain were three times more likely to report moderate to severe MEP after breast cancer surgery (OR 3.18, 95% CI 1.45–6.99). Increased psychological ‘robustness', a composite variable representing positive affect and dispositional optimism, was associated with lower intensity acute postoperative PAR (OR 0.63, 95% CI 0.48–0.82) and MEP (OR 0.71, 95% CI 0.54–0.93). Sentinel lymph node biopsy (SLNB) and intraoperative nerve division were associated with reduced postoperative pain. No relationship was found between preoperative neuropathic pain and acute pain outcomes; altered sensations and numbness postoperatively were more common after axillary sample or clearance compared with SLNB. Conclusion: Chronic preoperative pain, axillary surgery and psychological robustness significantly predicted acute pain outcomes after surgery for breast cancer. Preoperative identification and targeted intervention of subgroups at risk could enhance the recovery trajectory in cancer survivors.

Bruce, J; Thornton, A J; Scott, N W; Marfizo, S; Powell, R; Johnston, M; Wells, M; Heys, S D; Thompson, A M



A Clinical Outcome-Based Prospective Study on Venous Thromboembolism After Cancer Surgery  

PubMed Central

Summary Background Data: The epidemiology of venous thromboembolism (VTE) after cancer surgery is based on clinical trials on VTE prophylaxis that used venography to screen deep vein thrombosis (DVT). However, the clinical relevance of asymptomatic venography-detected DVT is unclear, and the population of these clinical trials is not necessarily representative of the overall cancer surgery population. Objective: The aim of this study was to evaluate the incidence of clinically overt VTE in a wide spectrum of consecutive patients undergoing surgery for cancer and to identify risk factors for VTE. Methods: @RISTOS was a prospective observational study in patients undergoing general, urologic, or gynecologic surgery. Patients were assessed for clinically overt VTE occurring up to 30 ± 5 days after surgery or more if the hospital stay was longer than 35 days. All outcome events were evaluated by an independent Adjudication Committee. Results: A total of 2373 patients were included in the study: 1238 (52%) undergoing general, 685 (29%) urologic, and 450 (19%) gynecologic surgery. In-hospital prophylaxis was given in 81.6% and postdischarge prophylaxis in 30.7% of the patients. Fifty patients (2.1%) were adjudicated as affected by clinically overt VTE (DVT, 0.42%; nonfatal pulmonary embolism, 0.88%; death 0.80%). The incidence of VTE was 2.83% in general surgery, 2.0% in gynecologic surgery, and 0.87% in urologic surgery. Forty percent of the events occurred later than 21 days from surgery. The overall death rate was 1.72%; in 46.3% of the cases, death was caused by VTE. In a multivariable analysis, 5 risk factors were identified: age above 60 years (2.63, 95% confidence interval, 1.21–5.71), previous VTE (5.98, 2.13–16.80), advanced cancer (2.68, 1.37–5.24), anesthesia lasting more than 2 hours (4.50, 1.06–19.04), and bed rest longer than 3 days (4.37, 2.45–7.78). Conclusions: VTE remains a common complication of cancer surgery, with a remarkable proportion of events occurring late after surgery. In patients undergoing cancer surgery, VTE is the most common cause of death at 30 days after surgery.

Agnelli, Giancarlo; Bolis, Giorgio; Capussotti, Lorenzo; Scarpa, Roberto Mario; Tonelli, Francesco; Bonizzoni, Erminio; Moia, Marco; Parazzini, Fabio; Rossi, Romina; Sonaglia, Francesco; Valarani, Bettina; Bianchini, Carlo; Gussoni, Gualberto



Extrahepatic Bile Duct Cancers: Surgery Alone Versus Surgery Plus Postoperative Radiation Therapy  

SciTech Connect

Purpose: The goal of this study was to determine the role of radiotherapy after curative-intent surgery in the management of extrahepatic bile duct (EHBD) cancers. Methods and Materials: From 1997 through 2005, 78 patients with EHBD cancer were surgically staged. These patients were stratified by the absence of adjuvant radiation (n = 47, group I) versus radiation (n = 31, group II) after resection. Pathology examination showed 27 cases in group I and 20 cases in group II had microscopically positive resection margins. The patients in group II received 45 to 54 Gy of external beam radiotherapy. The primary endpoints of this study were overall survival, disease-free survival, and prognostic factors. Results: There were no differences between the 5-year overall survival rates for the two groups (11.6% in group I vs. 21% in group II). However, the patients with microscopically positive resection margins who received adjuvant radiation therapy had higher median disease-free survival rates than those who underwent surgery alone (21 months vs. 10 months, respectively, p = 0.042). Decreasing local failure was found in patients who received postoperative radiotherapy (61.7% in group I and 35.6% in group II, p = 0.02). Outcomes of the patients with a positive resection margin and lymph node metastasis who received postoperative radiation therapy were doubled compared to those of patients without adjuvant radiotherapy. Resection margin status, lymph node metastasis, and pathology differentiation were significant prognostic factors in disease-free survival. Conclusions: Adjuvant radiotherapy might be useful in patients with EHBD cancer, especially for those patients with microscopic residual tumors and positive lymph nodes after resection for increasing local control.

Gwak, Hee Keun [Department of Radiation Oncology, Inha University College of Medicine, Incheon (Korea, Republic of); Kim, Woo Chul, E-mail: [Department of Radiation Oncology, Inha University College of Medicine, Incheon (Korea, Republic of); Kim, Hun Jung; Park, Jeong Hoon [Department of Radiation Oncology, Inha University College of Medicine, Incheon (Korea, Republic of)



Venous thromboembolism prevention in patients undergoing colorectal surgery for cancer.  


INTRODUCTION: Patients undergoing surgery for colorectal cancer are at high risk of post-operative venous thromboembolism (VTE). Thromboprophylaxis has been shown to have significant risk reduction, although there remains some controversy surrounding the optimal duration of pharmacological prophylaxis. Our institution does not routinely practise extended prophylaxis. The aim of this study was to retrospectively review the rate of post-operative thromboprophylaxis in colorectal cancer patients, and incidence of symptomatic VTE. METHODS: We conducted a retrospective audit of 200 consecutive patients who underwent colorectal surgery for cancer. Data to 90 days post-operatively were collected from medical records and imaging and phone calls to patients and family practitioners. RESULTS: Of the patients, 98% received pharmacological prophylaxis, with a median duration of eight days. Eight (4%) symptomatic VTEs were diagnosed within the 90-day follow-up period: two deep vein thrombosis (DVTs), five pulmonary emboli (PE) and one patient with both PE and DVT. A higher proportion of patients developed DVT/PE if they received prophylaxis other than low molecular weight heparin and similarly there was a trend in increased risk of DVT in the presence of metastatic disease. However, using univariate analysis, these results were not statistically significant (P = 0.18 and 0.11, respectively). DISCUSSION: The use of thromboprophylaxis was high in our centre, and the incidence of VTE was low when patients received a median of 8 days pharmacological prophylaxis combined with mechanical prophylaxis. The VTE incidence of 4% is similar to previous studies using extended prophylaxis. Our study findings do not support changing local protocol to extended prophylaxis. PMID:23782713

Holwell, Anna; McKenzie, Jo-Lyn; Holmes, Miranda; Woods, Rodney; Nandurkar, Harshal; Tam, Constantine S; Bazargan, Ali



Contralateral pneumothorax after lung cancer surgery: report of two cases.  


Due to recent increases in numbers of patients who underwent surgical treatments for lung cancer, numbers of complications of contralateral pneumothorax after lung surgery are suggested to increase. Moreover, recent spread of surgical indication to elderly people and patients with severely damaged pulmonary function may lead postoperative complication of contralateral pneumothorax more lethal. We herein describe 2 cases of contralateral pneumothorax following lung cancer surgery with a review of recent literatures. Case 1 underwent left lower lobectomy with combined partial resection of the chest wall for lung cancer. Five months later, he suffered from contralateral pneumothorax and respiratory failure. Immediate chest drainage followed by bullectomy and pleurodesis were performed. Case 2 was surgically treated for left lung cancer. Preoperative computed tomography incidentally demonstrated contralateral pneumothorax. Chest drainage was started immediately, followed by left lower lobectomy. Contralateral bullectomy and pleurodesis were performed 6 days after lobectomy. Both patients have been well without recurrence of pneumothorax or lung cancer. PMID:18819264

Iwata, Takashi; Inoue, Kiyotoshi; Nishiyama, Noritoshi; Izumi, Nobuhiro; Mizuguchi, Shinjiro; Morita, Ryuhei; Tsukioka, Takuma; Suehiro, Shigefumi



Tangential Radiotherapy Without Axillary Surgery in Early-Stage Breast Cancer: Results of a Prospective Trial  

Microsoft Academic Search

Purpose: To determine the risk of regional-nodal recurrence in patients with early-stage, invasive breast cancer, with clinically negative axillary nodes, who were treated with breast-conserving surgery, 'high tangential' breast radiotherapy, and hormonal therapy, without axillary surgery or the use of a separate nodal radiation field. Methods and Materials: Between September 1998 and November 2003, 74 patients who were {>=}55 years

Julia S. Wong; Alphonse G. Taghian; Jennifer R. Bellon; Aparna Keshaviah; Barbara L. Smith; Eric P. Winer; Barbara Silver; Jay R. Harris



Long-term health-related quality of life following surgery for lung cancer  

Microsoft Academic Search

Objective: The aim of the study was to examine the long-term health-related quality of life following surgery for lung cancer. Methods: We performed a prospective population-based cohort study to explore health-related quality of life after lung surgery. We used a validated quality-of-life instrument (Short Form-36 (SF-36)) to gather information on health-related quality of life at baseline, 6 months, and 2

Axel Möller; Ulrik Sartipy


Improved Outcomes Associated with Higher Surgery Rates for Older Patients with Early-Stage Non-Small Cell Lung Cancer  

PubMed Central

Background Although surgery offers the greatest chance of cure for patients with early stage non-small cell lung cancer (NSCLC), older and sicker patients often fail to undergo resection. The benefits of surgery in older patients and patients with multiple co-morbidities are uncertain. Methods We identified a national cohort of 17,638 Medicare beneficiaries, aged ?66 years living in Surveillance, Epidemiology, and End Results (SEER) areas who were diagnosed with stage I or II NSCLC during 2001–2005. We compared areas with high and low rates of curative surgery for early-stage lung cancer to estimate the effectiveness of surgery in older and sicker patients. We used logistic regression models to assess mortality by quintile of area-level surgery rates, adjusting for potential confounders. Findings Fewer than 63% of patients underwent surgery in low-surgery areas while >79% underwent surgery in high-surgery areas. High-surgery areas operated on more patients with advanced age and COPD than low-surgery areas. Adjusted all-cause one year mortality was 18.0% in high-surgery areas vs. 22.8% in low-surgery areas (adjusted odds ratio (OR)=0.89 (95% confidence interval [CI] 0.86–0.93) for each 10% increase in surgery rates). One year lung-cancer-specific mortality was similarly lower in high-versus low-surgery areas (12.0% versus 16.9%), adjusted OR=0.86 (95% CI 0.82–0.91) for each 10% increase in surgery rates. Interpretations Higher rates of surgery for stage I/II NSCLC are associated with improved survival, even when older patients and sicker patients undergo resection. More work is needed to identify and reduce barriers to surgery for early-stage NSCLC.

Gray, Stacy W.; Landrum, Mary Beth; Lamont, Elizabeth B.; McNeil, Barbara J.; Jaklitsch, Michael T.; Keating, Nancy L.



Persisting anorectal dysfunction after rectal cancer surgery.  


AIM: Sphincter saving rectal cancer management affects anorectal function. This study evaluated persisting anorectal dysfunction and its impact on patients' well-being. METHOD: Seventy-nine patients with a follow-up of 12 - 37 (median 22) months and seventy-nine age- and sex-matched control subjects completed questionnaires. RESULTS: The median number of diurnal bowel movements was 3 in patients and 1 in controls (p<.0001). Nocturnal defecation occurred in 53% of patients. The median Vaizey score was 8 in patients and 4 in controls (p<.0001). Urgency without incontinence was reported by 47% of patients and 49% of controls (p=0.873), soiling by 28% of patients and 3% in controls (p<0.0001), incontinence for flatus by 73% of patients and 49% of controls (p=0.0019), incontinence for solid stools by 16% of patients and 4% of controls (p=0.0153). Incontinence of liquid stools occurred in 17 of 20 patients and 1 of 5 controls who had liquid stools (p=0.0123). Incontinence for gas, liquid or solid stool occurred once or more weekly in 47%, 19% and 6% of patients respectively. Evacuation difficulties were reported by 98% of patients, but also by 77% in controls. Neoadjuvant radio(chemo)therapy adversely affected defecation frequency and continence. Incontinence was associated with severe discomfort in 50% of patients, severe anxiety in 40%, and severe embarrassment in 48%. CONCLUSION: Anorectal dysfunction is a frequent problem after management of rectal cancer with an impact on the wellbeing of patients. This article is protected by copyright. All rights reserved. PMID:23692392

Maris, A; Penninckx, F; Devreese, A M; Staes, F; Moons, P; Van Cutsem, E; Haustermans, K; D'Hoore, A



Association of clinical experiences with patient-reported outcomes among breast cancer surgery patients: breast cancer quality care study  

Microsoft Academic Search

Background  We aimed to clarify the association of breast cancer patients’ clinical experiences with patient-reported outcomes (PRO) of\\u000a satisfaction with care, choice of the same type of surgery again, and health-related quality of life (HRQOL).\\u000a \\u000a \\u000a \\u000a Methods  There were 2,403 (25.9%) of 9,283 eligible women who had undergone primary curative surgery for breast cancer in one of five\\u000a selected hospitals between 1993 and

Dong Young Noh; Seok Jin Nam; Se Hyun Ahn; Byeong Woo Park; Eun Sook Lee; Myung Kyung Lee; Soo Hyun Kim; Yoo Min Kim; Sang Min Park; Young Ho Yun



Comparison of robotic-assisted surgery outcomes with laparotomy for endometrial cancer staging in Turkey  

Microsoft Academic Search

Purpose  To compare the results of patients on whom staging was applied by robotic-assisted laparoscopic surgery and laparotomy for\\u000a endometrial cancer.\\u000a \\u000a \\u000a \\u000a \\u000a Method  The study included 10 patients who had undergone robotic-assisted endometrial staging (group 1) and 12 patients staged by\\u000a open surgery (group 2). Demographical characteristics and operative outcomes of all patients were compared. Body mass index,\\u000a age, previous abdominal surgeries, histopathologic

Ahmet GocmenFatih; Fatih ?anl?kan; Mustafa Gazi Uçar



Trocar site recurrence in laparoscopic surgery for colorectal cancer  

Microsoft Academic Search

Background  Laparoscopic colorectal surgery has been associated with less postoperative pain, an early return of bowel function, a shorter\\u000a period of hospitalization and disability, and better cosmetic results. However, the application of laparoscopic techniques\\u000a to the curative resection of colorectal cancer is still controversial, owing to reports of cancer recurrence at the port site\\u000a wounds. The accumulation of numerous such reports

O. Zmora; P. Gervaz; S. D. Wexner



Cancer surgery: the last 25 years  

Microsoft Academic Search

Surgery is, and always has been, the main treatment modality of solid tumours. For a long period, it consisted of a number of surgical procedures dictated by basic oncologic principles, most of which are still adhered to. Over the last few decades, increased understanding of the disease, new or improved diagnostic facilities, novel and perfected adjuvant treatments, improved surgical techniques

A. J. A. Bremers; E. J. Th. Rutgers



Surgery Insight: surgical management of pancreatic cancer  

Microsoft Academic Search

Pancreatic ductal adenocarcinoma is a common malignancy of the gastrointestinal tract. The number of new cases diagnosed and the number of deaths each year are almost identical, demonstrating the particularly dismal prognosis for patients affected by this disease. Despite recent advances in the field of medical and radiation oncology, and the introduction of neoadjuvant and adjuvant regimens, surgery remains the

Christoph W Michalski; Jürgen Weitz; Markus W Büchler



Prognostic and predictive relevance of CA125 at primary surgery of ovarian cancer  

Microsoft Academic Search

Introduction  Despite radical surgery and chemotherapy, most patients with ovarian cancer develop recurrence and die due to progressive\\u000a disease. To stratify patients for optimal therapy, prognostic and predictive factors are needed. We examined the role of pre-\\u000a and postoperative CA-125 in this context.\\u000a \\u000a \\u000a \\u000a \\u000a Methods  A total of 231 patients with primary ovarian cancer who presented for surgery at our institution between 1996

Dina Mury; Linn Woelber; Sabine Jung; Christine Eulenburg; Matthias Choschzick; Isabell Witzel; Joerg Schwarz; Fritz Jaenicke; Sven Mahner



Laparoscopic Versus Open Surgery for Rectal Cancer: A Meta-Analysis  

Microsoft Academic Search

Background  Laparoscopic rectal cancer surgery aims to provide patients with curative resection while minimizing postoperative morbidity\\u000a and mortality. This study used meta-analytical techniques to compare laparoscopic and open surgery as the primary treatment\\u000a for patients with rectal cancer with regard to short-term and long-term outcomes.\\u000a \\u000a \\u000a \\u000a Methods  A literature search was performed on all studies between 1993 and 2004 comparing laparoscopic and open

Omer Aziz; Vasilis Constantinides; Thanos Athanasiou; Sanjay Purkayastha; Paraskevas Paraskeva; Ara W. Darzi; Alexander G. Heriot



Propensity-Based Matching between Esophagogastric Cancer Patients Who Had Surgery and Who Declined Surgery after Preoperative Chemoradiation.  


Background: Trimodality therapy (TMT; chemoradiation plus surgery) has level-1 evidence for survival advantage for TMT-eligible esophagogastric cancer patients. Some patients, however, decline surgery after preoperative chemoradiation. The question of which patient should have esophagectomy and which one should not is unlikely to be answered by a prospective comparison; therefore, we matched the clinical covariates of several patients who had surgery with those who declined surgery (DS). Methods: Between 2002 and 2011, we identified 623 patients in our databases. Of 623 patients, 244 patients had TMT and 61 TMT-eligible patients were in the DS group. Using the propensity-score method, we matched 16 covariates between 36 DS patients and 36 TMT patients. Results: Baseline characteristics between the two groups were balanced (p = NS). The median overall survival times were: 57.9 months (95% CI: 27.7 to not applicable, NA) for the DS group and 50.8 months (95% CI: 30.7 to NA) for the TMT group (p = 0.28). The median relapse-free survival times were: 18.5 (95% CI: 11.5-30.4) for the DS group and 26.5 months (95% CI: 15.5-NA) for the TMT group (p = 0.45). Eleven (31%) of 36 patients in the DS group had salvage surgery. Conclusions: Our results are intriguing but skewed by the patients who had salvage surgery in the DS group. Until highly reliable predictive models are developed for esophageal preservation, TMT must be encouraged for all TMT-eligible gastroesophageal cancer patients. PMID:23860252

Taketa, Takashi; Xiao, Lianchun; Sudo, Kazuki; Suzuki, Akihiro; Wadhwa, Roopma; Blum, Mariela A; Lee, Jeffrey H; Weston, Brian; Bhutani, Manoop S; Skinner, Heath; Komaki, Ritsuko; Maru, Dipen M; Rice, David C; Swisher, Stephen G; Hofstetter, Wayne L; Ajani, Jaffer A



Is There a Place for Esogastric Cancer Surgery in Cirrhotic Patients?  

Microsoft Academic Search

It is well established that surgery, especially gastrointestinal cancer surgery, in nonbleeding cirrhotic patients carries a high risk of mortality and morbidity. Esophagogastrectomy for carcinoma in cirrhotic patients has been mentioned only occasionally in the literature. Our aim was to review literature results in esophageal and gastric cancer surgery, to identify cirrhotic patients who will benefit from surgery, and to

Christophe Mariette



Surgery of liver metastases from colorectal cancer: new promises  

Microsoft Academic Search

For a long time, patients with liver metastases from colorectal cancer were considered to be incurable. Over the last 30 years, the benefits of surgical resection and systemic chemotherapy have been established. Actually, surgical resections are feasible with a very low mortality and a 5-year survival that approaches 40%, but only 10-20% of patients are candidates for surgery. The others

Christophe Penna; Bernard Nordlinger


[Lymphedema after breast cancer surgery and research in physiotherapy].  


The incidence of lymphoedema after breast cancer surgery with axillary dissection varies according to different studies, from 15 to 47%. The risk is 60% higher in cases of axillary radiotherapy. A rehabilitation service was undertaken as part of a research project aiming to show the benefit of the early treatment of lymphoedema of the arm. PMID:23878885

Biffaud, Jean-Christophe



Radioguided Sentinel Lymph Node Biopsy in Breast Cancer Surgery  

Microsoft Academic Search

The concept of sentinel lymph node biopsy in breast cancer surgery relates to the fact that the tumor drains in a logical way through the lymphatic system, from the first to upper levels. Therefore, the first lymph node met (the sentinel node) will most likely be the first to be affected by metastasis, and a negative sentinel node makes it

Giuliano Mariani; Luciano Moresco; Giuseppe Viale; Giuseppe Villa; Marcello Bagnasco; Giuseppe Canavese; John Buscombe; H. William Strauss; Giovanni Paganelli


Video-assisted thoracoscopic surgery lobectomy for lung cancer.  


Surgical resection is currently the gold standard in operable patients with early-stage lung cancer. Video-assisted thoracoscopic surgery (VATS) lobectomy is a technique that has technically evolved and grown increasingly popular over the past two decades. This article presents the evolution, definition, current application, and some of the controversies surrounding VATS lobectomy. PMID:23158083

Puri, Varun; Meyers, Bryan F



Results of conservative surgery and radiation therapy for breast cancer  

Microsoft Academic Search

For stage I or II breast cancer, conservative surgery and radiation therapy are as effective as modified radical or radical mastectomy. In most cases, cosmetic considerations and the availability of therapy are the primary concerns. The extent of a surgical resection less than a mastectomy has not been a subject of a randomized trial and is controversial. It appears that

R. T. Osteen; B. L. Smith



Some Older Women Can Forgo Radiation after Breast Cancer Surgery

Women 70 years of age or older with early-stage breast cancer did not benefit from the addition of radiation therapy to breast-conserving surgery and tamoxifen, according to results of a phase III randomized study presented in advance of the 2010 American Society of Clinical Oncology annual meeting.


Systematic Review of Surgery in Malignant Bowel Obstruction in Advanced Gynecological and Gastrointestinal Cancer  

Microsoft Academic Search

Objective.The objective was to locate, appraise, and summarize evidence from scientific studies on intestinal obstruction due to advanced gynecological and gastrointestinal cancer in order to assess the efficacy of surgery.Materials and methods. Data sources: A comprehensive list of studies was provided by an extensive search of electronic databases, relevant journals, bibliographic databases, conference proceedings, reference lists, the gray literature, personal

D. J. Feuer; K. E. Broadley; J. H. Shepherd; D. P. J. Barton



Transoral Robotic Surgery with Laser for Head and Neck Cancers: A Feasibility Study  

Microsoft Academic Search

Aims: To assess the feasibility of a flexible thulium laser coupled with a novel robotic introducer for head and neck cancers. Methods: In a prospective nonrandomized clinical trial, 58 patients were evaluated. When indicated, transoral robotic surgery (TORS) with laser was performed using an Intuitive da Vinci S System with the Intuitive Surgical® Endo Wrist Introducer, 5Fr to hold and

Marco Benazzo; Pietro Canzi; Antonio Occhini



Pancreatic cancer: Surgery is a feasible therapeutic option for elderly patients  

Microsoft Academic Search

BACKGROUND: Compromised physiological reserve, comorbidities, and the natural history of pancreatic cancer may deny pancreatic resection from elderly patients. We evaluated outcomes of elderly patients amenable to pancreatic surgery. METHODS: The medical records of all patients who underwent pancreatic resection at our institution (1995-2007) were retrospectively reviewed. Patient, tumor, and outcomes characteristics in elderly patients aged ? 70 years were

Guy Lahat; Ronen Sever; Nir Lubezky; Ido Nachmany; Fabian Gerstenhaber; Menahem Ben-Haim; Richard Nakache; Josef Koriansky; Josef M Klausner



A prospective study of tumor recurrence and the acute-phase response after apparently curative colorectal cancer surgery  

Microsoft Academic Search

Background: Approximately 70% of patients who are going to develop tumor recurrence following curative colorectal surgery do so within 24 months of surgery.Patients and methods: The relationship was prospectively examined between an ongoing acute-phase response and subsequent clinical relapse in 36 colorectal cancer patients who had undergone a curative resection. Approximately 4 months after their operation, patients were grouped according

Donald C. McMillan; Heather A. Wotherspoon; Kenneth C. H. Fearon; Catherine Sturgeon; Timothy G. Cooke; Colin S. McArdle



Short-term outcomes after laparoscopic surgery following preoperative chemoradiotherapy for rectal cancer  

PubMed Central

Purpose The safety and the feasibility of performing laparoscopic surgery for rectal cancer after preoperative chemoradiotherapy (CRT) have not yet been established. Thus, the aim of this study was to evaluate the efficacy and the safety of laparoscopic rectal cancer surgery performed after preoperative CRT. Methods We enrolled 124 consecutive patients who underwent laparoscopic surgery for rectal cancer. Of these patients, 56 received preoperative CRT (CRT group), whereas 68 did not (non-CRT group). The patients who were found to have distant metastasis and open conversion during surgery were excluded. The clinicopathologic parameters were evaluated and the short-term outcomes were compared between the CRT and non-CRT groups. Results The mean operation time was longer in the CRT group (294 minutes; range, 140 to 485 minutes; P = 0.004). In the non-CRT group, the tumor sizes were larger (mean, 4.0 cm; range, 1.2 to 8.0 cm; P < 0.001) and more lymph nodes were harvested (mean, 12.9; range, 0 to 35; P < 0.001). However, there was no significant difference between the two groups in time to first bowel movement, tolerance of a soft diet, length of hospital stay, and postoperative complication rate. Conclusion Performing laparoscopic surgery for rectal cancer after preoperative CRT may be safe and feasible if performed by a highly skilled laparoscopic surgeon. Randomized controlled trials and long-term follow-up studies are necessary to support our results.

Ahn, Byong Hyon; Lee, Kyung Ha; Park, Jun Beom; Song, Min Sang; Kim, Ji Yeon



Risk adjustment for congenital heart surgery: the RACHS-1 method  

Microsoft Academic Search

The new health care environment has increased the need for accurate information about outcomes after pediatric cardiac surgery to facilitate quality improvement efforts both locally and globally. The Risk Adjustment for Congenital Heart Surgery (RACHS-1) method was created to allow a refined understanding of differences in mortality among patients undergoing congenital heart surgery, as would typically be encountered within a

Kathy J Jenkins



Concomitant lung cancer resection and lung volume reduction surgery.  


Patients who are offered concomitant surgery are highly selected and must satisfy the strict criteria set out for both LVRS and cancer surgery. Several evaluative processes have been reported for the selection of suitable patients. These various evaluative processes, together with the physical condition of the patient and the surgeon's experience, help to best select patients suitable for combined surgical resection. Several intraoperative strategies are available for dealing with a patient who has concomitant lung cancer and severe emphysema. The choice of technique depends on the location and size of the tumor, the severity and distribution of the emphysema, and the surgeon's experience and preference. Lung volume reduction surgery in well-selected patients who have severe emphysema results in postoperative improvement of symptoms and measured pulmonary function. The combination of lung cancer resection with LVRS offers selected patients who have concomitant early lung cancer and severe emphysema the opportunity to undergo resection of their cancer with improvement rather than further reduction in their pulmonary function. By traditional criteria these patients would otherwise be considered unsuitable surgical candidates because of the limited pulmonary function. PMID:19662963

Choong, Cliff K; Mahesh, Balakrishnan; Patterson, G Alexander; Cooper, Joel D



Repair of the Threatened Feminine Identity: Experience of Women With Cervical Cancer Undergoing Fertility Preservation Surgery.  


BACKGROUND:: Fertility preservation is important for women of reproductive age with cervical cancer. The underlying reasons behind suboptimal reproductive results after successful fertility-preserving surgery have not yet been fully revealed. OBJECTIVE:: The objective of this study was to explore the experience of fertility preservation with radical trachelectomy from the perspective of women with cervical cancer. METHODS:: We conducted interviews with women with cervical cancer who underwent radical trachelectomy using a Grounded Theory methodology with a theoretical framework of symbolic interactionism. RESULTS:: Our findings articulate a process in which feminine identity is first threatened by a diagnosis of cancer, then repaired by fertility preservation with radical trachelectomy, and finally reconstructed after the surgery, through interactions with self, others, and external events in women with cervical cancer. Feeling incomplete as a woman because of the loss of the uterus was a critical factor in the women's feeling that their feminine identity was threatened. Thus, fertility preservation was significant for these women. The meaning of fertility preservation varied among the women, and their life perspectives were therefore distinct after the surgery. CONCLUSIONS:: Women with cervical cancer who undergo radical trachelectomy experience an identity transformation process, and child bearing is not the only expected outcome of fertility preservation. IMPLICATIONS FOR PRACTICE:: Nurses should coordinate care through the cancer trajectory. Understanding the identity transformation process helps nurses to assess patients' needs and provide appropriate individual care. PMID:23486357

Komatsu, Hiroko; Yagasaki, Kaori; Shoda, Rie; Chung, Younghui; Iwata, Takashi; Sugiyama, Juri; Fujii, Takuma



Current Status of Surgery for Pancreatic Cancer  

Microsoft Academic Search

Background: In Japan the annual incidence of pancreatic cancer has increased over the last decade, but no advancement has been made in the long-term prognosis after resection. The significant differences in the surgical procedures between Western countries and Japan have been discussed. Therefore, an adequate comparison and analysis of the data from Japan, Europe and the USA is required. This

Koichi Hirata; Shinichi Egawa; Yasutoshi Kimura; Takayuki Nobuoka; Hidenori Oshima; Tadashi Katsuramaki; Toru Mizuguchi; Tomohisa Furuhata



Can anesthetic technique for primary breast cancer surgery affect recurrence or metastasis?  

PubMed Central

Background: Regional anesthesia is known to prevent or attenuate the surgical stress response; thus, inhibiting surgical stress by paravertebral anesthesia might attenuate perioperative factors that enhance tumor growth and spread. We hypothesized that breast cancer patients undergoing surgery with paravertebral anesthesia and analgesia combined with general anesthesia have a lower incidence of cancer recurrence or metastases than patients undergoing surgery with general anesthesia and patient-controlled morphine analgesia. Methods: In this retrospective study, we examined the medical records of 129 consecutive patients undergoing mastectomy and axillary clearance for breast cancer between September 2001 and December 2002. Results: 50 patients had surgery with paravertebral anesthesia and analgesia combined with general anesthesia and 79 patients had general anesthesia combined with postoperative morphine analgesia. The follow-up time was 32±5 months (mean±SD). There were no significant differences in patients or surgical details, tumor presentation, or prognostic factors. Recurrence and metastasis-free survival was 94% (95% CI 87,100) and 82% (74, 91) at 24 months and 94 (87, 100) and 77 (68, 87) at 36 months in the paravertebral and general anesthesia patients, respectively, P=0.012. Conclusions: This retrospective analysis suggests that paravertebral anesthesia and analgesia for breast cancer surgery reduces the risk of recurrence or metastasis during the initial years of follow-up. Prospective trials evaluating the effects of regional analgesia and morphine sparing on cancer recurrence seem warranted.

Exadaktylos, Aristomenis K; Buggy, Donal J; Moriarty, Denis C; Mascha, Edward; Sessler, Daniel I



Preoperative chemoradiotherapy, surgery and adjuvant therapy for resectable pancreatic cancer.  


Background/Aims: In order to improve the poor prognosis of pancreatic cancer, a combination therapy consisting of preoperative chemoradiotherapy, surgery and postoperative chemotherapy may be an ideal strategy; nevertheless, the influence of preoperative therapy to postoperative therapy is not investigated. Methodology: Thirty patients with resectable pancreatic ductal adenocarcinoma were enrolled. A 40Gy of radiation (2Gy/day x 20 fractions/4 weeks) was administered together with intravenous infusion of gemcitabine (800mg/m2, days 1, 8 and 15) before surgery. Surgery was performed 3-7 weeks after the final fraction of radiation, and postoperative chemotherapy consisting of 1000mg/m2 gemcitabine (days 1, 8 and 15 every 4 weeks for 6 cycles) was started within 8 weeks after surgery. Results: All 30 patients successfully completed preoperative therapy. Re-staging after such therapy showed radiologically unresectable disease in 4 patients and 1 patient rejected surgery. Among the 25 patients who underwent laparotomy, 21 underwent curative resection. After curative resection, 4 were inadequate in performance status, thus postoperative therapy could not be started. Ten patients completed postoperative adjuvant therapy. Conclusions: The combination therapy for resectable pancreatic cancer seems a feasible and effective approach, though preoperative therapy may reduce the feasibility of postoperative therapy. PMID:23321032

Eguchi, Hidetoshi; Nagano, Hiroaki; Tanemura, Masahiro; Takeda, Yutaka; Marubashi, Shigeru; Kobayashi, Shogo; Kawamoto, Koichi; Wada, Hiroshi; Hama, Naoki; Akita, Hirofumi; Mori, Masaki; Doki, Yuichiro



Methods for the treatment of cancers  

US Patent & Trademark Office Database

Methods for the treatment of cancers involving dysregulation of thromboxane receptor .beta. (TP-.beta.) are provided, including in certain aspects methods for diagnosing such cancers. Specific cancers included are genitourinary cancers, gastrointestinal cancers and leukemias.



[Timing of surgery after neoadjuvant chemotherapy for advanced gastric cancer].  


Several studies have demonstrated the benefit of perioperative chemotherapy in the treatment of advanced gastric cancers, especially the neoadjuvant chemotherapy(NAC). Many NAC trials in the United States, UK and Japan have proved that NAC can shrink the tumor and metastatic lymph nodes, downstage the T and N staging, achieve more curative(R0) resection for the unresectable cases, and even improve survival. Various neoadjuvant chemotherapy regimens have different effects on the body, therefore the timing selection of surgery, surgical programs and goals are different accordingly. Optimal surgery after neoadjuvant chemotherapy should be based on full comprehension of the pharmacology and pharmacokinetics. Strict surgical quality control is necessary. PMID:23801199

Hu, Xiang



Laparoscopic surgery for rectal cancer: The state of the art  

PubMed Central

At present time, there is evidence from randomized controlled studies of the success of laparoscopic resection for the treatment of colon cancer with reported smaller incisions, lower morbidity rate and earlier recovery compared to open surgery. Technical limitations and a steep learning curve have limited the wide application of mini-invasive surgery for rectal cancer. The present article discusses the current status of laparoscopic resection for rectal cancer. A review of the more recent retrospective, prospective and randomized controlled trial (RCT) data on laparoscopic resection of rectal cancer including the role of trans-anal endoscopic microsurgery and robotics was performed. A particular emphasis was dedicated to mid and low rectal cancers. Few prospective and RCT trials specifically addressing laparoscopic rectal cancer resection are currently available in the literature. Improved short-term outcomes in term of lesser intraoperative blood loss, reduced analgesic requirements and a shorter hospital stay have been demonstrated. Concerns have recently been raised in the largest RCT trial of the oncological adequacy of laparoscopy in terms of increased rate of circumferential margin. This data however was not confirmed by other prospective comparative studies. Moreover, a similar local recurrence rate has been reported in RCT and comparative series. Similar findings of overall and disease free survival have been reported but the follow-up time period is too short in all these studies and the few RCT trials currently available do not draw any definitive conclusions. On the basis of available data in the literature, the mini-invasive approach to rectal cancer surgery has some short-term advantages and does not seem to confer any disadvantage in term of local recurrence. With respect to long-term survival, a definitive answer cannot be given at present time as the results of RCT trials focused on long-term survival currently ongoing are still to fully clarify this issue.

Staudacher, Carlo; Vignali, Andrea



Cytoreductive Surgery Combined with Hyperthermic Intraperitoneal Intraoperative Chemotherapy in the Treatment of Advanced Epithelial Ovarian Cancer  

PubMed Central

Background/Aims. Intraperitoneal intraoperative hyperthermic chemotherapy (HIPEC) has been used in the treatment of ovarian cancer. The purpose of the study is to determine the efficacy of HIPEC after cytoreductive surgery in advanced ovarian cancer. Patients/Methods. From 2006 to 2010 patients with advanced ovarian cancer were enrolled in a prospective nonrandomized study to undergo cytoreductive surgery combined with HIPEC. Clinical and histopathological variables were correlated to hospital mortality, morbidity, survival, and recurrences. Results. The mean age of 43 women was 59.9 ± 13.8 (16–82) years. The hospital mortality and morbidity rate were 4.7% and 51.2%, respectively. Complete cytoreduction was possible in 69.8%. The overall 5-year survival rate was 54%. The prognostic indicators of survival were the extent of prior surgery (P = 0.048) and the extent of peritoneal dissemination (P = 0.011). The recurrence rate was 30.2%. Conclusions. Maximal cytoreductive surgery combined with HIPEC is a well-tolerated, feasible, and promising method of treatment in advanced ovarian cancer.

Tentes, Antonios-Apostolos K.; Kakolyris, Stylianos; Kyziridis, Dimitrios; Karamveri, Christina



Optimal surgery for gastric cancer: is more always better?  


The extent of surgical resection for carcinoma of the stomach has been debated for many years. The aims of surgery are to obtain complete histopathological clearance of all possible sites of disease based on oncological principles. This has included radical resection of the primary site with combined organ resection as required and resection of associated lymph nodes. Detailed understanding of the natural history of gastric cancer has resulted in the Pichlmayr total gastrectomy "en principe" approach being super-ceded by a tailored approach according to tumour and patient characteristics. Careful tumour staging is fundamental to the selection of surgical intervention. Endoscopic therapy is recommended for well differentiated, mucosal cancers less than 2 cm in size as the risk of nodal disease is 0-3 %. Recently, these criteria have been extended to include some larger and ulcerated cancers. Although extended lymphadenectomy has formed the basis of radical surgery, Japanese experience has also confirmed that for early gastric cancer involving the submucosa limited nodal resection can achieve the same outcome as standardised D2 lymphadenectomy. The approach to locally advanced T2, T3 and some T4 cancers has been defined by the Japanese rules specifying proximal and distal margins as well as extent of lymph node resection. Translation of Japanese results to Western patients has not been straightforward. Two randomised controlled trials have shown limited or no benefit over conventional limited nodal dissection. However, these studies have not been without criticism and individual specialist practice in the West now preferentially includes D2 lymphadenectomy in suitable patients. Extending conventional D2 lymphadenectomy has been evaluated but the results are not conclusive. Japanese RCTs have not shown an advantage but in selected cases several groups have reported a benefit. Historically, radical gastric surgery in the West was associated with significant morbidity and mortality reflecting the comorbidity of the patient groups. Perioperative approaches have shown that outcome approaching that of radical surgery can be achieved with multimodal therapies for high-risk patient groups for whom radical surgery would be contraindicated. Surgery for gastric cancer needs to be determined by a multidisciplinary team to ensure appropriate procedure selection for an individual patient. This allows all relevant information to be considered and to provide the best chance for high-quality patient outcome. PMID:23129377

Allum, William H



Determining the use of prophylactic antibiotics in breast cancer surgeries: a survey of practice  

PubMed Central

Background Prophylactic antibiotics (PAs) are beneficial to breast cancer patients undergoing surgery because they prevent surgical site infection (SSI), but limited information regarding their use has been published. This study aims to determine the use of PAs prior to breast cancer surgery amongst breast surgeons in Colombia. Methods An online survey was distributed amongst the breast surgeon members of the Colombian Association of Mastology, the only breast surgery society of Colombia. The scope of the questions included demographics, clinical practice characteristics, PA prescription characteristics, and the use of PAs in common breast surgical procedures. Results The survey was distributed amongst eighty-eight breast surgeons of whom forty-seven responded (response rate: 53.4%). Forty surgeons (85.1%) reported using PAs prior to surgery of which >60% used PAs during mastectomy, axillary lymph node dissection, and/or breast reconstruction. Surgeons reported they targeted the use of PAs in cases in which patients had any of the following SSI risk factors: diabetes mellitus, drains in situ, obesity, and neoadjuvant therapy. The distribution of the self-reported PA dosing regimens was as follows: single pre-operative fixed-dose (27.7%), single preoperative dose followed by a second dose if the surgery was prolonged (44.7%), single preoperative dose followed by one or more postoperative doses for >24 hours (10.6%), and single preoperative weight-adjusted dose (2.1%). Conclusion Although this group of breast surgeons is aware of the importance of PAs in breast cancer surgery there is a discrepancy in how they use it, specifically with regards to prescription and timeliness of drug administration. Our findings call for targeted quality-improvement initiatives, such as standardized national guidelines, which can provide sufficient evidence for all stakeholders and therefore facilitate best practice medicine for breast cancer surgery.



Characterizing Biased Cancer-Related Cognitive Processing: Relationships With BRCA1/2 Genetic Mutation Status, Personal Cancer History, Age, and Prophylactic Surgery.  


Objective: This study evaluated associations of cancer-related cognitive processing with BRCA1/2 mutation carrier status, personal cancer history, age, and election of prophylactic surgery in women at high risk for breast cancer. Method: In a 2 (BRCA1/2 mutation carrier status) × 2 (personal cancer history) matched-control design, with age as an additional predictor, participants (N = 115) completed a computerized cancer Stroop task. Dependent variables were response latency to cancer-related stimuli (reaction time [RT]) and cancer-related cognitive interference (cancer RT minus neutral RT). RT and interference were tested as predictors of prophylactic surgery in the subsequent four years. Results: RT for cancer-related words was significantly slower than other word groups, indicating biased processing specific to cancer-related stimuli. Participants with a cancer history evidenced longer RT to cancer-related words than those without a history; moreover, a significant Cancer History × Age interaction indicated that, among participants with a cancer history, the typical advantage associated with younger age on Stroop tasks was absent. BRCA mutation carriers demonstrated more cancer-related cognitive interference than noncarriers. Again, the typical Stroop age advantage was absent among carriers. Exploratory analyses indicated that BRCA+ status and greater cognitive interference predicted greater likelihood of undergoing prophylactic surgery. Post hoc tests suggest that cancer-related distress does not account for these relationships. Conclusions: In the genetic testing context, younger women with a personal cancer history or who are BRCA1/2 mutation carriers might be particularly vulnerable to biases in cancer-related cognitive processing. Biased processing was associated marginally with greater likelihood of prophylactic surgery. (PsycINFO Database Record (c) 2013 APA, all rights reserved). PMID:23772886

Carpenter, Kristen M; Eisenberg, Stacy; Weltfreid, Sharone; Low, Carissa A; Beran, Tammy; Stanton, Annette L



Economics and the Laparoscopic Surgery Learning Curve: Comparison with Open Surgery for Rectosigmoid Cancer  

Microsoft Academic Search

Background  Wide-ranging costs of laparoscopic surgery (LAP) are associated with variations in the experience levels of surgeons. There\\u000a is no available report on the changes of economic outcomes relative to the LAP learning curve in the treatment of colorectal\\u000a cancer. In the present study, we have compared changes in economic outcomes according to the LAP learning curve with the economic\\u000a outcomes

Jun-Seok Park; Sung-Bum Kang; Sung-Wook Kim; Gui-Neum Cheon



Determining Which Patients Require Irradiation of the Supraclavicular Nodal Area After Surgery for N1 Breast Cancer  

Microsoft Academic Search

Purpose: We designed this study to determine which patients have a high risk of supraclavicular node recurrence in N1 breast cancer previously treated with surgery but not having received supraclavicular radiation therapy (SCRT) and to identify which patients needed SCRT. Methods and Materials: We performed a retrospective review of 448 pathologic N1 breast cancer patients treated with mastectomy or breast-conserving

Jeong Il Yu; Won Park; Seung Jae Huh; Doo Ho Choi; Young Hyuk Lim; Jin Suk Ahn; Jung Hyun Yang; Suk Jin Nam



Morbidity and Mortality Following Breast Cancer Surgery in Women  

PubMed Central

Background: Most reports on postoperative (OP) morbidity and mortality following breast cancer surgery (BCS) are limited by relatively small sample size resulting in a lack of national benchmarks for quality of care. This paper reports the 30-day morbidity and mortality following BCS in women using a large prospective multi-institutional database. Methods: The National Surgical Quality Improvement Program Patient Safety in Surgery, prospectively collected inpatient and outpatient 30 day postoperative morbidity and mortality data on patients undergoing surgery at 14 university and 4 community centers. Using the procedure CPT code, the database was queried for all women undergoing mastectomy (MT) or lumpectomy with an axillary procedure (L-ANP). Morbidity and mortality were categorized as mortality, wound, cardiac, renal, pulmonary, and central nervous system. Logistic regression models for the prediction of wound complications were developed. Preoperative variables having bivariate relationships with postoperative wound complications with P ? 0.20 were submitted for consideration. Results: We identified 1660 and 1447 women who underwent MT and l-ANP, respectively. The mean age was 55.9 years. The majority of procedures were under general anesthesia. The 30-day postoperative mortality for MT and l-ALNP were 0.24% and 0%, respectively. The most frequent morbid complication was wound infection, more commonly occurring in the mastectomy (4.34%) group versus the lumpectomy group (1.97%). Cardiac and pulmonary complications occurred infrequently in the mastectomy group (cardiac: MT, 0.12%; and pulmonary: MT, 0.66%). There were no cardiac or pulmonary complications in the lumpectomy group. CNS morbidities were rare in both surgical groups (MT, 0.12%; and l-ALNP, 0.07%). Development of a UTI was more common in women who underwent a mastectomy (0.66%) when compared with women that had a lumpectomy (0.14%). The only significant predictors of a wound complication were morbid obesity (BMI >30), having had a MT, low preoperative albumin and hematocrit greater than 45%. Conclusion: Morbidity and mortality rates following BCS in women are low, limiting their value in assessing quality of care. Mastectomy carries higher complication rate than l-ANP with wound infection being the most common.

El-Tamer, Mahmoud B.; Ward, B Marie; Schifftner, Tracy; Neumayer, Leigh; Khuri, Shukri; Henderson, William



Outcomes of Laparoscopic Surgery for Colorectal Cancer in Elderly Patients  

PubMed Central

Objective: To evaluate the short-term outcomes of laparoscopic colorectal surgery for cancer in the elderly compared with younger patients. Methods: We retrospectively considered a consecutive unselected series of 159 patients who underwent elective laparoscopic procedures for colorectal cancer at our institution between January 2007 and December 2009. Of these patients, 101 (63.5%) were ?70 years of age (Group A), and 58 (36.5%) were >70 (Group B). Operative steps and instrumentation were standardized. Demographics, disease-related, operative, and short-term data were analyzed for each group, and an appropriate statistical comparison was made. Comorbidity was quantified by using the Charlson Comorbidity Index. Results: We reviewed right colectomies (29.5%), left colectomies (44.7%), rectal resections (19.5%), and other procedures (6.3%). There was no significant difference in sex ratio, body mass index, American Society of Anesthesiology score, type of surgical procedures, and tumor stage between Group A and Group B. A statistically higher comorbidity according to the Charlson index characterized Group B (2.2 vs 3.8; P=.034). Median operative time (228±78.1min vs 224.3±97.6min; NS), estimated blood loss (50.0±94.8mL vs 31.2±72.7mL; NS), conversion rate (2.0% vs 1.7%; NS), and timing to canalization (4.5±1.7dd vs 4.4±1.3dd; NS) were statistically comparable in both Groups. Group B was associated with a significantly longer length of hospital stay compared with Group A (8.1±2.8dd vs 10.8±6.6dd; P<.01) There was no statistically significant difference in major postoperative complications (3.8% vs 3.4%; NS), reoperations (0.9% vs 1.7%; NS), and 30-day mortality (0% vs 1.7%; NS). Conclusions: Laparoscopic colorectal surgery appears feasible and safe in elderly patients with increased comorbidity.

Bertoglio, Camillo; Bertoglio, Camillo; De Luca, Antonio; Frigerio, Alessandro; Galli, Freddy; Scandroglio, Ildo



Optical coherence tomography in guided surgery of GI cancer  

NASA Astrophysics Data System (ADS)

Optical Coherence Tomography (OCT) is a new high spatial resolution, real-time optical imaging modality, known from prior pilot studies for its high sensitivity to invasive cancer. We reported our results in an OCT feasibility study for accurate determination of the proximal border for esophageal carcinoma and the distal border for rectal carcinoma. The OCT study enrolled 19 patients with rectal adenocarcinoma and 24 patients with distal esophageal carcinoma (14 squamous cell carcinomas, 10 adenocarcinomas). During pre-surgery planning endoscopy we performed in vivo OCT imaging of the tumor border at four dial clock axes (12, 3, 6 and 9 o"clock). The OCT border then was marked by an electrocoagulator, or by a methylene blue tattoo. A cold biopsy (from the esophagus) was performed at visual and OCT borders and compared with visual and OCT readings. 27 post-surgery excised specimens were analyzed. OCT borders matched the histopathology in 94% cases in the rectum and 83.3% in the esophagus. In the cases of a mismatch between the OCT and histology borders, a deep tumor invasion occurred in the muscle layer (esophagus, rectum). Because of its high sensitivity to mucosal cancer, OCT can be used for pre-surgery planning and surgery guidance of the proximal border for esophageal carcinoma and the distal border for rectal carcinoma. However, deep invasion in the rectum or esophageal wall has to be controlled by alternative diagnostic modalities.

Zagaynova, Elena V.; Abelevich, Alexander I.; Zagaynov, Vladimir E.; Gladkova, Natalia D.; Denisenko, Arkady N.; Feldchtein, Felix I.; Snopova, Ludmila B.; Kutis, Irina S.



Hepatic cytoreductive surgery for neuroendocrine cancer.  


Patients with gut-based metastatic neuroendocrine tumors (NET) often present late in the course of their slowly progressive disease, when cancer has extended beyond the point of reasonable expectation for surgical cure. At this stage of disease, the tumor's overwhelming hormonal production often significantly impairs the patient's quality of life. Unlike patients with other malignancies that might involve a heavy burden of hepatic metastatic disease, many patients with metastatic NET continue to live for a long time despite escalating hormone-related symptoms. This establishes the justification and rationale for cytoreduction, a noncurative surgical intervention that reduces tumor burden and hormonal burden and thereby can significantly increase symptom-free survival in the setting of an often slow but inevitable disease progression. PMID:17606197

Wright, Byron E; Lee, Chris C; Bilchik, Anton J



Breast Cancer Surgery and Financial Reimbursement in Germany  

PubMed Central

The reimbursement for breast cancer-specific operative interventions in Germany is regulated by the diagnosis-related group (DRG) system. The essential elements of the German DRG system, which was developed as a per-case lump-sum payment system, are presented, including the participating institutions. The actual treatment situation in breast cancer surgery is now aptly reflected in the introduction of the OPS (operation and treatment procedure classification) 2012. This is oriented on the classification model of Hoffmann and Wallwiener, with its complexity-based differentiation that reflects the basic idea of different resource usage. Despite the actual potential of the appropriately differentiated encryption of surgical procedures, which illustrates their differences in resource costs and consumption, appropriate reimbursement has still not been achieved. Hopefully, in the future the calculation of the DRGs in the field of breast cancer surgery will be based on data feedback from the hospitals and treatment institutions, and will be more suited to the main purpose of the DRG system, i.e. that reimbursement reflects resource expenditure. A necessary basic tool for differentiated, complexity-oriented encryption has been achieved with the OPS 2012, which mirrors our classification model for oncological, oncoplastic and reconstructive breast surgery.

Hoffmann, Juergen; Wallwiener, Diethelm



Surgery and Adjuvant Chemotherapy Use Among Veterans With Colon Cancer: Insights From a California Study  

PubMed Central

Purpose US veterans have been shown to be a vulnerable population with high cancer rates, and cancer care quality in Veterans Affairs (VA) hospitals is the focus of a congressionally mandated review. We examined rates of surgery and chemotherapy use among veterans with colon cancer at VA and non-VA facilities in California to gain insight into factors associated with quality of cancer care. Methods A retrospective cohort of incident colon cancer patients from the California Cancer Registry, who were ? 66 years old and eligible to use VA and Medicare between 1999 and 2001, were observed for 6 months after diagnosis. Results Among 601 veterans with colon cancer, 72% were initially diagnosed and treated in non-VA facilities. Among veterans with stage I to III cancer, those diagnosed and initially treated in VA facilities experienced similar colectomy rates as those at non-VA facilities. Stage III patients diagnosed and initially treated in VA versus non-VA facilities had similar odds of receiving adjuvant chemotherapy. In both settings, older patients had lower odds of receiving chemotherapy than their younger counterparts even when race and comorbidity were considered (age 76 to 85 years: odds ratio [OR] = 0.18; 95% CI, 0.07 to 0.46; age ? 86 years: OR = 0.17; 95% CI, 0.04 to 0.73). Conclusion In California, older veterans with colon cancer used both VA and non-VA facilities for cancer treatment, and odds of receiving cancer-directed surgery and chemotherapy were similar in both systems. Among stage III patients, older age lowered odds of receiving adjuvant chemotherapy in both systems. Further studies should continue to explore potential health system effects on quality of colon cancer care across the United States.

Hynes, Denise M.; Tarlov, Elizabeth; Durazo-Arvizu, Ramon; Perrin, Ruth; Zhang, Qiuying; Weichle, Thomas; Ferreira, M. Rosario; Lee, Todd; Benson, Al B.; Bhoopalam, Nirmala; Bennett, Charles L.



Hypnosis Before Breast-Cancer Surgery Reduces Pain, Discomfort, and Cost

Women undergoing surgery for breast cancer who received hypnosis before entering the operating room required less anesthesia and pain medication during surgery, and reported less pain, nausea, fatigue, and discomfort after surgery than women who did not receive hypnosis, according to the Sept. 5, 2007, Journal of the National Cancer Institute.


Hospital Factors and Racial Disparities in Mortality After Surgery for Breast and Colon Cancer  

PubMed Central

Purpose Black patients have worse prognoses than whites with breast or colorectal cancer. Mechanisms underlying such disparities have not been fully explored. We examined the role of hospital factors in racial differences in late mortality after surgery for breast or colon cancer. Methods Patients undergoing surgery after new diagnosis of breast or colon cancer were identified using the Surveillance Epidemiology and End Results–Medicare linked database (1995 to 2005). The main outcome measure was mortality at 5 years. Proportional hazards models were used to assess relationships between race and late mortality, accounting for patient factors, socioeconomic measures, and hospital factors. Fixed and random effects models were used to account for quality differences across hospitals. Results Black patients, compared with white patients, had lower 5-year overall survival rates after surgery for breast (62.1% v 70.4%, respectively; P < .001) and colon cancer (41.3% v 45.4%, respectively; P < .001). After controlling for age, comorbidity, and stage, black race remained an independent predictor of mortality for breast (adjusted hazard ratio [HR] = 1.25; 95% CI, 1.16 to 1.34) and colon cancer (adjusted HR = 1.13; 95% CI, 1.07 to 1.19). After risk adjustment, hospital factors explained 36% and 54% of the excess mortality for black patients with breast cancer and colon cancer, respectively. Hospitals with large minority populations had higher late mortality rates independent of race. Conclusion Hospital factors, including quality, are important mediators of the association between race and mortality for breast and colon cancer. Hospital-level quality improvement should be a major component of efforts to reduce disparities in cancer outcomes.

Breslin, Tara M.; Morris, Arden M.; Gu, Niya; Wong, Sandra L.; Finlayson, Emily V.; Banerjee, Mousumi; Birkmeyer, John D.



Decision Making about Surgery for Early Stage Breast Cancer  

PubMed Central

Background Practice variation in breast cancer surgery has raised concerns about the quality of treatment decisions. We sought to evaluate the quality of decisions about surgery for early stage breast cancer by measuring patient knowledge, concordance between goals and treatments, and involvement in decisions. Study Design A mailed survey of Stage I/II breast cancer survivors was conducted at four sites. The Decision Quality Instrument measured knowledge, goals, and involvement in decisions. A multivariable logistic regression model of treatment was developed. The model-predicted probability of mastectomy was compared to treatment received for each patient. Concordance was defined as having mastectomy and predicted probability >=0.5 or partial mastectomy and predicted probability <0.5. Frequency of discussion about partial mastectomy was compared to discussion about mastectomy using chi-squared tests. Results 440 patients participated (59% response rate). Mean overall knowledge was 52.7%. 45.9% knew that local recurrence risk is higher after breast conservation. 55.7% knew that survival is equivalent for the two options. Most participants (89.0%) had treatment concordant with their goals. Participants preferring mastectomy had lower concordance (80.5%) than those preferring partial mastectomy (92.6%, p=0.001). Participants reported more frequent discussion of partial mastectomy and its advantages than of mastectomy. 48.6% reported being asked their preference. Conclusions Breast cancer survivors had major knowledge deficits, and those preferring mastectomy were less likely to have treatment concordant with goals. Patients perceived that discussions focused on partial mastectomy, and many were not asked their preference. Improvements in the quality of decisions about breast cancer surgery are needed.

Lee, Clara N; Chang, Yuchiao; Adimorah, Nesochi; Belkora, Jeff; Moy, Beverly; Partridge, Ann; Ollila, David W.; Sepucha, Karen



Present and future status of gastric cancer surgery.  


The type of surgery and the role of adjuvant therapies in the treatment of gastric cancer have changed in recent times. The treatment of gastric cancer with curative intent is moving away from standard D2 or more extensive surgery to a tailored approach depending on the stage of the disease. Data collected from extensive lymphadenectomy for all stages of gastric cancer have confirmed that some subsets of early gastric cancer are very low risk for nodal metastasis. This group of patients may benefit from resection by endoscopic or laparoscopic techniques and may also be suitable for function-preserving procedures. The extent of resection for gastric cancer has always excited debate. D2 gastrectomy was criticized for its higher mortality in the early European Phase III trials, but recent studies from Taiwan and Italy have shown that the procedure is safe when performed by experienced surgeons and has a survival benefit over D1 gastrectomy. The role of para-aortic lymph node dissection for nodes without apparent metastasis in advanced gastric cancer was assessed by a Phase III Japanese trial and showed no additional benefit over D2 resection. Radical gastric resections, involving resection of adjacent organs for direct tumor invasion result in higher rates of complications, and the role of multi-visceral resections has also been reevaluated. Effective adjuvant therapies for gastric cancer have been reported since the early part of 2000. Development of more effective adjuvant therapy combined with D2 resection should continue to improve survival in the future. PMID:21242182

Saka, Makoto; Morita, Shinji; Fukagawa, Takeo; Katai, Hitoshi



[New methods of cruciate ligament surgery].  


Although long-term results in cruciate ligament surgery are continuously improving, we are still confronted with a certain rate of surgical failures and an increasing number of revision procedures. Despite a tremendous effort towards experimental and clinical research in the field of anterior and posterior cruciate ligament surgery over the past decades, there is still a strong need to further improve results. Therefore, the goal of the present paper is to introduce and discuss new developments in the rapidly changing field of cruciate ligament surgery, in order to give the clinician a base for discussion to include these developments in their daily clinical work. The present paper focuses on current developments and future perspectives such as biodegradable implants, new aspects in graft selection, double-bundle posterior cruciate ligament reconstruction, possibilities of biological intervention with growth factors, and the new technology of robotics and navigation. PMID:11043120

Südkamp, N P; Haas, N P



Feasibility of MR Metabolomics for Immediate Analysis of Resection Margins during Breast Cancer Surgery  

PubMed Central

In this study, the feasibility of high resolution magic angle spinning (HR MAS) magnetic resonance spectroscopy (MRS) of small tissue biopsies to distinguish between tumor and non-involved adjacent tissue was investigated. With the current methods, delineation of the tumor borders during breast cancer surgery is a challenging task for the surgeon, and a significant number of re-surgeries occur. We analyzed 328 tissue samples from 228 breast cancer patients using HR MAS MRS. Partial least squares discriminant analysis (PLS-DA) was applied to discriminate between tumor and non-involved adjacent tissue. Using proper double cross validation, high sensitivity and specificity of 91% and 93%, respectively was achieved. Analysis of the loading profiles from both principal component analysis (PCA) and PLS-DA showed the choline-containing metabolites as main biomarkers for tumor content, with phosphocholine being especially high in tumor tissue. Other indicative metabolites include glycine, taurine and glucose. We conclude that metabolic profiling by HR MAS MRS may be a potential method for on-line analysis of resection margins during breast cancer surgery to reduce the number of re-surgeries and risk of local recurrence.

Sitter, Beathe; Fj?sne, Hans E.; Lundgren, Steinar; Buydens, Lutgarde M.; Gribbestad, Ingrid S.; Postma, Geert; Giske?degard, Guro F.



Feasibility of MR metabolomics for immediate analysis of resection margins during breast cancer surgery.  


In this study, the feasibility of high resolution magic angle spinning (HR MAS) magnetic resonance spectroscopy (MRS) of small tissue biopsies to distinguish between tumor and non-involved adjacent tissue was investigated. With the current methods, delineation of the tumor borders during breast cancer surgery is a challenging task for the surgeon, and a significant number of re-surgeries occur. We analyzed 328 tissue samples from 228 breast cancer patients using HR MAS MRS. Partial least squares discriminant analysis (PLS-DA) was applied to discriminate between tumor and non-involved adjacent tissue. Using proper double cross validation, high sensitivity and specificity of 91% and 93%, respectively was achieved. Analysis of the loading profiles from both principal component analysis (PCA) and PLS-DA showed the choline-containing metabolites as main biomarkers for tumor content, with phosphocholine being especially high in tumor tissue. Other indicative metabolites include glycine, taurine and glucose. We conclude that metabolic profiling by HR MAS MRS may be a potential method for on-line analysis of resection margins during breast cancer surgery to reduce the number of re-surgeries and risk of local recurrence. PMID:23613877

Bathen, Tone F; Geurts, Brigitte; Sitter, Beathe; Fjøsne, Hans E; Lundgren, Steinar; Buydens, Lutgarde M; Gribbestad, Ingrid S; Postma, Geert; Giskeødegård, Guro F



Robot-assisted endoscopic surgery for thyroid cancer: experience with the first 100 patients  

Microsoft Academic Search

Background  Various robotic surgical procedures have been performed in recent years, and most reports have proved that the application\\u000a of robotic technology for surgery is technically feasible and safe. This study aimed to introduce the authors’ technique of\\u000a robot-assisted endoscopic thyroid surgery and to demonstrate its applicability in the surgical management of thyroid cancer.\\u000a \\u000a \\u000a \\u000a \\u000a Methods  From 4 October 2007 through 14 March

Sang-Wook Kang; Jong Ju Jeong; Ji-Sup Yun; Tae Yon Sung; Seung Chul Lee; Yong Sang Lee; Kee-Hyun Nam; Hang Seok Chang; Woong Youn Chung; Cheong Soo Park



Prospective Observation of Small Adenomas in Patients After Colorectal Cancer Surgery Through Magnification Chromocolonoscopy  

Microsoft Academic Search

Purpose  This study was designed to confirm the safety of not removing small adenoma in patients who undergo colorectal cancer surgery.\\u000a \\u000a \\u000a \\u000a Methods  Patients who underwent surveillance colonoscopy after surgery were enrolled. The study was approved by our institutional review\\u000a board. Colonoscopy was performed with magnification chromocolonoscopy. Benign adenomas of 6 mm or less in size, diagnosed\\u000a based on both nonmagnified and magnified observation,

Kazutomo Togashi; Kunihiko Shimura; Fumio Konishi; Yasuyuki Miyakura; Koji Koinuma; Hisanaga Horie; Yoshikazu Yasuda



The future of surgery in the treatment of breast cancer.  


The role of surgery cannot be discussed independently, but in relationship to the other modalities of treatment. Sentinel lymph node mapping and biopsy has revolutionized the role of surgery in axillary staging. Techniques of sentinel node mapping, the timing relative to chemotherapy, possible contraindications, and the necessity of completion axillary dissection are all under active investigation. The next few years will see continued changes in this important technique. Techniques of localizing clinically occult tumors are numerous and under study. These are not yet at the level of Phase III comparative trials. Induction chemotherapy has long been standard care for women with locally advanced breast cancer. It has not become standard care for Stage I or II breast cancers that meet criteria for adjuvant therapy. The ability to significantly downsize 80% of breast cancers is reason enough to make it usual practice for women who are certain to receive chemotherapy, if only for the cosmetic advantage that would accrue. Much has been made of the use of thermal ablation of small breast cancers by small probes introduced by skin puncture. In initial trials the lesions were excised after being heated or frozen. Current studies are leaving the destroyed tissue in place and following for evidence of control or recurrence. The value of this approach in terms of cosmesis is unproven, and the timing of its introduction when small tumors are being evaluated for margins and genetic markers, make it difficult to imagine broad acceptance. Finally, the role of prophylactic surgery for women at increased risk remains a difficult equation, compounded of alternatives such as chemoprevention, availability and effectiveness of surveillance techniques, and the level of fear and anxiety of the patient. PMID:14659123

Wood, William C



Endoscopic Breast Surgery in Treating Patients With Breast Cancer

Male Breast Cancer; Recurrent Breast Cancer; Stage IA Breast Cancer; Stage IB Breast Cancer; Stage II Breast Cancer; Stage IIIA Breast Cancer; Stage IIIB Breast Cancer; Stage IIIC Breast Cancer; Stage IV Breast Cancer



Iris recognition: a biometric method after refractive surgery  

Microsoft Academic Search

Iris recognition, as a biometric method, outperforms others because of its high accuracy. Iris is the visible internal organ of human, so it is stable and very difficult to be altered. But if an eye surgery must be made to some individuals, it may be rejected by iris recognition system as imposters after the surgery, because the iris pattern was

YUAN Xiao-yan; ZHOU Hao; SHI Peng-fei



Follow-Up Surveillance for Recurrence After Curative Gastric Cancer Surgery Lacks Survival Benefit  

Microsoft Academic Search

Background: Although routine follow-up to detect asymptomatic recurrence after surgery for gastric cancer is recommended, the effect\\u000a of such reassessment on survival has not been evaluated.\\u000a \\u000a \\u000a Methods: Clinical records of patients developing recurrent disease after potentially curative resection between 1985 and 1996 were\\u000a retrieved. Among these patients, 197 were in our follow-up program. We analyzed survival in these patients according

Yasuhiro Kodera; Seiji Ito; Yoshitaka Yamamura; Yoshinari Mochizuki; Michitaka Fujiwara; Kenji Hibi; Katsuki Ito; Seiji Akiyama; Akimasa Nakao



Do Elderly Cancer Patients Care about Cure? Attitudes to Radical Gynecologic Oncology Surgery in the Elderly  

Microsoft Academic Search

Objective. The aim of this study was to address the hypothesis of no difference between elderly and younger patients' desire for optimal surgery and disease cure.Methods. The new ARGOSE questionnaire with established instruments was administered to 189 gynecologic cancer patients (95 aged <65, 57 aged 65–74, and 37 aged 75+ years).Results. Disease diagnosis differed between the <65 years and 65+

A. J. Nordin; D. J. Chinn; I. Moloney; R. Naik; A. de Barros Lopes; J. M. Monaghan



Thyroid cancer in Graves' disease: is surgery the best treatment for Graves' disease?  


BACKGROUND: Graves' disease is a common cause of thyrotoxicosis. Treatment options include anti-thyroid medications or definitive therapy: thyroidectomy or radioactive iodine (I(131) ). Traditionally, I(131) has been the preferred definitive treatment for Graves' disease in New Zealand. Reports of concomitant thyroid cancer occurring in up to 17% of Graves' patients suggest surgery, if performed with low morbidity, may be the preferred option. The aim of this study was to determine the rate of thyroid cancer and surgical outcomes in a New Zealand cohort of patients undergoing thyroidectomy for Graves' disease. METHOD: This study is a retrospective review of Waikato region patients undergoing thyroid surgery for Graves' disease during the 10-year period prior to 1 December 2011. RESULTS: A total of 833 patients underwent thyroid surgery. Of these, 117 were for Graves' disease. Total thyroidectomy was performed in 82, near-total in 33 and subtotal in 2 patients. Recurrent thyrotoxicosis developed in one subtotal patient requiring I(131) therapy. There were two cases of permanent hypoparathyroidism and one of permanent recurrent laryngeal nerve palsy. Eight patients (6.8%) had thyroid cancer detected, none of whom had overt nodal disease. Five were papillary microcarcinomas (one of which was multifocal), two were papillary carcinomas (11?mm and 15?mm) and one was a minimally invasive follicular carcinoma. CONCLUSION: Thyroid cancer was identified in approximately 7% of patients undergoing surgery for Graves' disease. A low complication rate (<2%) of permanent hypoparathyroidism and nerve injury (<1%) supports surgery being a safe alternative to I(131) especially for patients with young children, ophthalmopathy or compressive symptoms. PMID:22985335

Tamatea, Jade A U; Tu'akoi, Kelson; Conaglen, John V; Elston, Marianne S; Meyer-Rochow, Goswin Y



Impact of screening colonoscopy on outcomes in colon cancer surgery.  


IMPORTANCE Screening colonoscopy seemingly decreases colorectal cancer rates in the United States. In addition to removing benign lesions and preventing progression to malignancy, screening colonoscopy theoretically identifies asymptomatic patients with early-stage disease, potentially leading to higher survival rates. OBJECTIVES To assess the effect of screening colonoscopy on outcomes of colon cancer surgery by reviewing differences in staging, disease-free interval, risk of recurrence, and survival and to identify whether diagnosis through screening improves long-term outcomes independent of staging. DESIGN Retrospective review of prospectively maintained, institutional review board-approved database. SETTING Tertiary care center with high patient volume. PATIENTS All patients who underwent colon cancer surgery at Massachusetts General Hospital from January 1, 2004, through December 31, 2011. INTERVENTION Colon cancer surgery. MAIN OUTCOMES AND MEASURES Postoperative staging, death, and recurrence, measured as incidence and time to event. RESULTS A total of 1071 patients were included, with 217 diagnosed through screening. Patients not diagnosed through screening were at risk for a more invasive tumor (?T3: relative risk [RR]?=?1.96; P?cancer identified on screening colonoscopy not only have lower-stage disease on presentation but also have better outcomes independent of their staging. Compliance to screening colonoscopy guidelines can play an important role in prolonging longevity, improving quality of life, and reducing health care costs through early detection of colon cancer. PMID:23784448

Amri, Ramzi; Bordeianou, Liliana G; Sylla, Patricia; Berger, David L



Psychosocial Adaptationand Cellular Immunity in Breast Cancer Patients in the Weeks After Surgery: An Exploratory Study  

PubMed Central

Background The period just after surgery for breast cancer requires psychosocial adaptation and is associated with elevated distress. Distress states have been associated with decreased cellular immune functioning in this population, which could have negative effects on physical recovery. However little is known about relations between psychological status (negative and positive mood states and overall quality of life) and cellular signaling cytokines that could account for these associations in women undergoing treatment for breast cancer. Methods The present study examined associations between psychological adaptation indicators (mood, quality of life) and T-helper cell-type 1 (Th1) cytokine production from stimulated peripheral mononuclear cells in women who had recently undergone surgery for early-stage breast cancer but had not yet begun adjuvant therapy. These associations were evaluated while controlling for relevant disease/treatment, sociodemographic and health behavior covariates. Results Lower anxiety related to greater production of the Th1 cytokine interleukin-2 (IL-2) while greater positive mood (affection) related to greater production of the Th1 cytokines IL-12 and interferon-gamma (IFN-?). Better quality of life (QOL) related to greater production of the Th1 cytokine, tumor necrosis factor-alpha (TNF-?). Conclusion Individual differences in psychosocial adaptation in women with breast cancer during the period after surgery relate to biological parameters that may be relevant for health and well-being as they move through treatment.

Blomberg, Bonnie B.; Alvarez, Juan P.; Diaz, Alain; Romero, Maria G.; Lechner, Suzanne; Carver, Charles S.; Holly, Heather; Antoni, Michael H.



Assessment of body image in patients undergoing surgery for colorectal cancer  

Microsoft Academic Search

Purpose  This study tested the scale properties and validity of the ten-item body image scale (BIS) in patients undergoing surgery\\u000a for colorectal cancer (CRC).\\u000a \\u000a \\u000a \\u000a Methods  Patients completed the BIS and a validated measure of health-related quality of life (European Organisation for Research and\\u000a Treatment of Cancer (EORTC) QLQ-C30) after open or laparoscopic resection. A sample of the patients had also previously completed

Robert N. Whistance; Rebecca Gilbert; Peter Fayers; Robert J. Longman; Anne Pullyblank; Michael Thomas; Jane M. Blazeby



Early results of laparoscopic surgery for colorectal cancer  

Microsoft Academic Search

PURPOSE: This study was undertaken to determine the early experience of the embers of the COST Study Group with colorectal cancer treated by laparoscopic approaches. METHOD: A retrospective review was performed of all patients with colorectal cancer treated with laparoscopy by the COST Study Group before August 1994. Tumor site, stage, differentiation, procedure completion, presence of recurrence (local, distant, trocar

James W. Fleshman; Heidi Nelson; Walter R. Peters; H. Charles Kim; Sergio Larach; Richard R. Boorse; Wayne Ambroze; Phillip Leggett; Ronald Bleday; Steven Stryker; Brent Christenson; Steven Wexner; Anthony Senagore; David Rattner; John Sutton; Arthur P. Fine



Relation of Surgeon and Hospital Volume to Processes and Outcomes of Colorectal Cancer Surgery  

PubMed Central

Background: Greater hospital volume has been associated with lower mortality after colorectal cancer surgery. The contribution of surgeon volume to processes and outcomes of care is less well understood. We assessed the relation of surgeon and hospital volume to postoperative and overall mortality, colostomy rates, and use of adjuvant radiation therapy. Methods: From the California Cancer Registry, we studied 28,644 patients who underwent surgical resection of stage I to III colorectal cancer during 1996 to 1999 and were followed up to 6 years after surgery to assess 30-day postoperative mortality, overall long-term mortality, permanent colostomy, and use of adjuvant radiation therapy. Results: Across decreasing quartiles of hospital and surgeon volume, 30-day postoperative mortality ranged from 2.7% to 4.2% (P<0.001). Adjusting for age, stage, comorbidity, and median income among patients with colorectal cancer who survived at least 30 days, patients in the lowest quartile of surgeon volume had a higher adjusted overall mortality rate than those in the highest quartile (hazard ratio, 1.16; 95% confidence interval, 1.09–1.24), as did patients in the lowest quartile of hospital volume relative to those treated in the highest quartile (hazard ratio, 1.11; 95% confidence interval, 1.05–1.19). For rectal cancer, adjusted colostomy rates were significantly higher for low-volume surgeons, and the use of adjuvant radiation therapy was significantly lower for low-volume hospitals. Conclusions: Greater surgeon and hospital volumes were associated with improved outcomes for patients undergoing surgery for colorectal cancer. Further study of processes that led to these differences may improve the quality of colorectal cancer care.

Rogers, Selwyn O.; Wolf, Robert E.; Zaslavsky, Alan M.; Wright, William E.; Ayanian, John Z.



Improving quality of breast cancer surgery through development of a national breast cancer surgical outcomes (BRCASO) research database  

PubMed Central

Background Common measures of surgical quality are 30-day morbidity and mortality, which poorly describe breast cancer surgical quality with extremely low morbidity and mortality rates. Several national quality programs have collected additional surgical quality measures; however, program participation is voluntary and results may not be generalizable to all surgeons. We developed the Breast Cancer Surgical Outcomes (BRCASO) database to capture meaningful breast cancer surgical quality measures among a non-voluntary sample, and study variation in these measures across providers, facilities, and health plans. This paper describes our study protocol, data collection methods, and summarizes the strengths and limitations of these data. Methods We included 4524 women ?18 years diagnosed with breast cancer between 2003-2008. All women with initial breast cancer surgery performed by a surgeon employed at the University of Vermont or three Cancer Research Network (CRN) health plans were eligible for inclusion. From the CRN institutions, we collected electronic administrative data including tumor registry information, Current Procedure Terminology codes for breast cancer surgeries, surgeons, surgical facilities, and patient demographics. We supplemented electronic data with medical record abstraction to collect additional pathology and surgery detail. All data were manually abstracted at the University of Vermont. Results The CRN institutions pre-filled 30% (22 out of 72) of elements using electronic data. The remaining elements, including detailed pathology margin status and breast and lymph node surgeries, required chart abstraction. The mean age was 61 years (range 20-98 years); 70% of women were diagnosed with invasive ductal carcinoma, 20% with ductal carcinoma in situ, and 10% with invasive lobular carcinoma. Conclusions The BRCASO database is one of the largest, multi-site research resources of meaningful breast cancer surgical quality data in the United States. Assembling data from electronic administrative databases and manual chart review balanced efficiency with high-quality, unbiased data collection. Using the BRCASO database, we will evaluate surgical quality measures including mastectomy rates, positive margin rates, and partial mastectomy re-excision rates among a diverse, non-voluntary population of patients, providers, and facilities.



Cytoreductive surgery and HIPEC in peritoneal recurrent ovarian cancer: experience and lessons learned  

Microsoft Academic Search

Purpose  Peritoneal recurrence of ovarian cancer is frequent after primary surgery and chemotherapy and has poor long-term survival.\\u000a De novo cytoreductive surgery is crucial with the potential to improve prognosis, especially when combined with hyperthermic\\u000a intraperitoneal chemotherapy (HIPEC).\\u000a \\u000a \\u000a \\u000a \\u000a Methods  The sampled data of 40 consecutive patients were retrospectively analyzed. Thirty-one patients were treated with cytoreductive\\u000a surgery combined with hyperthermic intraperitoneal chemotherapy.\\u000a \\u000a \\u000a \\u000a \\u000a Results  No

Ingmar Königsrainer; Stefan Beckert; Sven Becker; Derek Zieker; Tanja Fehm; Eva-Maria Grischke; Olivia Lauk; Jörg Glatzle; Björn Brücher; Diethelm Wallwiener; Alfred Königsrainer


Neoadjuvant chemotherapy and surgery of cancer of the esophagus.  


Neoadjuvant, or preoperative, chemotherapy for esophageal cancer has become an area of increasing interest because of the failure of conventional therapy (surgery or radiation) to improve disease-free or overall survival. Several autopsy series have demonstrated that, in many symptomatic western patients, esophageal cancer is a systemic disease. Neoadjuvant chemotherapy thus, in theory, allows a simultaneous attack on both the primary and metastatic disease. A number of single-arm, phase II multimodality trials have been completed. Toxicities of chemotherapy, while substantial, have been tolerable. With careful attention to detail, operative morbidity and mortality has not been increased. Large-scale randomized trials are needed to evaluate the impact of this technique on disease-free and overall survival. PMID:3330276

Kelsen, D P; Hilaris, B; Martini, N



Sigmoid volvulus after laparoscopic surgery for sigmoid colon cancer.  


We report the first case of sigmoid volvulus after laparoscopic surgery for sigmoid colon cancer. The patient is a 75-year-old man who presented with the sudden onset of severe abdominal pain. He had undergone laparoscopic sigmoidectomy for cancer 2 years before presentation. CT scan showed a distended sigmoid colon with a mesenteric twist, or "whirl sign." Colonoscopy showed a mucosal spiral and luminal stenosis with dilated sigmoid colon distally and ischemic mucosa. The diagnosis of ischemic colonic necrosis due to sigmoid volvulus was established. Resection of the necrotic sigmoid colon was performed and a descending colon stoma was created. A long remnant sigmoid colon and chronic constipation may contribute to the development of sigmoid volvulus after laparoscopic sigmoidectomy. Prompt diagnosis is essential for adequate treatment, and colonoscopy aids in the diagnosis of ischemic changes in patients without definitive findings of a gangrenous colon. PMID:23879414

Sadatomo, Ai; Miyakura, Yasuyuki; Zuiki, Toru; Koinuma, Koji; Horie, Hisanaga; Lefor, Alan T; Yasuda, Yoshikazu



Iris recognition as a biometric method after cataract surgery  

Microsoft Academic Search

BACKGROUND: Biometric methods are security technologies, which use human characteristics for personal identification. Iris recognition systems use iris textures as unique identifiers. This paper presents an analysis of the verification of iris identities after intra-ocular procedures, when individuals were enrolled before the surgery. METHODS: Fifty-five eyes from fifty-five patients had their irises enrolled before a cataract surgery was performed. They

Roberto Roizenblatt; Paulo Schor; Fabio Dante; Jaime Roizenblatt; Rubens Belfort Jr



Surreptitious surgery on Long Island Sound: The oral cancer surgeries of President Grover Cleveland.  


Grover Cleveland rose from being the mayor of Buffalo to the governor of New York to the president of the United States. At the start of Cleveland's second term as president, the nation was involved in a severe financial crisis, the extent of which was not known by the general public. President Cleveland was to make a strong appeal to Congress in the coming months to repeal the Sherman Silver Purchase Act of 1890. He thought this would set the nation on the road to fiscal recovery. However, his vice president, Adlai Stevenson, strongly opposed repeal of the Sherman Act. Prior to scheduling his appearance before Congress, President Cleveland noticed a rough spot on his palate. A biopsy confirmed that it was cancer, and it was determined that surgery was needed. Cleveland and his advisors thought the nation would be thrown into a panic if the President's health did not remain a secret. A surgical team, which included a dentist, performed the surgery in secrecy while traveling aboard a yacht. A prosthetic obturator was fabricated by a New York prosthodontist to close the surgical defect. Cleveland recovered well, made a forceful speech before Congress, had the Sherman Act repealed and lived without a recurrence of his oral cancer for the rest of his life. The public remained unaware, for the most part, of the gravity of President Cleveland's health for decades. PMID:20359065

Maloney, William



Nanoshell-mediated laser surgery simulation for prostate cancer treatment  

PubMed Central

Laser surgery, or laser-induced thermal therapy, is a minimally invasive alternative or adjuvant to surgical resection in treating tumors embedded in vital organs with poorly defined boundaries. Its use, however, is limited due to the lack of precise control of heating and slow rate of thermal diffusion in the tissue. Nanoparticles, such as nanoshells, can act as intense heat absorbers when they are injected into tumors. These nanoshells can enhance thermal energy deposition into target regions to improve the ability for destroying larger cancerous tissue volumes with lower thermal doses. The goal of this paper is to present an integrated computer model using a so-called nested-block optimization algorithm to simulate laser surgery and provide transient temperature field predictions. In particular, this algorithm aims to capture changes in optical and thermal properties due to nanoshell inclusion and tissue property variation during laser surgery. Numerical results show that this model is able to characterize variation of tissue properties for laser surgical procedures and predict transient temperature fields comparable to those measured by in vivo magnetic resonance temperature imaging techniques. Note that the computational approach presented in the study is quite general and can be applied to other types of nanoparticle inclusions.

Feng, Yusheng; Fuentes, David; Hawkins, Andrea; Bass, Jon; Rylander, Marissa Nichole; Elliott, Andrew; Shetty, Anil; Stafford, R. Jason; Oden, J. Tinsley



Development of a screening instrument for risk factors of persistent pain after breast cancer surgery  

PubMed Central

Background: Persistent postsurgical pain can have a significant effect on the quality of life of women being treated for breast cancer. The aim of this prospective study was to develop a screening tool to identify presurgical demographic, psychological and treatment-related factors that predict persistence of significant pain in the operated area after 6 months from surgery. Methods: Background and self-reported questionnaire data were collected the day before surgery and combined with treatment-related data. Pain in the operated area was assessed 6 months after surgery with a questionnaire. The Bayesian model was used for the development of a screening tool. Results: Report of preoperative chronic pain, more than four or more previous operations, preoperative pain in the area to be operated, high body mass index, previous smoking and older age were included in the six-factor model that best predicted significant pain at the follow-up in the 489 women studied. Conclusion: A six-factor risk index was developed to estimate the risk of developing significant pain after breast cancer surgery. Neither treatment- nor mood-related variables were included in the model. Identification of risk factors may lead to prevention of persistent postsurgery pain. This tool could be used for target prevention to those who are at the highest risk of developing persistent postsurgery pain.

Sipila, R; Estlander, A-M; Tasmuth, T; Kataja, M; Kalso, E



Tangential Radiotherapy Without Axillary Surgery in Early-Stage Breast Cancer: Results of a Prospective Trial  

SciTech Connect

Purpose: To determine the risk of regional-nodal recurrence in patients with early-stage, invasive breast cancer, with clinically negative axillary nodes, who were treated with breast-conserving surgery, 'high tangential' breast radiotherapy, and hormonal therapy, without axillary surgery or the use of a separate nodal radiation field. Methods and Materials: Between September 1998 and November 2003, 74 patients who were {>=}55 years of age with Stage I-II clinically node-negative, hormone-receptor-positive breast cancer underwent tumor excision to negative margins without axillary surgery as a part of a multi-institutional prospective study. Postoperatively, all underwent high-tangential, whole-breast radiotherapy with a boost to the tumor bed, followed by 5 years of hormonal therapy. Results: For the 74 patients enrolled, the median age was 74.5 years, and the median pathologic tumor size was 1.2 cm. Lymphatic vessel invasion was present in 5 patients (7%). At a median follow-up of 52 months, no regional-nodal failures or ipsilateral breast recurrences had been identified (95% confidence interval, 0-4%). Eight patients died, one of metastatic disease and seven of other causes. Conclusion: In this select group of mainly older patients with early-stage hormone-responsive breast cancer and clinically negative axillary nodes, treatment with high-tangential breast radiotherapy and hormonal therapy, without axillary surgery, yielded a low regional recurrence rate. Such patients might be spared more extensive axillary treatment (axillary surgery, including sentinel node biopsy, or a separate nodal radiation field), with its associated time, expense, and morbidity.

Wong, Julia S. [Department of Radiation Oncology, Dana-Farber/Brigham and Women's Cancer Center, Boston, MA (United States)], E-mail:; Taghian, Alphonse G. [Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA (United States); Bellon, Jennifer R. [Department of Radiation Oncology, Dana-Farber/Brigham and Women's Cancer Center, Boston, MA (United States); Keshaviah, Aparna [Department of Biostatistics and Computational Biology, Dana-Farber/Brigham and Women's Cancer Center, Boston, MA (United States); Smith, Barbara L. [Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA (United States); Winer, Eric P. [Department of Medical Oncology, Dana-Farber/Brigham and Women's Cancer Center, Boston, MA (United States); Silver, Barbara; Harris, Jay R. [Department of Radiation Oncology, Dana-Farber/Brigham and Women's Cancer Center, Boston, MA (United States)



Iris recognition: a biometric method after refractive surgery  

Microsoft Academic Search

Iris recognition, as a biometric method, outperforms others because of its high accuracy. Iris is the visible internal organ\\u000a of human, so it is stable and very difficult to be altered. But if an eye surgery must be made to some individuals, it may\\u000a be rejected by iris recognition system as imposters after the surgery, because the iris pattern was

Xiao-yan Yuan; Hao Zhou; Peng-fei Shi



Discovery May Help Pinpoint Risk of Lung Cancer Returning After Surgery  


... enable JavaScript. Discovery May Help Pinpoint Risk of Lung Cancer Returning After Surgery Tumors with specific cell pattern ... Preidt Wednesday, August 7, 2013 Related MedlinePlus Pages Lung Cancer Surgery WEDNESDAY, Aug. 7 (HealthDay News) -- Certain characteristics ...


Impact of Increased Body Mass Index on Laparoscopic Surgery for Rectal Cancer  

Microsoft Academic Search

Background: Laparoscopy was initially considered to be a risky procedure for rectal cancer patients, especially patients with an increased body weight. The literature is scarce regarding the effects of obesity on laparoscopic rectal surgery. The aim of the current study was to analyze the effect of an increased body mass index (BMI) on outcome of laparoscopic surgery for rectal cancer.

Tayfun Karahasanoglu; Ismail Hamzaoglu; Bilgi Baca; Erman Aytac; Ebru Kirbiyik



[Hypnosis and ultrasound-guided paravertebral block in breast cancer surgery].  


The combination of hypnosis and paravertebral block (PVB) was studied in three patients scheduled for breast cancer surgery. The three procedures were realized under hypnosis. Median postoperative pain was rated at zero and comfort felt at 8 on a 10 points scale. Hypnosis could be an alternative to conventional anesthesia in combination with a PVB for breast cancer surgery. PMID:22763307

Bouzinac, A; Delbos, A; Mazières, M; Rontes, O; Manenc, J-L



Risk Factors for Complications After Laparoscopic Surgery in Colorectal Cancer Patients: Experience of 401 Cases at a Single Institution  

Microsoft Academic Search

Background  Laparoscopic surgery is widely used for the treatment of colorectal cancer, but little is known about perioperative risk factors\\u000a for complications.\\u000a \\u000a \\u000a \\u000a Methods  Clinical data were reviewed for 401 consecutive unselected colorectal cancer patients who underwent laparoscopic surgery at\\u000a Kyoto Medical Center between 1998 and 2005. The outcome variable was incidence of postoperative complications. Using logistic\\u000a regression analysis, 58 background, clinical, preoperative,

Koya Hida; Takashi Yamaguchi; Hiroaki Hata; Hiroya Kuroyanagi; Satoshi Nagayama; Harue Tada; Satoshi Teramukai; Masanori Fukushima; Kinya Koizumi; Yoshiharu Sakai



Intensity-Modulated Whole Abdominal Radiotherapy After Surgery and Carboplatin\\/Taxane Chemotherapy for Advanced Ovarian Cancer: Phase I Study  

Microsoft Academic Search

Purpose: To assess the feasibility and toxicity of consolidative intensity-modulated whole abdominal radiotherapy (WAR) after surgery and chemotherapy in high-risk patients with advanced ovarian cancer. Methods and Materials: Ten patients with optimally debulked ovarian cancer International Federation of Gynecology and Obstetrics Stage IIIc were treated in a Phase I study with intensity-modulated WAR up to a total dose of 30

Nathalie Rochet; Florian Sterzing; Alexandra D. Jensen; Julien Dinkel; Klaus K. Herfarth; Kai Schubert; Michael H. Eichbaum; Andreas Schneeweiss; Christof Sohn; Juergen Debus; Wolfgang Harms



Endoscopy-assisted Breast-Conserving Surgery for Early Breast Cancer  

Microsoft Academic Search

Purpose  Breast-conserving surgery is now accepted as one of the standard therapeutic options for stages I and II breast cancers. Although\\u000a breast-conserving surgery can help retain a good breast shape, a long marked scar would be a disadvantage. Endoscopic surgery\\u000a can be performed via a small and remote incision that becomes inconspicuous after surgery. To improve the cosmetic outcome,\\u000a endoscopic breast-conserving

Eun-Kyu Lee; Shin-Ho Kook; Yong-Lai Park; Won-Gil Bae



Fluorescence-Guided Surgery and Fluorescence Laparoscopy for Gastrointestinal Cancers in Clinically-Relevant Mouse Models  

PubMed Central

There are many challenges that face surgeons when attempting curative resection for gastrointestinal cancers. The ability to properly delineate tumor margins for complete resection is of utmost importance in achieving cure and giving the patient the best chance of prolonged survival. Targeted tumor imaging techniques have gained significant interest in recent years to enable better identification of tumor lesions to improve diagnosis and treatment of cancer from preoperative staging modalities to optimizing the surgeon's ability to visualize tumor margins at the initial operation. Using unique characteristics of the tumor to fluorescently label the tissue can delineate tumor margins from normal surrounding tissue, allowing improved precision of surgical resection. In this paper, different methods of fluorescently labeling native tumor are discussed as well as the development of fluorescence laparoscopy and the potential role for fluorescence-guided surgery in the treatment of gastrointestinal cancers.

Metildi, Cristina A.; Hoffman, Robert M.; Bouvet, Michael



Indications for and limits of conservative surgery in breast cancer.  


Improvements in diagnostic techniques and, above all, breast cancer screening campaigns - essential for early diagnosis - have enabled the objectives of conservative surgery to be pursued: disease control, no or low incidence of recurrences and an excellent esthetic result. However, to reach these objectives, it is essential to ensure a careful evaluation of the medical history of every patient, a detailed clinical examination and the correct interpretation of imaging. Particular attention should be paid to all factors influencing the choice of treatment and/or possible local recurrence: age, site, tumor volume, genetic predisposition, pregnancy, previous radiotherapy, pathological features, and surgical margins. The decision to undertake conservative treatment thus requires a multidisciplinary approach involving pathologists, surgeons and oncological radiologists, as well, of course, as the patient herself. PMID:23578414

Barbuscia, M A; Cingari, E A; Torchia, U; Querci, A; Lemma, G; Ilacqua, A; Caizzone, A; Sanò, A; Fabiano, V



Implications of Prostate-Specific Antigen Doubling Time as Indicator of Failure after Surgery or Radiation Therapy for Prostate Cancer  

Microsoft Academic Search

Objectives: To review the methodology of PSA doubling time (PSA DT) calculations and the implications of PSA DT for the follow-up of prostate cancer patients curatively treated with surgery or radiation therapy. Methods: A literature search of the most recent articles on PSA DT (those published after 2000) led to the selection of six studies with the largest and best-documented

Massimo Maffezzini; Alberto Bossi; Laurence Collette


Nd:YAG laser resection of lung cancer invading the airway as a bridge to surgery and palliative treatment  

Microsoft Academic Search

Background. Thirty percent of patients with lung cancer have airway obstruction requiring palliation. In addition, endoscopic resection may be considered before surgery or induction therapy to improve quality of life and functional status, and to allow better staging. It may also help to prevent infectious complications during induction chemotherapy.Methods. Since 1993, 351 Nd:YAG laser resections were performed in 273 patients

Federico Venuta; Erino A Rendina; Tiziano De Giacomo; Edoardo Mercadante; Federico Francioni; Francesco Pugliese; Marco Moretti; Giorgio F Coloni



Association of shared decision-making with type of breast cancer surgery: a cross-sectional study  

Microsoft Academic Search

BACKGROUND: Although some studies examined the association between shared decision-making (SDM) and type of breast cancer surgery received, it is little known how treatment decisions might be shaped by the information provided by physicians. The purpose of this study was to identify the associations between shared decision making (SDM) and surgical treatment received. METHODS: Questionnaires on SDM were administered to

Myung Kyung Lee; Dong Young Noh; Seok Jin Nam; Se Hyun Ahn; Byeong Woo Park; Eun Sook Lee; Young Ho Yun



Technical description of a regional lymphadenectomy in radical surgery for gallbladder cancer  

PubMed Central

Background The guidelines for resection of gallbladder cancer include a regional lymphadenectomy; yet it is uncommonly performed in practice and inadequately described in the literature. The present study describes the technique of a regional lymphadenectomy for gallbladder cancer, as practiced by the author. Methods/Technique After confirming resectability, the duodenum is kocherized. The dissection starts from the posterior aspects of the duodenum and head of the pancreas and extends superiorly to the retroportal area. This is followed by dissection of the common hepatic artery and its branches, the bile duct and the anterior aspect of the portal vein until the hepatic hilum. Resection of the gallbladder with an appropriate liver resection completes the surgery. Results This technique was used for a regional lymphadenectomy in 27 patients, of which 14 underwent radical cholecystectomy upfront, and 13 had revisional surgery for incidentally detected gallbladder cancer. The median number of lymph nodes dissected on histopathology was 8 (range 3 to 18). Eleven patients had metastatic lymph nodes on histopathological examination. There was no post-operative mortality. Two patients had a bile leak which resolved with conservative management. Conclusion A systematic approach towards a regional lymphadenectomy ensures a consistent nodal harvest in patients undergoing radical resection for gallbladder cancer.

Pandey, Durgatosh



The impact of the sentinel node concept on the aesthetic outcome of breast cancer conservative surgery.  


BACKGROUND: The sentinel node (SN) concept has brought numerous advantages to women with breast cancer. Sparing axillary node anatomy and physiology may enhance the cosmetic results of breast cancer conservative surgery, either owing to less breast edema or to a better tolerance to the effects of surgery and radiotherapy. Our aim was to compare the cosmetic outcome of two randomized groups of patients, on a subjective and objective basis. METHODS: A consecutive series of breast cancer patients (n = 60) submitted to partial mastectomy plus axillary dissection or partial mastectomy plus SN biopsy (included in a randomized trial) was photographed. Photos were analysed in three ways: by seven different observers according to seven features from poor to excellent; two observers estimated the percentage of breast retraction assessment (pBRA); or by the BCCT.core 1.0(®) software. RESULTS: The panel subjective analysis showed a benefit in terms of the skin colour for the patients submitted to SN biopsy only. This group of patients did not show any advantage in terms of pBRA estimates even after the complex BCCT.core appraisal. CONCLUSIONS: The sentinel node concept is not associated with improvements in the aesthetic outcome of breast cancer conservative treatment. PMID:22467404

Fougo, José Luis; Reis, Paulo; Giesteira, Laurinda; Dias, Teresa; Araújo, Cláudia; Dinis-Ribeiro, Mário



Optical image-guided cancer surgery: challenges and limitations.  


Optical image-guided cancer surgery is a promising technique to adequately determine tumor margins by tumor-specific targeting, potentially resulting in complete resection of tumor tissue with improved survival. However, identification of the photons coming from the fluorescent contrast agent is complicated by autofluorescence, optical tissue properties, and accurate fluorescent targeting agents and imaging systems. All these factors have an important influence on the image that is presented to the surgeon. Considering the clinical consequences at stake, it is a prerequisite to answer the questions that are essential for the surgeon. What is optical image-guided surgery and how can it improve patient care? What should the oncologic surgeon know about the fundamental principles of optical imaging to understand which conclusions can be drawn from the images? And how do the limitations influence clinical decision making? This article discusses these questions and provides a clear overview of the basic principles and practical applications. Although there are limitations to the intrinsic capacity of the technique, when practical and technical surgical possibilities are considered, optical imaging can be a very powerful intraoperative tool in guiding the future oncologic surgeon toward radical resection and optimal clinical results. PMID:23674494

Keereweer, Stijn; Van Driel, Pieter B A A; Snoeks, Thomas J A; Kerrebijn, Jeroen D F; Baatenburg de Jong, Robert J; Vahrmeijer, Alexander L; Sterenborg, Henricus J C M; Löwik, Clemens W G M



Colorectal Cancer with Multiple Metastases: Is Palliative Surgery Needed?  

PubMed Central

In patients with symptomatic incurable metastatic colorectal cancer (mCRC), the goal of resection of the primary lesion is to palliate cancer-related morbidity, including obstruction, bleeding, or perforation. In patients with asymptomatic primary tumors and incurable metastatic disease, however, the necessity of primary tumor resection is less clear. Although several retrospective analyses suggest survival benefit in patients who undergo resection of the primary tumor, applying this older evidence to modern patients is out of date for several reasons. Modern chemotherapy regimens incorporating the novel cytotoxic agents oxaliplatin and irinotecan, as well as the target agents bevacizumab and cetuximab, have improved median survival from less than 1 year with the only available single-agent 5-fluorouracil until the mid-1990s to over 2 years. In addition to significant prolongation of overall survival, combinations of novel chemotherapeutic and target agents have allowed improved local and distant tumor control, decreasing the likelihood of local tumor-related complications requiring surgical resection. Resection of an asymptomatic primary tumor risks surgical complications and may postpone the administration of chemotherapy that may offer both systemic and local control. In conclusion, the morbidity and the mortality of unnecessary surgery or surgery that does not improve quality of life or survival in patients with mCRC of a limited life expectancy should be carefully evaluated. With the availability of effective combinations of chemotherapy and target agents, systemic therapy for the treatment of life-threatening metastases would be a preferable treatment strategy for unresectable asymptomatic patients with mCRC.

Shin, Jin Yong



Population-based study of laparoscopic colorectal cancer surgery 2006-2008  

PubMed Central

Background Clinical guidelines recommend that, where clinically appropriate, laparoscopic tumour resections should be available for patients with colorectal cancer. This study aimed to examine the introduction of laparoscopic surgery in the English National Health Service. Methods Data were extracted from the National Cancer Data Repository on all patients who underwent major resection for a primary colorectal cancer diagnosed between 2006 and 2008. Laparoscopic procedures were identified from codes in the Hospital Episode Statistics and National Bowel Cancer Audit Project data in the resource. Trends in the use of laparoscopic surgery and its influence on outcomes were examined. Results Of 58 135 resections undertaken over the study period, 10 955 (18·8 per cent) were attempted laparoscopically. This increased from 10·0 (95 per cent confidence interval (c.i.) 8·1 to 12·0) per cent in 2006 to 28·4 (25·4 to 31·4) per cent in 2008. Laparoscopic surgery was used less in patients with advanced disease (modified Dukes' stage ‘D’ versus A: odds ratio (OR) 0·45, 95 per cent c.i. 0·40 to 0·50), rectal tumours (OR 0·71, 0·67 to 0·75), those with more co-morbidity (Charlson score 3 or more versus 0: OR 0·69, 0·58 to 0·82) or presenting as an emergency (OR 0·15, 0·13 to 0·17). A total of 1652 laparoscopic procedures (15·1 per cent) were converted to open surgery. Conversion was more likely in advanced disease (modified Dukes' stage ‘D’ versus A: OR 1·56, 1·20 to 2·03), rectal tumours (OR 1·29, 1·14 to 1·46) and emergencies (OR 2·06, 1·54 to 2·76). Length of hospital stay (OR 0·65, 0·64 to 0·66), 30-day postoperative mortality (OR 0·55, 0·48 to 0·64) and risk of death within 1 year (hazard ratio 0·60, 0·55 to 0·65) were reduced in the laparoscopic group. Conclusion Laparoscopic surgery was used more frequently in low-risk patients. Copyright © 2012 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.

Taylor, E F; Thomas, J D; Whitehouse, L E; Quirke, P; Jayne, D; Finan, P J; Forman, D; Wilkinson, J R; Morris, E J A



[Value of radical oncological surgery in bilateral synchronous renal cell cancer and coincidental simultaneous prostate cancer].  


To date, the current literature does not report on oncological surgery in bilateral renal cell cancer and coincidental simultaneous prostate cancer. We present the case of a 66-year-old patient presenting as a challenge due to this oncological-surgical constellation. Based on the present case study and the postoperative follow-up, we discuss possible surgical strategies and demonstrate that, even in the case of multiple tumour locations, a satisfying oncological and functional long-term result is achievable. PMID:19603378

Rud, Oleg; Krause, F S; Engehausen, D G; May, M; Gilfrich, C



Young breast cancer patients' involvement in treatment decisions: the major role played by decision-making about surgery.  


OBJECTIVE: The objective of this study is to investigate young breast cancer patients' preferred and actual involvement in decision-making about surgery, chemotherapy, and adjuvant endocrine therapy (AET). METHODS: A total of 442 women aged 18-40?years at the time of the diagnosis participated in the region-wide ELIPPSE40 cohort study (southeastern France). Logistic regression analyses were performed on various factors possibly affecting patients' preferred and perceived involvement in the decisions about their cancer treatment. RESULTS: The women's mean age was 36.8?years at enrolment. Preference for a fully passive role in decision-making was stated by 20.7% of them. It was favored by regular breast surveillance (p?=?0.04) and positive experience of being informed about cancer diagnosis (p?=?0.02). Patients' preferences were independently associated with their reported involvement in decision-making about surgery (p?=?0.01). A fully passive role in decision-making about chemotherapy and AET was more likely to be reported by patients who perceived their involvement in decision-making about surgery as having been fully passive (adjusted odds ratio?=?4.8, CI95% [2.7-8.7], and adjusted odds ratio?=?9.8, CI95% [3.3-29.2], respectively). This study shows a significant relationship between the use of antidepressants and involvement in decision-making about surgery, and confirms the relationship between impaired quality of life (in the psychological domain) and a fully passive role in decisions about cancer treatment. CONCLUSIONS: Patients' involvement in decision-making about chemotherapy and AET was strongly influenced by their experience of decision-making about surgery, regardless of their tumor stage and history of breast or ovarian cancer. When decisions are being made about surgery, special attention should be paid to facilitating breast cancer patients' involvement in the decision-making. Copyright © 2013 John Wiley & Sons, Ltd. PMID:23749441

Seror, Valérie; Cortaredona, Sébastien; Bouhnik, Anne-Deborah; Meresse, Mégane; Cluze, Camille; Viens, Patrice; Rey, Dominique; Peretti-Watel, Patrick



Neoadjuvant chemotherapy and radical surgery in locally advanced cervical cancer during pregnancy: case report and review of literature.  


For pregnant patients with cervical cancer, treatment recommendations are individualized and dependent on the stage of the disease, gestational age at the time of diagnosis, and the patient's desire as to the cosntinuation of the pregnancy. The aim of this study is to describe the outcome of neoadjuvant chemotherapy with radical surgery and pelvic lymphadenectomy in a woman with cervical cancer who wished to maintain her pregnancy. This is a report of a 26-week pregnant woman with locally advanced cervical cancer stage I(b2) (FIGO) who was successfully treated with neoadjuvant chemotherapy Paclitaxel plus platinum, followed by C/S and radical surgery. Her neonate was healthy and had no abnormalities. This case was the first cervical cancer during pregnancy that was treated using this method at the tumor clinic, Mashhad University of Medical Sciences, Iran. Neoadjuvant chemotherapy is an effort to allow time for the fetal to reach viability by preventing the progression of the disease. PMID:23386949

Yousefi, Zohreh; Hoshyar, Azam Hoseini; Kadkhodayan, Sima; Hasanzade, Maliheh; Kalantari, Mahmoud Reza; Mottaghi, Mansoureh



The role of the robotic technique in minimally invasive surgery in rectal cancer  

PubMed Central

Laparoscopic rectal surgery is feasible, oncologically safe, and offers better short-term outcomes than traditional open procedures in terms of pain control, recovery of bowel function, length of hospital stay, and time until return to working activity. Nevertheless, laparoscopic techniques are not widely used in rectal surgery, mainly because they require a prolonged and demanding learning curve that is available only in high-volume and rectal cancer surgery centres experienced in minimally invasive surgery. Robotic surgery is a new technology that enables the surgeon to perform minimally invasive operations with better vision and more intuitive and precise control of the operating instruments, promising to overcome some of the technical difficulties associated with standard laparoscopy. The aim of this review is to summarise the current data on clinical and oncological outcomes of minimally invasive surgery in rectal cancer, focusing on robotic surgery, and providing original data from the authors’ centre.

Bianchi, Paolo Pietro; Luca, Fabrizio; Petz, Wanda; Valvo, Manuela; Cenciarelli, Sabine; Zuccaro, Massimiliano; Biffi, Roberto



Perioperative chemotherapy with FOLFOX4 and surgery versus surgery alone for resectable liver metastases from colorectal cancer (EORTC Intergroup trial 40983): a randomised controlled trial  

PubMed Central

Summary Background Surgical resection alone is regarded as the standard of care for patients with liver metastases from colorectal cancer, but relapse is common. We assessed the combination of perioperative chemotherapy and surgery compared with surgery alone for patients with initially resectable liver metastases from colorectal cancer. Methods This parallel-group study reports the trial's final data for progression-free survival for a protocol unspecified interim time-point, while overall survival is still being monitored. 364 patients with histologically proven colorectal cancer and up to four liver metastases were randomly assigned to either six cycles of FOLFOX4 before and six cycles after surgery or to surgery alone (182 in perioperative chemotherapy group vs 182 in surgery group). Patients were centrally randomised by minimisation, adjusting for centre and risk score. The primary objective was to detect a hazard ratio (HR) of 0·71 or less for progression-free survival. Primary analysis was by intention to treat. Analyses were repeated for all eligible (171 vs 171) and resected patients (151 vs 152). This trial is registered with, number NCT00006479. Findings In the perioperative chemotherapy group, 151 (83%) patients were resected after a median of six (range 1–6) preoperative cycles and 115 (63%) patients received a median six (1–8) postoperative cycles. 152 (84%) patients were resected in the surgery group. The absolute increase in rate of progression-free survival at 3 years was 7·3% (from 28·1% [95·66% CI 21·3–35·5] to 35·4% [28·1–42·7]; HR 0·79 [0·62–1·02]; p=0·058) in randomised patients; 8·1% (from 28·1% [21·2–36·6] to 36·2% [28·7–43·8]; HR 0·77 [0·60–1·00]; p=0·041) in eligible patients; and 9·2% (from 33·2% [25·3–41·2] to 42·4% [34·0–50·5]; HR 0·73 [0·55–0·97]; p=0·025) in patients undergoing resection. 139 patients died (64 in perioperative chemotherapy group vs 75 in surgery group). Reversible postoperative complications occurred more often after chemotherapy than after surgery (40/159 [25%] vs 27/170 [16%]; p=0·04). After surgery we recorded two deaths in the surgery alone group and one in the perioperative chemotherapy group. Interpretation Perioperative chemotherapy with FOLFOX4 is compatible with major liver surgery and reduces the risk of events of progression-free survival in eligible and resected patients. Funding Swedish Cancer Society, Cancer Research UK, Ligue Nationale Contre le Cancer, US National Cancer Institute, Sanofi-Aventis.

Nordlinger, Bernard; Sorbye, Halfdan; Glimelius, Bengt; Poston, Graeme J; Schlag, Peter M; Rougier, Philippe; Bechstein, Wolf O; Primrose, John N; Walpole, Euan T; Finch-Jones, Meg; Jaeck, Daniel; Mirza, Darius; Parks, Rowan W; Collette, Laurence; Praet, Michel; Bethe, Ullrich; Van Cutsem, Eric; Scheithauer, Werner; Gruenberger, Thomas



Does Delay in Breast Irradiation Following Conservative Breast Surgery in Node-Negative Breast Cancer Patients Have an Impact on Risk of Recurrence?  

Microsoft Academic Search

Purpose: This retrospective review was conducted to determine if delay in the start of radiotherapy after definitive breast surgery had any detrimental effect on local recurrence or disease-free survival in node-negative breast cancer patients.Methods and Materials: A total of 568 patients with T1-T2, N0 breast cancer were treated with breast-conserving surgery and breast irradiation, without adjuvant systemic therapy between January

Olga Vujovic; Francisco Perera; A. Rashid Dar; Larry Stitt; Edward Yu; Sachi M Voruganti; Pauline T Truong



Association between tumour angiogenesis and tumour cell shedding into effluent venous blood during breast cancer surgery  

Microsoft Academic Search

Tumour angiogenesis is a powerful prognostic indicator in breast cancer. Shedding of tumour cells into the bloodstream is essential for haematogenous metastasis. The relation between cell shedding and angiogenesis in human cancer is not known. We studied vascular density and cell shedding in 16 women undergoing breast cancer surgery. Circulating cells were found in one patient before, in six during,

P. McCulloch; A. Choy; L. Martin



Gynecologic examination and cervical biopsies after (chemo) radiation for cervical cancer to identify patients eligible for salvage surgery  

SciTech Connect

Purpose: The aim of this study was to evaluate efficacy of gynecologic examination under general anesthesia with cervical biopsies after (chemo) radiation for cervical cancer to identify patients with residual disease who may benefit from salvage surgery. Methods and Materials: In a retrospective cohort study data of all cervical cancer patients with the International Federation of Gynecology and Obstetrics (FIGO) Stage IB1 to IVA treated with (chemo) radiation between 1994 and 2001 were analyzed. Patients underwent gynecologic examination under anesthesia 8 to 10 weeks after completion of treatment. Cervical biopsy samples were taken from patients judged to be operable. In case of residual cancer, salvage surgery was performed. Results: Between 1994 and 2001, 169 consecutive cervical cancer patients received primary (chemo) radiation, of whom 4 were lost to follow-up. Median age was 56 years (interquartile range [IQR], 44-71) and median follow-up was 3.5 years (IQR, 1.5-5.9). In each of 111 patients a biopsy sample was taken, of which 90 (81%) showed no residual tumor. Vital tumor cells were found in 21 of 111 patients (19%). Salvage surgery was performed in 13 of 21 (62%) patients; of these patients, 5 (38%) achieved long-term, complete remission after salvage surgery (median follow-up, 5.2 years; range, 3.9-8.8 years). All patients with residual disease who did not undergo operation (8/21) died of progressive disease. Locoregional control was more often obtained in patients who underwent operation (7 of 13) than in patients who were not selected for salvage surgery (0 of 8 patients) (p < 0.05). Conclusions: Gynecologic examination under anesthesia 8 to 10 weeks after (chemo) radiation with cervical biopsies allows identification of those cervical cancer patients who have residual local disease, of whom a small but significant proportion may be salvaged by surgery.

Nijhuis, Esther R. [Department of Gynecologic Oncology, University Medical Centre Groningen, University of Groningen, Groningen (Netherlands); Zee, Ate G.J. van der [Department of Gynecologic Oncology, University Medical Centre Groningen, University of Groningen, Groningen (Netherlands); Hout, Bertha A. in 't [Department of Gynecologic Oncology, University Medical Centre Groningen, University of Groningen, Groningen (Netherlands); Boomgaard, Jantine J. [Department of Gynecologic Oncology, University Medical Centre Groningen, University of Groningen, Groningen (Netherlands); Hullu, Joanne A. de [Department of Obstetrics and Gynaecology, Radboud University Nijmegen Medical Centre, Nijmegen (Netherlands); Pras, Elisabeth [Department of Radiation Oncology, University Medical Centre Groningen, University of Groningen, Groningen (Netherlands); Hollema, Harry [Department of Pathology, University Medical Centre Groningen, University of Groningen, Groningen (Netherlands); Aalders, Jan G. [Department of Gynecologic Oncology, University Medical Centre Groningen, University of Groningen, Groningen (Netherlands); Nijman, Hans W. [Department of Gynecologic Oncology, University Medical Centre Groningen, University of Groningen, Groningen (Netherlands); Willemse, Pax H.B. [Department of Medical Oncology, University Medical Centre Groningen, University of Groningen, Groningen (Netherlands); Mourits, Marian J.E. [Department of Gynecologic Oncology, University Medical Centre Groningen, University of Groningen, Groningen (Netherlands)]. E-mail:



Health-Related Quality of Life in Breast Cancer Patients with Lymphedema Who Survived More than One Year after Surgery  

PubMed Central

Purpose To identify the influence of lymphedema on health-related quality of life (HRQOL) more than 1 year after breast cancer surgery. Methods Ninety-six breast cancer patients who survived more than 1 year after surgery and 104 members of the general population were recruited. Patients were divided into 2 groups according to the presence of lymphedema. HRQOL was evaluated with the Short-Form 36-Item Health Survey. Results There were no statistically significant differences in any scales between groups: groups of breast cancer survivors with and without lymphedema. Compared with the general population, breast cancer survivors had lower quality of life scores in all scales, although the vitality and mental health scales did not differ from chance variation at the 5% level. Conclusion In this study, the presence of lymphedema in breast cancer patients who survived over 1 year after surgery might not affect the quality of life. However quality of life of breast cancer survivors is lower than in general population except for some mental health components.

Lee, So Hyun; Min, Yu-Sun; Park, Ho Yong



Mayo Clinic study finds less invasive surgery detects residual breast cancer in lymph nodes after chemotherapy

Most patients whose breast cancer has spread to their lymph nodes have most of the lymph nodes in their armpit area removed after chemotherapy to see if any cancer remains. A study conducted through the American College of Surgeons Oncology Group and led by the Mayo Clinic shows that a less invasive procedure known as sentinel lymph node surgery successfully identified whether cancer remained in lymph nodes in 91 percent of patients with node-positive breast cancer who received chemotherapy before their surgery. In sentinel lymph node surgery, only a few lymph nodes, the ones most likely to contain cancer, are removed. The findings are being presented at the 2012 CTRC-AACR San Antonio Breast Cancer Symposium.


The Role of Immediate Recurrent Laryngeal Nerve Reconstruction for Thyroid Cancer Surgery  

PubMed Central

Unilateral vocal fold paralysis (UVFP) is one of the most serious problems in conducting surgery for thyroid cancer. Different treatments are available for the management of UVFP including intracordal injection, type I thyroplasty, arytenoid adduction, and laryngeal reinnervations. The effects of immediate recurrent laryngeal nerve (RLN) reconstruction during thyroid cancer surgery with or without UVFP before the surgery were evaluated with videostroboscopic, aerodynamic, and perceptual analyses. All subjects experienced postoperative improvements in voice quality. Particularly, aerodynamic analysis showed that the values for all patients entered normal ranges in both patients with and without UVFP before surgery. Immediate RLN reconstruction has the potential to restore a normal or near-normal voice by returning thyroarytenoid muscle tone and bulk seen with vocal fold denervation. Immediate RLN reconstruction is an efficient and effective approach to the management of RLN resection during surgery for thyroid cancer.

Sanuki, Tetsuji; Yumoto, Eiji; Minoda, Ryosei; Kodama, Narihiro



Patients with persistent pain after breast cancer surgery show both delayed and enhanced cortical stimulus processing  

PubMed Central

Background Women who undergo breast cancer surgery have a high risk of developing persistent pain. We investigated brain processing of painful stimuli using electroencephalograms (EEG) to identify event-related potentials (ERPs) in patients with persistent pain after breast cancer treatment. Methods Nineteen patients (eight women with persistent pain, eleven without persistent pain), who were surgically treated more than 1 year previously for breast cancer (mastectomy, lumpectomy, and axillary lymph node dissection) and/or had chemoradiotherapy, were recruited and compared with eleven healthy female volunteers. A block of 20 painful electrical stimuli was applied to the calf, somatopically remote from the initially injured or painful area. Simultaneously an EEG was recorded, and a visual analog scale (VAS) pain rating obtained. Results In comparison with healthy volunteers, breast cancer treatment without persistent pain is associated with accelerated stimulus processing (reduced P260 latency) and shows a tendency to be less intense (lower P260 amplitude). In comparison to patients without persistent pain, persistent pain after breast cancer treatment is associated with stimulus processing that is both delayed (ie, increased latency of the ERP positivity between 250–310 ms [P260]), and enhanced (ie, enhanced P260 amplitude). Conclusion These results show that treatment and persistent pain have opposite effects on cortical responsiveness.

van den Broeke, Emanuel N; de Vries, Marjan; van Goor, Harry; Vissers, Kris CP; van Rijn, Clementina M; Wilder-Smith, Oliver HG



Meta-analysis of robotic and laparoscopic surgery for treatment of rectal cancer  

PubMed Central

AIM: To conduct a meta-analysis to determine the relative merits of robotic surgery (RS) and laparoscopic surgery (LS) for rectal cancer. METHODS: A literature search was performed to identify comparative studies reporting perioperative outcomes for RS and LS for rectal cancer. Pooled odds ratios and weighted mean differences (WMDs) with 95% confidence intervals (95% CIs) were calculated using either the fixed effects model or random effects model. RESULTS: Eight studies matched the selection criteria and reported on 661 subjects, of whom 268 underwent RS and 393 underwent LS for rectal cancer. Compared the perioperative outcomes of RS with LS, reports of RS indicated favorable outcomes considering conversion (WMD: 0.25; 95% CI: 0.11-0.58; P = 0.001). Meanwhile, operative time (WMD: 27.92, 95% CI: -13.43 to 69.27; P = 0.19); blood loss (WMD: -32.35, 95% CI: -86.19 to 21.50; P = 0.24); days to passing flatus (WMD: -0.18, 95% CI: -0.96 to 0.60; P = 0.65); length of stay (WMD: -0.04; 95% CI: -2.28 to 2.20; P = 0.97); complications (WMD: 1.05; 95% CI: 0.71-1.55; P = 0.82) and pathological details, including lymph nodes harvested (WMD: 0.41, 95% CI: -0.67 to 1.50; P = 0.46), distal resection margin (WMD: -0.35, 95% CI: -1.27 to 0.58; P = 0.46), and positive circumferential resection margin (WMD: 0.54, 95% CI: 0.12-2.39; P = 0.42) were similar between RS and LS. CONCLUSION: RS for rectal cancer is superior to LS in terms of conversion. RS may be an alternative treatment for rectal cancer. Further studies are required.

Lin, Shuang; Jiang, Hong-Gang; Chen, Zhi-Heng; Zhou, Shu-Yang; Liu, Xiao-Sun; Yu, Ji-Ren



Gastrointestinal Cancer Surgery in Patients With a Prior Ventriculoperitoneal Shunt: The Department of Veterans Affairs Experience  

PubMed Central

ABSTRACT BACKGROUND: The estimated prevalence of hydrocephalus in all age groups is between 1% and 1.5%. Placement of a ventriculoperitoneal (VP) shunt in such patients offers them relatively normal lives. There are minimal data concerning the risk of postoperative complications in patients with shunts who undergo subsequent major visceral operations. We hypothesized that healthy adults who had VP shunts placed for acquired conditions and later underwent surgery for gastric or colon cancer would frequently have dense, shunt-related adhesions and high rates of adverse outcomes, particularly infection. METHODS: We assumed that all veterans were healthy on entry into military service. We searched national Department of Veterans Affairs databases from October 1994 through September 2003 to identify all Department of Veterans Affairs patients with shunts for acquired conditions and a curative-intent operation for stomach or colon cancer. We conducted chart reviews to determine their clinical courses. RESULTS: Five patients had codes for VP shunt, gastric cancer, and gastrectomy; 3 met our inclusion criteria. Fourteen had codes for VP shunt, colon cancer, and colectomy; 4 met our criteria. One of the evaluable gastrectomy patients had dense, shunt-related adhesions. None of the colectomy patients had notable adhesions. There were no postoperative complications in any of the seven patients. CONCLUSION: We believe this is the first report analyzing the clinical course of adults with VP shunts who later had major abdominal cancer surgery. The presence of a shunt was associated with dense adhesions in 1 (14%) of the 7 patients in this series, but not with an increased risk of postoperative complications.

Wadhwa, Shilpi; Hanna, George K.; Barina, Andrew R.; Audisio, Riccardo A.; Virgo, Katherine S.



Erbium: YAG Laser Incision of Urethral Strictures for Treatment of Urinary Incontinence After Prostate Cancer Surgery.  

National Technical Information Service (NTIS)

Urethral and bladder neck strictures occur in 5-20 % of all prostate cancer surgeries, resulting in urinary incontinence. Conventional treatments for stricture have widely variable success rates with sub-optimal longterm results. The failure of these trea...

N. M. Fried



Patterns of Locoregional Recurrence After Surgery and Radiotherapy or Chemoradiation for Rectal Cancer  

SciTech Connect

Purpose: To identify patterns of locoregional recurrence in patients treated with surgery and preoperative or postoperative radiotherapy or chemoradiation for rectal cancer. Methods and Materials: Between November 1989 and October 2001, 554 patients with rectal cancer were treated with surgery and preoperative (85%) or postoperative (15%) radiotherapy, with 95% receiving concurrent chemotherapy. Among these patients, 46 had locoregional recurrence as the first site of failure. Computed tomography images showing the site of recurrence and radiotherapy simulation films were available for 36 of the 46 patients. Computed tomography images were used to identify the sites of recurrence and correlate the sites to radiotherapy fields in these 36 patients. Results: The estimated 5-year locoregional control rate was 91%. The 36 patients in the study had locoregional recurrences at 43 sites. There were 28 (65%) in-field, 7 (16%) marginal, and 8 (19%) out-of-field recurrences. Among the in-field recurrences, 15 (56%) occurred in the low pelvis, 6 (22%) in the presacral region, 4 (15%) in the mid-pelvis, and 2 (7%) in the high pelvis. Clinical T stage, pathologic T stage, and pathologic N stage were significantly associated with the risk of in-field locoregional recurrence. The median survival after locoregional recurrence was 24.6 months. Conclusions: Patients treated with surgery and radiotherapy or chemoradiation for rectal cancer had a low risk of locoregional recurrence, with the majority of recurrences occurring within the radiation field. Because 78% of in-field recurrences occur in the low pelvic and presacral regions, consideration should be given to including the low pelvic and presacral regions in the radiotherapy boost field, especially in patients at high risk of recurrence.

Yu, T.-K. [Department of Radiation Oncology, University of Texas M. D. Anderson Cancer Center, Houston, TX (United States); Bhosale, Priya R. [Department of Diagnostic Radiology, University of Texas M. D. Anderson Cancer Center, Houston, TX (United States); Crane, Christopher H. [Department of Radiation Oncology, University of Texas M. D. Anderson Cancer Center, Houston, TX (United States); Iyer, Revathy B. [Department of Diagnostic Radiology, University of Texas M. D. Anderson Cancer Center, Houston, TX (United States); Skibber, John M. M.D.; Rodriguez-Bigas, Miguel A.; Feig, Barry W.; Chang, George J. [Department of Surgical Oncology, University of Texas M. D. Anderson Cancer Center, Houston, TX (United States); Eng, Cathy; Wolff, Robert A. [Department of Gastrointestinal Medical Oncology, University of Texas M. D. Anderson Cancer Center, Houston, TX (United States); Janjan, Nora A.; Delclos, Marc E.; Krishnan, Sunil [Department of Radiation Oncology, University of Texas M. D. Anderson Cancer Center, Houston, TX (United States); Das, Prajnan [Department of Radiation Oncology, University of Texas M. D. Anderson Cancer Center, Houston, TX (United States)], E-mail:



Breast cancer, breast surgery, and the makeover metaphor  

Microsoft Academic Search

This paper discusses cosmetic breast surgery in relation to reconstructive surgery of the mastectomized breast. We will show how both kinds of surgery participate in what we are calling “the makeover metaphor,” because both can be seen as an aesthetic practice. We are interested in tracing some of the ways that women undergoing both procedures experience a disconnect between the

Shelley Cobb; Susan Starr



Does the act of surgery provoke activation of "latent" metastases in early breast cancer?  

PubMed Central

This paper is written in support of the challenging article by Retsky and colleagues in this issue of Breast Cancer Research, and develops on the idea that the act of surgery can provoke the outgrowth of dormant micrometastases, which often leads to the failure of screening to deliver its promise. The therapeutic consequence of this idea involves the use of antiangiogenic drugs before surgery.

Baum, Michael



A prospective, randomized trial comparing laparoscopic versus conventional techniques in colorectal cancer surgery: a preliminary report  

Microsoft Academic Search

Background: Uncontrolled studies using laparoscopic techniques in colorectal surgery have not demonstrated clear advantages to these procedures compared with conventional ones, and surgeons are concerned about unusual early recurrences reported after laparoscopic colorectal cancer surgery.Study Design: We conducted a prospective, randomized trial in one surgical department comparing laparoscopic (LAP) and conventional (CON) techniques in 109 patients undergoing bowel resection for

Jeffrey W Milsom; Bartholomäus Böhm; Katherine A Hammerhofer; Victor Fazio; Ezra Steiger; Paul Elson



Resection or palliation: Priority of surgery in the treatment of hilar cancer  

Microsoft Academic Search

During the past 25 years, 213 patients with hilar cancer have been treated in this unit. One hundred seventy-eight patients had some form of surgical intervention and 35 were unfit for any surgery. The preoperative and peroperative assessment of the 178 patients having surgery was directed toward identifying tumors which might be suitable for potentially curative resection. On this basis,

Henri Bismuth; Denis Castaing; Oscar Traynor




The Primary Study Objective is to Assess the Efficacy and; Safety of Extended 4-week Heparin Prophylaxis Compared to; Prophylaxis Given for 8±2 Days After Planned Laparoscopic; Surgery for Colorectal Cancer.; The Clinical Benefit Will be Evaluated as the Difference in; the Incidence of VTE or VTE-related Death Occurring Within 30 Days; From Surgery in the Two Study Groups.



Psychological support for patients undergoing breast cancer surgery: a randomised study  

Microsoft Academic Search

AbstractObjective: To evaluate the effect of support from a nurse specialising in breast care and a voluntary support organisation on prevalence of psychological morbidity after surgery for breast cancer.Design: Prospective randomised study.Setting: Three teaching hospitals in Glasgow with established breast clinics.Subjects: 272 women aged less than 70 years undergoing surgery for breast cancer.Interventions: Patients were randomly allocated to receive routine

June M C McArdle; W David George; Colin S McArdle; David C Smith; Alastair R Moodie; A V Mark Hughson; Gordon D Murray



Influence of Surgery-related Factors on Quality of Life after Esophageal or Cardia Cancer Resection  

Microsoft Academic Search

Knowledge of how factors related to esophageal cancer resection affect long-term quality of life after surgery is scarce,\\u000a and no population-based studies are available. Therefore, we conducted a Swedish nationwide, prospective, population-based\\u000a study of how esophageal surgery–related factors influence quality of life 6 months postoperatively. The Swedish Esophageal\\u000a and Cardia Cancer register (SECC-register) encompasses 174 hospital departments (97%). Microscopically radically

Pernilla Viklund; Mats Lindblad; Jesper Lagergren



Efficacy of manual lymphatic drainage in preventing secondary lymphedema after breast cancer surgery.  


This study evaluated the effectiveness of manual lymphatic drainage (MLD) in the prevention of secondary lymphedema after treatment of breast cancer. The study consisted of 67 women, who underwent breast surgery for primary breast cancer. From the second day of surgery, 33 randomly chosen women were given MLD. The control group consisted of 34 women who did not receive MLD. Measurements of the volumes of both the arms were taken before surgery and on days 2, 7, 14, and at 3 and 6 months after surgery. At 6 months after breast cancer surgery, among the women who did not undergo MLD, a significant increase in the arm volume on the operated side was observed (p=0.0033) when compared with the arm volume before surgery. At this time, there was no statistically significant increase in the volume of the upper limb on the operated side in women who underwent MLD. This study demonstrates that regardless of the surgery type and the number of the lymph nodes removed, MLD effectively prevented lymphedema of the arm on the operated side. Even in high risk breast cancer treatments (operation plus irradiation), MLD was demonstrated to be effective against arm volume increase. Even though confirmatory studies are needed, this study demonstrates that MLD administered early after operation for breast cancer should be considered for the prevention of lymphedema. PMID:23342930

Zimmermann, A; Wozniewski, M; Szklarska, A; Lipowicz, A; Szuba, A





... After surgery there can be a risk of complications, including infection, too much bleeding, reaction to anesthesia, or accidental injury. There is almost always some pain with surgery. Agency for Healthcare Research and Quality




... how pain will be treated Preparing for the Day of Surgery Various preparations are made in the ... Then, this device can perform more accurately. The Day of Surgery Before most operations, a person removes ...


Hematogenous umbilical metastasis from colon cancer treated by palliative single-incision laparoscopic surgery  

PubMed Central

Sister Mary Joseph’s nodule (SMJN) is a rare umbilical nodule that develops secondary to metastatic cancer. Primary malignancies are located in the abdomen or pelvis. Patients with SMJN have a poor prognosis. An 83-year-old woman presented to our hospital with a 1-month history of a rapidly enlarging umbilical mass. Endoscopic findings revealed advanced transverse colon cancer. computer tomography and fluorodeoxyglucose-positron emission tomography revealed tumors of the transverse colon, umbilicus, right inguinal lymph nodes, and left lung. The feeding arteries and drainage veins for the SMJN were the inferior epigastric vessels. Imaging findings of the left lung tumor allowed for identification of the primary lung cancer, and a diagnosis of advanced transverse colon cancer with SMJN and primary lung cancer was made. The patient underwent local resection of the SMNJ and subsequent single-site laparoscopic surgery involving right hemicolectomy and paracolic lymph node dissection. Intra-abdominal dissemination to the mesocolon was confirmed during surgery. Histopathologically, the transverse colon cancer was confirmed to be moderately differentiated tubular adenocarcinoma. We suspect that SMJN may occur via a hematogenous pathway. Although chemotherapy for colon cancer and thoracoscopic surgery for the primary lung cancer were scheduled, the patient and her family desired home hospice. Seven months after surgery, she died of rapidly growing lung cancer.

Hori, Tomohide; Okada, Noriyuki; Nakauchi, Masaya; Hiramoto, Shuji; Kikuchi-Mizota, Ayako; Kyogoku, Masahisa; Oike, Fumitaka; Sugimoto, Hidemitsu; Tanaka, Junya; Morikami, Yoshiki; Shigemoto, Kaori; Ota, Toyotsugu; Kaneko, Masanobu; Nakatsuji, Masato; Okae, Shunji; Tanaka, Takahiro; Gunji, Daigo; Yoshioka, Akira



Rapid Planning Method for Robot Assited Minimally Invasive Surgery  

Microsoft Academic Search

\\u000a The traditional space mapping and surgical planning method for surgery are time-consuming, and the accuracy of positioning\\u000a is not high. This paper aims to present a practical and fast way for planning. In the session of visual orientation for spatial\\u000a location, MicronTracker camera and self-calibration template are used for positioning; in the session of tracking and locating\\u000a for four markers

Yanhua Cheng; Chun Gong; Can Tang; Jianwei Zhang; Sheng Cheng



The effect of age on the outcome of esophageal cancer surgery  

PubMed Central

BACKGROUND: Surgery is still the best way for treatment of esophageal cancer. The increase in life expectancy and the rising incidence of esophageal tumors have led to a great number of elderly candidates for complex surgery. The purpose of this study was to evaluate the effects of advanced age (70 years or more) on the surgical outcome of esophagectomy for esophageal cancer at a single high-volume center. MATERIALS AND METHODS: Between January 2000 and April 2006, 480 cases with esophageal cancer underwent esophagectomy in the referral cancer institute. One hundred sixty-five patients in the elderly group (70 years old or more) were compared with 315 patients in the younger group (< 70 years). All in-hospital morbidity and mortality were studied. RESULTS: The range of age was 38–84 years, with a mean of 58.7. The mean age of the elderly and younger groups was 74 and 53.2, respectively. In the younger group, 70 patients (22.2%) and in the elderly group, 39 patients (23.6%) were complicated (P 0.72).The most common complications in the two groups were pulmonary complications (9.8% in younger and 10.3% in elderly) (P 0.87). Rates of anastomotic leakage and cardiac complications were also similar between the two groups. Hospital mortality rates in younger and elderly patients were 2.8% and 3%, respectively. There was no significant difference between the two groups in morbidities and mortality (P-value > 0.05). CONCLUSIONS: With increased experience and care, the outcomes of esophagectomy in elderly patients are comparable to young patients. Advanced age alone is not a contraindication for esophagectomy.

Alibakhshi, Abbas; Aminian, Ali; Mirsharifi, Rasoul; Jahangiri, Yosra; Dashti, Habibollah; Karimian, Faramarz



Effect of Interval to Definitive Breast Surgery on Clinical Presentation and Survival in Early-Stage Invasive Breast Cancer  

SciTech Connect

Purpose: To examine the effect of clinical presentation and interval to breast surgery on local recurrence and survival in early-stage breast cancer. Methods and Materials: The data from 397 patients with Stage T1-T2N0 breast carcinoma treated with conservative surgery and breast radiotherapy between 1985 and 1992 were reviewed at the London Regional Cancer Program. The clinical presentation consisted of a mammogram finding or a palpable lump. The intervals from clinical presentation to definitive breast surgery used for analysis were 0-4, >4-12, and >12 weeks. The Kaplan-Meier estimates of the time to local recurrence, disease-free survival, and cause-specific survival were determined for the three groups. Cox regression analysis was used to evaluate the effect of clinical presentation and interval to definitive surgery on survival. Results: The median follow-up was 11.2 years. No statistically significant difference was found in local recurrence as a function of the interval to definitive surgery (p = .424). A significant difference was noted in disease-free survival (p = .040) and cause-specific survival (p = .006) with an interval of >12 weeks to definitive breast surgery. However, the interval to definitive surgery was dependent on the presentation for cause-specific survival, with a substantial effect for patients with a mammographic presentation and a negligible effect for patients with a lump presentation (interaction p = .041). Conclusion: The results of this study suggest that an interval of >12 weeks to breast surgery might be associated with decreased survival for patients with a mammographic presentation, but it appeared to have no effect on survival for patients presenting with a palpable breast lump.

Vujovic, Olga, E-mail: olga.vujovic@lhsc.on.c [Department of Radiation Oncology, London Regional Cancer Program, London, ON (Canada); Yu, Edward [Department of Radiation Oncology, London Regional Cancer Program, London, ON (Canada); Cherian, Anil [Department of Medical Oncology, London Regional Cancer Program, London, ON (Canada); Perera, Francisco; Dar, A. Rashid [Department of Radiation Oncology, London Regional Cancer Program, London, ON (Canada); Stitt, Larry [Department of Biometry, London Regional Cancer Program, London, ON (Canada); Hammond, A. [Department of Radiation Oncology, London Regional Cancer Program, London, ON (Canada)



Bone tissue engineering in oral surgery: a new method of bone development in periodontal surgery.  


This article describes the development of a new surgical approach to periodontal treatment. Twenty patients who suffered from bone defects without existing bony walls due to adult periodontitis were treated in three different groups using methods of bone tissue engineering. At that time no surgical technique existed that could be applied to those patients to generate new bone. The periodontal surgeries were performed between 2004 and 2008. All patients received follow-up examinations at 6, 12, and 24 months after surgical procedure. Measured parameters were compared to baseline. The surgical approach and the augmentation material have been improved based on the results of the previous group. This strategy was applied because of the ethical fact that a medical treatment of patients has to be carried out with the knowledge and experience of previous settings. All groups received recombinant human bone morphogenetic protein 2 and platelet-rich plasma. The above-mentioned procedure had been approved in other indications in the field of oral and maxillofacial surgery. The first group underwent conventional muco-periosteal flap technique and obtained an augmentation with absorbable collagen sponge (ACS). The second and third groups were treated using endoscopically assisted microsurgery due to wound healing disturbances that appeared in the first group. The augmentation was carried out with demineralized bone matrix (DBM) instead of ACS (group 2) or tricalciumphosphate as a further development instead of DBM (group 3). The radiological control 12 months (group 1), 18 months (group 2), and 2 years (group 3) after surgery proved the following results-first group: 1.7?mm (average) vertical bone development (VBD); second group: 2.5?mm (average) VBD; third group: 3.2?mm (average) VBD. These results of single patient treatment open new ways into periodontal surgery. They have to be confirmed by prospective case series and multicenter studies. PMID:21895495

Schuckert, Karl-Heinz; Osadnik, Magdalena



Optimal Time of Initiating Adjuvant Chemotherapy After Curative Surgery in Colorectal Cancer Patients  

PubMed Central

Purpose Adjuvant chemotherapy is routinely recommended for locally advanced colorectal cancer (CRC). There are very few data for the optimal starting date of adjuvant chemotherapy after the surgery. This study aimed to evaluate the effectiveness of earlier adoption of adjuvant chemotherapy after curative surgery for stage III CRC. Methods In this study, 159 patients with stage III CRC, who had undergone a curative resection, were enrolled retrospectively. Patients were categorized into 3 groups representing different timings to initiate the chemotherapy; less than 2 weeks (group 1), 3 to 4 weeks (group 2), and more than 5 weeks (group 3). The overall survival rate (OS) and the relapse-free survival rate (RFS) were analyzed to evaluate the effectiveness of adjuvant chemotherapy. Results The 5-year OSs of the patients were 73.7% in group 1, 67.0% in group 2, and 55.2% in group 3. The 5-year RFSs of the patients were 48.8% in group 1, 64.7% in group 2, and 57.1% in group 3. There were no significant differences in either the OS or the RFS (P = 0.200, P = 0.405). Conclusion Starting chemotherapy earlier than 6 weeks after surgery does not show any significant difference. Thus, although adjuvant chemotherapy should preferably begin within 6 weeks, the starting date should not necessarily be hastened, and the patient's general condition should be taken into consideration.

Kang, Kyu Min; Hong, Kyung Sook; Noh, Gyoung Tae; Oh, Bo-Young; Chung, Soon Sup; Lee, Ryung-Ah



Challenging Dogma: Radical Conservation Surgery for Early Stage Cervical Cancer in Order to Retain Fertility  

PubMed Central

INTRODUCTION Cervical cancer is the second commonest cancer to affect women with over half a million cases world-wide yearly. Screening programmes have reduced the incidence and death rate dramatically in Western societies. At the same time, professional and social pressures may delay child bearing such that a significant number of women will present with early stage disease, but be anxious to retain their fertility potential. Standard treatment by radical hysterectomy or radiotherapy has good results, but inevitably renders the women infertile. The rationale for extensive surgery resecting parametrium or destructive radiotherapy treating the whole pelvis in all cases of cervical cancer has been questioned. PATIENTS AND METHODS Lessons learnt from the less radical surgical approach to breast cancer can be applied to cervical cancer whilst still observing Halstead's principles of surgical oncology. Wide, local excision of early stage small tumours by radical vaginal trachelectomy combined with a laparoscopic pelvic lymphadenectomy utilises modern technology with traditional surgery. Radical vaginal trachelectomy comprises the distal half of a radical abdominal (Wertheim's) or vaginal (Schauta's) hysterectomy. An isthmic–vaginal anastomosis restores continuity of the lower genital tract after insertion of a cerclage that is necessary to maintain competence during future pregnancies. RESULTS A total of 142 cases were performed between 1994 and 2006, most (98%) in women with Stage 1B carcinoma of the cervix with a mean follow-up of 57 months. Twelve (9%) had completion treatment, 11 with chemo/radiotherapy and one radical hysterectomy. There were four recurrences (3%) among the women who did not have completion treatment, and two (18%) in those that did. There were 72 pregnancies in 43 women and 33 live births in 24 women. The 5-year accumulative pregnancy rate among women trying to conceive was 53%. Delivery was by classical caesarean section in a high-risk feto-maternal units with 8 babies (25%) born before 32 weeks. CONCLUSIONS Radical vaginal trachelectomy appears safe when performed in centres with appropriate experience of radical vaginal surgery and laparoscopic techniques. The impact of this new approach questions traditional teaching whilst preserving potential fertility in hitherto impossible circumstances.

Shepherd, John H



Intensified surveillance after surgery for colorectal cancer significantly improves survival  

PubMed Central

Background Postoperative surveillance after curative resection for colorectal cancer has been demostrated to improve survival. It remains unknown however, whether intensified surveillance provides a significant benefit regarding outcome and survival. This study was aimed at comparing different surveillance strategies regarding their effect on long-term outcome. Methods Between 1990 and 2006, all curative resections for colorectal cancer were selected from our prospective colorectal cancer database. All patients were offered to follow our institution's surveillance programm according to the ASCO guidelines. We defined surveillance as "intensive" in cases where > 70% appointments were attended and the program was completed. As "minimal" we defined surveillance with < 70% of the appointments attended and an incomplete program. As "none" we defined the group which did not take part in any surveillance. Results Out of 1469 patients 858 patients underwent "intensive", 297 "minimal" and 314 "none" surveillance. The three groups were well balanced regarding biographical data and tumor characteristics. The 5-year survival rates were 79% (intensive), 76% (minimal) and 54% (none) (OR 1.480, (95% CI 1.135-1.929); p < 0.0001), respectively. The 10-year survival rates were 65% (intensive), 50% (minimal) and 31% (none) (p < 0.0001), respectively. With a median follow-up of 70 months the median time of survival was 191 months (intensive), 116 months (minimal) and 66 months (none) (p < 0.0001). After recurrence, the 5-year survival rates were 32% (intensive, p = 0.034), 13% (minimal, p = 0.001) and 19% (none, p = 0.614). The median time of survival after recurrence was 31 months (intensive, p < 0.0001), 21 months (minimal, p < 0.0001) and 16 month (none, p < 0.0001) respectively. Conclusion Intensive surveillance after curative resection of colorectal cancer improves survival. In cases of recurrent disease, intensive surveillance has a positive impact on patients' prognosis. Large randomized, multicenter trials are needed to substantiate these results.



Nonclinical factors associated with surgery received for treatment of early-stage breast cancer.  

PubMed Central

BACKGROUND. Women diagnosed with early breast cancer have had the opportunity to receive breast-conserving surgical treatment, which reduces the physical and psychological morbidity heretofore associated with breast removal. METHODS. Nonclinical factors associated with women receiving partial mastectomies with radiation (P + R) compared with modified radical mastectomies without radiation (MOR) were examined in 2238 Black and White women diagnosed, in 1985 through 1987, with early-stage breast cancer in the metropolitan Detroit area. RESULTS. Age at diagnosis and size of hospital were the strongest predictors of type of surgery received, with younger women (less than 55 years of age) and women treated in larger hospitals (more than 500 beds) more than twice as likely to receive P + R. Stratifying on race, age at diagnosis remained the strongest predictor for White women, followed by hospital size. Among Black women, hospital size was more strongly associated with surgery received than was age. CONCLUSIONS. Younger women and women undergoing treatment at large hospitals are more likely to receive the breast-conserving P + R. Black women treated in small hospitals appear to be particularly unlikely to receive P + R.

Satariano, E R; Swanson, G M; Moll, P P



Results of conservative surgery and radiation therapy for breast cancer  

SciTech Connect

For stage I or II breast cancer, conservative surgery and radiation therapy are as effective as modified radical or radical mastectomy. In most cases, cosmetic considerations and the availability of therapy are the primary concerns. The extent of a surgical resection less than a mastectomy has not been a subject of a randomized trial and is controversial. It appears that removal of a quadrant of the breast for small lesions is safe but excessive. It may be possible to limit the breast resection to gross tumor removal for most patients while using wider resections for patients with an extensive intraductal component or for invasive lobular carcinoma. It also appears that excluding patients from breast conservation on the basis of positive margins on the first attempt at tumor excision may be unnecessarily restrictive. Although patients with an extensive intraductal component or invasive lobular carcinoma should have negative margins, it appears that a patient with predominantly invasive ductal carcinoma can be treated without re-excision if all gross tumor has been resected and there is no reason to suspect extensive microscopic disease. Patients with indeterminate margins should have a re-excision. Axillary dissection provides prognostic information and prevents progression of the disease within the axilla. Axillary dissections limited to level I will accurately identify a substantial number of patients who have pathologically positive but clinically negative nodes. When combined with radiation therapy to the axilla, a level I dissection results in a limited number of patients with progressive axillary disease. Patients with pathologically positive axillas and patients at particularly high risk for systemic disease because of the extent of axillary node involvement can be identified by dissections of levels I and II. 60 references.

Osteen, R.T.; Smith, B.L. (Harvard Medical School, Boston, MA (USA))



Cost of care in a randomised trial of early hospital discharge after surgery for breast cancer  

Microsoft Academic Search

The aim of this study was to determine the effect of the reduction of the length of hospital stay after surgery for breast cancer on the rate of care consumption and the cost of care. Patients with operable breast cancer were randomised to a short or long postoperative hospital stay. Data on care consumption were collected for a period of

J Bonnema; A. M. E. A van Wersch; A. N van Geel; J. F. A Pruyn; P. I. M Schmitz; C. A Uyl-de Groot; T Wiggers



Total laparoscopic versus open surgery for stage 1 endometrial cancer: The LACE randomized controlled trial  

Microsoft Academic Search

PurposeEndometrial cancer is the most common gynaecological malignancy in Australia and the US. Current standard treatment involves open surgery to remove the uterus, and both tubes and ovaries (TAH). The Laparoscopic Approach to Cancer of the Endometrium (LACE) trial was designed to assess equivalence of performing this in a total laparoscopic approach (TLH).

M. Janda; V. Gebski; P. Forder; D. Jackson; G. Williams; A. Obermair



Shoulder Movement After Breast Cancer Surgery: Results of a Randomised Controlled Study of Postoperative Physiotherapy  

Microsoft Academic Search

Breast screening programmes have facilitated more conservative approaches to the surgical and radiotherapy management of women diagnosed with breast cancer. This study investigated changes in shoulder movement after surgery for primary, operable breast cancer to determine the effect of elective physiotherapy intervention. Sixty-five women were randomly assigned to either the treatment (TG) or control group (CG) and assessments were completed

Robyn C. Box; Hildegard M. Reul-Hirche; Joanne E. Bullock-Saxton; Colin M. Furnival



Fox Chase researchers find that most Medicare patients wait weeks before breast cancer surgery

Although patients may feel anxious waiting weeks from the time of their first doctor visit to evaluate their breast until they have breast cancer surgery, new findings from Fox Chase Cancer Center show that these waits are typical in the United States. Results were published on Monday, November 19 in the Journal of Clinical Oncology.


Efficacy of hybrid 2-port hand-assisted laparoscopic surgery (Mukai's operation) for patients with primary colorectal cancer.  


In this study, a total of 108 patients with primary colorectal cancer who underwent hybrid 2-port hand-assisted laparoscopic surgery (HALS) were classified as 58 patients with colon cancer and 50 patients with rectal cancer. The mean operating time, mean blood loss, postoperative complications, and mean postoperative hospital stay were compared between the two groups. In patients who underwent colon cancer surgery, the mean operating time was 2 h and 26 min, the mean blood loss was 166.3 ml, and the postoperative complications were wound infection in 5/58 patients (8.6%), postoperative ileus in 3 patients (5.2%), and anastomotic stricture in 1 patient (1.7%). There was no anastomotic leakage and no conversion to conventional open laparotomy. The mean postoperative hospital stay was 12.6 days. In patients who underwent rectal cancer surgery, the mean operating time was 3 h and 38 min, the mean blood loss was 238.8 ml, and the postoperative complications consisted of wound infection in 6/50 patients (12.0%), anastomotic leakage in 3/35 patients (8.6%), anastomotic stricture in 3/47 patients (6.4%), postoperative ileus in 3/50 patients (6.0%), and conversion to conventional open laparotomy in 1/50 patients (2.0%). A covering stoma was constructed during surgery in 12/47 patients (25.5%). The mean postoperative hospital stay was 19.1 days. These results suggest that hybrid 2-port HALS (Mukai's operation) could become a standard method for the treatment of colorectal cancer, and that the long-term outcome should be compared in detail with that of standard laparotomy in the future. PMID:19724870

Mukai, Masaya; Kishima, Kyoko; Tajima, Takayuki; Hoshikawa, Tatsuhiko; Yazawa, Naoki; Fukumitsu, Hiroshi; Okada, Kazutake; Ogoshi, Kyouji; Makuuchi, Hiroyasu



Smoking cessation and the success of lung cancer surgery  

Microsoft Academic Search

Lung cancer is the number one cause of cancer-related mortality in the United States. Cigarette smoke is associated with 90%\\u000a of lung cancer deaths, making it the most important risk factor for the disease. The strong correlation between smoking and\\u000a lung cancer is well established, but there is evidence that smoking further increases the morbidity and mortality of lung\\u000a cancer

Loretta Erhunmwunsee; Mark W. Onaitis



Sexual dysfunction following surgery for rectal cancer - a clinical and neurophysiological study  

PubMed Central

Background Sexual dysfunction following surgery for rectal cancer may be frequent and often severe. The aim of the present study is to evaluate the occurrence of this complication from both a clinical point of view and by means of neurophysiological tests. Methods We studied a group of 57 patients submitted to rectal resection for adenocarcinoma. All the patients underwent neurological, psychological and the following neurophysiological tests: sacral reflex (SR), pudendal somatosensory evoked potentials (PEPs), motor evoked potential (MEPs) and sympathetic skin responses (SSRs). The results were compared with a control group of 67 rectal cancer patients studied before surgery. Only 10 of these patients could be studied both pre- and postoperatively. 10 patients submitted to high dose preoperative chemoradiation were studied to evaluate the effect of this treatment on sexual function. Statistical analysis was performed by means of the two-tailed Student's t test for paired observations and k concordance test. Results 59.6% of patients operated reported sexual dysfunction, while this symptom occurred in 16.4% in the control group. Moreover, a significantly higher rate of alterations of the neurophysiological tests and longer mean latencies of the SR, PEPs, MEPs and SSRs were observed in the patients who had undergone resection. In the 10 patients studied both pre and post-surgery impotence occurred in 6 of them and the mean latencies of SSRs were longer after operation. In the 10 patients studied pre and post chemoradiation impotence occurred in 1 patient only, showing the mild effect of these treatments on sexual function. Conclusion Patients operated showed severe sexual dysfunctions. The neurophysiological test may be a useful tool to investigate this complication. The neurological damage could be monitored to decide the rehabilitation strategy.

Pietrangeli, Alberto; Pugliese, Patrizia; Perrone, Maria; Sperduti, Isabella; Cosimelli, Maurizio; Jandolo, Bruno



Optimal timing of surgery after neoadjuvant chemoradiation therapy in locally advanced rectal cancer  

PubMed Central

Purpose The optimal time between neoadjuvant chemoradiotherapy (CRT) and surgery for rectal cancer has been debated. This study evaluated the influence of this interval on oncological outcomes. Methods We compared postoperative complications, pathological downstaging, disease recurrence, and survival in patients with locally advanced rectal cancer who underwent surgical resection <8 weeks (group A, n = 105) to those who had surgery ?8 weeks (group B, n = 48) after neoadjuvant CRT. Results Of 153 patients, 117 (76.5%) were male and 36 (23.5%) were female. Mean age was 57.8 years (range, 28 to 79 years). There was no difference in the rate of sphincter preserving surgery between the two groups (group A, 82.7% vs. group B, 77.6%; P = 0.509). The longer interval group had decreased postoperative complications, although statistical significance was not reached (group A, 28.8% vs. group B, 14.3%; P = 0.068). A total of 111 (group A, 75 [71.4%] and group B, 36 [75%]) patients were downstaged and 26 (group A, 17 [16.2%] and group B, 9 [18%]) achieved pathological complete response (pCR). There was no significant difference in the pCR rate (P = 0.817). The longer interval group experienced significant improvement in the nodal (N) downstaging rate (group A, 46.7% vs. group B, 66.7%; P = 0.024). The local recurrence (P = 0.279), distant recurrence (P = 0.427), disease-free survival (P = 0.967), and overall survival (P = 0.825) rates were not significantly different. Conclusion It is worth delaying surgical resection for 8 weeks or more after completion of CRT as it is safe and is associated with higher nodal downstaging rates.

Jeong, Duck Hyoun; Lee, Han Beom; Hur, Hyuk; Min, Byung Soh; Baik, Seung Hyuk



Comparison of laparoscopy-assisted surgery and laparotomy for treating locally advanced distal gastric antral cancer  

PubMed Central

The aim of this study was to investigate the safety, feasibility and mid-term results of laparoscopy-assisted surgery in the treatment of locally advanced gastric antral cancer. The clinical data of 50 patients who received laparoscopy-assisted surgery (Group A) and 62 patients who were treated by conventional laparotomy (Group B) from August 2009 to January 2011 were retrospectively analyzed. The surgical incision length, the volume of blood loss, the intestinal function recovery time, the postoperative complications, the postoperative 1- and 3-year cumulative survival rates and the average survival time in the two groups were observed. The results of the two groups were compared using the ?2 test for the enumeration data, a t-test for the numerical data and a Wilcoxon rank sum test for the skewed data. In addition, the Kaplan-Meier method of single factor analysis was utilized to comwpare the 1- and 3-year cumulative survival rates, as well as the average survival time of the two groups. The results indicated that the duration of surgery for Group A was significantly longer compared with that of Group B (P<0.05); however, the incision length and the volume of intraoperative blood loss in Group A were significantly smaller compared with those of Group B (P<0.01). Furthermore, in Group A, the recovery of intestinal function was more rapid and the time spent in hospital was shorter. However, between Groups A and B, the respective number of dissected lymph nodes (16.3 and 17.2), 1-year survival rates (86.0 and 88.6%) and 3-year survival rates (52.6 and 53.7%) were not significantly different (P<0.05). The results indicate that laparoscopy-assisted surgery is a safe approach for the treatment of locally advanced gastric antral cancer and has beneficial treatment effects. Laparoscopy-assisted surgery is advantageous compared with laparotomy, due to the smaller incision length and reductions in intraoperative blood loss, invasiveness, postoperative recovery time and the number of complications.




Timing of radiotherapy and chemotherapy following breast-conserving surgery for patients with node-positive breast cancer  

Microsoft Academic Search

Purpose: A controversy exists regarding whether it is safe to delay radiation therapy until the completion of chemotherapy following breast-conserving surgery for patients with node-positive breast cancer. Within the context of two concurrent randomized clinical trials we had the opportunity to evaluate outcomes for patients who received breast irradiation after completing different durations of chemotherapy.Methods and Materials: From July 1986

Arne Wallgren; Jacques Bernier; Richard D Gelber; Aron Goldhirsch; Mario Roncadin; David Joseph; Monica Castiglione-Gertsch



The future of surgery in the treatment of breast cancer  

Microsoft Academic Search

The role of surgery cannot be discussed independently, but in relationship to the other modalities of treatment. Sentinel lymph node mapping and biopsy has revolutionized the role of surgery in axillary staging. Techniques of sentinel node mapping, the timing relative to chemotherapy, possible contraindications, and the necessity of completion axillary dissection are all under active investigation. The next few years

William C Wood



Gastric Cancer Surgery: An American Perspective on the Current Options and Standards  

Microsoft Academic Search

Opinion statement  Gastric cancer is prevalent globally, particularly in Asian countries such as Japan and Korea. While the prevalence of gastric\\u000a cancer is not nearly as high in the United States (U.S.) as in Asia, the treatment armamentarium differs widely between regions.\\u000a The role of surgery for gastric cancer in the U.S. has changed drastically over the last decade. While the

Joyce Wong; Patrick Jackson



Intra-abdominal recurrence of colorectal cancer detected by radioimmunoguided surgery (RIGS system)  

SciTech Connect

Since 1986, 32 patients with metastatic colorectal cancer have undergone second-look radioimmunoguided surgery (RIGS system). The primary tumor was located in the right and transverse colon in 11 patients, left and sigmoid colon in 16, and rectum in five. The carcinoembryonic antigen level was elevated in 30 patients (94%); all patients underwent a computed tomographic scan of the abdomen and pelvis. The overall sensitivity of the computed tomographic scan was 41% (abdomen other than liver, 27%; liver, 58%; and pelvis, 22%). The RIGS system identified recurrent tumor in 81% of the patients. The most common site of metastasis was the liver (41%), independent of the primary location. Local/regional recurrences alone accounted for 40% of all recurrences. In six patients (18%), recurrent tumor was found only with the RIGS system. The RIGS system is more dependable in localizing clinically obscure metastases than other methods, and carcinoembryonic antigen testing remains the most accurate preoperative method to indicate suspected recurrences.

Sardi, A.; Workman, M.; Mojzisik, C.; Hinkle, G.; Nieroda, C.; Martin, E.W. Jr.



The effect of laparoscopic surgery in stage II and III right-sided colon cancer: a retrospective study  

PubMed Central

Background This retrospective study compared the clinicopathological results among three groups divided by time sequence to evaluate the impact of introducing laparoscopic surgery on long-term oncological outcomes for right-sided colon cancer. Methods From April 1986 to December 2006, 200 patients who underwent elective surgery with stage II and III right-sided colon cancer were analyzed. The period for group I referred back to the time when laparoscopic approach had not yet been introduced. The period for group II was designated as the time when first laparoscopic approach for right colectomy was carried out until we overcame its learning curve. The period for group III was the period after overcoming this learning curve. Results When groups I and II, and groups II and III were compared, overall survival (OS) did not differ significantly whereas disease-free survival (DFS) in groups I and III were statistically higher than in group II (P?=?0.042 and P?=?0.050). In group III, laparoscopic surgery had a tendency to provide better long-term OS ( P?=?0.2036) and DFS ( P?=?0.2356) than open surgery. Also, the incidence of local recurrence in group III (2.6%) was significantly lower than that in groups II (7.4%) and I (12.1%) ( P?=?0.013). Conclusions Institutions should standardize their techniques and then provide fellowship training for newcomers of laparoscopic colon cancer surgery. This technique once mastered will become the gold standard approach to colon surgery as it is both safe and feasible considering the oncological and technical aspects.



Liver only metastatic disease in patients with metastatic colorectal cancer: Impact of surgery and chemotherapy.  


Abstract Background. Metastatectomy in colorectal cancer (CRC) is now a standard of care with improved survival reported. Conversion chemotherapy has increased the population who are suitable for surgery. Here we assess patterns of care and treatment outcome in liver only metastases in South Australia using the clinical registry for advanced CRC. Methods. We analysed the outcomes for patients with liver only metastatic involvement from the SA Metastatic CRC Database with the aim to investigate the role of chemotherapy on liver resection and outcome in comparison to liver resection only and chemotherapy without liver resection. Patients who had no therapy or non-surgical liver interventions were excluded for this analysis. Results. One thousand nine hundred and eight patients were available for analysis, 687 (36%) had liver only metastatic disease and 455 (24%) had active therapy as defined. In total 54.2% (247/455) had chemotherapy alone, 19.1% (87/455) had liver resection alone, and 26.6% (121/455) had combined treatment. The three-year survival for chemotherapy, resection and combined treatment subgroups is 19.5%, 73.8% and 73.7%, respectively. The addition of chemotherapy to surgery did not improve survival. Switching chemotherapy was associated with a poorer outcome; three-year overall survival for chemotherapy switch was 62.5%, compared with same regimen pre- and post-74%, and chemo post-resection 80%. Conclusion. Liver only metastatic disease is common in CRC and patients undergoing liver resection have improved long-term survival. Survival for a combined approach of chemotherapy and hepatic resection is similar to surgery alone. Patients not suitable for surgery with liver only disease have a poorer prognosis highlighting the need for improved liver-directed therapies and attempts to covert non-resectable to resectable disease if possible. PMID:24102180

Padman, Sunita; Padbury, Robert; Beeke, Carol; Karapetis, Christos S; Bishnoi, Sarwan; Townsend, Amanda R; Maddern, Guy; Price, Timothy J



Influence of yoga on postoperative outcomes and wound healing in early operable breast cancer patients undergoing surgery  

PubMed Central

Context: Pre- and postoperative distress in breast cancer patients can cause complications and delay recovery from surgery. Objective: The aim of our study was to evaluate the effects of yoga intervention on postoperative outcomes and wound healing in early operable breast cancer patients undergoing surgery. Methods: Ninety-eight recently diagnosed stage II and III breast cancer patients were recruited in a randomized controlled trial comparing the effects of a yoga program with supportive therapy and exercise rehabilitation on postoperative outcomes and wound healing following surgery. Subjects were assessed at the baseline prior to surgery and four weeks later. Sociodemographic, clinical and investigative notes were ascertained in the beginning of the study. Blood samples were collected for estimation of plasma cytokines—soluble Interleukin (IL)-2 receptor (IL-2R), tumor necrosis factor (TNF)-alpha and interferon (IFN)-gamma. Postoperative outcomes such as the duration of hospital stay and drain retention, time of suture removal and postoperative complications were ascertained. We used independent samples t test and nonparametric Mann Whitney U tests to compare groups for postoperative outcomes and plasma cytokines. Regression analysis was done to determine predictors for postoperative outcomes. Results: Sixty-nine patients contributed data to the current analysis (yoga: n = 33, control: n = 36). The results suggest a significant decrease in the duration of hospital stay (P = 0.003), days of drain retention (P = 0.001) and days for suture removal (P = 0.03) in the yoga group as compared to the controls. There was also a significant decrease in plasma TNF alpha levels following surgery in the yoga group (P < 0.001), as compared to the controls. Regression analysis on postoperative outcomes showed that the yoga intervention affected the duration of drain retention and hospital stay as well as TNF alpha levels. Conclusion: The results suggest possible benefits of yoga in reducing postoperative complications in breast cancer patients.

Rao, Raghavendra M; Nagendra, H R; Raghuram, Nagarathna; Vinay, C; Chandrashekara, S; Gopinath, K. S.; Srinath, B. S.



Predicting recreational difficulties and decreased leisure activities in women 6–12 months post breast cancer surgery  

Microsoft Academic Search

Introduction  A Canadian research team is conducting a multi-centered, non-interventional national study with the objective of charting\\u000a the course of arm morbidity after breast cancer surgery. This paper examined the relationship between arm morbidity and leisure\\u000a and recreational activities of affected women.\\u000a \\u000a \\u000a \\u000a Methods  Five hundred and forty seven women with stage I-III breast cancer were recruited in four centers across Canada: Surrey

Baukje Miedema; Ryan Hamilton; Sue Tatemichi; Roanne Thomas-MacLean; Anna Towers; Thomas F. Hack; Andrea Tilley; Winkle Kwan



Perioperative fast track program in intraoperative hyperthermic intraperitoneal chemotherapy (HIPEC) after cytoreductive surgery in advanced ovarian cancer  

Microsoft Academic Search

IntroductionDiffuse peritoneal dissemination in advanced ovarian cancer can be treated using optimal effort surgery involving peritonectomy procedures and the administration of hyperthermic intraoperative intraperitoneal chemotherapy (HIPEC).

P. A. Cascales Campos; J. Gil Martínez; P. J. Galindo Fernández; E. Gil Gómez; I. M. Martínez Frutos; P. Parrilla Paricio



Long-term results of breast conserving surgery for stages I and II breast cancer: Experiences at Osaka Medical Center for cancer and cardiovascular diseases  

Microsoft Academic Search

Purpose  The purpose of this study is to summarize the long-term results of breast conserving surgery (BCS) for Japanese patients with\\u000a stage I and II breast cancer at a single institute and to identify risk factors for local recurrence after BCS.\\u000a \\u000a \\u000a \\u000a Patients and Methods  Between October 1986 and June 2000, 979 women underwent BCS with or without radiation therapy (RT). Overall survival,

Yoshifumi Komoike; Kazuyoshi Motomura; Hideo Inaji; Tsutomu Kasugai; Takayuki Nose; Masahiko Koizumi; Hiroki Koyama



Assessing outcomes following surgery for colorectal cancer using quality of care indicators  

PubMed Central

Background We sought to assess the feasibility of applying Cancer Care Ontario’s quality of care indicators to a single institution’s colorectal cancer (CRC) database. We also sought to assess their utility in identifying areas that require improvement. Methods We included patients who had surgery for CRC between 1997 and 2006 at Mount Sinai Hospital, Toronto, Ont. We excluded patients who had transanal excisions, carcinoma in situ or recurrences that required pelvic exenteration, as well as those whose information was incomplete. We obtained data from a prospective database and verified the data with hospital and office charts. We evaluated trends over a 10-year period using the Cochran–Armitage trend test. Results During the study period there were 1005 surgical procedures performed in 987 patients with a mean age of 65.6 (standard deviation 15) years; the male:female ratio was 1:2. The most frequent tumour sites were the rectum and sigmoid colon (68%). Over the 10-year period, 9 indicators improved, including the proportion of patients with CRC identified by screening (p < 0.001), the proportion of patients who received preoperative liver imaging (p = 0.05), the proportion of rectal cancer patients who received preoperative pelvic imaging (p = 0.04), the proportion of patients with stage II or III rectal cancer who received radiotherapy (p = 0.03), the proportion of surgical specimens with more than 12 lymph nodes (p < 0.001), the proportion of pathology reports that included quantitative distal (p = 0.004) and radial (p < 0.001) margin measurements, the proportion of patients with an anastomotic leak (p = 0.03), the proportion of patients who received a colonoscopy 1 year after surgery (p < 0.001) and the proportion of operative reports that were complete (p < 0.001). Conclusion The use of quality of care indicators to assess the quality of colorectal surgery is feasible. This study provides benchmarks that can be used to assess changes in the quality of CRC care at our institution.

Vergara-Fernandez, Omar; Swallow, Carol J.; Victor, J. Charles; O'Connor, Brenda I.; Gryphe, Robert; MacRae, Helen M.; Cohen, Zane; McLeod, Robin S.



Associations between single-nucleotide polymorphisms and epidural ropivacaine consumption in patients undergoing breast cancer surgery.  


Up to date, few published studies indicated the associations between genetic polymorphisms and epidural local anesthetics consumption. In this study, we investigated the associations between seven single-nucleotide polymorphisms (SNPs) and epidural ropivacaine consumption during breast cancer surgery in women from northeastern China. These seven SNPs (rs3803662 and rs12443621 in TNCR9, rs889312 in MAP3K1, rs3817198 in LSP1, rs13387042 at 2q35, rs13281615 at 8q24, and rs2046210 at 6q25.1) were identified by recent genome-wide association studies associated with tumor susceptibility. A total of 418 breast cancer women received thoracic epidural anesthesia with ropivacaine for elective mastectomy with axillary clearance. Their blood samples were genotyped for the seven SNPs using the SNaPshot method. For SNP rs13281615, the subjects with genotype AG and GG consumed a greater amount of the total epidural ropivacaine and the mean ropivacaine dose than the subjects with genotype AA (p=0.047 and p=0.003, respectively). Furthermore, no statistical differences were found in the total dose of ropivacaine, the mean consumption of ropivacaine, the onset of ropivacaine, or the initial dose of lidocaine among the three genotypic groups for the other six SNPs studied. Our study indicated that SNP rs13281615 at 8q24 was associated with the consumption of epidural ropivacaine during breast cancer surgery in northeastern Chinese women. It might provide new insights into the mechanisms of ropivacaine action and metabolism and facilitate the development of personalized medicine. PMID:23577780

Liu, Jing; Jiang, Yongdong; Pang, Da; Xi, Hongjie; Liu, Yan; Li, Wenzhi



Clinicopathologic Characteristics of Gastric Cancer Patients according to the Timing of the Recurrence after Curative Surgery  

PubMed Central

Purpose There are few studies that have focused on the predictors of recurrence after gastrectomy for gastric carcinoma. This study analyzed the patients who died of recurrent gastric carcinoma and we attempted to clarify the clinicopathologic factors that are associated with the timing of recurrence. Materials and Methods From June 1992 to March 2009, 1,795 patients underwent curative gastric resection at the Department of Surgery, Hanyang University College of Medicine. Among them, 428 patients died and 311 of these patients who died of recurrent gastric carcinoma were enrolled in this study. The clinicopathologic findings were compared between the 72 patients who died within one year after curative gastrectomy (the early recurrence group) and the 92 patients who died 3 years after curative gastrectomy (the late recurrence group). Results Compared with the late recurrence group, the early recurrence group showed an older age, a more advanced stage, a poorly differentiated type of cancer and a significantly higher tendency to have lymphatic invasion, vascular invasion and perineural invasion.Especially in the gastric cancer patients with a more advanced stage (stage III and IV), the early recurrence group was characterized by a significantly higher preoperative serum carcino embryonic antigen level, perineural invasion and a relatively small number of dissected lymph nodes. Conclusions The clinicopathologic characteristics of recurrent gastric cancer are significantly different according to the stage of disease, and even in the same stage. For the early detection of recurrence after curative surgery, it is important to recognize the clinicopathological factors that foretell a high risk of recurrence. It is mandatory to make an individualized surveillance schedule according to the clinicopathologic factors.

Choi, Ji Yoon; Ha, Tae Kyung



After Breast Cancer Surgery, Patient Assistance Programs Can Help  


... October 25, 2013 Related MedlinePlus Pages Breast Cancer Health Disparities FRIDAY, Oct. 25 (HealthDay News) -- Patient assistance programs ... rights reserved. More Health News on: Breast Cancer Health Disparities Recent Health News Page last updated on 28 ...


Surgery to Reduce the Risk of Breast Cancer  


... outcomes: the NSABP Study of Tamoxifen and Raloxifene (STAR) P–2 trial. JAMA 2006; 295(23):2727– ... and Bowel Project Study of Tamoxifen and Raloxifene (STAR) P-2 Trial: Preventing breast cancer. Cancer Prevention ...




... candidate for lung surgery. Lung Volume Reduction Surgery (LVRS) is a procedure to help people with severe COPD. LVRS is not a cure for COPD but can ... that the remaining healthier portion can perform better. LVRS can also allow the diaphragm to return to ...


[A patient education program after breast cancer surgery].  


In France, one woman in eight is treated for breast cancer before the age of 75. The 2009-2013 cancer plan recommends providing support for women after cancer. A therapeutic education programme helps them reintegrate into their daily life. PMID:23878886

Pfeil-Thiriet, Francine



Is there a role for arterial reconstruction in surgery for pancreatic cancer?  

PubMed Central

Surgery remains the only potentially curative treatment for patients with pancreatic cancer. Locally advanced pancreatic cancer with vascular involvement remains a surgical challenge because high perioperative risk and the uncertainty of a survival benefit. Whilst portal vein resection has started to gather momentum because the perioperative morbidity and long term survival is comparable to standard pancreatectomy, there isn’t yet a consensus on arterial resections. There have been various reports and case series of arterial resections in pancreatic cancer, with mixed survival results. Mollberg et al have appraised the heterogeneous published literature available on arterial resection in pancreatic cancer in an attempt to compare this to standard pancreatectomy. In this article, we discuss the results of this systematic review and meta-analysis, and the limitations associated with analysing results from heterogenous data. We have outlined the important features in surgery for pancreatic cancer and specifically to arterial resections, and compared arterial resections to the published literature on venous resections.

Ravikumar, Reena; Holroyd, David; Fusai, Giuseppe



Neoadjuvant Treatment Does Not Influence Perioperative Outcome in Rectal Cancer Surgery  

SciTech Connect

Purpose: To identify the risk factors for perioperative morbidity in patients undergoing resection of primary rectal cancer, with a specific focus on the effect of neoadjuvant therapy. Methods and Materials: This exploratory analysis of prospectively collected data included all patients who underwent anterior resection/low anterior resection or abdominoperineal resection for primary rectal cancer between October 2001 and October 2006. The study endpoints were perioperative surgical and medical morbidity. Univariate and multivariate analyses of potential risk factors were performed. Results: A total of 485 patients were included in this study; 425 patients (88%) underwent a sphincter-saving anterior resection/low anterior resection, 47 (10%) abdominoperineal resection, and 13 (2%) multivisceral resection. Neoadjuvant chemoradiotherapy was performed in 100 patients (21%), and 168 (35%) underwent neoadjuvant short-term radiotherapy (5 x 5 Gy). Patient age and operative time were independently associated with perioperative morbidity, and operative time, body mass index >27 kg/m{sup 2} (overweight), and resection type were associated with surgical morbidity. Age and a history of smoking were confirmed as independent prognostic risk factors for medical complications. Neoadjuvant therapy was not associated with a worse outcome. Conclusion: The results of this prospective study have identified several risk factors associated with an adverse perioperative outcome after rectal cancer surgery. In addition, neoadjuvant therapy was not associated with increased perioperative complications.

Ulrich, Alexis [Department of Surgery, University of Heidelberg, Heidelberg (Germany); Weitz, Juergen [Department of Surgery, University of Heidelberg, Heidelberg (Germany)], E-mail:; Slodczyk, Matthias; Koch, Moritz [Department of Surgery, University of Heidelberg, Heidelberg (Germany); Jaeger, Dirk [Nationales Centrum fuer Tumorerkrankungen, University of Heidelberg, Heidelberg (Germany); Muenter, Marc [Department of Clinical Radiology, Radiooncology and Radiotherapy, University of Heidelberg, Heidelberg (Germany); Buechler, Markus W. [Department of Surgery, University of Heidelberg, Heidelberg (Germany)



Separate and combined analysis of successive dependent outcomes after breast-conservation surgery: recurrence, metastases, second cancer and death  

PubMed Central

Background In the setting of recurrent events, research studies commonly count only the first occurrence of an outcome in a subject. However this approach does not correctly reflect the natural history of the disease. The objective is to jointly identify prognostic factors associated with locoregional recurrences (LRR), contralateral breast cancer, distant metastases (DM), other primary cancer than breast and breast cancer death and to evaluate the correlation between these events. Methods Patients (n = 919) with a primary invasive breast cancer and treated in a cancer center in South-Western France with breast-conserving surgery from 1990 to 1994 and followed up to January 2006 were included. Several types of non-independent events could be observed for the same patient: a LRR, a contralateral breast cancer, DM, other primary cancer than breast and breast cancer death. Data were analyzed separately and together using a random-effects survival model. Results LRR represent the most frequent type of first failure (14.6%). The risk of any event is higher for young women (less than 40 years old) and in the first 10 years of follow-up after the surgery. In the combined analysis histological tumor size, grade, number of positive nodes, progesterone receptor status and treatment combination are prognostic factors of any event. The results show a significant dependence between these events with a successively increasing risk of a new event after the first and second event. The risk of developing a new failure is greatly increased (RR = 4.25; 95%CI: 2.51-7.21) after developing a LRR, but also after developing DM (RR = 3.94; 95%CI: 2.23-6.96) as compared to patients who did not develop a first event. Conclusion We illustrated that the random effects survival model is a more satisfactory method to evaluate the natural history of a disease with multiple type of events.



Compounds and methods for treatment of cancer  

US Patent & Trademark Office Database

Compounds for treating, preventing or managing cancer are disclosed. Also provided are methods for using the compounds in treatment of various cancers. Also provided are methods of treatment using the compounds together with another chemotherapy, radiation therapy, hormonal therapy, biological therapy, or immunotherapy. Pharmaceutical compositions suitable for use in the methods are also disclosed.



Long-Term Survival and Recurrence Outcomes Following Surgery for Distal Rectal Cancer  

PubMed Central

Background Treatment of distal rectal cancer remains clinically challenging and includes proctectomy and coloanal anastomosis (CAA) or abdominoperineal resection (APR). The purpose of this study is to evaluate operative and pathologic factors associated with long-term survival and local recurrence outcomes in patients treated for distal rectal cancer. Methods A retrospective consecutive cohort study of 304 patients treated for distal rectal cancer with radical resection from 1993 to 2003 was performed. Patients were grouped by procedure (CAA or APR). Demographic, pathologic, recurrence, and survival data were analyzed utilizing chi-square analysis for comparison of proportions. Survival analysis was performed using Kaplan–Meier method and log-rank test for univariate and Cox regression for multivariate comparison. Results The median tumor distance from the anal verge was 2 cm [interquartile range (IQR) 0.5–4 cm]. Margins were negative in all but four patients (one distal, 0.3%; three radial, 1%). The 5-year overall survival rate was 82% (88.6% stage pI, 80.5% stage pII, 67.9% stage pIII). Older age, advanced pathologic stage, presence of lymphovascular or perineural invasion, earlier treatment period, and APR surgery type were associated with worse survival on multivariate analysis. The 5-year local recurrence rate was 5.3% after CAA and 7.9% after APR (p = 0.33). Conclusions Low rates of local recurrence and good overall survival can be achieved after treatment of distal rectal cancer with stage-appropriate chemoradiation and proctectomy with CAA or APR. Sphincter preservation can be achieved even with distal margins less than 2 cm.

Silberfein, Eric J.; Kattepogu, Kiran M.; Hu, Chung-Yuan; Skibber, John M.; Rodriguez-Bigas, Miguel A.; Feig, Barry; Das, Prajnan; Krishnan, Sunil; Crane, Christopher; Kopetz, Scott; Eng, Cathy; Chang, George J.



Single-port Video-Assisted Thoracic Surgery for Lung Cancer  

PubMed Central

Video-assisted thoracic surgery (VATS) is a minimally invasive technique that has many advantages in postoperative pain and recovery time. Because of its advantages, VATS is one of the surgical techniques widely used in patients with lung cancer. Most surgeons perform VATS for lung cancer with three or more incisions. As the technique of VATS has evolved, single-port VATS for lung cancer has been attempted and its advantages have been reported. We describe our experiences of VATS for lung cancer with a single incision in this report.

Min, Ho Ki; Jun, Hee Jae; Hwang, Youn Ho; Kang, Min Kyun





... be treated with radiation or chemotherapy. Enable direct access for chemotherapy, radiation implants, or genetic treatment of malignant tumors. Relieve seizures (due to a brain tumor) that are hard to control. Types The most common types of surgery for ...


Patient characteristics and hospital quality for colorectal cancer surgery  

Microsoft Academic Search

Objective. To assess associations of patient characteristics with quality-related characteristics of the hospitals where they were treated for colorectal cancer and the role of these associations in disparities in treatment quality affecting vulnerable patient groups or variations across health plans. Setting. Population-based cancer registry in California. Participants. A total of 38 237 patients diagnosed with stage I-III (non-metastatic) colorectal cancer




Breast Surgery  


... Friday, 9 AM to 10 PM EST. FACTS FOR LIFE Breast Cancer Surgery The goal of breast cancer surgery is to ... Choose a surgeon who does a lot of breast cancer surgeries. • Ask your surgeon which options are best for you and why. You may want to get ...


Quality of Life After Breast Cancer Surgery With or Without Reconstruction  

PubMed Central

In the modern era, where breast-conserving surgery is a viable alternative to mastectomy, breast cancer patients and their healthcare providers have to consider the issue of quality of life in regards to the type of surgery. The choice of surgical procedure should consider the perceptions of women diagnosed with breast cancer as well as their functional and emotional well-being. A more holistic approach to the patient should be implemented with proper psychological evaluation before and psychological support after the crisis.

Stavrou, Demetris; Weissman, Oren; Polyniki, Anna; Papageorgiou, Neofytos; Haik, Joseph; Farber, Nimrod; Winkler, Eyal



[Assessment of oncologic risk of breast reconstruction simultaneous with surgery for breast cancer].  


The report deals with retrospective research in possible induction of relapse by breast reconstruction carried out simultaneously with surgery for breast cancer. The end results were compared between cases of modification of radical mastectomy combined with reconstruction (n=124) and controls who underwent surgery for cancer alone (n=379). Standard radio- and systemic therapy was used. Median follow-up was 64 months. Local and general recurrence as well as relapse-free and overall survival rates were identical. Multivariate analysis failed to establish any correlation between primary breast reconstruction and relapse. Nor did it increase the risk of the development of the latter. PMID:19241846

Portno?, S M; Blokhin, S N; Arslanov, Kh S; Laktionov, K P; Balakireva, G V; Akhmetov, M Sh



A snapshot of waiting times for cancer surgery provided by surgeons affiliated with regional cancer centres in Ontario  

Microsoft Academic Search

Background: There is evidence that delays in treatment result in increased psy- chosocial morbidity for patients diagnosed with cancer. We evaluated waiting times for care among cancer patients treated by surgeons affiliated with regional cancer centres in Ontario. Methods: Dates for 5 key events related to the surgical management of a patient with cancer were collected by a convenience sample

Marko Simunovic; Anna Gagliardi; David McCready; Angela Coates; Mark Levine; Denny DePetrillo


Infl uence of yoga on postoperative outcomes and wound healing in early operable breast cancer patients undergoing surgery  

Microsoft Academic Search

After surgery, breast cancer patients experience particularly high levels of distress(1-4) manifested as anxiety, depression and anger due to the effects of surgery and the disease itself on life expectancy, physical appearance and sexual identity.(5) Furthermore, concerns regarding one's physical condition, postoperative recovery, hospital admissions, anticipating painful procedures, image problems, confronting cancer diagnosis and worries about survival and recovery can

Raghavendra M Rao; Nagendra H R; Nagarathna Raghuram; Vinay C; Chandrashekara S


Multifunctional mesoporous composite nanocapsules for highly efficient MRI-guided high-intensity focused ultrasound cancer surgery.  


Bloodless surgical knife: Nano-biotechnology has been introduced into imaging-guided high-intensity focused ultrasound (HIFU) cancer surgery by adopting engineered multifunctional manganese-based mesoporous composite nanocapsules as the contrast agents for T(1)-weighted magnetic resonance imaging (MRI) and simultaneously as synergistic agents for MRI-guided HIFU cancer surgery. PMID:22076783

Chen, Yu; Chen, Hangrong; Sun, Yang; Zheng, Yuanyi; Zeng, Deping; Li, Faqi; Zhang, Shengjian; Wang, Xia; Zhang, Kun; Ma, Ming; He, Qianjun; Zhang, Linlin; Shi, Jianlin



Laparoscopic Total Mesorectal Excision for Rectal Cancer Surgery  

Microsoft Academic Search

The introduction of total mesorectal excision in the early 1980s has improved local control and survival in patients with rectal cancer. Laparoscopic resections for colonic malignancies are gaining acceptance in the light of the recent evidence of oncologic adequacy from randomized clinical trials. Technical difficulties and the difference in the natural history of the disease have excluded rectal cancer from

Jacques Marescaux; Francesco Rubino; Joel Leroy



Meta-analytic comparison of randomized and nonrandomized studies of breast cancer surgery  

PubMed Central

Background Randomized controlled trials (RCTs) are thought to provide the most accurate estimation of “true” treatment effect. The relative quality of effect estimates derived from nonrandomized studies (nRCTs) remains unclear, particularly in surgery, where the obstacles to performing high-quality RCTs are compounded. We performed a meta-analysis of effect estimates of RCTs comparing surgical procedures for breast cancer relative to those of corresponding nRCTs. Methods English-language RCTs of breast cancer treatment in human patients published from 2003 to 2008 were identified in MEDLINE, EMBASE and Cochrane databases. We identified nRCTs using the National Library of Medicine’s “related articles” function and reference lists. Two reviewers conducted all steps of study selection. We included studies comparing 2 surgical arms for the treatment of breast cancer. Information on treatment efficacy estimates, expressed as relative risk (RR) for outcomes of interest in both the RCTs and nRCTs was extracted. Results We identified 12 RCTs representing 10 topic/outcome combinations with comparable nRCTs. On visual inspection, 4 of 10 outcomes showed substantial differences in summary RR. The pooled RR estimates for RCTs versus nRCTs differed more than 2-fold in 2 of 10 outcomes and failed to demonstrate consistency of statistical differences in 3 of 10 cases. A statistically significant difference, as assessed by the z score, was not detected for any of the outcomes. Conclusion Randomized controlled trials comparing surgical procedures for breast cancer may demonstrate clinically relevant differences in effect estimates in 20%–40% of cases relative to those generated by nRCTs, depending on which metric is used.

Edwards, Janet P.; Kelly, Elizabeth J.; Lin, Yongtao; Lenders, Taryn; Ghali, William A.; Graham, Andrew J.



Laparoscopic surgery for endometrial cancer: increasing body mass index does not impact postoperative complications  

PubMed Central

Objective To determine the effect of body mass index on postoperative complications and the performance of lymph node dissection in women undergoing laparoscopy or laparotomy for endometrial cancer. Methods Retrospective chart review of all patients undergoing surgery for endometrial cancer between 8/2004 and 12/2008. Complications graded and analyzed using Common Toxicity Criteria for Adverse Events ver. 4.03 classification. Results 168 women underwent surgery: laparoscopy n=65, laparotomy n=103. Overall median body mass index 36.2 (range, 18.1 to 72.7) with similar distributions for age, body mass index and performance of lymph node dissection between groups. Following laparoscopy vs. laparotomy the percent rate of overall complications 53.8:73.8 (p=0.01), grade ?3 complications 9.2:34.0 (p<0.01), ?3 wound complications 3.1:22.3 (p<0.01) and ?3 wound infection 3.1:20.4 (p=0.01) were significantly lower after laparoscopy. In a logistic model there was no effect of body mass index (?36 and<36) on complications after laparoscopy in contrast to laparotomy. Para-aortic lymph node dissection was performed by laparoscopy 19/65 (29%): by laparotomy 34/103 (33%) p=0.61 and pelvic lymph node dissection by laparoscopy 21/65 (32.3%): by laparotomy 46/103 (44.7%) p=0.11. Logistic regression analysis revealed that for patients undergoing laparoscopy for stage I disease there was an inverse relationship between the performance of both para-aortic lymph node dissection and pelvic lymph node dissection and increasing body mass index (p=0.03 and p<0.01 respectively) in contrast to the laparotomy group where there was a trend only (p=0.09 and 0.05). Conclusion For patients undergoing laparoscopy, increasing body mass index did not impact postoperative complications but did influence the decision to perform lymph node dissection.

Arumugam, Cibi; Gordinier, Mary E.; Metzinger, Daniel S.; Pan, Jianmin; Rai, Shesh N.



Systematic lymphadenectomy in ovarian cancer at second-look surgery: a randomised clinical trial  

PubMed Central

Background: The role of systematic aortic and pelvic lymphadenectomy (SAPL) at second-look surgery in early stage or optimally debulked advanced ovarian cancer is unclear and never addressed by randomised studies. Methods: From January 1991 through May 2001, 308 patients with the International Federation of Gynaecology and Obstetrics stage IA–IV epithelial ovarian carcinoma were randomly assigned to undergo SAPL (n=158) or resection of bulky nodes only (n=150). Primary end point was overall survival (OS). Results: The median operating time, blood loss, percentage of patients requiring blood transfusions and hospital stay were higher in the SAPL than in the control arm (P<0.001). The median number of resected nodes and the percentage of women with nodal metastases were higher in the SAPL arm as well (44% vs 8%, P<0.001 and 24.2% vs 13.3%, P:0.02). After a median follow-up of 111 months, 171 events (i.e., recurrences or deaths) were observed, and 124 patients had died. Sites of first recurrences were similar in both arms. The adjusted risk for progression and death were not statistically different (hazard ratio (HR) for progression=1.18, 95% confidence interval (CI)=0.87–1.59; P=0.29; 5-year progression-free survival (PFS)=40.9% and 53.8% HR for death=1.04, 95% CI=0.733–1.49; P=0.81; 5-year OS=63.5% and 67.4%, in the SAPL and in the control arm, respectively). Conclusion: SAPL in second-look surgery for advanced ovarian cancer did not improve PFS and OS.

Dell' Anna, T; Signorelli, M; Benedetti-Panici, P; Maggioni, A; Fossati, R; Fruscio, R; Milani, R; Bocciolone, L; Buda, A; Mangioni, C; Scambia, G; Angioli, R; Campagnutta, E; Grassi, R; Landoni, F



Outcome of Low-Volume Surgery for Esophageal Cancer in a High-Volume Referral Center  

Microsoft Academic Search

Background  There is a known inverse relationship between the number of esophagectomies and in-hospital mortality. Our institute is a\\u000a tertiary referral center with a high caseload of esophageal cancer patients, but with a low annual volume of esophagectomies.\\u000a The objective of our study was to evaluate the results of esophageal cancer surgery in our institute and to compare these\\u000a results with

Ewout F. W. Courrech Staal; Frits van Coevorden; Annemieke Cats; Berthe M. P. Aleman; Marie-Louise F. van Velthuysen; Henk Boot; Marie-Jeanne T. F. D. Vrancken Peeters; Johanna W. van Sandick



Need for immunologic stimulators during immunosuppression produced by major cancer surgery.  

PubMed Central

Although surgery, radiology, and anticancer chemicals have been effective in the treatment of cancer, the immunologic phase of therapy deserves more effort and thought, because the possibilities are considerable. However, the immunologic phase is so complicated that, without the advances made during the past few years, little could be expected from immunology. The focus of this paper is on the immunosuppression produced by major cancer operations, at which time the patient needs immunologic help.

Cole, W H; Humphrey, L



Rectal Cancer Surgery in a District General Hospital: Controlled Follow-up Study  

Microsoft Academic Search

.   Local recurrence after curative surgery of rectal cancer indicates failure of the initial treatment. In recent years reported\\u000a local recurrence rates have steadily decreased. In this study 364 patients treated for rectal cancer were analyzed retrospectively\\u000a to determine if it is still justified to treat this disease in small nonspecialized hospitals. An overall local recurrence\\u000a rate of 9.7% was

Gaston Schütz; Marko Aleksic; Bernward Ulrich



Post-surgery radiation in early breast cancer: survival analysis of registry data  

Microsoft Academic Search

Backgroundandpurpose: Overviews of randomized trials have shown a small survival advantage with post-surgery radiation in early breast cancer. The present study attempts to extend this observation through a systematic analysis of population data.Materialsandmethods: This retrospective cohort study used the Surveillance, Epidemiology, and End Results (SEER) data on 83,776 women with breast cancer diagnosed between 1988 and 1997, stage T1–T2, node

Vincent Vinh-Hung; Tomasz Burzykowski; Jan Van de Steene; Guy Storme; Guy Soete



Laparoscopic-assisted versus open surgery for rectal cancer: a meta-analysis of randomized controlled trials on oncologic adequacy of resection and long-term oncologic outcomes  

Microsoft Academic Search

Background  Whether laparoscopic-assisted surgery (LS) can achieve the same oncologic outcomes compared with open surgery (OS) for rectal\\u000a cancer remains controversial. The aim of this meta-analysis of randomized controlled trials (RCTs) is to compare oncologic\\u000a adequacy of resection and long-term oncologic outcomes of LS with OS in the treatment of rectal cancer.\\u000a \\u000a \\u000a \\u000a \\u000a Methods  Literature searches of electronic databases (Pubmed, Embase, Web of

Mei-Jin Huang; Jing-Lin Liang; Hui Wang; Liang Kang; Yan-Hong Deng; Jian-Ping Wang



Risk Factors of Postoperative Pancreatic Fistula in Curative Gastric Cancer Surgery  

PubMed Central

Purpose Postoperative pancreatic fistula is a dreadful complication after gastric cancer surgery. The purpose of this study is to evaluate the actual incidence and risk factors of postoperative pancreatic fistula after curative gastrectomy for gastric cancer. Materials and Methods A total of 900 patients who underwent gastrectomy for gastric cancer (laparoscopic gastrectomy, 594 patients; open gastrectomy 306 patients) were enrolled between January 2009 and December 2010. Clinical outcomes, including postoperative pancreatic fistula grade based on the International Study Group on Pancreatic Fistula, were investigated. Results Overall, the postoperative pancreatic fistula rate was 3.3% (30/900) (1.5% in laparoscopic gastrectomy versus 6.9% in open gastrectomy, P<0.001). Patients who underwent D2 lymphadenectomy, total gastrectomy, splenectomy or distal pancreatectomy showed higher postoperative pancreatic fistula rates (4.7%, 13.8%, 13.6%, or 57.1%, respectively, P<0.001). Patients with postoperative pancreatic fistula had higher morbidity (46.7% versus 13.1%, P<0.001), delayed gas out (4.9 days versus 3.8 days, P<0.001), belated diet start (5.8 days versus 3.5 days, P<0.001) and longer postoperative hospital stay (13.7 days versus 6.8 days, P<0.001). On the multivariate analysis, total gastrectomy (odds ratio 9.751, 95% confidence interval: 3.348 to 28.397, P<0.001), distal pancreatectomy (odds ratio 7.637, 95% confidence interval: 1.668 to 34.961, P=0.009) and open gastrectomy (odds ratio 2.934, 95% confidence interval: 1.100 to 7.826, P=0.032) were the independent risk factors of postoperative pancreatic fistula. Conclusions Laparoscopic gastrectomy had an advantage over open gastrectomy in terms of the lower postoperative pancreatic fistula rate. Total gastrectomy and combined resection, such as distal pancreatectomy, should be performed carefully to minimize postoperative pancreatic fistula in gastric cancer surgery.

Yu, Hyeong Won; Jung, Do Hyun; Son, Sang-Yong; Lee, Chang Min; Lee, Ju Hee; Ahn, Sang-Hoon; Kim, Hyung-Ho



Gene therapy for gastrointestinal tract cancer: Prospects for combination treatment consisting of surgery and molecular surgery  

Microsoft Academic Search

Progress in understanding carcinogenesis has shown cancer to be a disease caused by gene abnormalities, and a variety of oncogenes\\u000a and tumor suppressor genes have thus been identified. Advances in molecular biology have given us new tools for diagnosing,\\u000a staging and predicting the outcome for cancer patients and gene therapy could therefore potentially revolutionize the treatment\\u000a of gastrointestinal (GI) tract

Masahiko Onda; Norio Matsukura



Laparoscopic versus open surgery for the treatment of colorectal cancer: a literature review and recommendations from the Comit? de l'?volution des pratiques en oncologie  

PubMed Central

Background Adoption of the laparoscopic approach for colorectal cancer treatment has been slow owing to initial case study results suggesting high recurrence rates at port sites. The use of laparoscopic surgery for colorectal cancer still raises a number of concerns, particularly with the technique’s complexity, learning curve and longer duration. After exploring the scientific literature comparing open and laparoscopic surgery for the treatment of colorectal cancer with respect to oncologic efficacy and short-term outcomes, the Comité de l’évolution des pratiques en oncologie (CEPO) made recommendations for surgical practice in Quebec. Methods Scientific literature published from January 1995 to April 2012 was reviewed. Phase III clinical trials and meta-analyses were included. Results Sixteen randomized trials and 10 meta-analyses were retrieved. Analysis of the literature confirmed that for curative treatment of colorectal cancer, laparoscopy is not inferior to open surgery with respect to survival and recurrence rates. Moreover, laparoscopic surgery provides short-term advantages, including a shorter hospital stay, reduced analgesic use and faster recovery of intestinal function. However, this approach does require a longer operative time. Conclusion Considering the evidence, the CEPO recommends that laparoscopic resection be considered an option for the curative treatment of colon and rectal cancer; that decisions regarding surgical approach take into consideration surgeon experience, tumour stage, potential contraindications and patient expectations; and that laparoscopic resection for rectal cancer be performed only by appropriately trained surgeons who perform a sufficient volume annually to maintain competence.

Morneau, Melanie; Boulanger, Jim; Charlebois, Patrick; Latulippe, Jean-Francois; Lougnarath, Rasmy; Thibault, Claude; Gervais, Normand



Methods of Identifying Metastatic Potential in Cancer.  

National Technical Information Service (NTIS)

The present invention encompasses methods for predicting metastasis in cancer by assessing the structure of the complement protein C1qA. The methods may encompass examining either protein or nucleic acids, and may further include making treatment decision...

D. M. Racila E. V. Racila G. J. Weiner



Results of surgery on 6589 gastric cancer patients and immunochemosurgery as the best treatment of advanced gastric cancer.  

PubMed Central

Results of 6589 gastric cancer operations at the Department of Surgery, Seoul National University Hospital, from 1970 to 1990 were reported. About two thirds (76.6%) were advanced gastric cancer (stages III and IV). The 5-year survival rate of operated stage III gastric cancer was only 30.6%, with frequent recurrence. Conversely, cell-mediated immunities of advanced gastric cancer patients were significantly decreased. Therefore, to improve the cure rate and to prevent or delay recurrence, curative surgery with confirmation of free resection margins and systematic lymph node dissection of perigastric vessels were performed and followed by early postoperative immunotherapy and chemotherapy (immunochemosurgery) in stage III patients. To evaluate the effect of immunochemosurgery, two randomized trials were studied in 1976 and 1981. In first trial, 5-fluorouracil, mitomycin C, and cytosine arabinoside for chemotherapy and OK 432 for immunotherapy were used. The 5-year survival rates for surgery alone (n = 64) and immunochemosurgery (n = 73) were 23.4% and 44.6%, respectively, a significant difference. In the second trial, there were three groups: group I, immunochemosurgery (n = 159); group II, surgery and chemotherapy (n = 77); and group III, surgery alone (n = 94). 5-Fluorouracil and mitomycin C for chemotherapy and OK-432 for immunotherapy were administered for 2 years. The 5-year survival rate of group I was 45.3%, significantly higher than the 29.8% of group II and than the 24.4% of group III. The postoperative 1-chloro-2.4-dinitrobenzene test, T-lymphocyte percentage, phytohemagglutinin- and con-A-stimulated lymphoblastogenesis and the antibody-dependent cell-mediated cytotoxicity test showed more favorable values in the immunochemosurgery group. Therefore, immunochemosurgery is the best multimodality treatment for advanced gastric cancer.

Kim, J P; Kwon, O J; Oh, S T; Yang, H K



Is Robotic Surgery Superior to Endoscopic and Open Surgeries in Thyroid Cancer?  

Microsoft Academic Search

Background  Endoscopic thyroidectomies have been performed using various approaches, and indications have expanded with the development\\u000a of new surgical techniques and instruments. Endoscopic thyroid surgery using bilateral axillo-breast approaches have excellent\\u000a cosmetic results and a symmetrical, optimal operative view. However, because of the two-dimensional view and the nonflexible\\u000a instruments, these approaches are not easy to use in performing a central lymph

Wan Wook Kim; Jee Soo Kim; Sung Mo Hur; Sung Hoon Kim; Se-Kyung Lee; Jae Hyuck Choi; Sangmin Kim; Jeong Eon Lee; Jung-Han Kim; Seok Jin Nam; Jung-Hyun Yang; Jun-Ho Choe



Prognostic Value of p27, p53, and Vascular Endothelial Growth Factor in Dukes A and B Colon Cancer Patients Undergoing Potentially Curative Surgery  

Microsoft Academic Search

PURPOSE Early-stage colon cancer patients (Dukes A or B; pT1–T3 pNO pMO) are excluded from adjuvant chemotherapy following potentially curative surgery because they are expected to have good long-term survival. However, 20 percent to 30 percent of these patients ultimately succumb from recurrent disease. This indicates that the conventional staging procedures may be unable to precisely predict cancer prognosis. METHODS

Gennaro Galizia; Francesca Ferraraccio; Eva Lieto; Michele Orditura; Paolo Castellano; Vincenzo Imperatore; Ciro Romano; Mario Vollaro; Bruno Agostini; Carlo Pignatelli; Ferdinando De Vita



Proteomic Methods in Cancer Research  

Microsoft Academic Search

\\u000a Recent advancements and progress in proteomics technologies and research protocols have made a demonstrable impact upon clinical\\u000a investigations, particularly in the area of cancer research. This chapter reviews the overall requirements and approaches\\u000a involved in clinical proteomics research with particular emphasis on and review of accomplishments in the field of cancer\\u000a research and therapy. A detailed discussion of the challenges

Scot Weinberger; Egisto Boschetti


Prognostic Factors of Peritoneal Metastases from Colorectal Cancer following Cytoreductive Surgery and Perioperative Chemotherapy  

PubMed Central

Background. Prolonged survival of patients affected by peritoneal metastasis (PM) of colorectal origin treated with complete cytoreduction followed by intraoperative hyperthermic intraperitoneal chemotherapy (HIPEC) has been reported. However, two-thirds of the patients after complete cytoreduction and perioperative chemotherapy (POC) develop recurrence. This study is to analyze the prognostic factors of PM from colorectal cancer following the treatment with cytoreductive surgery (CRS) + POC. Patients and Methods. During the last 8 years, 142 patients with PM of colorectal origin have been treated with CRS and perioperative chemotherapy. The surgical resections consisted of a combination of peritonectomy procedures. Results. Complete cytoreduction (CCR-0) was achieved at a higher rate in patients with peritoneal cancer index (PCI) score less than 10 (94.7%, 71/75) than those of PCI score above 11 (40.2%, 37/67). Regarding the PCI of small bowel (SB-PCI), 89 of 94 (91.5%) patients with ?2 and 22 of 48 (45.8%) patients with SB-PCI ? 3 received CCR-0 resection (P < 0.001). Postoperative Grade 3 and Grade 4 complications occurred in 11 (7.7%) and 14 (9.9%). The overall operative mortality rate was 0.7% (1/142). Cox hazard model showed that CCR-0, SB-PCI ? 2, differentiated carcinoma, and PCI ? 10 were the independent favorite prognostic factors. Conclusions. Complete cytoreduction, PCI, SB-PCI threshold, and histologic type were the independent prognostic factors.

Yonemura, Yutaka; Canbay, Emel; Ishibashi, Haruaki



Role of salvage radiotherapy for regional lymph node recurrence after radical surgery in advanced gastric cancer  

PubMed Central

Purpose To evaluate the role of salvage radiotherapy (RT) for the treatment of regional lymph node recurrence (RLNR) after radical surgery in advanced gastric cancer. Materials and Methods We retrospectively analyzed medical records of 26 patients who underwent salvage treatment after diagnosis of RLNR between 2006 and 2011. Patients with peritoneal seeding or distant metastasis were excluded. Eighteen patients received RT with or without chemotherapy and the other 8 did chemotherapy only without RT. A three-dimensional conformal RT was performed with median dose of 56 Gy (range, 44 to 60 Gy). Sixteen patients had fluoropyrimidine-based chemotherapy, 5 did taxane-based chemotherapy, and irinotecan was applied in 4. Results With a median follow-up of 20 months (range, 5 to 57 months), median overall survival (OS) and progression-free survival (PFS) after diagnosis of RLNR were 29 months and 12 months in the entire patients, respectively. Radiotherapy (p = 0.007) and disease-free interval (p = 0.033) were statistically significant factors for OS in multivariate analysis. Median OS was 36 months in patients who received RT and 16 months in those who did not. Furthermore, delivery of RT (p < 0.001), complete remission after salvage treatment (p = 0.040) and performance status (p = 0.023) were associated with a significantly better PFS. Gastrointestinal toxicities from RT were mild in most patients. Conclusion Salvage RT combined with systemic chemotherapy may be an effective treatment managing RLNR from advanced gastric cancer.

Kim, Byoung Hyuck; Kim, Jae-Sung; Kim, Hyung-Ho; Park, Do Joong



Body Image of Greek Breast Cancer Patients Treated with Mastectomy or Breast Conserving Surgery  

Microsoft Academic Search

The aim of this study was to assess and compare the body image of breast cancer patients (n = 70) whom underwent breast conserving surgery or mastectomy, as well as to compare patients’ scores with that of a sample of healthy control women (n = 70). A secondary objective of this study was to examine the reliability and validity of the 10-item Greek version

Fotios Anagnostopoulos; Spyridoula Myrgianni



#69 Racial and ethnic differences in bowel surveillance procedures following colorectal cancer surgery with curative intent  

Microsoft Academic Search

PURPOSE: Bowel surveillance with colonoscopy or barium enema is recommended for early detection of recurrences and metachronous tumors after colorectal cancer surgery with curative intent. There is a documented pattern of under-use coupled with some overuse of these procedures. Sociodemographic variation has been observed among those undergoing these procedures. The purpose of this analysis was to investigate racial\\/ethnic differences in

GL Ellison; ML Brown; JL Warren; KB Knopf



Factors related to dropout in a study of head and neck cancer patients after surgery  

Microsoft Academic Search

The extent and nature of dropout was assessed in a longitudinal study whose objective was to define and quantify the functional effects of oral surgical resection and reconstruction on speech and swallowing function in patients with head and neck cancer. Of 150 patients who were enrolled to be followed up with speech and swallow assessments for 1 year after surgery,




Preliminary trial of surgery after chemotherapy for advanced gastric cancer with peritoneal dissemination  

PubMed Central

Systemic chemotherapy is the key treatment for patients presenting with advanced gastric cancer with peritoneal dissemination. In certain cases, adjuvant surgery following systemic chemotherapy may result in improved long-term survival. This study aimed to evaluate the efficacy of adjuvant surgery following response to chemotherapy for advanced gastric cancer with peritoneal dissemination. The study included 13 patients with a diagnosis of advanced gastric cancer with peritoneal dissemination. Of the 13 patients, 5 patients underwent surgery after the peritoneal dissemination was eradicated following systemic chemotherapy (group S), while the remaining 8 patients continued to receive systemic chemotherapy due to persistent peritoneal dissemination (group C). All 13 patients underwent treatment between October 2008 and February 2011. The chemotherapy regimen included cis-diamminedichloride platinum plus S-1 (an oral fluoropyrimidine) or docetaxel plus S-1 for all patients. The median overall survival time of the 13 patients was 660 days. The survival time did not differ with patient response to chemotherapy. The median survival time of the patients in group S was 794 days, which was significantly higher than that of the patients in group C (505 days; p<0.05). One- and 2-year survival was observed in 100 and 60% of patients, respectively, in group S, and 66.7 and 0% of patients in group C. In conclusion, adjuvant surgery led to longer survival in patients having advanced gastric cancer with peritoneal dissemination, which was eradicated following systemic chemotherapy.




Optimal Total Mesorectal Excision for Rectal Cancer: the Role of Robotic Surgery from an Expert's View  

PubMed Central

Total mesorectal excision (TME) has gained worldwide acceptance as a standard surgical technique in the treatment of rectal cancer. Ever since laparoscopic surgery was first applied to TME for rectal cancer, with increasing penetration rates, especially in Asia, an unstable camera platform, the limited mobility of straight laparoscopic instruments, the two-dimensional imaging, and a poor ergonomic position for surgeons have been regarded as limitations. Robotic technology was developed in an attempt to reduce the limitations of laparoscopic surgery. The robotic system has many advantages, including a more ergonomic position, stable camera platform and stereoscopic view, as well as elimination of tremor and subsequent improved dexterity. Current comparison data between robotic and laparoscopic rectal cancer surgery show similar intraoperative results and morbidity, postoperative recovery, and short-term oncologic outcomes. Potential benefits of a robotic system include reduction of surgeon's fatigue during surgery, improved performance and safety for intracorporeal suture, reduction of postoperative complications, sharper and more meticulous dissection, and completion of autonomic nerve preservation techniques. However, the higher cost for a robotic system still remains an obstacle to wide application, and many socioeconomic issues remain to be solved in the future. In addition, we need more concrete evidence regarding the merits for both patients and surgeons, as well as the merits compared to conventional laparoscopic techniques. Therefore, we need large-scale prospective randomized clinical trials to prove the potential benefits of robot TME for the treatment of rectal cancer.

Kang, Jeonghyun



Good prognosis in thyroid cancer found incidentally at surgery for thyrotoxicosis  

PubMed Central

An analysis of the outcome of thyroid carcinoma incidentally discovered in patients undergoing surgery for hyperthyroidism is presented. Among 986 patients with differentiated thyroid cancer, 23 had presented with symptoms and signs of hyperthyroidism. Graves' disease was diagnosed in 11, multinodular goitre in eight and toxic adenoma in four. Following thyroidectomy, histology revealed papillary (18), follicular (four) and Hurthle cell (one) carcinoma. Tumour size ranged from 4 mm to 5.5 cm, multifocality was detected in three patients, and lymph node involvement in one. Two patients (one with associated Graves' disease, one with multinodular goitre) relapsed locally and required further surgery; one developed distant metastases and died 7 years after initial presentation. Two patients died of unrelated causes; the remaining 20 patients are alive and well with a median follow-up of 16 (1-34) years. Differentiated thyroid cancer found incidentally at surgery for hyperthyroidism has a good prognosis.???Keywords: thyroid neoplasms; thyrotoxicosis; thyroidectomy

Vini, L.; Hyer, S.; Pratt, B.; Harmer, C.



Principles of Rehabilitation after Limb-sparing Surgery for Cancer  

Microsoft Academic Search

Until around 1970 amputation was the principal operation performed for bone and soft-tissue sarcomas of the extremities, shoulder,\\u000a and pelvic girdle. Today 85% of these tumors are treated by limb-sparing surgery (LSS), a procedure that involves reconstruction\\u000a of bones, joints, and soft tissues using endoprostheses, allografts, autografts, and composites. With proper evaluation and\\u000a surgical management about 60% of these patients

Riki Oren; Alice Zagury; Orit Katzir; Yehuda Kollender; Isaac Meller


Factors that Affect Patients' Decision-Making about Mastectomy or Breast Conserving Surgery, and the Psychological Effect of this Choice on Breast Cancer Patients  

PubMed Central

Summary Background Breast cancer is the most common cancer in women. Primary treatment is surgery, with breast conserving surgery (BCS) being widely used for early-stage disease. Due to changes in body image, depressive symptoms can occur after surgery. Here, we evaluate factors that affect patients’ decision on surgery, and investigate differences in the level of depression after mastectomy or BCS in a population of Turkish patients. Patients and Methods One hundred breast cancer patients who had undergone mastectomy or BCS and were followed up at our institution between 2007 and 2008 were included. Patients were questioned about their involvement in surgical decision-making. Depression was diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-III) criteria via a Structural Clinical Interview for DSM (SCID). Severity of depression was evaluated by using the Beck Depression Inventory (BDI). Results Patients who were older than 50 years, had more than 1 child, a history of lactation, and a positive family history of breast cancer mostly preferred mastectomy. However, patients who sought a second opinion and further information on BCS preferred BCS (p < 0.005). There was no statistical correlation between marital status, first childbearing age, and educational status and the decision on surgery type (p > 0.005). Mastectomy patients were prone to depression, but this was not statistically significant (p = 0.099). Conclusion Age, parenthood, lactation, and positive familial history, as well as thorough information about the type of surgery were important factors for the patients’ decision. After breast cancer surgery, patients might experience depression affecting treatment and quality of life. Therefore, adequate information and communication are essential.

Gumus, Mahmut; Ustaalioglu, Basak O.; Garip, Meral; Kiziltan, Emre; Bilici, Ahmet; Seker, Mesut; Erkol, Burcak; Salepci, Taflan; Mayadagli, Alpaslan; Turhal, Nazim S.



First case of isolated vaginal metastasis from breast cancer treated by surgery  

PubMed Central

Background Breast cancer is a leading cause of death in developed countries. This neoplasm frequently relapses at distant sites such as bone, lung, pleura, brain and liver but rarely in the lower female genital tract. Case presentation We present the first case of isolated vaginal breast cancer metastasis and its surgical treatment. Conclusion This case report focuses on the importance of an accurate genital tract examination as part of regular follow up in breast cancer survivors. Indeed, after this experience we feel that surgery could be considered a valid option for the treatment of an isolated vaginal metastasis.



Factors Affecting Recovery of Functional Status in Older Adults After Cancer Surgery  

PubMed Central

OBJECTIVES To explore factors influencing functional status over time after cancer surgery in adults aged 65 and older. DESIGN Secondary data analysis of combined data subsets. SETTING Five prospective, longitudinal oncology nurse-directed clinical studies conducted at three academic centers in the northwest and northeast United States. PARTICIPANTS Three hundred sixteen community-residing patients diagnosed with digestive system, thoracic, genitourinary, and gynecological cancers treated primarily with surgery. MEASUREMENTS Functional status, defined as performance of current life roles, was measured using the Enforced Social Dependency Scale and the Medical Outcomes Study 36-item Short-Form Survey (using physical component summary measures) after surgery (baseline) and again at 3 and 6 months. Number of symptoms, measured using the Symptom Distress Scale, quantified the effect of each additional common cancer symptom on functional status. RESULTS After controlling for cancer site and stage, comorbidities, symptoms, psychological status, treatment, and demographic variables, functional status was found to be significantly better at 3 and 6 months after surgery than at baseline. Factors associated with better functional status included higher income and better mental health. Factors associated with poorer average functional status were a greater number of symptoms and comorbidities. Persons reporting three or more symptoms experienced statistically significant and clinically meaningful poorer functional status than those without symptoms. Persons reporting three or more comorbidities were also found to have poorer functional status than those without comorbidities. No significant relationship existed between age and functional status in patients aged 65 and older. CONCLUSION Factors other than age affect recovery of functional status in older adults after cancer surgery.

Van Cleave, Janet H.; Egleston, Brian L.; McCorkle, Ruth



[Technology: training centers--a new method for learning surgery in visceral surgery].  


The importance of training centers can be best described after first answering a few questions like: 1. What kind of surgery will we deal with in the future? 2. What kind of surgeon do we need for this surgery, if it is basically different? 3. How will this surgeon have to be educated/trained for this different surgery? Although I am aware of the fact, that statements about future prospects are usually doomed to fail, I maintain that endoscopic surgery will be an essential part of general surgery. If this is so, surgery will be dominated by extremely complicated technology, new techniques and new instruments. It will be a "different" surgery. It will offer more comfort at the same safety. The surgeon of the future will still need a certain personality; he will still need intuition and creativity. To survive in our society, he will have to be an organiser and even a businessman. Additionally, something new has to be added: he will have to understand modern, complicated technology and will have to use totally different instruments for curing surgical illness. This makes it clear that we will need a different education/training and may be even a different selection of surgeons. We should learn from other professions sharing common interests with surgery, for example, sports where the common interest is achieving most complicated motions and necessarily highly differentiated coordination. Common interest with airline pilots is the target of achieving absolute security. They have a highly differentiated selection and training concept. Training centers may be-under certain prerequisites-a true alternative for this necessary form of training. They must have a concept, i.e. contents and aims have to be defined, structured and oriented on the requirements of surgery for the patient. Responsibility for the concept, performance and control can only be in the hands of Surgical Societies and Universities. These prerequisites correspond most likely to training centers being established by universities and managed by them. Training centers set up by the industry contain some trouble spots, from "sponsoring" over "normal business" to "corruption". Being aware of the fact that training centers will replace traditional "surgery schools"-teaching in their current state is technology and techniques-they are a true alternative for learning/training in general surgery. PMID:9101978

Troidl, H



Association between Reduction of Plasma Adiponectin Levels and Risk of Bacterial Infection after Gastric Cancer Surgery  

PubMed Central

Background and Purpose Infections are important causes of postoperative morbidity after gastric surgery; currently, no factors have been identified that can predict postoperative infection. Adiponectin (ADN) mediates energy metabolism and functions as an immunomodulator. Perioperative ADN levels and perioperative immune functioning could be mutually related. Here we evaluated a potential biological marker to reliably predict the incidence of postoperative infections to prevent such comorbidities. Methods We analyzed 150 consecutive patients who underwent elective gastric cancer surgery at the Shiga University of Medical Science Hospital (Shiga, Japan) from 1997 to 2009; of these, most surgeries (n?=?100) were performed 2008 onwards. The patient characteristics and surgery-related factors between two groups (with and without infection) were compared by the paired t-test and ?2 test, including preoperative ADN levels, postoperative day 1 ADN levels, and ADN ratio (postoperative ADN levels/preoperative ADN levels) as baseline factors. Logistic regression analysis was performed to access the independent association between ADN ratio and postoperative infection. Finally, receiver operating curves (ROCs) were constructed to examine its clinical utility. Results Sixty patients (40%) experienced postoperative infections. The baseline values of age, American Society of Anesthesiologists physical status, total operating time, blood loss, surgical procedure, C-reactive protein (CRP) levels, preoperative ADN levels, and ADN ratio were significantly different between groups. Logistic regression analysis using these factors indicated that type 2 diabetes mellitus (T2DM) and ADN ratio were significantly independent variables (*p<0.05, ** p<0.01, respectively). ROC analysis revealed that the useful cutoff values (sensitivity/specificity) for preoperative ADN levels, ADN ratio, blood loss, operating time, and CRP levels were 8.81(0.567/0.568), 0.76 (0.767/0.761), 405 g (0.717/0.693), 342 min (0.617/0.614), and 8.94 mg/dl (0.583/0.591), respectively. Conclusion T2DM and ADN ratio were independent predictors of postoperative infection and ADN ratio was the most useful predictor for postoperative infection.

Uji, Yoshitaka; Tsuchihashi, Hiroshi; Mori, Tsuyoshi; Shimizu, Tomoharu; Endo, Yoshihiro; Kadota, Aya; Miura, Katsuyuki; Koga, Yusuke; Ito, Toshinori; Tani, Tohru



[Severe postoperative complications in colorectal surgery for cancer. Incidence related to the techniques employed: open versus laparoscopic colectomy].  


In this preliminary retrospective study, severe postoperative complications following surgery for colorectal cancer were analysed, comparing the results obtained with open versus laparoscopic colectomy. Over the period 2005-2007, 50 patients (29 female, 21 male; age range: 32-85 years) underwent surgical treatment for colorectal-anal cancer. Twenty-nine (58%) were submitted to the traditional open technique and 21 (42%) to the laparoscopic technique. No mortality occurred with either technique. None of the cases submitted to laparoscopy presented anastomotic dehiscence or severe intraoperative bleeding. In the group submitted to open surgery, 3 cases of severe complications occurred (10.3%), consisting in acute faecal peritonitis due to immediate dehiscence of the colorectal anastomosis; angulation of the intestinal loop with microdehiscence of the ileo-colic anastomosis; and pulmonary embolism. In the group submitted to laparoscopic surgery, 2 cases of severe complications occurred (9.5%), consisting in enterorrhagia due to haemoperitoneum; and intrafascial haematoma due to haemorrhage of the epigastric artery. The overall complication rate was 10%, corresponding to the minimum values reported in the literature. No statistically significant difference was observed in the incidence of these complications with the two methods employed. A very low incidence of minor complications was observed, limited to repercussions on the postoperative course. Furthermore, the laparoscopic technique led to early canalisation, a reduction in hospital stay, less need of drugs (antibiotics and pain killers) and better aesthetic results. The advantages obtained with the laparoscopic technique, with no significant differences in severe complications, indicate that this approach is preferable to the traditional technique in colorectal surgery for cancer. PMID:18709770

Procacciante, Fabio; Flati, Donato; Diamantini, Giulia; Angelakis, Konstantinos; Cerioli, Alessandra; Gaj, Fabio; Picozzi, Pietro; Trecca, Antonello; di Seri, Marisa


Biopsy Methods in Diagnosis of Lung Cancer.  

National Technical Information Service (NTIS)

Various biopsy methods were used in order to establish the pathological nature of pulmonary lesions in 433 patients. Pulmonary cancer was recognized in 218 (49.2%) of these patients of which 178 (81.2%) had pulmonary cancer(metastasis). Histological struc...

I. A. Zharakhovich



Methods and compositions for prostate cancer immunotherapy  

US Patent & Trademark Office Database

The present invention features methods and compositions (e.g., immune response stimulating peptides (e.g., ERG or SIM2 peptides), activated immune cells, antigen-presenting cells, and antibodies or antigen-binding fragments thereof) for generating an immune response for the treatment of cancer (e.g., prostate cancer).

Sanda; Martin G. (Weston, MA); Arredouani; Mohamed S. (Belmont, MA)



Benefits versus risks in conservation surgery with irradiation for breast cancer  

SciTech Connect

This report analyzes the survival and complications inherent in the conventional treatment of breast cancer, radical mastectomy, and the more conservative procedure, conservation surgery with irradiation. Both procedures have benefits and risks. The benefits as measured by survivorship appear to be approximately the same. The major benefit of conservation surgery with irradiation is that the breast is left intact. The possible complication of irradiation carcinogenesis is addressed, and the literature analyzed. This review indicates that the absolute risk of breast cancer developing in the second breast is not nearly as great as originally thought. It is concluded that if a woman with breast cancer is a candidate for either mastectomy or the conservative procedure, it is the clinician's obligation to objectively present the evidence regarding the benefits and risks of these procedures.

Levitt, S.H.; Mandel, J.



From mininvasive to maxinvasive surgery in colorectal cancer: modem evolution of oncologic specialized units.  


In the last years a wide range of new technique offers the possibility to have R0 resection in colorectal cancer. We report our experience about Single Port Laparoscopic Surgery (SPL) for not advanced right colon cancer and about pelvectomy with cilindric Abdominal Perineal Resection (APR) for advanced rectal cancer. SPL offer mainly cosmetic advantages but also quicker recovery. No touch technique with adequate surgical margin and lymphectomy were respected. Operative time of SPL was 85-115 minutes, the incision was 5 cm long. There were no complications. Length of hospital stay was 4-6 days. With advanced pelvic cancer, pelvic exenteration with en-bloc resection is indicated. Then we propose a case of a 55 years old woman with a pelvic recurrence from a metastatic rectal cancer involving the right obturator fossa, the vaginal stump, the right ureter. Modern surgical technique give us the chance to offer the most appropriate oncologic surgical treatment. PMID:21066988

Romano, G; Bianco, F; Delrio, P; Cremona, F; Ruffolo, F; Pace, U; Sassaroli, C; Scala, D; De Franciscis, S; Cardone, E; Atelli, P F



The dark side of the moon: Impact of moon phases on long-term survival, mortality and morbidity of surgery for lung cancer  

PubMed Central

Objective Superstition is common and causes discomfiture or fear, especially in patients who have to undergo surgery for cancer. One superstition is, that moon phases influence surgical outcome. This study was performed to analyse lunar impact on the outcome following lung cancer surgery. Methods 2411 patients underwent pulmonary resection for lung cancer in the past 30 years at our institution. Intra-and postoperative complications as well as long-term follow-up data were entered in our lung-cancer database. Factors influencing mortality, morbidity and survival were analyzed. Results Rate of intra-operative complications as well as rate of post-operative morbidity and mortality was not significantly affected by moon phases. Furthermore, there was no significant impact of the lunar cycle on long-term survial. Conclusion In this study there was no evidence that outcome of surgery for lung cancer is affected by the moon. These results may help the physician to quite the mind of patients who are somewhat afraid of wrong timing of surgery with respect to the moon phases. However, patients who strongly believe in the impact of moon phase should be taken seriously and correct timing of operations should be conceded to them as long as key-date scheduling doesn't constrict evidence based treatment regimens.



Spinal anaesthesia with a micro-catheter in high-risk patients undergoing colorectal cancer and other major abdominal surgery.  


Extended spinal anaesthesia using a spinal micro-catheter was used as a primary method of anaesthesia for elective colorectal cancer surgery in 68 high risk patients over a 14-year period in our institution. The technique was also useful in eight elective and 13 emergency abdominal surgeries. All patients suffered from severe chronic obstructive airway disease requiring multiple inhalers and drugs (ASA III). Thirty nine of these patients also suffered from angina, myocardial infarction, diabetes and other systemic diseases (ASA IV). Surgery included right hemicolectomy, left hemicolectomy, total colectomy, sigmoid colectomy, Hartman's resection, anterior resection of rectum, abdominoperineal resection, cholecystectomy (open and laparoscopic) and obstructed inguinal hernia requiring laparotomy. Spinal anaesthesia was performed under strict aseptic conditions with a 22 gauge spinal needle with a mixture consisting of 2.75ml of 0.5% heavy bupivacaine and 0.25ml of fentanyl (25microg). This was followed by placement of a spinal micro-catheter and the duration of anaesthesia was extended by intermittent injection of 0.5% isobaric bupivacaine. Brief hypotension occurred in 12.4% of patients during the establishment of anaesthetic block height to T6-7 and was duly treated with intravenous administration of fluid and ephedrine hydrochloride. Good anaesthesia resulted in all patients except for brief discomfort in some patients during hemicolectomy surgery possibly due to the dissection and traction on the peritoneum causing irritation to the diaphragm. The use of sedation was avoided. General anaesthesia was administered in one patient and this patient required postoperative ventilation and cardiovascular support in the Intensive Care Unit. The spinal micro-catheter was removed at the end of surgery. Postoperative pain relief was obtained by administering intravenous morphine through a patient controlled analgesia machine in the critical care ward area (High Dependency Unit). There was a low incidence of minor postoperative side effects such as nausea (14.6%), vomiting (7.9%), minor post dural puncture headache (5.6%) and pruritus (5.6%). We conclude that spinal anaesthesia with a micro-catheter may be used as a primary method of anaesthesia for colorectal cancer surgery and other major abdominal surgery in high-risk patients for whom general anaesthesia would be associated with higher morbidity and mortality. PMID:18035540

Kumar, Chandra M; Corbett, William A; Wilson, Robert G



Locoregional Recurrence of Breast Conserving Surgery after Preoperative Chemotherapy in Korean Women with Locally Advanced Breast Cancer  

PubMed Central

Purpose Preoperative chemotherapy has been used to increase the rate of breast conserving surgery (BCS) in Caucasian women. However, whether it would also increase the rate of BCS in Korean women has not been verified. The aim of this study was to determine the effectiveness of preoperative chemotherapy to make BCS possible in Korean women who have locally advanced cancer without any increase of locoregional recurrence according to operation methods (BCS vs. mastectomy). Methods From August 2002 to April 2005, 205 patients with stage II or III breast cancer were enrolled in a phase III randomized trial of preoperative chemotherapy. Surgeons decided on the type of surgery (mastectomy or BCS) at initial diagnosis. By randomization, patients received four cycles of either docetaxel/capecitabine or doxorubicin/cyclophosphamide followed by surgery and crossover to the other treatment as postoperative chemotherapy. Results The mean tumor size was 3.29 cm and the mean breast volume was 489 cc at diagnosis. After preoperative chemotherapy, clinical response was shown in 76.0% of the patients. Of the 71 patients planned for a mastectomy at initial diagnosis, 27 patients underwent BCS (38.0%). Clinical T stage after preoperative chemotherapy, pathologic T size and lymphatic invasion were correlated with conversion to BCS. In multivariate analysis, only lymphatic invasion showed statistical significance. Locoregional disease-free survival did not statistically differ between the two operation methods for the patients who were planned for a mastectomy at the initial exam. Conclusion This study showed that preoperative chemotherapy also increased the rate of BCS, while avoiding any increase of locoregional recurrence in Korean women with locally advanced breast cancer.

Lee, Seeyoun; Kim, Seok Won; Kim, Seok-Ki; Lee, Keun Seok; Kim, Eun A; Kwon, Youngmee; Shin, Kyung Hwan; Kang, Han-Sung; Ro, Jungsil



Endoscopic laser scalpel for head and neck cancer surgery  

NASA Astrophysics Data System (ADS)

Minimally invasive surgical (MIS) techniques, such as laparoscopic surgery and endoscopy, provide reliable disease control with reduced impact on the function of the diseased organ. Surgical lasers can ablate, cut and excise tissue while sealing small blood vessels minimizing bleeding and risk of lymphatic metastases from tumors. Lasers with wavelengths in the IR are readily absorbed by water causing minimal thermal damage to adjacent tissue, ideal for surgery near critical anatomical structures. MIS techniques have largely been unable to adopt the use of lasers partly due to the difficulty in bringing the laser into the endoscopic cavity. Hollow waveguide fibers have been adapted to bring surgical lasers to endoscopy. However, they deliver a beam that diverges rapidly and requires careful manipulation of the fiber tip relative to the target. Thus, the principal obstacle for surgical lasers in MIS procedures has been a lack of effective control instruments to manipulate the laser in the body cavity and accurately deliver it to the targeted tissue. To overcome this limitation, we have designed and built an endoscopic laser system that incorporates a miniature dual wedge beam steering device, a video camera, and the control system for remote and /or robotic operation. The dual wedge Risley device offers the smallest profile possible for endoscopic use. Clinical specifications and design considerations will be presented together with descriptions of the device and the development of its control system.

Patel, Snehal; Rajadhyaksha, Milind; Kirov, Stefan; Li, Yongbiao; Toledo-Crow, Ricardo



Neoadjuvant intra-arterial chemotherapy combined with radiotherapy and surgery in patients with advanced maxillary sinus cancer  

PubMed Central

Purpose The optimal treatment of advanced maxillary sinus cancer has been challenging for several decades. Intra-arterial chemotherapy (IAC) for head and neck cancer has been controversial. We have analyzed the long-term outcome of neoadjuvant IAC followed by radiation therapy (RT) and surgery. Materials and Methods Twenty-seven patients with advanced maxillary sinus cancer were treated between 1989 and 2002. Five-fluorouracil (5-FU, 500 mg/m2) was infused intra-arterially, and followed by RT (total 50.4 Gy/28 fractions). A planned surgery was performed 3 to 4 weeks after completion of IAC and RT. Results At a median follow-up of 77 months (range, 12 to 169 months), the 5-year rates of overall survival in all patients were 63%. The 5-year rates of overall survival of stage T3/T4 patients were 70.0% and 58.8%, respectively. Seven of fourteen patients with disease recurrence had a local recurrence alone. The 5-year actuarial local control rates in patients with stage T3/T4, and in all patients were 20.0%, 32.3%, and 27.4%, respectively. Overall response rate after the completion of IAC and RT was 70.3%. During the follow-up, seven patients (25.9%) showed mild to moderate late complications. The tumor extent (i.e., the involvement of either orbit and/or base of skull) appeared to be related with local recurrence. Conclusion Neoadjuvant IAC with 5-FU followed by RT and surgery may be effective to improve local tumor control in the patients with advanced maxillary sinus cancer. However, local failure was still the major cause of death. Further investigations are required to determine the optimal treatment schedule, radiotherapy techniques and chemotherapy regimens.

Kim, Won Taek; Ki, Yong Kan; Lee, Ju Hye; Kim, Dong Hyun; Park, Dahl; Cho, Kyu Sup; Roh, Hwan Jung; Kim, Dong Won



Activities of Daily Living and Quality of Life of Elderly Patients After Elective Surgery for Gastric and Colorectal Cancers  

PubMed Central

Objective: To establish reliable standards for surgical application to elderly patients 75 years old or older with gastric or colorectal cancer with special reference to the postoperative recovery of activities of daily living (ADL) and quality of life (QOL). Summary Background Data: ADL and QOL are important outcomes of surgery for the elderly. However, there has been only limited evidence on the natural course of recovery of functional independence. Methods: Two hundred twenty-three patients 75 years old or older with gastric or colorectal cancer were prospectively examined. Physical conditions, ADL, and QOL were evaluated preoperatively and at the first, third, and sixth postoperative month. Results: The mortality and morbidity rates were 0.4% and 28%, respectively. Twenty-four percent of patients showed a decrease in ADL at 1 month postoperatively, but most patients recovered from this transient reduction, with only 3% showing a decline at the sixth postoperative month (6POM). ADL of these patients was likely to decrease after discharge from the hospital. QOL of the patients showed a recovery to an extent equal to or better than their average preoperative scores. Conclusions: Of the patients 75 years old or older who underwent elective surgery for gastric or colorectal cancer, only a few showed a protracted decline in ADL and most exhibited better QOL after surgery. This indicates that surgical treatment should be considered, whenever needed, for elderly patients 75 years old or older with gastric or colorectal cancer. Estimation of Physical Ability and Surgical Stress is useful for predicting postoperative declines in ADL and protracted disability; this could aid in establishing a directed rehabilitation program for preventing protracted disability in elderly patients.

Amemiya, Takeshi; Oda, Koji; Ando, Masahiko; Kawamura, Takashi; Kitagawa, Yuichi; Okawa, Yayoi; Yasui, Akihiro; Ike, Hideyuki; Shimada, Hiroshi; Kuroiwa, Kojiro; Nimura, Yuji; Fukata, Shinji



Surgery, with or without tamoxifen, vs tamoxifen alone for older women with operable breast cancer: Cochrane review  

Microsoft Academic Search

The published literature comparing surgery, with or without adjuvant endocrine therapy, with endocrine therapy alone in older women with operable breast cancer was systematically reviewed. The design used is Cochrane review. Randomised controlled trials retrieved from the Cochrane Breast Cancer Group Specialised Register on 29 June 2005. Eligible studies recruited women aged 70 years or over with operable breast cancer,

D Hind; L Wyld; M W Reed



Method for Early Detection of Lung Cancer.  

National Technical Information Service (NTIS)

A method for early detection of lung cancer comprising: obtaining samples from the body, especially, the respiratory tract material including sputum or bronchial fluid or any other pulmonary or thoracic cells, tissue or regional lymph nodes and assaying s...

J. L. Mulshine M. S. Tockman P. K. Gupta J. K. Frost



Inhibitor compounds and cancer treatment methods  

US Patent & Trademark Office Database

A synergistically effective combination of an anti-cancer agent and a therapeutic compound, such as an mTOR-Rictor complex inhibitor, a Serine 473 phosphorylation inhibitor, an AKT2 inhibitor, or a combination thereof, for use in the treatment of cancer, and methods and uses thereof. Also included are methods and uses of a thiosemicarbazone for treating a cancer in a mammal in need thereof characterized by over-expression of RAS, by an EGFR mutation, and/or by over-expression of AKT2.



An extremely elderly patient with lung cancer who underwent surgery.  


We report the case of an extremely elderly patient with long-term survival after surgical resection for lung cancer. A 93-year-old man was evaluated for an abnormal density on chest radiography. Chest computed tomography (CT) showed a nodular density of 2.5 × 2.5 cm in the left S4b segment. Lung cancer was diagnosed by bronchoscopy, and left posterolateral thoracotomy and S4 segmentectomy were performed. Group 1 lymph node dissection and sampling of the 6th lymph node were also performed. Pathological examination revealed poorly differentiated squamous cell carcinoma without any lymph node metastases. The tumor was staged as p-T1aN0M0 stage IA. No complications were encountered postoperatively, and the patient was discharged. He remains alive as of 5 years postoperatively without any recurrence. PMID:24088908

Watanabe, Yuzuru; Yonechi, Atushi; Inoue, Takuya; Kanno, Ryuzo; Oishi, Akio; Suzuki, Hiroyuki



Effects of breast cancer surgery and surgical side effects on body image over time  

Microsoft Academic Search

We examined the impact of surgical treatments (breast-conserving surgery [BCS], mastectomy alone, mastectomy with reconstruction)\\u000a and surgical side-effects severity on early stage (0–IIA) breast cancer patients’ body image over time. We interviewed patients\\u000a at 4–6 weeks (T1), six (T2), 12 (T3), and 24 months (T4) following definitive surgical treatment. We examined longitudinal\\u000a relationships among body image problems, surgery type, and surgical side-effects

Karen Kadela Collins; Ying Liu; Mario Schootman; Rebecca Aft; Yan Yan; Grace Dean; Mark Eilers; Donna B. Jeffe



A case of anaphylactic shock attributed to latex allergy during gastric cancer surgery  

PubMed Central

Latex allergy is a known cause of allergic contact dermatitis. It produces mild symptoms, including skin rash and itching, which usually subside in a few days. However, latex allergy can also induce anaphylaxis, a severe type I hypersensitivity reaction that can cause urticaria, angioedema, hypotension, tachycardia, and bronchospasm. We report a case of anaphylactic shock during gastric cancer surgery in a patient with no previous allergic history. Surgery was suspended when hypotension, tachycardia, and wheezing developed. A thorough workup revealed that the patient had a latex allergy. The patient subsequently underwent curative gastrectomy performed with latex-free procedures.

Lee, Woohyung; Lee, Jue Hee; Kim, Hyung-Ho



Can stereotactic ablative radiotherapy in early stage lung cancers produce comparable success as surgery?  


Early stage non-small cell lung cancer is a potentially curable manifestation of a disease that is typically associated with a grim prognosis. Therapies directed at early stage disease can be challenging to deliver because patients tend to be elderly with multiple comorbidities. Surgery, the standard of care, has been validated with long-term follow-up. However, the risk of perioperative mortality and morbidity can limit the feasibility of an operation for many high-risk patients. Stereotactic ablative radiotherapy uses highly focused, ablative doses of radiation to treat tumors and has emerged as an alternative to surgery. PMID:23931020

Shirvani, Shervin M; Chang, Joe Y; Roth, Jack A



The Role of Prophylactic Surgery in Cancer Prevention  

Microsoft Academic Search

Background  Since the human genome has been sequenced many mysteries of cell biology have been unravelled, thereby clarifying the pathogenesis\\u000a of several diseases, particularly cancer. In members of kindreds with certain hereditary diseases, it is now possible early\\u000a in life to predict with great certainty whether or not a family member has inherited the mutated allele causing the disease.\\u000a In hereditary

Y. Nancy You; Vipul T. Lakhani; Samuel A. Wells Jr



Reconstructive surgery in young women with breast cancer  

Microsoft Academic Search

Recovery of body image after mastectomy is essential for physical and mental quality of life. Partial or total mastectomy\\u000a deformities can be reversed by reconstructive surgical procedures. Young women with breast cancer have specific characteristics\\u000a related to the age of onset of the disease, prognosis and reconstructive expectations. Patient individualization is the key\\u000a to a successful breast reconstruction. Autologous and

Martina Marín-Gutzke; Alberto Sánchez-Olaso



[Surgery for lung cancer invading the great vessels and left atrium].  


Surgery for early-stage lung cancer is associated with higher survival rates. Minimally invasive surgery such as segmentectomy and video-assisted thoracoscopic surgery is well established for peripheral small-sized lung tumors. On the other hand, advanced lung cancer invading the mediastinal organs has high morbidity rates and poor long-term survival if resection is achieved. According to the General Rules for Clinical and Pathological Records of Lung Cancer, lung cancer invading the atrium and great vessels including the superior vena cava (SVC) and aorta is classified as T4. In lung cancer involving the atrium and great vessels, T4N0 or T4N1 nodal status is an indication for surgery. Among cases with involvement of the atrium or great vessels in which combined resection is performed, those with invasion of the aorta have a favorable prognosis (5-year survival rate : 17-48%). After SVC and atrial resection, the 5-year survival rate is 11-24% and 14-16%, respectively. The postoperative morbidity rate is approximately 12.5%, 14%, and 9%, respectively. The Society of Japanease Thoracic Surgeons data demonstrate that the mortality rate after lobectomy and pneumonectomy is 0.4% and 1.8% respectively, and is thus higher after pnemonectomy. Patients who undergo resection of the great vessels and atrium have higher mortality rates compared with those who undergo pneumonectomy alone, which indicates that the former is a higer-risk procedure. The numerous pneumonectomy patients included in these groups may be associated with the increased morbidity. Occasionally, resection of the aorta and atrium requires cardiopulmonary bypass, which may allow complete resection with increased safety. Careful patient selection based on cardiovascular and pulmonary function, the use of advanced imaging systems, and improved management should be considered indications for the type of surgery performed. Resection of the aorta and atrium should be avoided in patients with N2 status. En-bloc resection in node-negative patients may have higher survival rates with low morbidity. Surgery in the treatment of lung cancer invading the great vessels and atrium may improve the results in selected patients, in which advanced new drugs such as targeted therapies, positron emission tomographic imaging, new approaches including aortic stent grafting, and improved surgical techniques all play a role. PMID:23898704

Iwasaki, Akinori



Breast cancer in the lower jaw after reconstructive surgery with a pectoralis major myocutaneous flap (PMMC) - A case report  

PubMed Central

For head and neck as well as for oromaxillofacial surgery, the use of the pectoralis major myocutaneous (PMMC) flap is a standard reconstructive technique after radical surgery for cancers in this region. We report to our knowledge for the first development of breast cancer in the PMMC flap in a 79 year old patient, who had undergone several operations in the past for recurring squamous cell carcinoma of the jaw. The occurrence of a secondary malignancy within the donor tissue after flap transfer is rare, but especially in the case of transferred breast tissue and the currently high incidence of breast cancer theoretically possible. Therefore preoperative screening mammography seems advisable to exclude a preexisting breast cancer in female patients undergoing such reconstruction surgery. Therapy for breast cancer under these circumstances is individual and consists of radical tumor resection followed by radiation if applicable and a standard systemic therapeutic regimen on the background of the patients individual prognosis due to the primary cancer.



Complex reconstructions in head and neck cancer surgery: decision making  

PubMed Central

Defects in head and neck after tumor resection often provide significant functional and cosmetic deformity. The challenge for reconstruction is not only the aesthetic result, but the functional repair. Cancer may involve composite elements and the in sano resection may lead to an extensive tissue defect. No prospective randomized controlled studies for comparison of different free flaps are available. There are many options to cover defects and restore function in the head and neck area, however we conclude from experience that nearly all defects in head and neck can be closed by 5 different free flaps: radial forearm flap, free fibula flap, anterior lateral thigh flap, lateral arm flap and parascapular flap.



Causes of death after surgery for colon cancer-impact of other diseases, urgent admittance, and gender.  


Abstract Objective. In patients with colon cancer, high age and comorbidity is common. In this population-based retrospective study we have investigated causes of death and the influence of urgent operation, and gender on survival. Material and methods. Medical records of 413 patients with verified colon cancer were reviewed. The diagnosis was made during 2000-2006 and operation was performed in 385 patients (93%). Results. The overall 5-year survival after surgery was 48.3%. At the end of the follow-up, 128 patients (54.9%) had verified colon cancer when they died but 105 patients (45.1%) had no signs of colon cancer. Their 5-year survival was 5.5% and 41.9%, respectively (p < 0.0001). Median survival time was significantly shorter after urgent compared with elective admittance, 20.7 months versus 77.9 months, and the 5-year survival 32.4% versus 57.9% (p = 0.0001). The tumor stage at operation was more favorable in patients dying with no signs of colon cancer than in those dying with cancer regarding stage I-II (66.7% versus 16.4%), and stage IV (1.0% versus 53.1%), but not regarding stage III (30.5% versus 29.7%). The overall survival in women who were operated was longer than in men (p = 0.045) as well as survival after elective admittance (p = 0.013). Conclusion. After a median follow-up of 56.1 months almost half of the patients who were dead had died from other causes than colon cancer. Ten percent of those patients had an incorrectly reported diagnosis of colon cancer as cause of death. Urgent admittance was associated with reduced survival time. The median survival time was longer in women than in men. PMID:23964717

Sjödahl, Rune; Rosell, Johan; Starkhammar, Hans



Persistent tumor cells in bone marrow of non-metastatic breast cancer patients after primary surgery are associated with inferior outcome  

PubMed Central

Background To investigate the prognostic significance of disseminated tumor cells (DTCs) in bone marrow (BM) from non-metastatic breast cancer patients before and after surgery. Methods Patients with non-metastatic breast cancer were consecutively recruited to this project during the years 1998–2000. Real-time RT-PCR quantification of a DTC multimarker panel consisting of cytokeratin 19, mammaglobin A and TWIST1 mRNA was performed in BM samples obtained from 154 patients three weeks (BM2) and/or six months after surgery (BM3). The results were compared to previously published data from pre-operative BM analyses for the same patients. Results DTCs were identified in post-operative BM samples (BM2 and/or BM3) from 23 (15%) of the 154 patients investigated. During a median follow-up of 98?months, 10 (44%) of these patients experienced systemic relapse as compared to 16 (12%) of 131 DTC-negative patients. Kaplan-Meier estimates of systemic recurrence-free- and breast-cancer specific survival demonstrated significantly shorter survival for patients with persistent DTCs in BM after surgery (p?0.001). By multivariate Cox regression analyses, persistent DTCs after surgery was an independent predictor of both systemic recurrence-free- (HR?=?5.4, p?cancer specific survival (HR?=?5.3, p?surgery samples. However, patients with DTCs both before and after surgery (BM1 and BM2/3) had a particularly poor prognosis (systemic recurrence-free survival: HR?=?7.2, p?cancer specific survival: HR?=?8.0, p?surgery identified non-metastatic breast cancer patients at high risk for systemic relapse, and with reduced breast-cancer specific survival. Furthermore, patients with positive DTC status both before and after surgery had a particularly poor prognosis.



Minimally invasive esophagectomy: the evolution and technique of minimally invasive surgery for esophageal cancer.  


Beginning with the widespread introduction of laparoscopic cholecystectomy in late 1989, minimally invasive surgical technique has been refined in conjunction with the development of advanced instrumentation and have subsequently been applied to increasingly complicated disease processes. Esophageal surgeons have increasingly incorporated minimally invasive surgery into their practice since the first laparoscopic fundoplication was described by Dallemagne et al. in 1991. Esophagectomy is associated with significant morbidity and mortality even in highly experienced centers. Many esophageal surgeons have had a great deal of interest in minimally invasive esophagectomy (MIE), which has the potential advantages of being a less traumatic procedure with a resultant improvement in postoperative convalescence and fewer wound and cardiopulmonary complications compared to the open approaches. Throughout the 1990s, as confidence with laparoscopic surgery of the esophagogastric junction grew, MIE was initially attempted with hybrid operations combining traditional open surgery with minimally invasive approaches. Subsequently, a totally laparoscopic transhiatal approach was described; however, this approach was perceived to be very challenging and has not gained widespread acceptance. Approaches used at present depend on cancer stage, cancer location, body habitus, and pulmonary function. For localized cancer (T1N0) or HGD, we prefer laparoscopic inversion esophagectomy (retrograde or antigrade). This approach may also be used for patients at high risk for thoracotomy. For locally advanced cancer in the middle third of the esophagus or for proximal third esophageal cancer, we prefer 3-field MIE (abdomen, and chest with neck anastomosis). For locally advanced cancer in the distal esophagus, especially in patients with a short thick neck, we prefer thoracoscopic-laparoscopic (2-field) esophagectomy (TLE). PMID:21409606

Hoppo, Toshitaka; Jobe, Blair A; Hunter, John G



Risk factors associated with lymphoedema among Chinese women after breast cancer surgery.  


Lymphoedema is recognized as a major sequela after breast cancer treatment. This study aims to estimate the risk factors of lymphoedema development after breast cancer treatment in Chinese women. A case-control study including 100 women with lymphoedema and 130 without lymphoedema, matched on the type of surgery. Lymphoedema was defined as breast cancer patients who complained of sensations such as swelling or heaviness. The logistic regression analysis was used to examine the relationship between lymphoedema and various factors. Findings from this study show that age, overweight or obesity and radiotherapy were associated with lymphoedema development. Oncologists and nurses should provide adequate information for breast cancer survivors, especially for those who are at high-risk of developing lymphoedema. PMID:23721382

Huang, Hua-Ping; Zeng, Qing; Zhou, Jian-Rong



Pulmonary metastasis from breast cancer with an 18-year disease-free interval: implication of the role of surgery.  


Abstract The appearance of pulmonary metastasis more than 15 years after primary treatment for breast cancer is rare. We herein report the case of a breast cancer patient with solitary pulmonary metastasis, after an 18-year disease-free period, treated with resection. A 66-year-old Japanese woman was found to exhibit an abnormal shadow on a chest X-ray. She had undergone a left mastectomy for breast cancer 18 years previously. The nodule was suspected to be either metastatic or primary lung cancer, and thus thoracoscopic surgery was performed. The histologic diagnosis was metastasis from breast cancer. Pulmonary resection in breast cancer recurrence is an important diagnostic tool that allows for a differential diagnosis with primary lung cancer. The clinical implication of surgery for a solitary pulmonary metastasis from breast cancer is discussed in this report. PMID:23294064

Fujii, Takaaki; Yajima, Reina; Yamaki, Ei; Kohsaka, Takayuki; Yamaguchi, Satoru; Tsutsumi, Soichi; Mogi, Akira; Asao, Takayuki; Kuwano, Hiroyuki


Video-assisted thoracoscopic surgery (VATS) right upper lobectomy and systematic lymph node dissection for lung cancer.  


Video-assisted thoracoscopic surgery (VATS) represents a new trend in the development of minimally invasive thoracic surgery. When applied in lung cancer surgeries, VATS can be used for both pulmonary lobectomy and regional lymph node dissection. Currently the main concerns are focused on the completeness of lymph node dissection for lung cancer and the safety of surgery. The lymph node dissection includes two parts: (I) dissection of interlobar and hilar lymph nodes; and (II) dissection of mediastinal lymph nodes. The demonstrated surgical procedures are featured by: (I) the interlobar and hilar lymph nodes are not removed separately; rathr, they are taken out en bloc with the pulmonary lobes during the surgery; and (II) systematic lymph node dissection, instead of systematic sampling, is applied for the removal of mediastinal lymph nodes. Also, during the fully anatomical resection, each blood vessel and bronchus underwent anatomical dissociation, indicating that this surgery is safe. PMID:24040542

Li, Xiao-Dong; Yang, Hong; Zheng, Ying-Bin; Huang, Qing-Yuan



Video-assisted thoracoscopic surgery (VATS) right upper lobectomy and systematic lymph node dissection for lung cancer  

PubMed Central

Video-assisted thoracoscopic surgery (VATS) represents a new trend in the development of minimally invasive thoracic surgery. When applied in lung cancer surgeries, VATS can be used for both pulmonary lobectomy and regional lymph node dissection. Currently the main concerns are focused on the completeness of lymph node dissection for lung cancer and the safety of surgery. The lymph node dissection includes two parts: (I) dissection of interlobar and hilar lymph nodes; and (II) dissection of mediastinal lymph nodes. The demonstrated surgical procedures are featured by: (I) the interlobar and hilar lymph nodes are not removed separately; rathr, they are taken out en bloc with the pulmonary lobes during the surgery; and (II) systematic lymph node dissection, instead of systematic sampling, is applied for the removal of mediastinal lymph nodes. Also, during the fully anatomical resection, each blood vessel and bronchus underwent anatomical dissociation, indicating that this surgery is safe.

Yang, Hong; Zheng, Ying-Bin; Huang, Qing-Yuan



Comparison of nodal positivity between SLNM vs conventional surgery in colon cancer patients with <12 and ?12 lymph nodes harvested  

Microsoft Academic Search

Background:Examination of ?12 lymph nodes (LNs) ensures accurate staging in colon cancer. The aim of this study was to compare nodal positivity between sentinel LN mapping (SLNM) and conventional surgery in patients with

Mehul Soni; David Wiese; Alpesh Korant; Saad Sirop; Bishan Chakravarty; Adam Gayar; Anton Bilchik; Thomas Beutler; David Ratz; Sukamal Saha


Role of endolaryngeal surgery (with or without laser) compared with radiotherapy in the management of early (T1) glottic cancer: a clinical practice guideline  

PubMed Central

Aims To provide evidence-based practice guideline recommendations concerning the role of endolaryngeal surgery (with or without laser) compared with radiation therapy for patients with early (T1) glottic cancer, assessing survival, locoregional control, laryngeal preservation rates, and voice outcomes. Methods The medline, embase, and Cochrane Library databases were searched to identify relevant studies from 1996 to 2011. Recommendations were formulated based on that evidence and on the expert opinion of Cancer Care Ontario’s Head and Neck Cancer disease site group. The systematic review and practice guideline were externally reviewed by practitioners in Ontario, Canada. Results The available evidence was of a level insufficient to demonstrate a clear difference between treatment options when considering the likelihood of local control or overall survival. Although the evidence was mainly retrospective, there was a suggestion that, compared with surgery, radiotherapy might be associated with less measureable perturbation of voice without a significant difference in patient perception. The likelihood of laryngeal preservation may be higher when surgery can be offered as initial treatment. Conclusions For patients with early (T1) glottic cancer, the evidence is insufficient to demonstrate a difference between endolaryngeal surgery (with or without laser) and external-beam radiation therapy. The choice between treatment modalities has been based on patient and clinician preferences and general medical condition.

Yoo, J.; Lacchetti, C.; Hammond, J.A.; Gilbert, R.W.



Surgery for endometrial cancers with suspected cervical involvement: is radical hysterectomy needed (a GOTIC study)?  


Background:Radical hysterectomy is recommended for endometrial adenocarcinoma patients with suspected gross cervical involvement. However, the efficacy of operative procedure has not been confirmed.Methods:The patients with endometrial adenocarcinoma who had suspected gross cervical involvement and underwent hysterectomy between 1995 and 2009 at seven institutions were retrospectively analysed (Gynecologic Oncology Trial and Investigation Consortium of North Kanto: GOTIC-005). Primary endpoint was overall survival, and secondary endpoints were progression-free survival and adverse effects.Results:A total of 300 patients who underwent primary surgery were identified: 74 cases with radical hysterectomy (RH), 112 patients with modified radical hysterectomy (mRH), and 114 cases with simple hysterectomy (SH). Median age was 47 years, and median duration of follow-up was 47 months. There were no significant differences of age, performance status, body mass index, stage distribution, and adjuvant therapy among three groups. Multi-regression analysis revealed that age, grade, peritoneal cytology status, and lymph node involvement were identified as prognostic factors for OS; however, type of hysterectomy was not selected as independent prognostic factor for local recurrence-free survival, PFS, and OS. Additionally, patients treated with RH had longer operative time, higher rates of blood transfusion and severe urinary tract dysfunction.Conclusion:Type of hysterectomy was not identified as a prognostic factor in endometrial cancer patients with suspected gross cervical involvement. Perioperative and late adverse events were more frequent in patients treated with RH. The present study could not find any survival benefit from RH for endometrial cancer patients with suspected gross cervical involvement. Surgical treatment in these patients should be further evaluated in prospective clinical studies. PMID:24002604

Takano, M; Ochi, H; Takei, Y; Miyamoto, M; Hasumi, Y; Kaneta, Y; Nakamura, K; Kurosaki, A; Satoh, T; Fujiwara, H; Nagao, S; Furuya, K; Yokota, H; Ito, K; Minegishi, T; Yoshikawa, H; Fujiwara, K; Suzuki, M



Clavicular osteomyelitis: a rare complication after surgery for head and neck cancer  

Microsoft Academic Search

Clavicular osteomyelitis (COM) is a rarely described disease entity, occurring especially after head and neck surgery. We herein report the ninth case according to the English language literature and describe the pertinent diagnostic and therapeutic measures to treat this complication. A 63-year-old Caucasian male underwent total laryngectomy and partial pharyngectomy for a post-radiotherapy recurrence of a T2 hypopharyngeal cancer. He

Cesare Piazza; Laura Magnoni; Piero Nicolai



EMLA reduces acute and chronic pain after breast surgery for cancer  

Microsoft Academic Search

Background and Objectives: A significant percentage of women undergoing breast surgery for cancer may develop neuropathic pain in the chest, and\\/or ipsilateral axilla and\\/or upper medial arm, with impairment in performing daily occupational activities. We designed this study to determine if the perioperative application of EMLA (eutectic mixture of local anesthetics; AstraZeneca) cream in the breast and axilla area reduces

Argyro Fassoulaki; Constantine Sarantopoulos; Aikaterini Melemeni; Quinn Hogan



Plastic surgery for cutaneous seeding of bile duct cancer following percutaneous biliary drainage  

Microsoft Academic Search

A case of cutaneous seeding of bile duct cancer along a drainage tube is reported. The cutaneous lesion, which caused pain\\u000a and bleeding, was resected and the defect covered by a transposition flap. After the operation, the pain abated. This is the\\u000a third case reported in the English literature and the first case reported in the field of plastic surgery.

A. Shiba; M. Hatoko; T. Okazaki; M. Kuwahara; A. Tanaka; T. Muramatsu



Magnetic Resonance-Guided Focused Ultrasound Surgery of Breast Cancer: Reliability and Effectiveness  

Microsoft Academic Search

BACKGROUND: Magnetic resonance-guided focused ultrasound surgery (MRgFUS) is a noninvasive technique that has been shown to coagulate benign and malignant tumors.The purpose of this study was to evaluate MRgFUS safety and effectiveness for the ablation of breast carcinomas. STUDY DESIGN: Thirty women with biopsy-proved breast cancer underwent MRgFUS treatment. Gadolinium- enhanced MR images were used for treatment planning and posttreatment

Hidemi Furusawa; Kiyoshi Namba; Sharon Thomsen; Futoshi Akiyama; Achiude Bendet; Chiaki Tanaka; Yukiko Yasuda; Hiroshi Nakahara



Lactation following conservation surgery and radiotherapy for breast cancer  

SciTech Connect

A 38-year-old woman with early stage invasive breast cancer was treated with wide excision of the tumor, axillary lymph node dissection, and breast irradiation. Three years later, she gave birth to a normal baby. She attempted breast feeding and had full lactation from the untreated breast. The irradiated breast underwent only minor changes during pregnancy and postpartum but produced small amounts of colostrum and milk for 2 weeks postpartum. There are only a few reports of lactation after breast irradiation. These cases are reviewed, and possible factors affecting breast function after radiotherapy are discussed. Because of scant information available regarding its safety for the infant, nursing from the irradiated breast is not recommended.

Varsos, G.; Yahalom, J. (Memorial Sloan-Kettering Cancer Center, New York, NY (USA))



The early days of surgery for cancer of the rectum.  


Long before being aware of tumours elsewhere along the alimentary canal, surgeons from the earliest days of the profession were all too familiar with cancer of the rectum. The vivid local symptoms of rectal bleeding and mucous discharge, bowel disturbance and then intractable local pain, and the ready detection of the growth by a finger inserted into the fundament made diagnosis all too easy and with it, of course, a hopeless outlook for the poor sufferer. Until quite recent times, treatment was entirely palliative, with the use of hot baths, emollient enemas and dilatations of the constricting growth with bougies. Opium and laudanum, (opium dissolved in alcohol), would be prescribed in advanced cases. Some bold surgeons would use the cautery--an iron heated to red heat--to burn down a fungating growth presenting at the anal margin. PMID:22493878

Ellis, Harold



Improving the Performance of Risk-adjusted Mortality Modeling for Colorectal Cancer Surgery by Combining Claims Data and Clinical Data  

PubMed Central

Objectives The objective of this study was to evaluate the performance of risk-adjusted mortality models for colorectal cancer surgery. Methods We investigated patients (n=652) who had undergone colorectal cancer surgery (colectomy, colectomy of the rectum and sigmoid colon, total colectomy, total proctectomy) at five teaching hospitals during 2008. Mortality was defined as 30-day or in-hospital surgical mortality. Risk-adjusted mortality models were constructed using claims data (basic model) with the addition of TNM staging (TNM model), physiological data (physiological model), surgical data (surgical model), or all clinical data (composite model). Multiple logistic regression analysis was performed to develop the risk-adjustment models. To compare the performance of the models, both c-statistics using Hanley-McNeil pair-wise testing and the ratio of the observed to the expected mortality within quartiles of mortality risk were evaluated to assess the abilities of discrimination and calibration. Results The physiological model (c=0.92), surgical model (c=0.92), and composite model (c=0.93) displayed a similar improvement in discrimination, whereas the TNM model (c=0.87) displayed little improvement over the basic model (c=0.86). The discriminatory power of the models did not differ by the Hanley-McNeil test (p>0.05). Within each quartile of mortality, the composite and surgical models displayed an expected mortality ratio close to 1. Conclusions The addition of clinical data to claims data efficiently enhances the performance of the risk-adjusted postoperative mortality models in colorectal cancer surgery. We recommended that the performance of models should be evaluated through both discrimination and calibration.

Jang, Won Mo; Park, Jae-Hyun; Park, Jong-Hyock; Oh, Jae Hwan



Micrometastatic Breast Cancer Cells in Bone Marrow at Primary Surgery: Prognostic Value in Comparison With Nodal Status  

Microsoft Academic Search

Background: Approximately 30% of the patients with primary breast cancer who have no axillary lymph node in- volvement (i.e., lymph node negative) at the time of surgery will relapse within 10 years; 10% -20% of the patients with distant metastases will be lymph node negative at surgery. Axillary lymph node dissection, as a surgical procedure, is associated with frequent complications.

Ingo J. Diel; Manfred Kaufmann; Serban D. Costa; Erich F. Solomayer; Sepp Kaul; Gunther Bastert


A nationwide epidemiologic study of breast cancer incidence followingbreast reduction surgery in a large cohort of Swedish women  

Microsoft Academic Search

Summary  While it has been demonstrated that prophylactic mastectomy reduces breast cancer incidence among women at high risk, many\\u000a women often consider this disfiguring surgery unacceptable. One alternative approach may be breast reduction surgery. In order\\u000a to evaluate the long-term incidence of breast cancer following surgical removal of breast tissue, we have extended by 9 years\\u000a the follow-up period of our earlier

Jon P. Fryzek; Weimin Ye; Olof Nyrén; Robert E. Tarone; Loren Lipworth; Joseph K. McLaughlin



[A successful treatment by surgery for axillary lymph node recurrence of lung cancer].  


This case concerns a 78-year-old man, who was diagnosed with lung cancer at the age of 73. He underwent right lobectomy and lymph node dissection, and pathological analysis revealed a poorly differentiated adenocarcinoma, pT1N0M0 pStage IA. 15 months after surgery, computed tomography showed recurrence of lung cancer at the apex of thoracic cavity. He underwent radiation to the recurrence site, and 33 months after surgery, fluorodeoxyglucose uptake was observed at the axillary and infraclavicular lymph nodes in positron emission tomography examination. Treatment with pemetrexed was started because carcinomatous pericarditis was also found. Although pericardial effusion disappeared, the patient complained of the enlarged size of the axillary and infraclavicular lymph nodes and severe numbness in an arm. Beyond lymph node involvement, no other metastatic sites were found. An operation was performed to relieve the pain and the pathological analysis of lymph nodes showed metastases of lung cancer. The operation successfully reduced the pain experienced by the patient. There has been no further recurrence in the 9 months following surgery. Axillary lymph node metastasis is thought to be a distant metastasis; however, this is a case where local control was needed and was effective. PMID:23268091

Oda, Goshi; Kobayashi, Toshiko; Yokosuka, Tetsuya; Yasuno, Masamichi



A randomised phase III trial comparing gemcitabine with surgery-only in patients with resected pancreatic cancer: Japanese Study Group of Adjuvant Therapy for Pancreatic Cancer  

PubMed Central

Background: This multicentre randomised phase III trial was designed to determine whether adjuvant chemotherapy with gemcitabine improves the outcomes of patients with resected pancreatic cancer. Methods: Eligibility criteria included macroscopically curative resection of invasive ductal carcinoma of the pancreas and no earlier radiation or chemotherapy. Patients were randomly assigned at a 1?:?1 ratio to either the gemcitabine group or the surgery-only group. Patients assigned to the gemcitabine group received gemcitabine at a dose of 1000?mg?m?2 over 30?min on days 1, 8 and 15, every 4 weeks for 3 cycles. Results: Between April 2002 and March 2005, 119 patients were enrolled in this study. Among them, 118 were eligible and analysable (58 in the gemcitabine group and 60 in the surgery-only group). Both groups were well balanced in terms of baseline characteristics. Although heamatological toxicity was frequently observed in the gemcitabine group, most toxicities were transient, and grade 3 or 4 non-heamatological toxicity was rare. Patients in the gemcitabine group showed significantly longer disease-free survival (DFS) than those in the surgery-only group (median DFS, 11.4versus 5.0 months; hazard ratio=0.60 (95% confidence interval (CI): 0.40–0.89); P=0.01), although overall survival did not differ significantly between the gemcitabine and surgery-only groups (median overall survival, 22.3 versus 18.4 months; hazard ratio=0.77 (95% CI: 0.51–1.14); P=0.19). Conclusion: The current results suggest that adjuvant gemcitabine contributes to prolonged DFS in patients undergoing macroscopically curative resection of pancreatic cancer.

Ueno, H; Kosuge, T; Matsuyama, Y; Yamamoto, J; Nakao, A; Egawa, S; Doi, R; Monden, M; Hatori, T; Tanaka, M; Shimada, M; Kanemitsu, K



The role of 18F-fluorodeoxyglucose positron emission tomography in differentiated thyroid cancer before surgery.  


The incidence of thyroid cancer in both men and women is increasing faster than that of any other cancer. Although positron emission tomography (PET) using (18)F-fluorodeoxyglucose (FDG) has received much attention, the use of FDG PET for the management of thyroid cancer is limited primarily to postoperative follow-up. However, it might have a role in selected, more aggressive pathologies, and so patients at a high risk of distant metastasis may benefit from PET before surgery. As less FDG-avid thyroid cancers may lower the diagnostic accuracy of PET in preoperative assessment, an understanding of FDG avidity is important for the evaluation of thyroid cancer. FDG avidity has been shown to be associated with tumor size, lymph node metastasis, and glucose transporter expression and differentiation. As PET is commonly used in clinical practice, the detection of incidentalomas by PET is increasing. However, incidentalomas detected by PET have a high risk of malignancy. Clinicians handling cytologically indeterminate nodules face a dilemma regarding a procedure for a definitive diagnosis, usually lobectomy. With 'nondiagnostic (ND)' fine-needle biopsy (FNA), PET has shown a negative predictive value (NPV) of 100%, which indicates that negative uptake in a ND FNA procedure accurately excludes malignancy. With 'atypia of undetermined significance' or 'follicular neoplasm', the sensitivity and NPV of PET are 84 and 88%. PET does not provide additional information for the preoperative assessment of thyroid cancer. However, factors associated with FDG positivity are related to a poor prognosis; therefore, FDG PET scans before surgery may facilitate the prediction of the prognosis of differentiated thyroid cancer. PMID:23722225

Pak, Kyoungjune; Kim, Seong-Jang; Kim, In Joo; Kim, Bo Hyun; Kim, Sang Soo; Jeon, Yun Kyung



Breast cancer surgery and diagnosis-related groups (DRGs): Patient classification and hospital reimbursement in 11 European countries.  


Researchers from eleven countries (i.e. Austria, England, Estonia, Finland, France, Germany, Ireland, Netherlands, Poland, Spain, and Sweden) compared how their DRG systems deal with breast cancer surgery patients. DRG algorithms and indicators of resource consumption were assessed for those DRGs that individually contain at least 1% of all breast cancer surgery patients. Six standardised case vignettes were defined and quasi prices according to national DRG-based hospital payment systems were ascertained. European DRG systems classify breast cancer surgery patients according to different sets of classification variables into three to seven DRGs. Quasi prices for an index case treated with partial mastectomy range from €577 in Poland to €5780 in the Netherlands. Countries award their highest payments for very different kinds of patients. Breast cancer specialists and national DRG authorities should consider how other countries' DRG systems classify breast cancer patients in order to identify potential scope for improvement and to ensure fair and appropriate reimbursement. PMID:23218742

Scheller-Kreinsen, David; Quentin, Wilm; Geissler, Alexander; Busse, Reinhard



Methods of Diagnosing Cervical Cancer.  

National Technical Information Service (NTIS)

The invention provides reagents and methods for detecting pathogen infections in human samples. This detection utilizes specific proteins to detect the presence of pathogen proteins or abnormal expression of human proteins resulting from pathogen infectio...

C. S. Diaz-Sarmiento J. Schweizer M. P. Belmares P. S. Lu



A Meta-analysis of the Short and Long-Term Results of Randomized Controlled Trials That Compared Laparoscopy-Assisted and Conventional Open Surgery for Rectal Cancer  

Microsoft Academic Search

Purpose  We conducted a meta-analysis to evaluate and compare the short- and long-term results of laparoscopy-assisted and open rectal\\u000a surgery for the treatment of patients with rectal cancer.\\u000a \\u000a \\u000a \\u000a \\u000a Methods  We searched MEDLINE, EMBASE, Science Citation Index, and the Cochrane Controlled Trial Register for relevant papers published\\u000a between January 1990 and April 2011 by using the search terms “laparoscopy,” “laparoscopy assisted,” “surgery,” “rectal

Hiroshi Ohtani; Yutaka Tamamori; Takashi Azuma; Yoshihiro Mori; Yukio Nishiguchi; Kiyoshi Maeda; Kosei Hirakawa


Long-term results of neoadjuvant chemotherapy and combined chemoradiotherapy before surgery in the management of locally advanced oesophageal cancer: a single-centre experience  

Microsoft Academic Search

Introduction  Neoadjuvant chemoradiotherapy before surgery is an option in the treatment of locally advanced resectable oesophageal cancer\\u000a (EC). However toxicity is substantial and the improvement in overall survival (OS) with this approach is controversial.\\u000a \\u000a \\u000a \\u000a Methods  This was a prospective, single-centre study of neoadjuvant chemotherapy and concomitant chemoradiotherapy with CDDP and 5-FU\\u000a and 50.4 Gy of external radiotherapy before possible radical surgery in

Robert Diaz; Gaspar Reynes; Alejandro Tormo; Manuel de Juan; Regina Gironés; Ángel Segura; Jorge Aparicio; Paula Richart; Helena de la Cueva; José García



Impact of intraoperative lung-protective interventions in patients undergoing lung cancer surgery  

PubMed Central

Introduction In lung cancer surgery, large tidal volume and elevated inspiratory pressure are known risk factors of acute lung (ALI). Mechanical ventilation with low tidal volume has been shown to attenuate lung injuries in critically ill patients. In the current study, we assessed the impact of a protective lung ventilation (PLV) protocol in patients undergoing lung cancer resection. Methods We performed a secondary analysis of an observational cohort. Demographic, surgical, clinical and outcome data were prospectively collected over a 10-year period. The PLV protocol consisted of small tidal volume, limiting maximal pressure ventilation and adding end-expiratory positive pressure along with recruitment maneuvers. Multivariate analysis with logistic regression was performed and data were compared before and after implementation of the PLV protocol: from 1998 to 2003 (historical group, n = 533) and from 2003 to 2008 (protocol group, n = 558). Results Baseline patient characteristics were similar in the two cohorts, except for a higher cardiovascular risk profile in the intervention group. During one-lung ventilation, protocol-managed patients had lower tidal volume (5.3 ± 1.1 vs. 7.1 ± 1.2 ml/kg in historical controls, P = 0.013) and higher dynamic compliance (45 ± 8 vs. 32 ± 7 ml/cmH2O, P = 0.011). After implementing PLV, there was a decreased incidence of acute lung injury (from 3.7% to 0.9%, P < 0.01) and atelectasis (from 8.8 to 5.0, P = 0.018), fewer admissions to the intensive care unit (from 9.4% vs. 2.5%, P < 0.001) and shorter hospital stay (from 14.5 ± 3.3 vs. 11.8 ± 4.1, P < 0.01). When adjusted for baseline characteristics, implementation of the open-lung protocol was associated with a reduced risk of acute lung injury (adjusted odds ratio of 0.34 with 95% confidence interval of 0.23 to 0.75; P = 0.002). Conclusions Implementing an intraoperative PLV protocol in patients undergoing lung cancer resection was associated with improved postoperative respiratory outcomes as evidence by significantly reduced incidences of acute lung injury and atelectasis along with reduced utilization of intensive care unit resources.

Licker, Marc; Diaper, John; Villiger, Yann; Spiliopoulos, Anastase; Licker, Virginie; Robert, John; Tschopp, Jean-Marie



A prospective study of conservative surgery without radiation therapy in select patients with Stage I breast cancer  

SciTech Connect

Purpose: The effectiveness of radiation therapy (RT) in reducing local recurrence after breast-conserving surgery (BCS) in unselected patients with early stage invasive breast cancer has been demonstrated in multiple randomized trials. Whether a subset of women can achieve local control without RT is unknown. In 1986, we initiated a prospective one-arm trial of BCS alone for highly selected breast-cancer patients. This report updates those results. Methods and Materials: Eighty-seven (of 90 planned) patients enrolled from 1986 until closure in 1992, when a predefined stopping boundary was crossed. Patients were required to have a unicentric, T1, pathologic node-negative invasive ductal, mucinous, or tubular carcinoma without an extensive intraductal component or lymphatic-vessel invasion. Surgery included local excision with margins of at least 1 cm or a negative re-excision. No RT or systemic therapy was given. Results: Results are available on 81 patients (median follow-up, 86 months). Nineteen patients (23%) had local recurrence (LR) as a first site of failure (average annual LR: 3.5 per 100 patient-years of follow-up). Other sites of first failure included 1 ipsilateral axilla, 2 contralateral breast cancers, and 4 distant metastases. Six patients developed other (nonbreast) malignancies. Nine patients have died, 4 of metastatic breast cancer and 5 of unrelated causes. Conclusions: Even in this highly selected cohort, a substantial risk of local recurrence occurred after BCS alone with margins of 1.0 cm or more. These results suggest that with the possible exception of elderly women with comorbid conditions, radiation therapy after BCS remains standard treatment.

Lim, May [Department of Radiation Oncology, Dana-Farber Cancer Institute, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (United States); Bellon, Jennifer R. [Department of Radiation Oncology, Dana-Farber Cancer Institute, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (United States)]. E-mail:; Gelman, Rebecca [Department of Radiation Oncology, Dana-Farber Cancer Institute, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (United States); Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (United States); Harvard School of Public Health, Boston, MA (United States); Silver, Barbara B.A. [Department of Radiation Oncology, Dana-Farber Cancer Institute, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (United States); Recht, Abram [Department of Radiation Oncology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (United States); Schnitt, Stuart J. [Department of Pathology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (United States); Harris, Jay R. [Department of Radiation Oncology, Dana-Farber Cancer Institute, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (United States)



Case-Matched comparison of contemporary radiation therapy to surgery in patients with locally advanced prostate cancer  

SciTech Connect

Purpose: Few studies critically compare current radiotherapy techniques to surgery for patients with locally advanced prostate cancer, despite an urgent need to determine which approach offers superior cancer control. Our objective was to compare rates of biochemical relapse-free survival (BFS) and surrogates of disease specific survival among men with high risk adenocarcinoma of the prostate as a function of treatment modality. Methods and Materials: Retrospective data from 409 men with prostate-specific antigen (PSA) {>=}10 or Gleason 7-10 or Stage {>=}T2b cancer treated uniformly at one university between March 1988 and December 2000 were analyzed. Patients had undergone radical prostatectomy (RP), brachytherapy implant alone (BTM), or external beam radiotherapy with brachytherapy boost with short-term neoadjuvant and adjuvant androgen deprivation therapy (BTC). From the total study population a 1:1 matched-cohort analysis (208 patients matched via prostate-specific antigen, Gleason score) comparing RP with BTC was performed as well. Results: Estimated 4-year BFS rates were superior for patients treated with BTC (BTC 72%, BTM 25%, RP 53%; p < 0.001). Matched analysis of BTC vs. RP confirmed these results (BTC 73%, BTM 55%; p = 0.010). Relative risk (RR) of biochemical relapse for BTM and BTC compared with RP were 2.92 (1.95-4.36) and 0.56 (0.36-0.87) (p < 0.001, p = 0.010). RR for BTC from the matched cohort analysis was 0.44 (0.26-0.74; p = 0.002). Conclusions: High-risk prostate cancer patients receiving multimodality radiation therapy (BTC) display apparently superior BFS compared with those receiving surgery (RP) or brachytherapy alone (BTM)

Fletcher, Sophie G. [Department of Urology, University of Virginia Health System, Charlottesville, VA (United States); Mills, Stacey E. [Department of Pathology, University of Virginia Health System, Charlottesville, VA (United States); Smolkin, Mark E. [Department of Public Health Sciences, University of Virginia Health System, Charlottesville, VA (United States); Theodorescu, Dan [Department of Urology, University of Virginia Health System, Charlottesville, VA (United States)]. E-mail:



Stereotactic Body Radiotherapy (SBRT) for Operable Stage I Non-Small-Cell Lung Cancer: Can SBRT Be Comparable to Surgery?  

SciTech Connect

Purpose: To review treatment outcomes for stereotactic body radiotherapy (SBRT) in medically operable patients with Stage I non-small-cell lung cancer (NSCLC), using a Japanese multi-institutional database. Patients and Methods: Between 1995 and 2004, a total of 87 patients with Stage I NSCLC (median age, 74 years; T1N0M0, n = 65; T2N0M0, n = 22) who were medically operable but refused surgery were treated using SBRT alone in 14 institutions. Stereotactic three-dimensional treatment was performed using noncoplanar dynamic arcs or multiple static ports. Total dose was 45-72.5 Gy at the isocenter, administered in 3-10 fractions. Median calculated biological effective dose was 116 Gy (range, 100-141 Gy). Data were collected and analyzed retrospectively. Results: During follow-up (median, 55 months), cumulative local control rates for T1 and T2 tumors at 5 years after SBRT were 92% and 73%, respectively. Pulmonary complications above Grade 2 arose in 1 patient (1.1%). Five-year overall survival rates for Stage IA and IB subgroups were 72% and 62%, respectively. One patient who developed local recurrences safely underwent salvage surgery. Conclusion: Stereotactic body radiotherapy is safe and promising as a radical treatment for operable Stage I NSCLC. The survival rate for SBRT is potentially comparable to that for surgery.

Onishi, Hiroshi, E-mail: [School of Medicine, Yamanashi University, Yamanashi (Japan); Shirato, Hiroki [School of Medicine, Hokkaido University, Sapporo (Japan); Nagata, Yasushi [School of Medicine, Hiroshima University, Hiroshima (Japan); Hiraoka, Masahiro [School of Medicine, Kyoto University, Kyoto (Japan); Fujino, Masaharu [School of Medicine, Hokkaido University, Sapporo (Japan); School of Medicine, Yamanashi University, Yamanashi (Japan); Gomi, Kotaro [Cancer Institute Suwa Red-Cross Hospital, Suwa (Japan); Karasawa, Katsuyuki [Tokyo Metropolitan Komagome Hospital, Tokyo (Japan); Hayakawa, Kazushige; Niibe, Yuzuru [Kitasato University, Kanagawa (Japan); Takai, Yoshihiro [School of Medicine, Hirosaki University, Hirosaki (Japan); Kimura, Tomoki [School of Medicine, Kagawa University, Hiroshima (Japan); Takeda, Atsuya [Ofuna Chuo Hospital, Kanagawa (Japan); Ouchi, Atsushi [Keijinkai Hospital, Sapporo (Japan); Hareyama, Masato [Sapporo Medical University, Sapporo (Japan); Kokubo, Masaki [Institute of Biomedical Research and Innovation, Kobe (Japan); Kozuka, Takuyo [School of Cancer Institute Ariake Hospital, Tokyo (Japan); Arimoto, Takuro [Kitami Red Cross Hospital, Kitami (Japan); Hara, Ryusuke [National Institute of Radiological Science, Chiba (Japan); Itami, Jun [National Cancer Center, Tokyo (Japan); Araki, Tsutomu [School of Medicine, Yamanashi University, Yamanashi (Japan)



In Vivo Cancer Targeting and Imaging-Guided Surgery with Near Infrared-Emitting Quantum Dot Bioconjugates  

PubMed Central

Early detection and subsequent complete surgical resection are among the most efficient methods for treating cancer. However, low detection sensitivity and incomplete tumor resection are two challenging issues. Nanoparticle-based imaging-guided surgery has proven promising for cancer-targeted imaging and subsequent debulking surgery. Particularly, the use of near infrared (NIR) fluorescent probes such as NIR quantum dots (QDs) allows deep penetration and high sensitivity for tumor detection. In this study, NIR-emitting CdTe QDs (maximum fluorescence emission peak at 728 nm) were synthesized with a high quantum yield (QY) of 38%. The tumor-specific QD bioconjugates were obtained by attaching cyclic Arg-Gly-Asp peptide (cRGD) to the surface of synthesized QDs, and then injected into U87 MG tumor-bearing mice via tail veins for tumor-targeted imaging. The tumor and its margins were visualized and distinguished by NIR QD bioconjugates, and tumor resection was successfully accomplished via NIR guidance using a Fluobeam-700 NIR imaging system. Our work indicates that the synthesized tumor-specific NIR QDs hold great promise as a potential fluorescent indicator for intraoperative tumor imaging.

Li, Yan; Li, Zhe; Wang, Xiaohui; Liu, Fengjun; Cheng, Yingsheng; Zhang, Bingbo; Shi, Donglu



Colorectal cancer surgery of octogenarians in Hong Kong: who will survive?  


OBJECTIVE. To assess the accuracy of the Association of Coloproctology of Great Britain and Ireland scoring system in predicting the 30-day mortality after surgery for colorectal cancer in Hong Kong elderly (aged 80 years or more) patients. DESIGN. Early mortality outcome audit in a historical cohort. SETTING. Queen Elizabeth Hospital, Hong Kong. PATIENTS. All Chinese patients (aged 80 years or more) who underwent elective or emergency surgery for colorectal cancer in the Department of Surgery between January 2005 and December 2009. MAIN OUTCOME MEASURES. Receiver operating characteristic curve analyses were used to estimate the predictive ability of the score. RESULTS. In all, 180 patients with colorectal cancer were included in this review. The overall 30-day and hospital mortality rates were 29/180 (16%) and 31/180 (17%), respectively. The Association of Coloproctology of Great Britain and Ireland score was significantly higher among patients who died within 30 days (4.2 vs 3.1, P=0.0001), and was the only independent predictor for 30-day mortality by logistic regression (P=0.009; odds ratio=2.555; 95% confidence interval, 1.277-4.932). The mean score of this study population was 3.22 (median, 3.10), giving a predicted 30-day mortality rate of 16.0 to 17.4%, which corresponded with an observed 30-day mortality of 16.1% encountered in this study. The score had a significantly larger area under the curve for the 30-day mortality rates (odds ratio=0.811; 95% confidence interval, 0.722-0.849) as compared to the American Society of Anesthesiologists score (0.664; 0.589-0.735) [P=0.0001]. CONCLUSION. The Association of Coloproctology of Great Britain and Ireland scoring system can accurately predict the 30-day mortality rate of elderly Hong Kong Chinese patients (aged 80 years or more) operated on for colorectal cancer. PMID:21979471

Li, W H; Lau, Tommy C F; Wong, K K; Chan, Arthur W H; Cheung, M T



The impact of old age on cancer-specific and non-cancer-related survival following elective potentially curative surgery for Dukes A/B colorectal cancer.  


Previous studies have suggested that survival following surgery for colorectal cancer is poorer in the elderly. However, the findings were inconsistent and none of the studies adjusted for case mix. The aim of this study was to establish whether there were age-related differences in cancer (colorectal)-specific and non-cancer (colorectal)-related survival in patients undergoing elective potentially curative resection for Dukes stage A/B colorectal cancer. One thousand and forty three patients who underwent elective potentially curative resection for Dukes' A/B colorectal cancer between 1991 and 1994 in 11 hospitals in Scotland were included in the study. Ten year cancer-specific and non-cancer-related survival and the hazard ratios were calculated according to age groups (<64; 65-74/>74 years). On follow-up 273 patients died of their cancer and 328 died of non-cancer-related causes. At 10 years, overall survival was 45%, cancer specific was 70% and non-cancer-related survival was 64%. On multivariate analysis of all factors, age (HR 1.38, 95% CI 1.18-1.62, P<0.001), sex (HR 1.74, 95% CI 1.36-2.23, P<0.001), site (HR 1.42, 95% CI 1.11-1.81, P<0.01) and Dukes' stage (HR 1.71, 1.19-2.47, P<0.01) were independently associated with cancer-specific survival. On multivariate analysis of all factors, age (HR 2.14, 1.84-2.49, P<0.001), sex (HR 1.43, 1.15-1.79, P<0.01) and deprivation (HR 1.30, 1.09-1.55, P<0.01) were independently associated with non-cancer-related survival. The results of this study show that increasing age impacts negatively both on cancer-specific and non-cancer-related survival following elective potentially curative resection for node-negative colorectal cancer. However, the effect of increasing age is greater on the non-cancer-related survival. These results suggest that cancer-specific and non-cancer-related mortality should be considered separately in survival analysis of these cancer patients. PMID:18797465

McMillan, D C; Hole, D J; McArdle, C S



The impact of surgery for oral cancer on quality of life as measured by the Medical Outcomes Short Form 36  

Microsoft Academic Search

Quality of life evaluation is an important measure of outcome following the treatment of head and neck cancer. The aim of this study was to evaluate the quality of life of patients undergoing primary surgery for oral and oropharyngeal squamous cell carcinoma. 50 consecutive patients with previously untreated oral cancer were assessed using using two questionnaires, the Medical Outcomes Short

S. N Rogers; G Humphris; D Lowe; J. S Brown; E. D Vaughan



Preventive Surgery Can Cut Risk of Ovarian and Fallopian Tube Cancers for BRCA1, BRCA2 Carriers

Women who are at high risk of ovarian cancer because they carry mutated BRCA1 and BRCA2 genes can reduce by about 80 percent their risk of developing this and other cancers of the reproductive organs by having preventive surgery to remove their ovaries and fallopian tubes, according to the July 12, 2006, Journal of the American Medical Association.


[Short-term outcomes of radical surgery for bladder cancer].  


A total of 102 radical cystectomies have been conducted for 1996-2001 (94 males, 8 females, age 37-78 years, mean age 57.5 years). Most of the patients (81.4%) were diagnosed to have transitional cell carcinoma. Supravesical urine derivation was made by means of ureterocutaneostomy and transureteroureteronephrostomy in 7(6.9) patients, ureterosigmoanastomosis--in 41(40.2%), Sigma-rectumpouch--in 1(0.9%) patients, ileocystoplasty, largely by Hautmann and Studer was carried out in 52(51%) patients. Postoperative complications developed in 25(24.5%) patients who often had adhesive ileus. Four patients died: 2 of pulmonary artery thromboembolism, 1 of acute cardiac failure and 1 of sepsis. Methods of continence urine derivation were preferred, such as ureterosigmoanastomosis by Mainz-Pouch II and creation of orthotopic bladder of the ileum. PMID:12077814

Komiakov, B K; Gorelov, S I; Novikov, A I; Gorelov, A I; Guliev, B G; Idrisov, Sh N; Kagan, O F; Sergeev, A V; Fadeev, V A


Colon and rectal surgery for cancer without mechanical bowel preparation: One-center randomized prospective trial  

PubMed Central

Background Mechanical bowel preparation is routinely done before colon and rectal surgery, aimed at reducing the risk of postoperative infectious complications. The aim of the study was to assess whether elective colon and rectal surgery can be safely performed without preoperative mechanical bowel preparation. Methods Patients undergoing elective colon and rectal resections with primary anastomosis were prospectively randomized into two groups. Group A had mechanical bowel preparation with polyethylene glycol before surgery, and group B had their surgery without preoperative mechanical bowel preparation. Patients were followed up for 30 days for wound, anastomotic, and intra-abdominal infectious complications. Results Two hundred forty four patients were included in the study, 120 in group A and 124 in group B. Demographic characteristics, type of surgical procedure and type of anastomosis did not significantly differ between the two groups. There was no difference in the rate of surgical infectious complications between the two groups but the overall infectious complications rate was 20.0% in group A and 11.3% in group B (p .05). Wound infection (p = 0.18), anastomotic leak (p = 0.52), and intra-abdominal abscess (p = 0.36) occurred in 9.2%, 5.8%, and 5.0% versus 4.8%, 4.0%, and 2.4%, respectively. No mechanical bowel preparation seems to be safe also in rectal surgery. Conclusions These results suggest that elective colon and rectal surgery may be safely performed without mechanical preparation.



Prognostic Factors and Morbidities After Completion Surgery in Patients Undergoing Initial Chemoradiation Therapy for Locally Advanced Cervical Cancer  

PubMed Central

Purpose. The aim of this study was to evaluate the prognostic factors and morbidities of patients undergoing completion surgery for locally advanced-stage cervical cancer after initial chemoradiation therapy (CRT). Patients and Methods. Patients fulfilling the following inclusion criteria were studied: stage IB2–IVA cervical carcinoma, tumor initially confined to the pelvic cavity on conventional imaging, pelvic external radiation therapy with delivery of 45 Gy to the pelvic cavity and concomitant chemotherapy (cisplatin, 40 mg/m2 per week) followed by uterovaginal brachytherapy, and completion surgery after the end of radiation therapy including at least a hysterectomy. Results. One-hundred fifty patients treated in 1998–2007 fulfilled the inclusion criteria. Prognostic factors for overall survival in the multivariate analysis were the presence and level of nodal spread (positive pelvic nodes alone: hazard ratio [HR], 2.03; positive para-aortic nodes: HR, 5.46; p < .001) and the presence and size of residual disease (RD) in the cervix (p = .02). Thirty-seven (25%) patients had 55 postoperative complications. The risk for complications was higher with a radical hysterectomy (p = .04) and the presence of cervical RD (p = .01). Conclusion. In this series, the presence and size of RD and histologic nodal involvement were the strongest prognostic factors. Such results suggest that the survival of patients treated using CRT for locally advanced cervical cancer could potentially be enhanced by improving the rate of complete response in the irradiated area (cervix or pelvic nodes) and by initially detecting patients with para-aortic spread so that treatment could be adapted in such patients. The morbidity of completion surgery is high in this context.

Touboul, Cyril; Uzan, Catherine; Mauguen, Audrey; Gouy, Sebastien; Rey, Annie; Pautier, Patricia; Lhomme, Catherine; Duvillard, Pierre; Haie-Meder, Christine



Validity of the Swedish Rectal Cancer Registry for patients treated with major abdominal surgery between 1995 and 1997.  


Abstract Background. Founded in 1995, the Swedish Rectal Cancer Registry (SRCR) is frequently used for rectal cancer research. However, the validity of the registry has not been extensively studied. This study aims to validate a large amount of registry data to assess SRCR quality. Material and methods. The study comprises 906 patients treated with major abdominal surgery registered in the SRCR between 1995 and 1997. SRCR data for 14 variables were scrutinized for validity against the medical records. Kappa's and Kendall's correlation coefficients for agreement between SRCR data and medical records data were calculated for 13 variables. Results. For 11 variables, concerning the tumor, neoadjuvant therapy, the surgical procedure, local radicality and TNM stage, data were missing in 5% or less of the registrations; for the remaining three variables, anastomotic leakage, local and distant recurrence, data were missing in 13-38%. For the variables surgery performed or not and type of surgical procedure, no data were missing. Erroneous registrations were found in less than 10% of all variables; for the variables preoperative chemotherapy and surgery performed or not, all registrations were correct. For the variables concerning neoadjuvant therapy, local radicality according to the surgeon as well as the pathologist and distant metastasis, the false-positive or -negative registrations were equally distributed, and for the variables rectal washout, rectal perforation, anastomotic leakage and local recurrence there was a discrepancy in distribution. The correlation coefficient for 12 variables ranged from 0.82 to 1.00, and was 0.78 for the remaining variable. Conclusion. The validity of the SRCR was good for the initial three registry years. Thus, research based on SRCR data is reliable from the beginning of the registry's use. PMID:23786178

Jörgren, Fredrik; Johansson, Robert; Damber, Lena; Lindmark, Gudrun



Fertility Preservation Methods in Breast Cancer  

PubMed Central

Thanks to the recent advances in reproductive medicine, more and more young women with breast cancer may be offered the possibility of preserving their fertility. Fertility can be endangered by chemotherapy, by treatment duration and by patient's age at diagnosis. The currently available means to preserve a young woman's fertility are pharmacological protection with gonadotrophin-releasing hormone analogues during chemotherapy, and ovarian tissue or oocyte/embryo freezing before treatment. New future venues, including in vitro maturation, will improve the feasibility and efficacy of the fertility preservation methods in breast cancer patients.

Peccatori, Fedro A.; Pup, Lino Del; Salvagno, Francesca; Guido, Maurizio; Sarno, Maria A.; Revelli, Alberto; Piane, Luisa Delle; Dolfin, Elisabetta; Franchi, Dorella; Molinari, Emanuela; Immediata, Valentina; Chiavari, Leonora; Vucetich, Alessandra; Borini, Andrea



Psychosocial Factors Affecting the Therapeutic Decision-making and Postoperative Mood States in Japanese Breast Cancer Patients who underwent Various Types of Surgery: Body Image and Sexuality  

Microsoft Academic Search

Objective: We conducted an empirical study to clarify how psychosocial factors (e.g. body image and sexuality) influence therapeutic decision-making and to identify the factors that affect post-operative mood states in Japanese women who underwent various types of surgery. Methods: One hundred and two patients who had undergone surgical treatment for breast cancer participated in this study. Twenty-five patients had undergone

Keiichiro Adachi; Tokumi Ueno; Toshio Fujioka; Yutaka Fujitomi; Hiroaki Ueo; G. K. Rath; Masaki Tsuchiya; Motoki Iwasaki; Tetsuya Otani; Jun-ichi Nitadori; Koichi Goto; Yutaka Nishiwaki; Yosuke Uchitomi; Shoichiro Tsugane


Clinical Equivalence of Controlled-Release Oxycodone 20 mg and Controlled-Release Tramadol 200 mg after Surgery for Breast Cancer  

Microsoft Academic Search

Aims: To assess clinical equivalence of 20 mg controlled-release oxycodone (Oxygesic®; Mundipharma, Limburg, Germany) and 200 mg controlled-release tramadol (Tramal long®; Grünenthal, Aachen, Germany) on a 12-hour dosing schedule in a randomized, double-blinded study of 54 ASA I–III physical status (American Society of Anesthesiologists classification of physical status) patients undergoing surgery for breast cancer. Methods: General anesthesia using remifentanil and

Sandra Kampe; Karsten Wolter; Mathias Warm; Oguzhan Dagtekin; Sasan Shaheen; Susanne Landwehr



[Radiotherapy for endobronchially invading recurrence of esophageal cancer after resective surgery].  


Sixty-eight patients with endobronchially invading recurrence of esophageal cancer after resective surgery were treated with radiotherapy from 1966 to 1988. The mean interval between resective surgery and diagnosis of recurrence was 11.1 months, that was significantly shortened in a3 group. The dose of radiation for recurrence ranged from 2 to 70.3 Gy, with a mean dose of 42.6 Gy. The mean survival time after treatment of recurrence was 4.9 months. The dose of radiation was found to have a positive correlation with survival time. The cause of death was bleeding in 20 patients, and respiratory failure in 36. High dose of radiation was thought to induce high incidence of bleeding. The results indicated that external beam radiotherapy with conventional fractionation was not so much effective for the recurrence. PMID:2262733

Ogino, T; Tsukiyama, I; Kajiura, Y; Akine, Y; Ono, R; Egawa, S; Tachimori, Y; Kato, H; Watanabe, H



Stereotactic Body Radiotherapy Versus Surgery for Medically Operable Stage I Non-Small-Cell Lung Cancer: A Markov Model-Based Decision Analysis  

SciTech Connect

Purpose: To compare the quality-adjusted life expectancy and overall survival in patients with Stage I non-small-cell lung cancer (NSCLC) treated with either stereotactic body radiation therapy (SBRT) or surgery. Methods and Materials: We constructed a Markov model to describe health states after either SBRT or lobectomy for Stage I NSCLC for a 5-year time frame. We report various treatment strategy survival outcomes stratified by age, sex, and pack-year history of smoking, and compared these with an external outcome prediction tool (Adjuvant{exclamation_point} Online). Results: Overall survival, cancer-specific survival, and other causes of death as predicted by our model correlated closely with those predicted by the external prediction tool. Overall survival at 5 years as predicted by baseline analysis of our model is in favor of surgery, with a benefit ranging from 2.2% to 3.0% for all cohorts. Mean quality-adjusted life expectancy ranged from 3.28 to 3.78 years after surgery and from 3.35 to 3.87 years for SBRT. The utility threshold for preferring SBRT over surgery was 0.90. Outcomes were sensitive to quality of life, the proportion of local and regional recurrences treated with standard vs. palliative treatments, and the surgery- and SBRT-related mortalities. Conclusions: The role of SBRT in the medically operable patient is yet to be defined. Our model indicates that SBRT may offer comparable overall survival and quality-adjusted life expectancy as compared with surgical resection. Well-powered prospective studies comparing surgery vs. SBRT in early-stage lung cancer are warranted to further investigate the relative survival, quality of life, and cost characteristics of both treatment paradigms.

Louie, Alexander V. [Department of Oncology, University of Western Ontario, London, ON (Canada); Rodrigues, George, E-mail: [Department of Oncology, University of Western Ontario, London, ON (Canada); Department of Epidemiology/Biostatistics, University of Western Ontario, London, ON (Canada); Hannouf, Malek [Department of Epidemiology/Biostatistics, University of Western Ontario, London, ON (Canada); Zaric, Gregory S. [Department of Epidemiology/Biostatistics, University of Western Ontario, London, ON (Canada); Richard Ivey School of Business, University of Western Ontario, London, ON (Canada); Palma, David A. [Department of Oncology, University of Western Ontario, London, ON (Canada); Cao, Jeffrey Q. [Department of Oncology, University of Western Ontario, London, ON (Canada); Richard Ivey School of Business, University of Western Ontario, London, ON (Canada); Yaremko, Brian P. [Department of Oncology, University of Western Ontario, London, ON (Canada); Malthaner, Richard [Department of Epidemiology/Biostatistics, University of Western Ontario, London, ON (Canada); Division of Surgery, University of Western Ontario, London, ON (Canada); Mocanu, Joseph D. [Richard Ivey School of Business, University of Western Ontario, London, ON (Canada)



Influence of yoga on mood states, distress, quality of life and immune outcomes in early stage breast cancer patients undergoing surgery  

PubMed Central

Context: Breast cancer patients awaiting surgery experience heightened distress that could affect postoperative outcomes. Aims: The aim of our study was to evaluate the effects of yoga intervention on mood states, treatment-related symptoms, quality of life and immune outcomes in breast cancer patients undergoing surgery. Settings and Design: Ninety-eight recently diagnosed stage II and III breast cancer patients were recruited for a randomized controlled trial comparing the effects of a yoga program with supportive therapy plus exercise rehabilitation on postoperative outcomes following surgery. Materials and Methods: Subjects were assessed prior to surgery and four weeks thereafter. Psychometric instruments were used to assess self-reported anxiety, depression, treatment-related distress and quality of life. Blood samples were collected for enumeration of T lymphocyte subsets (CD4 %, CD8 % and natural killer (NK) cell % counts) and serum immunoglobulins (IgG, IgA and IgM). Statistical Analysis Used: We used analysis of covariance to compare interventions postoperatively. Results: Sixty-nine patients contributed data to the current analysis (yoga n = 33, control n = 36). The results suggest a significant decrease in the state (P = 0.04) and trait (P = 0.004) of anxiety, depression (P = 0.01), symptom severity (P = 0.01), distress (P < 0.01) and improvement in quality of life (P = 0.01) in the yoga group as compared to the controls. There was also a significantly lesser decrease in CD 56% (P = 0.02) and lower levels of serum IgA (P = 0.001) in the yoga group as compared to controls following surgery. Conclusions: The results suggest possible benefits for yoga in reducing postoperative distress and preventing immune suppression following surgery.

Rao, Raghavendra M; Nagendra, H R; Raghuram, Nagarathna; Vinay, C; Chandrashekara, S; Gopinath, K S; Srinath, B S



Randomized clinical trial of omega-3 fatty acid-supplemented enteral nutrition versus standard enteral nutrition in patients undergoing oesophagogastric cancer surgery  

PubMed Central

Background Oesophagogastric cancer surgery is immunosuppressive. This may be modulated by omega-3 fatty acids (O-3FAs). The aim of this study was to assess the effect of perioperative O-3FAs on clinical outcome and immune function after oesophagogastric cancer surgery. Methods Patients undergoing subtotal oesophagectomy and total gastrectomy were recruited and allocated randomly to an O-3FA enteral immunoenhancing diet (IED) or standard enteral nutrition (SEN) for 7 days before and after surgery, or to postoperative supplementation alone (control group). Clinical outcome, fatty acid concentrations, and HLA-DR expression on monocytes and activated T lymphocytes were determined before and after operation. Results Of 221 patients recruited, 26 were excluded. Groups (IED, 66; SEN, 63; control, 66) were matched for age, malnutrition and co-morbidity. There were no differences in morbidity (P = 0·646), mortality (P = 1·000) or hospital stay (P = 0·701) between the groups. O-3FA concentrations were higher in the IED group after supplementation (P < 0·001). The ratio of omega-6 fatty acid to O-3FA was 1·9:1, 4·1:1 and 4·8:1 on the day before surgery in the IED, SEN and control groups (P < 0·001). There were no differences between the groups in HLA-DR expression in either monocytes (P = 0·538) or activated T lymphocytes (P = 0·204). Conclusion Despite a significant increase in plasma concentrations of O-3FA, immunonutrition with O-3FA did not affect overall HLA-DR expression on leucocytes or clinical outcome following oesophagogastric cancer surgery. Registration number: ISRCTN43730758 ( Copyright © 2012 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.

Sultan, J; Griffin, S M; Di Franco, F; Kirby, J A; Shenton, B K; Seal, C J; Davis, P; Viswanath, Y K S; Preston, S R; Hayes, N



Surgery for non-small cell lung cancer: systematic review and meta-analysis of randomised controlled trials  

PubMed Central

Background Surgery is considered the treatment of choice for patients with resectable stage I and II (and some patients with stage IIIA) non?small cell lung cancer (NSCLC), but there have been no previously published systematic reviews. Methods A systematic review and meta?analysis of randomised controlled trials was conducted to determine whether surgical resection improves disease specific mortality in patients with stages I–IIIA NSCLC compared with non?surgical treatment, and to compare the efficacy of different surgical approaches. Results Eleven trials were included. No studies had untreated control groups. In a pooled analysis of three trials, 4?year survival was superior in patients undergoing resection with stage I–IIIA NSCLC who had complete mediastinal lymph node dissection compared with lymph node sampling (hazard ratio estimated at 0.78 (95% CI 0.65 to 0.93)). Another trial reported an increased rate of local recurrence in patients with stage I NSCLC treated with limited resection compared with lobectomy. One small study reported a survival advantage among patients with stage IIIA NSCLC treated with chemotherapy followed by surgery compared with chemotherapy followed by radiotherapy. No other trials reported significant improvements in survival after surgery compared with non?surgical treatment. Conclusion It is difficult to draw conclusions about the efficacy of surgery for locoregional NSCLC because of the small number of participants studied and methodological weaknesses of the trials. However, current evidence suggests that complete mediastinal lymph node dissection is associated with improved survival compared with node sampling in patients with stage I–IIIA NSCLC undergoing resection.

Wright, G; Manser, R L; Byrnes, G; Hart, D; Campbell, D A



Application of a Complication Screening Method to Congenital Heart Surgery Admissions  

Microsoft Academic Search

There have been comprehensive screening methods developed to identify unwanted inpatient events. A comprehensive assessment\\u000a of complication diagnoses during congenital heart surgery admissions has not been performed. We examined the frequency of\\u000a complications identified by a complication screening method and their relationship to patient characteristics among congenital\\u000a heart surgery admissions. Data were obtained from the Healthcare Cost and Utilization Project

Oscar J. Benavidez; Kimberlee Gauvreau; Emile Bacha; Pedro Del Nido; Kathy J. Jenkins



Eleven-year follow-up results in the delay of breast irradiation after conservative breast surgery in node-negative breast cancer patients  

SciTech Connect

Purpose: This retrospective review was conducted to determine if delay in the start of radiotherapy after conservative breast surgery had any detrimental effect on local recurrence or disease-free survival in node-negative breast cancer patients. Methods and Materials: A total of 568 patients with T1 and T2, N0 breast cancer were treated with breast-conserving surgery and breast irradiation, without adjuvant systemic therapy, between January 1, 1985 and December 31, 1992 at the London Regional Cancer Centre. The time intervals from definitive breast surgery to breast irradiation used for analysis were 0 to 8 weeks (201 patients), greater than 8 to 12 weeks (235 patients), greater than 12 to 16 weeks (91 patients), and greater than 16 weeks (41 patients). Kaplan-Meier estimates of time to local-recurrence and disease-free survival rates were calculated. Results: Median follow-up was 11.2 years. Patients in all 4 time intervals were similar in terms of age and pathologic features. No statistically significant difference was seen between the 4 groups in local recurrence or disease-free survival with surgery radiotherapy interval (p = 0.521 and p = 0.222, respectively). The overall local-recurrence rate at 5 and 10 years was 4.6% and 11.3%, respectively. The overall disease-free survival at 5 and 10 years was 79.6% and 67.0%, respectively. Conclusion: This retrospective study suggests that delay in the start of breast irradiation of up to 16 weeks from definitive surgery does not increase the risk of recurrence in node-negative breast cancer patients. The certainty of these results is limited by the retrospective nature of this analysis.

Vujovic, Olga [Department of Radiation Oncology, London Regional Cancer Centre, London, Ontario (Canada)]. E-mail:; Yu, Edward [Department of Radiation Oncology, London Regional Cancer Centre, London, Ontario (Canada); Cherian, Anil [Department of Medical Oncology, London Regional Cancer Centre, London, Ontario (Canada); Dar, A. Rashid [Department of Radiation Oncology, London Regional Cancer Centre, London, Ontario (Canada); Stitt, Larry [Clinical Research Unit, London Regional Cancer Centre, London, Ontario (Canada); Perera, Francisco [Department of Radiation Oncology, London Regional Cancer Centre, London, Ontario (Canada)



Laser Doppler assessment of the influence of division at the root of the inferior mesenteric artery on anastomotic blood flow in rectosigmoid cancer surgery  

Microsoft Academic Search

Aims  The aim of this study is to evaluate the influence of dividing the inferior mesenteric artery (IMA) and preserving the left\\u000a colic artery (LCA) on rectosigmoid cancer surgery.\\u000a \\u000a \\u000a \\u000a Patients and methods  Colonic blood flow at the proximal site of the anastomosis was measured by laser Doppler flowmetry in 96 patients with cancer\\u000a of the rectum and sigmoid colon while clamping IMA

Kazuhiro Seike; Keiji Koda; Norio Saito; Kenji Oda; Chihiro Kosugi; Kimio Shimizu; Masaru Miyazaki




Microsoft Academic Search

Purpose: To investigate the effect of induction chemotherapy (CHT) before trimodality therapy on the outcome of patients with resectable cancer of the esophagus. Methods and Materials: This retrospective study included 81 consecutive patients with resectable cancer of the esophagus who received neoadjuvant chemoradiotherapy followed by esophagectomy between January 1990 and December 1998 (inclusive). Thirty-nine patients underwent chemoradiotherapy followed by esophagectomy




Multidisciplinary team management is associated with improved outcomes after surgery for esophageal cancer.  


We aim to compare the outcomes of patients undergoing R0 esophagectomy by a multidisciplinary team (MDT) with outcomes after surgery alone performed by surgeons working independently in a UK cancer unit. An historical control group of 77 consecutive patients diagnosed with esophageal cancer and undergoing surgery with curative intent by six general surgeons between 1991 and 1997 (54 R0 esophagectomies) were compared with a group of 67 consecutive patients managed by the MDT between 1998 and 2003 (53 R0 esophagectomies, 26 patients received multimodal therapy). The proportion of patients undergoing open and closed laparotomy and thoracotomy decreased from 21% and 5%, respectively, in control patients, to 13% and 0% in MDT patients (chi2 = 11.90, DF = 1, P = 0.001; chi2 = 5.45, DF = 1, P = 0.02 respectively). MDT patients had lower operative mortality (5.7%vs. 26%; chi2 = 8.22, DF = 1, P = 0.004) than control patients, and were more likely to survive 5 years (52%vs. 10%, chi2 = 15.05, P = 0.0001). In a multivariate analysis, MDT management (HR = 0.337, 95% CI = 0.201-0.564, P < 0.001), lymph node metastases (HR = 1.728, 95% CI = 1.070-2.792, P = 0.025), and American Society of Anesthesiologists grade (HR = 2.207, 95% CI = 1.412-3.450, P = 0.001) were independently associated with duration of survival. Multidisciplinary team management and surgical subspecialization improved outcomes after surgery significantly for patients diagnosed with esophageal cancer. PMID:16722993

Stephens, M R; Lewis, W G; Brewster, A E; Lord, I; Blackshaw, G R J C; Hodzovic, I; Thomas, G V; Roberts, S A; Crosby, T D L; Gent, C; Allison, M C; Shute, K



Is community treatment best? a randomised trial comparing delivery of cancer treatment in the hospital, home and GP surgery.  


Background:Care closer to home is being explored as a means of improving patient experience as well as efficiency in terms of cost savings. Evidence that community cancer services improve care quality and/or generate cost savings is currently limited. A randomised study was undertaken to compare delivery of cancer treatment in the hospital with two different community settings.Methods:Ninety-seven patients being offered outpatient-based cancer treatment were randomised to treatment delivered in a hospital day unit, at the patient's home or in local general practice (GP) surgeries. The primary outcome was patient-perceived benefits, using the emotional function domain of the EORTC quality of life (QOL) QLQC30 questionnaire evaluated after 12 weeks. Secondary outcomes included additional QOL measures, patient satisfaction, safety and health economics.Results:There was no statistically significant QOL difference between treatment in the combined community locations relative to hospital (difference of -7.2, 95% confidence interval: -19·5 to +5·2, P=0.25). There was a significant difference between the two community locations in favour of home (+15·2, 1·3 to 29·1, P=0.033). Hospital anxiety and depression scale scores were consistent with the primary outcome measure. There was no evidence that community treatment compromised patient safety and no significant difference between treatment arms in terms of overall costs or Quality Adjusted Life Year. Seventy-eight percent of patients expressed satisfaction with their treatment whatever their location, whereas 57% of patients preferred future treatment to continue at the hospital, 81% at GP surgeries and 90% at home. Although initial pre-trial interviews revealed concerns among health-care professionals and some patients regarding community treatment, opinions were largely more favourable in post-trial interviews.Interpretation:Patient QOL favours delivering cancer treatment in the home rather than GP surgeries. Nevertheless, both community settings were acceptable to and preferred by patients compared with hospital, were safe, with no detrimental impact on overall health-care costs. PMID:23989945

Corrie, P G; Moody, A M; Armstrong, G; Nolasco, S; Lao-Sirieix, S-H; Bavister, L; Prevost, A T; Parker, R; Sabes-Figuera, R; McCrone, P; Balsdon, H; McKinnon, K; Hounsell, A; O'Sullivan, B; Barclay, S



Is community treatment best? a randomised trial comparing delivery of cancer treatment in the hospital, home and GP surgery  

PubMed Central

Background: Care closer to home is being explored as a means of improving patient experience as well as efficiency in terms of cost savings. Evidence that community cancer services improve care quality and/or generate cost savings is currently limited. A randomised study was undertaken to compare delivery of cancer treatment in the hospital with two different community settings. Methods: Ninety-seven patients being offered outpatient-based cancer treatment were randomised to treatment delivered in a hospital day unit, at the patient's home or in local general practice (GP) surgeries. The primary outcome was patient-perceived benefits, using the emotional function domain of the EORTC quality of life (QOL) QLQC30 questionnaire evaluated after 12 weeks. Secondary outcomes included additional QOL measures, patient satisfaction, safety and health economics. Results: There was no statistically significant QOL difference between treatment in the combined community locations relative to hospital (difference of ?7.2, 95% confidence interval: ?19·5 to +5·2, P=0.25). There was a significant difference between the two community locations in favour of home (+15·2, 1·3 to 29·1, P=0.033). Hospital anxiety and depression scale scores were consistent with the primary outcome measure. There was no evidence that community treatment compromised patient safety and no significant difference between treatment arms in terms of overall costs or Quality Adjusted Life Year. Seventy-eight percent of patients expressed satisfaction with their treatment whatever their location, whereas 57% of patients preferred future treatment to continue at the hospital, 81% at GP surgeries and 90% at home. Although initial pre-trial interviews revealed concerns among health-care professionals and some patients regarding community treatment, opinions were largely more favourable in post-trial interviews. Interpretation: Patient QOL favours delivering cancer treatment in the home rather than GP surgeries. Nevertheless, both community settings were acceptable to and preferred by patients compared with hospital, were safe, with no detrimental impact on overall health-care costs.

Corrie, P G; Moody, A M; Armstrong, G; Nolasco, S; Lao-Sirieix, S-H; Bavister, L; Prevost, A T; Parker, R; Sabes-Figuera, R; McCrone, P; Balsdon, H; McKinnon, K; Hounsell, A; O'Sullivan, B; Barclay, S



Laparoscopic Surgery for Advanced Gastric Cancer: Current Status and Future Perspectives  

PubMed Central

Laparoscopic gastrectomy has been widely accepted especially in patients with early-stage gastric cancer. However, the safety and oncologic validity of laparoscopic gastrectomy for advanced gastric cancer are still being debated. Since the late 90s', we have been engaged in developing a stable and robust methodology of laparoscopic radical gastrectomy for advanced gastric cancer, and have established laparoscopic distinctive technique for suprapancreatic lymph node dissection, namely the outermost layer-oriented medial approach. In this article, We present the development history of this method, and current status and future perspectives of laparoscopic gastrectomy for advanced gastric cancer based on our experience and a review of the literature.

Suda, Koichi; Satoh, Seiji



MRI and Mammography Before Surgery in Patients With Stage I-II Breast Cancer

Estrogen Receptor-negative Breast Cancer; HER2-negative Breast Cancer; HER2-positive Breast Cancer; Progesterone Receptor-negative Breast Cancer; Stage IA Breast Cancer; Stage IB Breast Cancer; Stage II Breast Cancer; Triple-negative Breast Cancer



[Pulmonary thromboembolism that developed 16 days after surgery for lung cancer].  


An 79-year-old man underwent right upper lobectomy with mediastinal lymph node dissection for lung cancer. He was discharged without complications on postoperative day( POD) 8. However, on POD 16 he become dyspneic at home and was transported to a hospital by ambulance. Pulmonary thromboembolism (PTE) was detected by contrast-enhanced computed tomography. Anticoagulant therapy was initiated and inferior vena cava filter placement was performed.Due to its many possible clinical manifestations, early detection of postoperative PTE is difficult. Therefore prevention of PTE is thought to be more important. Intermittent application of pneumatic compression stockings and preventive anticoagulant therapy may help prevent PTE after surgery. PMID:23917244

Tsuchiya, Takehiro; Sano, Atsushi; Fukami, Takeshi



Clinicopathological characteristics and long-term outcomes of colorectal cancer in elderly Chinese patients undergoing potentially curative surgery.  


PURPOSE: The aim of this study was to determine the clinicopathological characteristics and outcomes of Chinese colorectal cancer (CRC) patients aged 75 years and older undergoing potentially curative surgery. METHODS: A total of 2,482 CRC patients at TNM stage I-III undergoing surgical treatment between 1995 and 2005 were evaluated, and patients were divided into a younger (<75 years old) and an elderly (?75 years) group. RESULTS: There were 2,482 CRC patients in this study, of which 2,194 (88.4 %) patients were in the younger group (mean age 57 years) and 288 (11.6 %) were in the elderly group (mean age 79 years). Significant differences were observed between the two groups with regard to the American Society of Anesthesiologists' score, tumor location, co-morbidities, emergency procedures, use of chemotherapy, proportion admitted to the ICU, length of ICU stay, causes of death, T/N stage and postoperative recurrence. The postoperative mortality increased from 4.8 % in the younger group to 8.3 % in the older group (p = 0.011). Although significant differences were found in the overall 5-year survival (73 vs. 56 %, p < 0.0001) and disease-free 5-year survival (68 vs. 54 %, p < 0.0001) between the two groups, the cancer-specific 5-year survival was similar (88 vs. 85 %, p = 0.089) in both groups. CONCLUSIONS: Although elderly CRC patients have unique clinicopathological features, a higher postoperative mortality and a worse overall and disease-free survival compared with younger patients, the cancer-specific survival at five years is similar between elderly and younger patients. Elderly patients benefit from radical surgery and have a good postoperative oncological outcome, irrespective of their age. PMID:23440360

Yang, Zuli; Chen, Hao; Liao, Yi; Xiang, Jun; Kang, Liang; Wang, Lei; Cui, Ji; Cai, Guanfu; Peng, Junsheng; Lan, Ping; Wang, Jianping



Effects of breast cancer surgery and surgical side effects on body image over time  

PubMed Central

We examined the impact of surgical treatments (breast-conserving surgery [BCS], mastectomy alone, mastectomy with reconstruction) and surgical side-effects severity on early stage (0–IIA) breast cancer patients' body image over time. We interviewed patients at 4–6 weeks (T1), six (T2), 12 (T3), and 24 months (T4) following definitive surgical treatment. We examined longitudinal relationships among body image problems, surgery type, and surgical side-effects severity using the Generalized Estimating Equation approach, controlling for demographic, clinical, and psychosocial factors. We compared regression coefficients of surgery type from two models, one with and one without surgical side-effects severity. Of 549 patients enrolled (mean age 58; 75% White; 65% BCS, 12% mastectomy, 23% mastectomy with reconstruction), 514 (94%) completed all four interviews. In the model without surgical side-effects severity, patients who underwent mastectomy with reconstruction reported poorer body image than patients who underwent BCS at T1–T3 (each P < 0.02), but not at T4. At T2, patients who underwent mastectomy with reconstruction also reported poorer body image than patients who underwent mastectomy alone (P = 0.0106). Adjusting for surgical side-effects severity, body image scores did not differ significantly between patients with BCS and mastectomy with reconstruction at any interview; however, patients who underwent mastectomy alone had better body image at T2 than patients who underwent mastectomy with reconstruction (P = 0.011). The impact of surgery type on body image within the first year of definitive surgical treatment was explained by surgical side-effects severity. After 2 years, body image problems did not differ significantly by surgery type.

Collins, Karen Kadela; Liu, Ying; Schootman, Mario; Aft, Rebecca; Yan, Yan; Dean, Grace; Eilers, Mark; Jeffe, Donna B.



Surgery and Chemotherapy With or Without Chemotherapy After Surgery in Treating Patients With Ovarian, Fallopian Tube, Uterine, or Peritoneal Cancer

Recurrent Endometrial Carcinoma; Recurrent Fallopian Tube Cancer; Recurrent Ovarian Epithelial Cancer; Recurrent Ovarian Germ Cell Tumor; Recurrent Primary Peritoneal Cavity Cancer; Recurrent Uterine Sarcoma; Stage IIC Fallopian Tube Cancer; Stage IIC Ovarian Epithelial Cancer; Stage IIC Ovarian Germ Cell Tumor; Stage IIC Primary Peritoneal Cavity Cancer; Stage IIIA Endometrial Carcinoma; Stage IIIA Fallopian Tube Cancer; Stage IIIA Ovarian Epithelial Cancer; Stage IIIA Ovarian Germ Cell Tumor; Stage IIIA Primary Peritoneal Cavity Cancer; Stage IIIA Uterine Sarcoma; Stage IIIB Endometrial Carcinoma; Stage IIIB Fallopian Tube Cancer; Stage IIIB Ovarian Epithelial Cancer; Stage IIIB Ovarian Germ Cell Tumor; Stage IIIB Primary Peritoneal Cavity Cancer; Stage IIIB Uterine Sarcoma; Stage IIIC Endometrial Carcinoma; Stage IIIC Fallopian Tube Cancer; Stage IIIC Ovarian Epithelial Cancer; Stage IIIC Ovarian Germ Cell Tumor; Stage IIIC Primary Peritoneal Cavity Cancer; Stage IIIC Uterine Sarcoma; Stage IV Fallopian Tube Cancer; Stage IV Ovarian Epithelial Cancer; Stage IV Ovarian Germ Cell Tumor; Stage IV Primary Peritoneal Cavity Cancer; Stage IVA Endometrial Carcinoma; Stage IVA Uterine Sarcoma; Stage IVB Endometrial Carcinoma; Stage IVB Uterine Sarcoma



Laparoscopy to predict the result of primary cytoreductive surgery in advanced ovarian cancer patients (LapOvCa-trial): a multicentre randomized controlled study  

PubMed Central

Background Standard treatment of advanced ovarian cancer is surgery and chemotherapy. The goal of surgery is to remove all macroscopic tumour, as the amount of residual tumour is the most important prognostic factor for survival. When removal off all tumour is considered not feasible, neoadjuvant chemotherapy (NACT) in combination with interval debulking surgery (IDS) is performed. Current methods of staging are not always accurate in predicting surgical outcome, since approximately 40% of patients will have more than 1 cm residual tumour after primary debulking surgery (PDS). In this study we aim to assess whether adding laparoscopy to the diagnostic work-up of patients suspected of advanced ovarian carcinoma may prevent unsuccessful primary debulking surgery for ovarian cancer. Methods Multicentre randomized controlled trial, including all gynaecologic oncologic centres in the Netherlands and their affiliated hospitals. Patients are eligible when they are planned for PDS after conventional staging. Participants are randomized between direct PDS or additional diagnostic laparoscopy. Depending on the result of laparoscopy patients are treated by PDS within three weeks, followed by six courses of platinum based chemotherapy or with NACT and IDS 3-4 weeks after three courses of chemotherapy, followed by another three courses of chemotherapy. Primary outcome measure is the proportion of PDS's leaving more than one centimetre tumour residual in each arm. In total 200 patients will be randomized. Data will be analysed according to intention to treat. Discussion Patients who have disease considered to be resectable to less than one centimetre should undergo PDS to improve prognosis. However, there is a need for better diagnostic procedures because the current number of debulking surgeries leaving more than one centimetre residual tumour is still high. Laparoscopy before starting treatment for ovarian cancer can be an additional diagnostic tool to predict the outcome of PDS. Despite the absence of strong evidence and despite the possible complications, laparoscopy is already implemented in many countries. We propose a randomized multicentre trial to provide evidence on the effectiveness of laparoscopy before primary surgery for advanced stage ovarian cancer patients. Trial registration Netherlands Trial Register number NTR2644



Effectiveness of early physiotherapy to prevent lymphoedema after surgery for breast cancer: randomised, single blinded, clinical trial  

Microsoft Academic Search

Objective To determine the effectiveness of early physiotherapy in reducing the risk of secondary lymphoedema after surgery for breast cancer.Design Randomised, single blinded, clinical trial.Setting University hospital in Alcalá de Henares, Madrid, Spain.Participants 120 women who had breast surgery involving dissection of axillary lymph nodes between May 2005 and June 2007.Intervention The early physiotherapy group was treated by a physiotherapist

María Torres Lacomba; María José Yuste Sánchez; Álvaro Zapico Goñi; David Prieto Merino; Orlando Mayoral del Moral; Ester Cerezo Téllez; Elena Minayo Mogollón



Oncological and functional outcomes of transoral robotic surgery for oropharyngeal cancer.  


In this prospective study we analysed the oncological and functional results of transoral robotic surgery (TORS) to find out if it was suitable as a minimally invasive treatment for oropharyngeal cancer. Between April 2008 and September 2011, 39 patients with oropharyngeal cancer were treated by TORS. We assessed overall and disease-free survival by the Kaplan-Meier test, and we used videopharyngography and the functional outcome swallowing scale (FOSS) to evaluate swallowing. We used nasometry to estimate hypernasality, and acoustic waveform analysis to evaluate the voice. Thirty-seven patients (95%) had histologically clear margins of resection. Overall survival at 2 years was 96% and disease-free survival 92%. An oral diet was tolerable after a mean of 6 (range 1-18) days. No serious swallowing difficulties were seen on the videopharyngogram. Thirty-six of 38 patients could swallow well (97%) with FOSS scores ranging from 0 to 2 (1 patient had a poor score but was able to take an oral diet after postural training). Voices were maintained close to the normal range on the acoustic waveform analysis. The oncological and functional results of TORS were quite acceptable for the treatment of oropharyngeal cancer. TORS is a valid treatment for selected patients with oropharyngeal cancer. PMID:23063012

Park, Young Min; Kim, Won Shik; Byeon, Hyung Kwon; Lee, Sei Young; Kim, Se-Heon



[Sphincter-preserving surgery for lower rectal cancer aimed at improving postoperative bowel function].  


Much attention has been focused on sphincter-preserving surgery for patients with lower rectal cancer, leading to renewed interest in the outcome of postoperative bowel function. Some patients who undergo sphincter-preserving surgery experience bowel dysfunction, such as frequent stools, severe constipation, soiling, and incontinence. These symptoms were thought to be correlate with lower resting pressure, lower rectal compliance, sensory disturbance of the anal canal, spasm, and delayed transit in the colon above the anastomosis. To improve postoperative bowel function, reconstruction with the colonic J-pouch has been performed, which results in a satisfactory functional outcome. About 80% of patients with a J-pouch were able to tolerate over 10 minutes after feeling the desire to defecate. An anorectal manometric study showed no abnormal spastic movement of the neorectum and a transit study showed that the J-pouch group was superior to the straight group with respect to the smoothness of movement of radiopaque markers from the cecum to anal ring, although a small number of markers were retained in the colonic J-pouch. Patients who received a colonic J-pouch had fewer defecation problems in daily life. Further study is need to improve postoperative bowel movement in patients who undergo sphincter-preserving surgery. PMID:10919155

Morita, T; Suzuki, J; Yoshizaki, T; Kimura, Y; Nakamura, F; Itoh, T; Murata, A; Nishi, T; Koyama, M; Sasaki, M



Miscellaneous syndromes and their management: occult breast cancer, breast cancer in pregnancy, male breast cancer, surgery in stage IV disease.  


Surgical therapy for occult breast cancer has traditionally centered on mastectomy; however, breast conservation with whole breast radiotherapy followed by axillary lymph node dissection has shown equivalent results. Patients with breast cancer in pregnancy can be safely and effectively treated; given a patient's pregnancy trimester and stage of breast cancer, a clinician must be able to guide therapy accordingly. Male breast cancer risk factors show strong association with BRCA2 mutations, as well as Klinefelter syndrome. Several retrospective trials of surgical therapy in stage IV breast cancer have associated a survival advantage with primary site tumor extirpation. PMID:23464700

Colfry, Alfred John



Vascular and Cognitive Assessments in Patients With Breast Cancer Undergoing Chemotherapy After Surgery

Cognitive/Functional Effects; Recurrent Breast Cancer; Stage IA Breast Cancer; Stage IB Breast Cancer; Stage II Breast Cancer; Stage IIIA Breast Cancer; Stage IIIB Breast Cancer; Stage IIIC Breast Cancer



Octreotide as Palliative Therapy for Cancer-Related Bowel Obstruction That Cannot Be Removed by Surgery

Colorectal Cancer; Constipation, Impaction, and Bowel Obstruction; Extrahepatic Bile Duct Cancer; Gastric Cancer; Gastrointestinal Stromal Tumor; Nausea and Vomiting; Ovarian Cancer; Pancreatic Cancer; Peritoneal Cavity Cancer; Small Intestine Cancer



Bone registration method for robot assisted surgery: pedicle screw insertion  

Microsoft Academic Search

SUMMARY A registration method that identifies bone geometry with respect to a robotic manipulator arm is presented. Although the method is generally applicable to many orthopaedic internal fixation, it was only demonstrated for the insertion of pedicle screws in vertebral bodies for spine fixation. The method relies upon obtaining an impression of the vertebral bodies. Computed Tomography scans of both

K Abdel-Malek; D P McGowan; V K Goel; D Kowalski; A Hager



Methods for identifying risk of breast cancer and treatments thereof  

US Patent & Trademark Office Database

Provided herein are methods for identifying risk of breast cancer in a subject and/or a subject at risk of breast cancer, reagents and kits for carrying out the methods, methods for identifying candidate therapeutics for treating breast cancer, and therapeutic methods for treating breast cancer in a subject. These embodiments are based upon an analysis of polymorphic variations in nucleotide sequences within the human genome.

Roth; Richard B. (La Jolla, CA); Nelson; Matthew Roberts (San Marcos, CA); Kammerer; Stefan M. (San Diego, CA); Braun; Andreas (San Diego, CA); Reneland; Rikard (San Diego, CA)



Transoral Robotic Surgery for Oropharyngeal Cancer: Long-term Quality of Life and Functional Outcomes.  


IMPORTANCE Because treatment for oropharyngeal squamous cell carcinoma (OPSCC), especially in patients of older age, is associated with decreased patient quality of life (QOL) after surgery, demonstration of a less QOL-impairing treatment technique would improve patient satisfaction substantially. OBJECTIVE To determine swallowing, speech, and QOL outcomes following transoral robotic surgery (TORS) for OPSCC. DESIGN, PATIENTS, AND SETTING This prospective cohort study of 81 patients with previously untreated OPSCC was conducted at a tertiary care academic comprehensive cancer center. INTERVENTIONS Primary surgical resection via TORS and neck dissection as indicated. MAIN OUTCOMES AND MEASURES Patients were asked to complete the Head and Neck Cancer Inventory (HNCI) preoperatively and at 3 weeks as well as 3, 6, and 12 months postoperatively. Swallowing ability was assessed by independence from a gastrostomy tube (G-tube). Clinicopathologic and follow-up data were also collected. RESULTS Mean follow-up time was 22.7 months. The HNCI response rates at 3 weeks and 3, 6, and 12 months were 79%, 60%, 63%, and 67% respectively. There were overall declines in speech, eating, aesthetic, social, and overall QOL domains in the early postoperative periods. However, at 1 year post TORS, scores for aesthetic, social, and overall QOL remained high. Radiation therapy was negatively correlated with multiple QOL domains (P < .05 for all comparisons), while age older than 55 years correlated with lower speech and aesthetic scores (P < .05 for both). Human papillomavirus status did not correlate with any QOL domain. G-tube rates at 6 and 12 months were 24% and 9%, respectively. Greater extent of TORS (>1 oropharyngeal site resected) and age older than 55 years predicted the need for a G-tube at any point after TORS (P < .05 for both). CONCLUSIONS AND RELEVANCE Patients with OPSCC treated with TORS maintain a high QOL at 1 year after surgery. Adjuvant treatment and older age tend to decrease QOL. Patients meeting these criteria should be counseled appropriately. PMID:23576186

Dziegielewski, Peter T; Teknos, Theodoros N; Durmus, Kasim; Old, Matthew; Agrawal, Amit; Kakarala, Kiran; Marcinow, Anna; Ozer, Enver



Facial plastic surgery area acquisition method based on point cloud mathematical model solution.  


It is one of the hot research problems nowadays to find a quick and accurate method of acquiring the facial plastic surgery area to provide sufficient but irredundant autologous or in vitro skin source for covering extensive wound, trauma, and burnt area. At present, the acquisition of facial plastic surgery area mainly includes model laser scanning, point cloud data acquisition, pretreatment of point cloud data, three-dimensional model reconstruction, and computation of area. By using this method, the area can be computed accurately, but it is hard to control the random error, and it requires a comparatively longer computation period. In this article, a facial plastic surgery area acquisition method based on point cloud mathematical model solution is proposed. This method applies symmetric treatment to the point cloud based on the pretreatment of point cloud data, through which the comparison diagram color difference map of point cloud error before and after symmetry is obtained. The slicing mathematical model of facial plastic area is got through color difference map diagram. By solving the point cloud data in this area directly, the facial plastic area is acquired. The point cloud data are directly operated in this method, which can accurately and efficiently complete the surgery area computation. The result of the comparative analysis shows the method is effective in facial plastic surgery area. PMID:24036743

Li, Xuwu; Liu, Fei



PS1-28: Rectal Cancer Survivors with Ostomies and Anastomoses: Effects of Cancer Surgery on Perceived Financial Burden and Employment.  


Background/Aims Rectal cancer surgery includes a colostomy (or ileostomy) or, more frequently, anastomosis of the rectum. Both surgery types may create long-term after-effects. We examined differences reported between survivors with ostomies versus anastomoses regarding levels of work, volunteering, and financial burdens, and how much they perceived their cancer operations affected these experiences. Methods We mailed questionnaires to 1,063 rectal cancer survivors (5+ years post-diagnosis) in Kaiser Permanente (Northern California, Northwest) during 2010-2011. We asked about current employment status and the impact of their cancers on labor force participation, demotions, job discrimination, forced retirement, volunteering, social activities, and marital status. Our overall response rate was 60.5% (578/955). We analyzed usable responses from 390 survivors with anastomoses (69%) and 178 survivors with ostomies (31%) for differences in self-reported functional health status, work, volunteer, and perceived financial burden. Results Survivorship ranged from 5 to 25 years. Mean ages for both groups were significantly beyond retirement age (anastomoses = 72 years, colostomies = 74 years) (NS). 56% of patients with anastomoses were male compared to 66% of ostomates (P <0.03). About 35% of all survivors were not married or partnered at time of survey. Survivors with anastomoses were more likely to be currently working (FT+PT=33% (128/383)) than survivors with colostomies (FT+PT=20% (35/178)), while survivors with ostomies were more likely to be retired or homemakers (77% (137/178) vs. 64% (247/383) or on Disability (ostomies = 3.4% (6/178), anastomoses = 2.1% (8/383)) (P <0.01). Stage at diagnosis was not associated with employment or volunteer activities among survivors, but employed survivors had significantly shorter survivorship periods than non-working survivors (P <0.05). Compared to survivors with anastomoses, survivors with ostomies reported significantly higher perceived financial burden from their cancer and its treatment (P <0.001). Permanently disabled survivors reported even higher perceived financial burden than non-disabled survivors, with no differences by ostomy and anastomosis status. Conclusions Compared to survivors with ostomies, survivors with anastomoses were more likely to report being currently employed/working in the home and having lesser financial burdens from their illness. Interventions are needed to support survivors with ostomies to participate in work and volunteer activities, to manage their personal finances, and to maintain their social networks and personal relationships. PMID:24085878

Hornbrook, Mark; Grant, Marcia; Wendel, Christopher; Bulkley, Joanna; McMullen, Carmit; Altschuler, Andrea; Temple, Larissa; Herrinton, Lisa; Krouse, Robert



PS1-28: Rectal Cancer Survivors with Ostomies and Anastomoses: Effects of Cancer Surgery on Perceived Financial Burden and Employment  

PubMed Central

Background/Aims Rectal cancer surgery includes a colostomy (or ileostomy) or, more frequently, anastomosis of the rectum. Both surgery types may create long-term after-effects. We examined differences reported between survivors with ostomies versus anastomoses regarding levels of work, volunteering, and financial burdens, and how much they perceived their cancer operations affected these experiences. Methods We mailed questionnaires to 1,063 rectal cancer survivors (5+ years post-diagnosis) in Kaiser Permanente (Northern California, Northwest) during 2010–2011. We asked about current employment status and the impact of their cancers on labor force participation, demotions, job discrimination, forced retirement, volunteering, social activities, and marital status. Our overall response rate was 60.5% (578/955). We analyzed usable responses from 390 survivors with anastomoses (69%) and 178 survivors with ostomies (31%) for differences in self-reported functional health status, work, volunteer, and perceived financial burden. Results Survivorship ranged from 5 to 25 years. Mean ages for both groups were significantly beyond retirement age (anastomoses = 72 years, colostomies = 74 years) (NS). 56% of patients with anastomoses were male compared to 66% of ostomates (P <0.03). About 35% of all survivors were not married or partnered at time of survey. Survivors with anastomoses were more likely to be currently working (FT+PT=33% (128/383)) than survivors with colostomies (FT+PT=20% (35/178)), while survivors with ostomies were more likely to be retired or homemakers (77% (137/178) vs. 64% (247/383) or on Disability (ostomies = 3.4% (6/178), anastomoses = 2.1% (8/383)) (P <0.01). Stage at diagnosis was not associated with employment or volunteer activities among survivors, but employed survivors had significantly shorter survivorship periods than non-working survivors (P <0.05). Compared to survivors with anastomoses, survivors with ostomies reported significantly higher perceived financial burden from their cancer and its treatment (P <0.001). Permanently disabled survivors reported even higher perceived financial burden than non-disabled survivors, with no differences by ostomy and anastomosis status. Conclusions Compared to survivors with ostomies, survivors with anastomoses were more likely to report being currently employed/working in the home and having lesser financial burdens from their illness. Interventions are needed to support survivors with ostomies to participate in work and volunteer activities, to manage their personal finances, and to maintain their social networks and personal relationships.

Hornbrook, Mark; Grant, Marcia; Wendel, Christopher; Bulkley, Joanna; McMullen, Carmit; Altschuler, Andrea; Temple, Larissa; Herrinton, Lisa; Krouse, Robert



Plastic Surgery  

Microsoft Academic Search

\\u000a Comprehensive cancer centers in the United States interweave subspecialty care from multiple disciplines. These centers’ very\\u000a existence is testimony to the broad interdisciplinary approach to cancer care today. Plastic surgery, with its ability to\\u000a restore form and function, represents a small but critical component of the comprehensive care of patients with cancer. Plastic\\u000a surgical reconstruction extends the capabilities of surgery

Neil A. Fine; Charles E. Butler


Thermography--a feasible method for screening breast cancer?  


Potential use of thermography for more effective detection of breast carcinoma was evaluated on 26 patients scheduled for breast carcinoma surgery. Ultrasonographic scan, mammography and thermography were performed at the University Hospital for Tumors. Thermographic imaging was performed using a new generation of digital thermal cameras with high sensitivity and resolution (ThermoTracer TH7102WL, NEC). Five images for each patient were recorded: front, right semi-oblique, right oblique, left- semi oblique and left oblique. While mammography detected 31 changes in 26 patients, thermography was more sensitive and detected 6 more changes in the same patients. All 37 changes were subjected to the cytological analysis and it was found that 16 of samples were malignant, 8 were suspected malignant and 11 were benign with atypia or proliferation while only 2 samples had benign findings. The pathohistological method (PHD) recorded 75.75% malignant changes within the total number of samples. Statistical analysis of the data has shown a probability of a correct mammographic finding in 85% of the cases (sensitivity of 85%, specificity of 84%) and a probability of a correct thermographic finding in 92% of the cases (sensitivity of 100%, specificity of 79%). As breast cancer remains the most prevalent cancer in women and thermography exhibited superior sensitivity, we believe that thermography should immediately find its place in the screening programs for early detection of breast carcinoma, in order to reduce the sufferings from this devastating disease. PMID:23941007

Kolari?, Darko; Herceg, Zeljko; Nola, Iskra Alexandra; Ramljak, Vesna; Kulis, Tomislav; Holjevac, Jadranka Katanci?; Deutsch, Judith A; Antonini, Svetlana



Surgery after induction chemotherapy in stage IIIA-N2 non-small cell lung cancer: Why pneumonectomy should be avoided  

Microsoft Academic Search

BackgroundThe role of surgery in the treatment of patients with stage IIIA (N2) non-small cell lung cancer (NSCLC) is a hot topic. Since variable results of surgery versus radiotherapy after induction chemotherapy are being reported, this study aimed to analyze results of surgery after induction chemotherapy and to identify relevant factors influencing outcome in patients with stage IIIA NSCLC.

Ingrid Kappers; Johanna W. van Sandick; Sjaak A. Burgers; José S. A. Belderbos; Nico van Zandwijk; Houke M. Klomp



CA-125-indicated asymptomatic relapse confers survival benefit to ovarian cancer patients who underwent secondary cytoreduction surgery  

PubMed Central

Background There is no consensus regarding the management of ovarian cancer patients, who have shown complete clinical response (CCR) to primary therapy and have rising cancer antigen CA-125 levels but have no symptoms of recurrent disease. The present study aims to determine whether follow-up CA-125 levels can be used to identify the need for imaging studies and secondary cytoreductive surgery (CRS). Methods We identified 410 ovarian cancer patients treated at The University of Texas MD Anderson Cancer Center between 1984 and 2011. These patients had shown CCR to primary therapy. Follow-up was conducted based on the surveillance protocol of the MD Anderson Cancer Center. We used the Cox proportional hazards model and log-rank test to assess the associations between the follow-up CA-125 levels and secondary CRS and survival duration. Results The CA-125 level of 1.68?×?nadir was defined as the indicator of recurrent disease (p??1.68?×?nadir at relapse (55.7 and 10.4?months; p?=?0.04 and 0.01, respectively). The overall and progression free survival duration of patients with asymptomatic relapse and underwent a secondary CRS was longer than that of patients with symptomatic relapse (p?=?0.02 and 0.04 respectively). Conclusions The increase of serum CA-125 levels is an early warning of clinical relapse in ovarian cancer. Using CA-125 levels in guiding the treatment of patients with asymptomatic recurrent ovarian cancer, who have shown CCR to primary therapy, can facilitate optimal secondary CRS and extend the survival duration of the patients.



The process of deciding about prophylactic surgery for breast and ovarian cancer: Patient questions, uncertainties, and communication.  


Many, women who have, or are at risk for, BRCA, 1/2 mutations or breast cancer decline prophylactic surgery, but questions remain as to how they make and experience these decisions. Our methods consisted of interviewing 32 women for 2 hr each; 19 were tested, 20 were symptomatic. Our results showed that these surgical options forced women to confront questions, involving stresses and uncertainties, regarding: implications of test results, prognoses with and without surgery, and effects of surgery (e.g., on self-image). Given these dilemmas, many women turned to doctors who then ranged in what and how they communicated about these issues, and how strongly they offered input. Some patients felt disappointed at provider non-directiveness, while others found providers too directive. Patients turned to family members and friends, who also ranged in how and what they communicated, and whether they agreed with the patient and/or each other. Many women turned to patient communities, but then had to decide how involved to be, and what information to provide or accept. These data suggest that providers and others may need to be more aware of the series of questions, involving stresses and uncertainties, that these women face, and the complex roles providers themselves may play. These data highlight needs for physicians to be able to address these issues flexibly, gauging patient preferences for information and paternalism (vs. autonomy). These data suggest areas for future research: for example, on how providers decide whether, what and how to communicate about these issues, and how these choices shape treatment decisions. PMID:20014126

Klitzman, Robert; Chung, Wendy



Integration of robotics into two established programs of minimally invasive surgery for endometrial cancer appears to decrease surgical complications  

PubMed Central

Objective To compare peri- and postoperative outcomes and complications of laparoscopic vs. robotic-assisted surgical staging for women with endometrial cancer at two established academic institutions. Methods Retrospective chart review of all women that underwent total hysterectomy with pelvic and para-aortic lymphadenectomy by robotic-assisted or laparoscopic approach over a four-year period by three surgeons at two academic institutions. Intraoperative and postoperative complications were measured. Secondary outcomes included operative time, blood loss, transfusion rate, number of lymph nodes retrieved, length of hospital stay and need for re-operation or re-admission. Results Four hundred and thirty-two cases were identified: 187 patients with robotic-assisted and 245 with laparoscopic staging. Both groups were statistically comparable in baseline characteristics. The overall rate of intraoperative complications was similar in both groups (1.6% vs. 2.9%, p=0.525) but the rate of urinary tract injuries was statistically higher in the laparoscopic group (2.9% vs. 0%, p=0.020). Patients in the robotic group had shorter hospital stay (1.96 days vs. 2.45 days, p=0.016) but an average 57 minutes longer surgery than the laparoscopic group (218 vs. 161 minutes, p=0.0001). There was less conversion rate (0.5% vs. 4.1%; relative risk, 0.21; 95% confidence interval, 0.03 to 1.34; p=0.027) and estimated blood loss in the robotic than in the laparoscopic group (187 mL vs. 110 mL, p=0.0001). There were no significant differences in blood transfusion rate, number of lymph nodes retrieved, re-operation or re-admission between the two groups. Conclusion Robotic-assisted surgery is an acceptable alternative to laparoscopy for staging of endometrial cancer and, in selected patients, it appears to have lower risk of urinary tract injury.

Cardenas-Goicoechea, Joel; Soto, Enrique; Chuang, Linus; Gretz, Herbert



Epidermal Growth Factor Receptor (EGFR) Expression is Associated With a Worse Prognosis in Gastric Cancer Patients Undergoing Curative Surgery  

Microsoft Academic Search

Background  In gastric cancer, the recurrence rate is high even after curative surgery. A relevant issue is the identification of independent\\u000a prognostic factors to select high-risk patients; such features can be used as predictive factors for tailored therapies. In\\u000a this study we have investigated the role of epidermal growth factor receptor (EGFR) expression as a prognostic marker for\\u000a predicting cancer behavior

Gennaro Galizia; Eva Lieto; Michele Orditura; Paolo Castellano; Anna La Mura; Vincenzo Imperatore; Margherita Pinto; Anna Zamboli; Ferdinando De Vita; Francesca Ferraraccio



Heart surface motion estimation framework for robotic surgery employing meshless methods  

Microsoft Academic Search

A novel heart surface motion estimation frame- work for a robotic surgery on a stabilized beating heart is proposed. It includes an approach for the reconstruction and prediction of heart surface motion based on a novel physical model of the intervention area described by a distributed- parameter system. Instead of conventional element methods, a meshless method is used for a

Evgeniya Bogatyrenko; Uwe D. Hanebeck; Gábor Szabó



A comparison of two methods for identifying surgical site infections following orthopaedic surgery  

Microsoft Academic Search

Many infection control practitioners (ICPs) dedicate a significant amount of time and resources to surveillance of surgical site infections (SSIs). Alternative surveillance methods need to be explored to reflect the changes to the healthcare system and the increasing economic constraints placed on infection control units. This study was undertaken to compare two methods of identifying SSIs in orthopaedic surgery. Surveillance

H. L. Cadwallader; M. Toohey; S. Linton; A. Dyson; T. V. Riley



Study of time-course changes in annual recurrence rates for breast cancer: data analysis of 2,209 patients for 10 years post-surgery  

Microsoft Academic Search

Annual recurrence rates (ARR) are used to assess changes in the risk of breast cancer recurrence following surgery. In this\\u000a retrospective study, ARR were calculated from the clinical records of 2,209 breast cancer patients who had undergone surgery.\\u000a The time-course changes of ARR associated with prognostic\\/predictive factors were calculated. Overall, ARR decreased for 5 years\\u000a following surgery and then remained almost

Morihiko Kimura; Yasuhiro Yanagita; Tomomi Fujisawa; Tokihiro Koida



[Rectal cancer--review of methods and treatment results].  


Rectal cancer poses a significant worldwide problem. Until the late 19 century surgeons were convinced that surgical attempts of treating rectal cancers were doomed to failure. Currently, surgery is associated with a poor prognosis, a high likelihood of permanent colostomy and a high rate of local recurrence in patients with regional disease. Functional changes such as bladder dysfunction and impotence remain distressingly common consequences of conventional surgery. An important understanding of rectal cancer pathology allied to modern surgical techniques such as intestinal stapling guns has led to an increased number of sphincter saving operations. The technique of sharp dissection along definable planes known as total mesorectal excision (TME) produces the complete resection of an intact package of the rectum and surrounding mesorectum, enveloped within the visceral pelvic fascia with uninvolved circumferential margins. As a result of TME, 5-year survival figures have risen from 45-50% to 78%, local recurrence rates have declined from 30% to 5-8%, sphincter preservation has risen by at least 20%, and the rates of bladder dysfunction and impotence have declined from 50-70% to 15%. In some selected cases transanal techniques with or without radiotherapy have improved the success of local excision. The value of laparoscopic surgery for rectal cancer in terms of cancer outcome can only be assessed by large clinical trials with sufficient follow-up. PMID:15190612

Grotowski, Maciej



Methods and compositions for improved articular surgery using collagen  

US Patent & Trademark Office Database

The invention provides methods for treating post-surgical articular or incisional pain and/or discomfort in a patient. The invention further provides improved surgical methods and controlled release formulations for treating an articular injury of a joint in a patient, in which a collagen formulation is used in conjunction with a surgical procedure to treat the articular injury or the side effects of the surgical procedure. Collagen formulations of the invention and their use, in addition to the surgical procedure, may provide at least one or more of the following benefits: reduced patient pain, shortened recovery time and/or improved joint condition (including treatment of the underlying articular injury). Moreover, the methods and compositions of the invention can be used in conjunction with essentially any surgical procedure used to treat an articular injury. The invention further provides compositions and methods for treating post-surgical articular or incisional pain in a patient as well as a catheter for use in the methods of the invention.

Alvis; Mark Ray (Santa Cruz, CA); Brown; Melissa K. C. (Los Altos, CA); Fiebiger; Roy C. (Los Gatos, CA)



Comparative analysis of intraocular lens power calculation methods after excimer laser surgery.  


Many methods have been used in an attempt to more accurate predict the intraocular lens (IOL) power in the eyes undergoing refractive surgery, but none has proved most accurate. The aim of this study was to evaluate the accuracy and predictability of different IOL power calculation methods in eyes after excimer laser surgery. The outcomes of phacoemulsification and IOL implantation in 18 eyes of 16 patients with prior excimer laser keratectomy were documented. The lowest error was achieved using history-derived method. The refractive results of IOL implantation using the same biometry data in eyes after excimer laser surgery can vary markedly. In the present study, the SRK-T formula resulted in highest accuracy. PMID:23431734

Alcorta Toro, Ivan; Blanco, Graciela; Losada Rodriguez, Antolin; Rodrigo Garcia, C; Guillermo Merino, B



Methods for haptic feedback in teleoperated robot-assisted surgery  

Microsoft Academic Search

Teleoperated minimally invasive surgical robots can significantly enhance a surgeon's accuracy, dexterity and visualization. However, current commercially available systems do not include significant haptic (force and tactile) feedback to the operator. This paper describes experiments to characterize this problem, as well as several methods to provide haptic feedback in order to improve surgeon's performance. There exist a variety of sensing

A. M. Okamura



Antifibrinolytic Therapy and Perioperative Blood Loss in Cancer Patients Undergoing Major Orthopedic Surgery  

Microsoft Academic Search

Background: Aprotinin has been reported to reduce blood loss and transfusion requirements in patients having major orthopedic operations. Data on whether ? amino-caproic acid (EACA) is effective in this population are sparse. Methods: Sixty-nine adults with malignancy scheduled for either pelvic, extremity or spine surgery during general anesthesia entered this randomized, double-blind, placebo-controlled trial, and received either intravenous aprotinin (n

David Amar; Florence M. Grant; Hao Zhang; Patrick J. Boland; Denis H Y Leung; John A. Healey



Image-guided surgery in head and neck cancer: current practice and future directions of optical imaging.  


A key aspect for the postoperative prognosis of patients with head and neck cancer is complete tumor resection. In current practice, the intraoperative assessment of the tumor-free margin is dependent on visual appearance and palpation of the tumor. Optical imaging has the potential of traversing the gap between radiology and surgery by providing real-time visualization of the tumor, thereby allowing for image-guided surgery. The use of the near-infrared light spectrum offers 2 essential advantages: increased tissue penetration of light and an increased signal-to-background ratio of contrast agents. In this review, the current practice and limitations of image-guided surgery by optical imaging using intrinsic fluorescence or contrast agents are described. Furthermore, we provide an overview of the various molecular contrast agents targeting specific hallmarks of cancer that have been used in other fields of oncologic surgery, and we describe perspectives on its future use in head and neck cancer surgery. PMID:21284051

Keereweer, S; Sterenborg, H J C M; Kerrebijn, J D F; Van Driel, P B A A; Baatenburg de Jong, R J; Löwik, C W G M



Social support and recovery after surgery for breast cancer: Frequency and correlates of supportive behaviours by family, friends and surgeon  

Microsoft Academic Search

In a longitudinal study of recovery after surgery for breast cancer, subjects reported the frequency of, and their satisfaction with, various supportive behaviours on the part of family members, close friends and medical professionals. The reliability of the Multi-Dimensional Support Scale (MDSS) devised for this purpose is described. Measures of psychological, social and physical adjustment approached normality by 3 months

Sandra J. Neuling; Helen R. Winefield



Breast cancer surgery: Comparing surgical groups and determining individual differences in postoperative sexuality and body change stress  

Microsoft Academic Search

Women diagnosed and surgically treated for regional breast cancer (N = 190) were studied to determine the sexual and body change sequelae for women receiving modified radical mastectomy (MRM) with breast reconstruction in comparison with the sequelae for women receiving breast-conserving therapy (BCT) or MRM without breast reconstruction. The sexuality pattern for women receiving reconstructive surgery was one that was

Debora Yurek; William Farrar; Barbara L. Andersen



A Prospective Randomized Study to Assess the Optimal Duration of Intravenous Antimicrobial Prophylaxis in Elective Gastric Cancer Surgery  

PubMed Central

The duration of antimicrobial prophylaxis in gastric cancer surgery is not yet established. This prospective randomized study was performed to confirm the noninferiority of single-dose versus multiple-dose antimicrobial prophylaxis in terms of the incidence of surgical-site infection in gastric cancer surgery. Three hundred twenty-five patients undergoing elective resection for gastric cancer were randomized to receive only single-dose cefazolin (1 g) during surgery (single-dose group) or an additional 5 doses every 12 hours postoperatively (multiple-dose group). The overall incidence of surgical-site infections was 9.1% in the single-dose group and 6.2% in the multiple-dose group [difference (95% confidence interval): ?2.9% (?5.9%–0.0%)]. Multivariate logistic regression analysis identified blood loss, being overweight, and advanced age as significant independent risk factors for surgical-site infection. Single-dose antimicrobial prophylaxis seemed to be acceptable, and choosing multiple-dose prophylaxis may have little impact on the prevention of surgical-site infections in elective gastric cancer surgery.

Haga, Norihiro; Ishida, Hideyuki; Ishiguro, Toru; Kumamoto, Kensuke; Ishibashi, Keiichiro; Tsuji, Yoshitaka; Miyazaki, Tatsuya



A New Noninvasive Approach in Breast Cancer Therapy Using Magnetic Resonance Imaging-guided Focused Ultrasound Surgery1  

Microsoft Academic Search

An ideal vision of modern medicine includes tumor surgery with the human body remaining completely intact. A noninvasive therapy could avoid infections and scar formation; it would require less anesthesia, reduce recovery time, and possibly also reduce costs. This study investi- gated whether human breast cancer can be effectively treated with a novel combination of image guidance and energy delivery,

Peter E. Huber; Juergen W. Jenne; Ralf Rastert; Ioannis Simiantonakis; Hans-Peter Sinn; Hans-Joachim Strittmatter; Dietrich von Fournier; Michael F. Wannenmacher; Juergen Debus



Vesicourethral Function after Surgery for Uterine Cancer: Predictive Value of Postoperative Maximum Urethral Closure Pressure on Residual Urine  

Microsoft Academic Search

Using a urodynamic technique, vesicourethral function was evaluated in 30 patients who had undergone surgery for uterine cancer. In all 28 patients treated with radical hysterectomy, detrusor function was damaged irrespective of the use of the Cavitron ultrasonic surgical aspirator (CUSA), whereas, in 2 patients treated with semiradical hysterectomy, the function was preserved. Vesicourethral functions 3 weeks after the operation

Hiroaki Shiina; Shoji Ehara; Tomoyuki Ishibe