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Sample records for surgically resected lung

  1. Reduction of Pulmonary Function After Surgical Lung Resections of Different Volume

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    Cukic, Vesna

    2014-01-01

    Introduction: In recent years an increasing number of lung resections are being done because of the rising prevalence of lung cancer that occurs mainly in patients with limited lung function, what is caused with common etiologic factor - smoking cigarettes. Objective: To determine how big the loss of lung function is after surgical resection of lung of different range. Methods: The study was done on 58 patients operated at the Clinic for thoracic surgery KCU Sarajevo, previously treated at th...

  2. SURGICAL RESECTION FOR SMALL-CELL CARCINOMA OF THE LUNG - A RETROSPECTIVE STUDY

    NARCIS (Netherlands)

    SMIT, EF; GROEN, HJM; TIMENS, W; POSTMUS, PE

    1994-01-01

    Background - A retrospective review was undertaken of the survival of 21 patients with histologically proven small cell carcinoma of the lung resected between 1977 and 1991. Methods - Twenty one patients (20 men) of median age 60 (range 44-73) years underwent surgical resection. Patients were subjec

  3. Reduction of Pulmonary Function After Surgical Lung Resections of Different Volume

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    Cukic, Vesna

    2014-01-01

    Introduction: In recent years an increasing number of lung resections are being done because of the rising prevalence of lung cancer that occurs mainly in patients with limited lung function, what is caused with common etiologic factor - smoking cigarettes. Objective: To determine how big the loss of lung function is after surgical resection of lung of different range. Methods: The study was done on 58 patients operated at the Clinic for thoracic surgery KCU Sarajevo, previously treated at the Clinic for pulmonary diseases “Podhrastovi” in the period from 01.06.2012. to 01.06.2014. The following resections were done: pulmectomy (left, right), lobectomy (upper, lower: left and right). The values of postoperative pulmonary function were compared with preoperative ones. As a parameter of lung function we used FEV1 (forced expiratory volume in one second), and changes in FEV1 are expressed in liters and in percentage of the recorded preoperative and normal values of FEV1. Measurements of lung function were performed seven days before and 2 months after surgery. Results: Postoperative FEV1 was decreased compared to preoperative values. After pulmectomy the maximum reduction of FEV1 was 44%, and after lobectomy it was 22% of the preoperative values. Conclusion: Patients with airway obstruction are limited in their daily life before the surgery, and an additional loss of lung tissue after resection contributes to their inability. Potential benefits of lung resection surgery should be balanced in relation to postoperative morbidity and mortality. PMID:25568542

  4. Neoadjuvant therapy and surgical resection for locally advanced non-small cell lung cancer.

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    Meko, J; Rusch, V W

    2000-10-01

    During the past 15 years, treatment of stage IIIA (N2) non-small cell lung cancer has evolved considerably because of improvements in patients selection, staging, and combined modality therapy. Results of several clinical trials suggest that induction chemotherapy or chemoradiation and surgical resection is superior to surgery alone. However, the optimal induction regimen has not been defined. An intergroup trial is also underway to determine whether chemoradiation and surgical resection leads to better survival than chemotherapy and radiation alone. Future studies will assess ways to combine radiation and novel chemotherapeutic agents, and will identify molecular abnormalities that predict response to induction therapy.

  5. Changes of Arterial Blood Gases After Different Ranges of Surgical Lung Resection

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    Cukic, Vesna; Lovre, Vladimir

    2012-01-01

    Introduction: In recent years there has been increase in the number of patients who need thoracic surgery – first of all different types of pulmonary resection because of primary bronchial cancer, and very often among patients whose lung function is impaired due to different degree of bronchial obstruction so it is necessary to assess functional status before and after lung surgery to avoid the development of respiratory insufficiency. Objective: To show the changes in the level of arterial blood gases after various ranges of lung resection. Material and methods: The study was done on 71 patients surgically treated at the Clinic for Thoracic Surgery KCU Sarajevo, who were previously treated at the Clinic for Pulmonary Diseases “Podhrastovi” in the period from 01. 06. 2009. to 01. 09. 2011. Different types of lung resection were made. Patients whose percentage of ppoFEV1 was (prognosed postoperative FEV1) was less than 30% of normal values of FEV1 for that patients were not given a permission for lung resection. We monitored the changes in levels-partial pressures of blood gases (PaO2, PaCO2 and SaO2) one and two months after resection and compared them to preoperative values. As there were no significant differences between the values obtained one and two months after surgery, in the results we showed arterial blood gas analysis obtained two months after surgical resection. Results were statistically analyzed by SPSS and Microsoft Office Excel. Statistical significance was determined at an interval of 95%. Results: In 59 patients (83%) there was an increase, and in 12 patients (17%) there was a decrease of PaO2, compared to preoperative values. In 58 patients (82%) there was a decrease, and in 13 patients (18%) there was an increase in PaCO2, compared to preoperative values. For all subjects (group as whole): The value of the PaO2 was significantly increased after lung surgery compared to preoperative values (p <0.05) so is the value of the SaO2%. The value

  6. Raman microscopy in the diagnosis and prognosis of surgically resected nonsmall cell lung cancer

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    Magee, Nicholas David; Beattie, James Renwick; Carland, Chris; Davis, Richard; McManus, Kieran; Bradbury, Ian; Fennell, Dean Andrew; Hamilton, Peter William; Ennis, Madeleine; McGarvey, John Joseph; Elborn, Joseph Stuart

    2010-03-01

    The main curative therapy for patients with nonsmall cell lung cancer is surgery. Despite this, the survival rate is only 50%, therefore it is important to more efficiently diagnose and predict prognosis for lung cancer patients. Raman spectroscopy is useful in the diagnosis of malignant and premalignant lesions. The aim of this study is to investigate the ability of Raman microscopy to diagnose lung cancer from surgically resected tissue sections, and predict the prognosis of these patients. Tumor tissue sections from curative resections are mapped by Raman microscopy and the spectra analzsed using multivariate techniques. Spectra from the tumor samples are also compared with their outcome data to define their prognostic significance. Using principal component analysis and random forest classification, Raman microscopy differentiates malignant from normal lung tissue. Principal component analysis of 34 tumor spectra predicts early postoperative cancer recurrence with a sensitivity of 73% and specificity of 74%. Spectral analysis reveals elevated porphyrin levels in the normal samples and more DNA in the tumor samples. Raman microscopy can be a useful technique for the diagnosis and prognosis of lung cancer patients receiving surgery, and for elucidating the biochemical properties of lung tumors.

  7. Predicting lung cancer prior to surgical resection in patients with lung nodules.

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    Deppen, Stephen A; Blume, Jeffrey D; Aldrich, Melinda C; Fletcher, Sarah A; Massion, Pierre P; Walker, Ronald C; Chen, Heidi C; Speroff, Theodore; Degesys, Catherine A; Pinkerman, Rhonda; Lambright, Eric S; Nesbitt, Jonathan C; Putnam, Joe B; Grogan, Eric L

    2014-10-01

    Existing predictive models for lung cancer focus on improving screening or referral for biopsy in general medical populations. A predictive model calibrated for use during preoperative evaluation of suspicious lung lesions is needed to reduce unnecessary operations for a benign disease. A clinical prediction model (Thoracic Research Evaluation And Treatment [TREAT]) is proposed for this purpose. We developed and internally validated a clinical prediction model for lung cancer in a prospective cohort evaluated at our institution. Best statistical practices were used to construct, evaluate, and validate the logistic regression model in the presence of missing covariate data using bootstrap and optimism corrected techniques. The TREAT model was externally validated in a retrospectively collected Veteran Affairs population. The discrimination and calibration of the model was estimated and compared with the Mayo Clinic model in both the populations. The TREAT model was developed in 492 patients from Vanderbilt whose lung cancer prevalence was 72% and validated among 226 Veteran Affairs patients with a lung cancer prevalence of 93%. In the development cohort, the area under the receiver operating curve (AUC) and Brier score were 0.87 (95% confidence interval [CI], 0.83-0.92) and 0.12, respectively compared with the AUC 0.89 (95% CI, 0.79-0.98) and Brier score 0.13 in the validation dataset. The TREAT model had significantly higher accuracy (p < 0.001) and better calibration than the Mayo Clinic model (AUC = 0.80; 95% CI, 75-85; Brier score = 0.17). The validated TREAT model had better diagnostic accuracy than the Mayo Clinic model in preoperative assessment of suspicious lung lesions in a population being evaluated for lung resection.

  8. Concurrent chemoradiotherapy for patients with postoperative recurrence of surgically resected non-small-cell lung cancer.

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    Takenaka, Tomoyoshi; Takenoyama, Mitsuhiro; Toyozawa, Ryo; Inamasu, Eiko; Yoshida, Tsukihisa; Toyokawa, Gouji; Shiraishi, Yoshimasa; Hirai, Fumihiko; Yamaguchi, Masafumi; Seto, Takashi; Ichinose, Yukito

    2015-01-01

    A few reports have evaluated the outcomes of concurrent chemoradiotherapy (CRT) for patients with postoperative recurrence of non-small cell lung cancer (NSCLC). From 2000 through 2011, 1237 consecutive patients with NSCLC underwent pulmonary resection at our institution. Of those, 280 patients had experienced postoperative recurrence by the end of 2012. Thirty-five patients received concurrent CRT as initial treatment of the recurrent disease. We retrospectively reviewed these cases, analyzed the outcomes of concurrent CRT after surgical resection, and examined the factors that predict long-term postrecurrence survival. The most common sites of recurrence in this cohort were the lymph nodes in 24 patients, followed by the lung in 5 patients and bone in 6 patients. The median radiation dose given as the initial treatment of recurrence was 60 Gy (range, 30-60 Gy). Chemotherapy included a platinum agent in all cases; cisplatin-based chemotherapy was administered in 23 cases, and a carboplatin-based chemotherapy regimen was administered in 12. The median progression-free and postrecurrence survival after CRT was 13 months (range, 4-127 months) and 31 months (range, 5-127 months), respectively. Seven patients were still alive without evidence of disease for > 3 years after the recurrence diagnosis. The ECOG performance status (PS), surgical procedure, and types of platinum agents used were independent prognostic factors for postrecurrence survival. Concurrent CRT for recurrent NSCLC is a promising therapy for selected patients. A poor PS and postpneumonectomy state were poor prognostic factors for patients who received concurrent CRT. Copyright © 2015 Elsevier Inc. All rights reserved.

  9. A Histomorphological Pattern Analysis of Pulmonary Tuberculosis in Lung Autopsy and Surgically Resected Specimens

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    Mamta Gupta

    2016-01-01

    Full Text Available Background. Tuberculosis (TB is a major cause of morbidity and mortality globally. Many cases are diagnosed on autopsy and a subset of patients may require surgical intervention either due to the complication or sequelae of TB. Materials and Methods. 40 cases of resected lung specimens following surgery or autopsy in which a diagnosis of pulmonary tuberculosis was made were included. Histopathological pattern analysis of pulmonary tuberculosis along with associated nonneoplastic changes and identification of Mycobacterium tuberculosis bacilli was done. Results. The mean age of diagnosis was 41 years with male predominance (92.5%. Tuberculosis was suspected in only 12.1% of cases before death. Seven cases were operated upon due to associated complications or suspicion of malignancy. Tubercular consolidation was the most frequent pattern followed by miliary tuberculosis. The presence of necrotizing granulomas was seen in 33 cases (82.5%. Acid fast bacilli were seen in 57.5% cases on Ziehl-Neelsen stain. Conclusion. Histopathology remains one of the most important methods for diagnosing tuberculosis, especially in TB prevalent areas. It should be considered in the differential diagnosis of all respiratory diseases because of its varied clinical presentations and manifestations.

  10. Surgical treatment of synchronous colorectal liver and lung metastases:the usefulness of thoracophrenolaparotomy for single stage resection

    Institute of Scientific and Technical Information of China (English)

    Daniele Del Fabbro; Marco Alloisio; Fabio Procopio; Matteo Cimino; Matteo Donadon; Angela Palmisano; Luca Viganò; Guido Torzilli

    2016-01-01

    When suitable, surgery still remains the therapeu-tic option to be preferred for patients carrier of colorectal liver and lung metastases. Since thoracophrenolaparotomy should be helpful during liver resection for some of these patients, si-multaneous removal of right lung metastases can be proposed through this approach. Eleven consecutive patients (median age of 53 years) carrier of colorectal liver and lung metastases, underwent single session surgical resection of both liver and right lung lesions by means of J-shaped thoracophrenolapa-rotomy. The median number of liver metastases removed was 5 (range 2-30) and of lung metastases removed was 2 (range 1-3). Lung metastases were located in the upper lobe in 1 pa-tient, in the middle lobe in 2, in the lower lobe in 6, and in the upper and lower lobe in 2. Mortality and major morbidity were nil. Two patients had a minor morbidity: one had wound infection and bile leakage treated conservatively and the other had transient fever. Mean overall survival was 24.4 months. An aggressive surgical approach should be undertaken for colorectal metastases: in case of multifocal liver disease with complex presentations, J-shaped thoracophrenolaparotomy could be considered as safe approach for combined liver and right lung metastasectomies.

  11. [Results of surgical treatment of intrathoracic recurrence after complete resection of non-small cell lung cancer: clinical significance of subsequent lesion in lung parenchyma].

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    Saito, Y; Takahashi, S; Sato, M; Sagawa, M; Kanma, K; Usuda, K; Endo, C; Chen, Y; Sakurada, A; Aikawa, H

    1995-01-01

    Results of surgical treatment for 33 intrathoracic recurrence after complete resection of non-small cell lung cancer were analyzed. Prognosis of the second surgical treatment were favorable in patients with subsequent cancer with in situ component and solitary lesion in lung parenchyma. Retrospective study of 53 patients who recurred and were thoroughly followed up their clinical course until lung cancer death revealed that the solitary one tends to be confined to the intrathoracic location, and the multiple one did not confined to the intrathoracic location but also extended to the extrathoracic distant metastasis or to the supraclavicular lymph nodes.

  12. Locally recurrent non-small-cell lung cancer after complete surgical resection.

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    Shaw, E G; Brindle, J S; Creagan, E T; Foote, R L; Trastek, V F; Buskirk, S J

    1992-12-01

    Between Jan. 1, 1976, and Dec. 31, 1985, at our institution, 37 patients who had undergone prior complete surgical resection of non-small-cell lung cancer received definitive thoracic radiation therapy (TRT) for locally recurrent disease. Of the 37 recurrences, 33 were in the pulmonary parenchyma or the hilar, mediastinal, or supraclavicular lymph nodes; the other 4 were in the chest wall. The initial stage of disease was I in 43%, II in 35%, and IIIA in 19%, whereas at the time of local recurrence, the stage was I in 8%, II in 11%, IIIA in 57%, IIIB in 22%, and IV in 3% (this patient had multiple pulmonary nodules encompassible within a single TRT field). The locally recurrent lesions were squamous cell carcinoma in 30%, adenocarcinoma or large-cell carcinoma in 46%, mixed types in 5%, and unknown type in 19%. All patients received megavoltage TRT, most often 4,000 cGy in 10 fractions administered in a split-course schedule. In addition, 15 patients received multiagent chemotherapy, usually a combination of cyclophosphamide, doxorubicin hydrochloride, and cisplatin or a regimen that included these drugs. The 2-year and 5-year survivals were 30% and 4%, respectively, and the median duration of survival was 13.7 months. Survival was not improved by the addition of chemotherapy. Approximately half of the patients had radiographic and symptomatic responses after TRT. Of 33 patients assessable for post-TRT patterns of failure, 46% had local failure only, 18% had local plus systemic failure, and 32% had systemic failure only. Two-thirds of the patients died as a direct consequence of progressive chest disease, despite receiving TRT.(ABSTRACT TRUNCATED AT 250 WORDS)

  13. Outcome of surgical resection for pathologic N0 and Nx non-small cell lung cancer.

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    Osarogiagbon, Raymond U; Allen, Jeffrey W; Farooq, Aamer; Berry, Allen; Spencer, David; O'Brien, Thomas

    2010-02-01

    Metastasis to lymph nodes (LNs) connotes poor prognosis in non-small cell lung cancer (NSCLC). Sufficient LNs must be examined to accurately determine LN negativity. Patients with no LNs examined (pNx) have an indeterminate stage, may have undetected disease and erroneous assignment to a low-risk group. To evaluate this possibility, we compared the survival of patients with node-negative disease and at least one LN examined (pN0) to those with pNx. Retrospective analysis of all resections for NSCLC from January 1, 2004 to December 31, 2007 at hospitals in the Memphis Metropolitan Area. Of 746 resections, 90 (12.1%) were Nx; 506 (67.8%) N0. Demographic and histologic characteristics were similar. A total of 54.4% Nx patients had sublobar resection, compared with 5.5% N0 (p Nx do significantly worse than those with pT2N0.

  14. The Use of Multislice Spiral CT to Predict the Resectability of Central Lung Cancer: Correlation with Pathologic and Surgical Findings

    Institute of Scientific and Technical Information of China (English)

    Yang Liu; Yu'e Sun; Naikang Zhou; Qiming Xu

    2005-01-01

    OBJECTIVE To assess the accuracy of multi-slice spiral CT (MSCT) with imaging reconstruction in judging central pulmonary vascular involvement from central lung cancer, and to explore its ability to predict the resectability of lung cancer.METHODS MSCTs were conducted on 48 patients who were diagnosed preoperatively with central lung cancer. Images of pulmonary arteries and veins that might affect Iobectomy or pneumonectomy were reconstructed by means of imaging processing techniques. Then the relationship of the tumor to the vessels was assessed prospectively on both axial CT images and axial CT images plus reconstructed images(CT-RI) in comparison to subsequent pathologic and surgical findings.RESULTS MSCTs were obtained on all 48 patients whom 42 underwent thoracotomy, Iobectomy or pneumonectomy. Compared with the axial CT images,CT-RI was more accurate in judging the relationship of the central pulmonary vessels to the tumor based on subsequent pathologic 78 vessels studiedand surgical findings (186 vessels studied) (0.01 <P<0.05). The sensitivity and positive predictive value of unresectability of the vessels were all remarkably higher with CT-RI (P<0.01).CONCLUSION MSCT with imaging reconstruction can improve the recognition of neoplastic invasion of central pulmonary vessels. It can be used to predict preoperatively the resectability of central lung cancer and to plan surgery.

  15. Surgical resection of synchronous and metachronous lung and liver metastases of colorectal cancers

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    Jeong, Shinseok; Park, Jin Young; Choi, Dong Wook; Choi, Seong Ho

    2017-01-01

    Purpose Surgical resection of isolated hepatic or pulmonary metastases of colorectal cancer is an established procedure, with a 5-year survival rate of about 50%. However, the role of surgical resections in patients with both hepatic and pulmonary metastases is not well established. We aimed to analyze overall survival of these patients and associated factors. Methods Data retrospectively collected from 66 patients who underwent both hepatic and pulmonary metastasectomy after colorectal cancer surgery from August 2002 through August 2013 were analyzed. In univariate analysis, the log-rank test compared patient survival between groups. P < 0.1 was considered indicative of significance. Multivariate analysis of the significance data using a Cox proportional hazard model identified factors associated with overall survival. The synchronous group (n = 57) was defined as patients who had metastasectomy within 3 months from primary colorectal cancer surgery. The remaining nine patients constituted the metachronous group. Results Median follow-up was 126 months from the primary colorectal cancer surgery. The 5-year survival was 73.4%. There was no difference in overall survival between the synchronous and metachronous groups, consistent with previous studies. Distribution (involving one hemiliver or both, P = 0.010 in multivariate analysis) of liver metastases and multiplicity of the pulmonary metastasis (P = 0.039) were predictors of poor prognosis. Conclusion Sequential or simultaneous resection of both hepatic and pulmonary metastasis of colorectal cancer resulted in good long-term survival in selected patients. Thus, an aggressive surgical approach and multidisciplinary decision making with surgeons seems to be justified. PMID:28203555

  16. Uncommon features of surgically resected ALK-positive cavitary lung adenocarcinoma: a case report.

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    Takamori, Shinkichi; Yamaguchi, Masafumi; Taguchi, Kenichi; Edagawa, Makoto; Shimamatsu, Shinichiro; Toyozawa, Ryo; Nosaki, Kaname; Hirai, Fumihiko; Seto, Takashi; Takenoyama, Mitsuhiro; Ichinose, Yukito

    2017-12-01

    Some features found on chest computed tomography (CT), such as central tumor location, large pleural effusion, and the absence of a pleural tail, and a patient age of less than 60 years, have been suggested to be useful in predicting anaplastic lymphoma kinase (ALK) rearrangement in patients with non-small cell lung cancer (NSCLC).A 68-year-old female patient with a history of gynecological treatment was found to have a cavitary mass in the right lower lobe on an annual chest roentgenogram. The tumor was located in the peripheral area with a pleural tail showing no pleural effusion. In addition, two pure ground-glass-opacity nodules (p-GGNs) in the right upper lobe of the lung were detected on consecutive chest CT scans. The patient underwent right lower lobectomy, partial resection of the right upper lobe, and hilar mediastinal lymph node dissection for complete resection of each tumor. The pathological diagnosis was invasive mucinous adenocarcinoma with signet-ring cells for the cavitary mass in the right lower lobe and invasive adenocarcinoma for the rest of the p-GGNs; subcarinal lymph node metastasis was also detected. The ALK rearrangement was detected by fluorescence in situ hybridization from the cavitary mass. The patient underwent four cycles of cisplatin and vinorelbine chemotherapy as standard adjuvant chemotherapy for pStage III NSCLC. The ALK fusion gene status of NSCLC with atypical CT features should also be investigated.

  17. Prognostic significance of CpG island methylator phenotype in surgically resected small cell lung carcinoma.

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    Saito, Yuichi; Nagae, Genta; Motoi, Noriko; Miyauchi, Eisaku; Ninomiya, Hironori; Uehara, Hirofumi; Mun, Mingyon; Okumura, Sakae; Ohyanagi, Fumiyoshi; Nishio, Makoto; Satoh, Yukitoshi; Aburatani, Hiroyuki; Ishikawa, Yuichi

    2016-03-01

    Methylation is closely involved in the development of various carcinomas. However, few datasets are available for small cell lung cancer (SCLC) due to the scarcity of fresh tumor samples. The aim of the present study is to clarify relationships between clinicopathological features and results of the comprehensive genome-wide methylation profile of SCLC. We investigated the genome-wide DNA methylation status of 28 tumor and 13 normal lung tissues, and gene expression profiling of 25 SCLC tissues. Following unsupervised hierarchical clustering and non-negative matrix factorization, gene ontology analysis was performed. Clustering of SCLC led to the important identification of a CpG island methylator phenotype (CIMP) of the tumor, with a significantly poorer prognosis (P = 0.002). Multivariate analyses revealed that postoperative chemotherapy and non-CIMP were significantly good prognostic factors. Ontology analyses suggested that the extrinsic apoptosis pathway was suppressed, including TNFRSF1A, TNFRSF10A and TRADD in CIMP tumors. Here we revealed that CIMP was an important prognostic factor for resected SCLC. Delineation of this phenotype may also be useful for the development of novel apoptosis-related chemotherapeutic agents for treatment of the aggressive tumor.

  18. Does obesity affect the outcomes of pulmonary resections for lung cancer? A National Surgical Quality Improvement Program analysis.

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    Mungo, Benedetto; Zogg, Cheryl K; Hooker, Craig M; Yang, Stephen C; Battafarano, Richard J; Brock, Malcolm V; Molena, Daniela

    2015-04-01

    Obesity has increased dramatically in the American population during the past 2 decades. Approximately 35% of adults are obese. Although obesity represents a major health issue, the association between obesity and operative outcomes has been a subject of controversy. We queried the National Surgical Quality Improvement Program (NSQIP) database to determine whether an increased body mass index (BMI) affects the outcomes of pulmonary resection for lung cancer. We identified 6,567 patients with a diagnosis of lung cancer who underwent pulmonary resection from 2005 to 2012 in the NSQIP database. We stratified this population into 6 BMI groups according to the World Health Organization classification. The primary outcome measured was 30-day mortality; secondary outcomes included length of stay (LOS), operative time, and NSQIP-measured postoperative complications. We performed both unadjusted analysis and adjusted multivariable analysis, controlling for statistically significant variables. Adjusted multivariable logistic regression showed no increase in 30-day mortality, overall morbidity, and serious morbidity among obese patients. Adjusted Poisson regression revealed greater operative times for both obese and underweight patients compared with normal weight patients. Overall, obese patients were younger and had a greater percentage of preoperative comorbidities, including diabetes, hypertension, dyspnea, renal disease, and history of previous cardiac surgery. The prevalence of active smokers was greater among patients with low and normal BMI. Underweight patients had a greater risk-adjusted LOS relative to normal weight patients, whereas overweight and mildly obese patients had lesser risk-adjusted LOS. The results of our analysis suggest that obesity does not confer greater mortality and morbidity after lung resection. Copyright © 2015 Elsevier Inc. All rights reserved.

  19. Risk factors associated with recurrence of surgically resected node-positive non-small cell lung cancer.

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    Ohtaki, Yoichi; Shimizu, Kimihiro; Kaira, Kyoichi; Nagashima, Toshiteru; Obayashi, Kai; Nakazawa, Seshiru; Kakegawa, Seiichi; Igai, Hitoshi; Kamiyoshihara, Mitsuhiro; Nishiyama, Masahiko; Takeyoshi, Izumi

    2016-10-01

    The aim of this study was to identify risk factors for recurrence in non-small cell lung cancer (NSCLC) patients with lymph node metastases after surgical resection. We reviewed 66 consecutive patients with surgically resected NSCLC who had pathologically proven positive lymph nodes (pN1 or pN2). All patients underwent a preoperative 2-[(18)F]-fluoro-2-deoxy-D-glucose positron emission tomography (FDG-PET) evaluation. We analyzed the recurrence-free survival (RFS) and recurrence-free proportion (RFP) according to the clinicopathological factors. A total of 27 patients were pathologically N1 and 39 were N2. The 5-year overall survival rate and the RFS rate were 47.2 and 27.7 %, respectively. The cut-off values for the SUVmax of the tumor and the lymph node ratio (LNR) were determined to be 6.5 and 0.12, respectively, using a receiver operating characteristics curve analysis. Both univariate and multivariate analyses revealed three significant independent factors for RFS: namely, the SUVmax of the tumor, the LNR, and the use of adjuvant chemotherapy. Only the SUVmax was an independent significant predictor of the RFP. Both the SUVmax and the LNR can serve as prognostic factors for patients with pN + NSCLC. Our study suggests that the LNR could be a stronger prognostic factor than the N classification of the TNM system and the SUVmax may predict recurrence in node-positive NSCLC patients.

  20. Nodal Stage of Surgically Resected Non-Small Cell Lung Cancer and Its Effect on Recurrence Patterns and Overall Survival

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    Varlotto, John M., E-mail: john.varlotto@umassmemorial.org [Department of Radiation Oncology, University of Massachusetts Medical Center, Worcester, Massachusetts (United States); Yao, Aaron N. [Department of Healthcare Policy and Research, Virginia Commonwealth University, Richmond, Virginia (United States); DeCamp, Malcolm M. [Division of Thoracic Surgery, Department of Surgery, Northwestern Memorial Hospital, Chicago, Illinois (United States); Northwestern University School of Medicine, Chicago, Illinois (United States); Ramakrishna, Satvik [Northwestern University School of Medicine, Chicago, Illinois (United States); Recht, Abe [Department of Radiation Oncology, Beth Israel Deaconess Medical Center, Boston, Massachusetts (United States); Flickinger, John [Department of Radiation Oncology, Pittsburgh Cancer Institute, Pittsburgh, Pennsylvania (United States); Andrei, Adin [Northwestern University, Chicago, Illinois (United States); Reed, Michael F. [Pennsylvania State University College of Medicine, Hershey, Pennsylvania (United States); Heart and Vascular Institute, Pennsylvania State University-Hershey, Hershey, Pennsylvania (United States); Toth, Jennifer W. [Pennsylvania State University College of Medicine, Hershey, Pennsylvania (United States); Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Pennsylvania State University-Hershey, Hershey, Pennsylvania (United States); Fizgerald, Thomas J. [Department of Radiation Oncology, University of Massachusetts Medical Center, Worcester, Massachusetts (United States); Higgins, Kristin [Department of Radiation Oncology, Emory University, Atlanta, Georgia (United States); Zheng, Xiao [Department of Healthcare Policy and Research, Virginia Commonwealth University, Richmond, Virginia (United States); Shelkey, Julie [Department of Anesthesiology, Columbia University, New York, New York (United States); and others

    2015-03-15

    Purpose: Current National Comprehensive Cancer Network guidelines recommend postoperative radiation therapy (PORT) for patients with resected non-small cell lung cancer (NSCLC) with N2 involvement. We investigated the relationship between nodal stage and local-regional recurrence (LR), distant recurrence (DR) and overall survival (OS) for patients having an R0 resection. Methods and Materials: A multi-institutional database of consecutive patients undergoing R0 resection for stage I-IIIA NSCLC from 1995 to 2008 was used. Patients receiving any radiation therapy before relapse were excluded. A total of 1241, 202, and 125 patients were identified with N0, N1, and N2 involvement, respectively; 161 patients received chemotherapy. Cumulative incidence rates were calculated for LR and DR as first sites of failure, and Kaplan-Meier estimates were made for OS. Competing risk analysis and proportional hazards models were used to examine LR, DR, and OS. Independent variables included age, sex, surgical procedure, extent of lymph node sampling, histology, lymphatic or vascular invasion, tumor size, tumor grade, chemotherapy, nodal stage, and visceral pleural invasion. Results: The median follow-up time was 28.7 months. Patients with N1 or N2 nodal stage had rates of LR similar to those of patients with N0 disease, but were at significantly increased risk for both DR (N1, hazard ratio [HR] = 1.84, 95% confidence interval [CI]: 1.30-2.59; P=.001; N2, HR = 2.32, 95% CI: 1.55-3.48; P<.001) and death (N1, HR = 1.46, 95% CI: 1.18-1.81; P<.001; N2, HR = 2.33, 95% CI: 1.78-3.04; P<.001). LR was associated with squamous histology, visceral pleural involvement, tumor size, age, wedge resection, and segmentectomy. The most frequent site of LR was the mediastinum. Conclusions: Our investigation demonstrated that nodal stage is directly associated with DR and OS but not with LR. Thus, even some patients with, N0-N1 disease are at relatively high risk of local recurrence. Prospective

  1. A Simple and Safe Technique for CT Guided Lung Nodule Marking prior to Video Assisted Thoracoscopic Surgical Resection Revisited

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    James A. Stephenson

    2015-01-01

    Full Text Available Aim. We describe our experience of a simple, safe, and reproducible technique for lung nodule marking prethoracoscopic metastasectomy. Thoracoscopic lung nodule resection reduces patient discomfort, complications, higher level of care, hospital stay, and cost; however, small deeply placed lung nodules are difficult to locate and resect thoracoscopically. Materials and Methods. We describe and review the success of our novel technique, where nodules are identified on a low dose CT and marked with methylene blue using CT fluoroscopy guidance immediately prior to surgery. Results. 30 nodules were marked with a mean size of 8 mm (4–18 mm located at a mean depth of 17 mm, distributed through both lungs. Dye was detected at the pleural surface in 97% of the patients and at the nodule in 93%. There were no major complications. Thoracoscopic resection was possible in 90%. Conclusion. This is a simple and safe method of lung nodule marking to facilitate thoracoscopic resection in cases where this may not be technically possible due to nodule location.

  2. Clinical evaluation of systemic inflammatory response syndrome (SIRS) in advanced lung cancer (T3 and T4) with surgical resection.

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    Iwasaki, Akinori; Shirakusa, Takayuki; Maekawa, Takafumi; Enatsu, Sotarou; Maekawa, Shinichi

    2005-01-01

    The systemic inflammatory response syndrome (SIRS) is well known to occur in patients who have suffered organ damage or trauma, or undergone surgery. SIRS provides useful information in patients with morbidity after surgery. To date, there has been no report of SIRS after surgery in patients with lung cancer. Therefore, based on this new concept of the syndrome, we review here a series of T3 and T4 NSCLC patients who underwent extended resection at our hospital, and attempt to identify the value and correlation of SIRS in predicting the morbidity of such patients. We retrospectively reviewed the patients with NSCLC treated at our hospital between January 1994 and August 2003. Among these 720 patients, a curative approach was attempted in 144 with advanced stage (T3, 100; T4, 44) cancer. The patients were consequently divided into three groups (G1, negative or less than 3 days in SIRS following surgery; G2, less than 7 days; G3, continued over 7 days). Pre- or peri-operative factors were evaluated, and the 5-year survival rates were analyzed. Post-operative morbidity was also compared between the three groups in association with SIRS. Pre-operative counts of WBC were 8848.28+/-3879.21/microl in G3 compared with 7383.33+/-3132.98/microl in G2 and 6778.31+/-3184.89/microl in G1. Values in G3 were significantly higher than those in the other groups (PSIRS after lung surgery was associated with high levels in WBC and low %FEV1. Post-operative morbidity such as bronchial fistula or ARDS were more frequent in the G3 and G2 groups than in G1. The 1-year survival was as follows; G1, 75.4%; G2, 47.9%; G3, 38.1%. Overall 5-year survival rate for NSCLC with T3 and T4 was 32.2%, and the difference between G3 and the other groups in terms of survival was statistically significant (PSIRS have been associated with post-operative complications and survival in NSCLC. Surgical candidates should be carefully according to the predicting factor of SIRS.

  3. Effect of Neoadjuvant Chemotherapy on Improvement of Surgical Resectibility and Survival of Patients with Stage ⅢA Non Small Cell Lung Cancer

    Institute of Scientific and Technical Information of China (English)

    LIJian; YULichao; 等

    2002-01-01

    Ojbective To assess the effect of neoadjuvant chemotherapy on surgical resectibility and survival in patients with stage ⅢA non small cell lung cancer(NSCLC).Methods 42 patients with stage ⅢA NSCLC were randomized to receive either two cycles chemotherapy followed by surgery(neoadjuvant chemotherapy group)or surgery alone(surgery alone group).All patients received four cycles chemotherapy after surgery.Results The overall response to chemotherapy was 42.9%(38.1% partial response and 4.8% complete response).Toxicity of chemotherapy was minor and consisted mainly of gastroenterological side effects and myelosuppression.Patients treated with neoadjuvant chemotherapy had estimated surgical resection rate of 95.2%(n=20)and a complete resection rate in 52.4%(n=11) compared to 66.7%(n=14)and 28.6%(n=6)respectively,for patients with surgery alone(P<0.05).None of the patients died from the operation.The median survival was 24.6 months in the neoadjuvant chemotherapy group as compared to only 10.8 months in the surgery alone group(P<0.05).The 2-year survival rate was 57.1% in the chemotherapy group as compared to 28.6% in the surgery alone group(P<0.05).Conclusion Neoadjuvant chemotherapy improves the surgical resectibility and increases the median survival and 2-year survival rate of patients with stage ⅢA NSCLC.

  4. [Post-recurrence survival after surgical resection of non-small cell lung cancer with local recurrence].

    Science.gov (United States)

    Yokouchi, Hideoki; Miyazaki, Masaki; Miyamoto, Takeaki; Tsuji, Fumio; Ebisui, Chikara; Murata, Kohei

    2014-11-01

    We retrospectively evaluated the clinical outcomes of 192 consecutive patients with local recurrence after complete resection of non-small cell lung cancer NSCLC). The initial local recurrent site was the resection stump in 5 patients the chest wall in 3 patients, mediastinum in 1 patient, and diaphragm in 1 patient), and the hilar and/or mediastinal lymph node (HMLN) in 17 patients. The sites of distant metastasis were the lungs in 10 patients, pleura in 4 patients, brain in 7 patients, liver in 5 patients, bone in 4 patients, and other sites in 4 patients. Treatments after initial recurrence included surgery in 2 patients, radiotherapy in 5 patients, chemotherapy in 9 patients, and chemo-radiotherapy in 5 patients. Only 1 patient received supportive care. The response to radiotherapy was a complete response (R) in 1 patient, partial response (PR) in 5 patients, stable disease (SD )in 3 patients, and progressive disease (PD )in 1 patient. The best response of all lines of chemotherapy was CR in 3 patients, PR in 4 patients, SD in 3 patients, and PD in 4 patients. The median post-recurrence survival (PRS) time with local recurrence was better than that with distant metastasis (23 vs 14 months); however, the best PRS was obtained in patients with recurrence in the lungs (29 months). A CR for more than 2 years was obtained in 1 patient after surgery, in 1 patient after radiotherapy, and in 2 patients after chemotherapy. Although local recurrence of resected NSCLC can be potentially controlled by using local treatments - such as surgery and radiotherapy - or systemic chemotherapy, curative aggressive treatment should be considered when required.

  5. The pri-let-7a-2 rs1143770C>T is associated with prognosis of surgically resected non-small cell lung cancer.

    Science.gov (United States)

    Shin, Kyung Min; Jung, Deuk Kju; Hong, Mi Jeong; Kang, Hyo Jung; Lee, Won Kee; Yoo, Seung Soo; Lee, Shin Yup; Cha, Seung Ick; Lee, Jaehee; Kim, Chang Ho; Seok, Yangki; Cho, Sukki; Son, Ji Woong; Lee, Eung Bae; Jheon, Sanghoon; Kim, Young Tae; Park, Jae Yong

    2016-02-15

    Evidence indicates that let-7 of microRNA may be a prognostic factor in lung cancer. Genetic variation in microRNA precursors could influence the processing and expression of microRNAs, which could affect the prognosis of lung cancer. We aimed to investigate the impact of single nucleotide polymorphisms (SNPs) of pri-let-7 on the prognosis of non-small cell lung cancer (NSCLC). A total of 761 patients with surgically resected NSCLC were included. Four SNPs (pri-let-7a-2 rs1143770 and rs629367, pri-let-7a-1 rs10739971, and pri-let-7f-2 rs17276588) were genotyped using sequenom mass spectrometry-based genotyping assay. Overall survival (OS) and disease-free survival (DFS) were evaluated using Kaplan-Meier method and Cox proportional hazards model. Of the 4 SNPs evaluated, the rs1143770C>T was found to be significantly associated with OS and DFS. The rs1143770 CT or TT genotype exhibited a significantly better OS and DFS compared with the rs1143770 CC genotype (adjusted hazard ratio for OS=0.67, confidence interval, 0.49-0.91, P=0.01 and adjusted hazard ratio for DFS=0.74, confidence interval, 0.58-0.95, P=0.02). This observation indicates that pri-let-7a-2 rs1143770C>T may have a prognostic impact on surgically resected NSCLC. Copyright © 2015 Elsevier B.V. All rights reserved.

  6. Outcome of surgical resection for brain metastases and radical treatment of the primary tumor in Chinese non–small-cell lung cancer patients

    Directory of Open Access Journals (Sweden)

    Li Z

    2015-04-01

    Full Text Available Zhenye Li,1,3,* Xiangheng Zhang,1,* Xiaobing Jiang,1 Chengcheng Guo,1 Ke Sai,1 Qunying Yang,1 Zhenqiang He,1 Yang Wang,1 Zhongping Chen,1 Wei Li,2 Yonggao Mou1 1Department of Neurosurgery, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, People’s Republic of China; 2Department of Anesthesiology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, People’s Republic of China; 3Beijing Neurosurgical Institute, Capital Medical University, Beijing, People’s Republic of China *These authors have contributed equally to this work Purpose: Brain metastasis is the most common complication of brain cancer; nevertheless, primary lung cancer accounts for approximately 20%–40% of brain metastases cases. Surgical resection is the preferred treatment for brain metastases. However, no studies have reported the outcome of surgical resection of brain metastases from non–small-cell lung cancer (NSCLC in the People’s Republic of China. Moreover, the optimal treatment for primary NSCLC in patients with synchronous brain metastases is hitherto controversial. Patients and methods: We retrospectively analyzed the cases of NSCLC patients with brain metastases who underwent neurosurgical resection at the Sun Yat-sen University Cancer Center, and assessed the efficacy of surgical resection and the necessity of aggressive treatment for primary NSCLC in synchronous brain metastases patients. Results: A total of 62 patients, including 47 men and 15 women, with brain metastases from NSCLC were enrolled in the study. The median age at the time of craniotomy was 54 years (range 29–76 years. At the final follow-up evaluation, 50 patients had died. The median OS time was 15.1 months, and the survival rates were 70% and 37% at 1 and 2 years, respectively. The median OS

  7. Angiogenic Response to Major Lung Resection for Non-Small Cell Lung Cancer with Video-Assisted Thoracic Surgical and Open Access

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    Calvin S. H. Ng

    2012-01-01

    Full Text Available Background. Angiogenic factors following oncological surgery is important in tumor recurrence. Vascular endothelial growth factor (VEGF, angiopoietin 1 (Ang-1, Ang-2, soluble VEGF-receptor 1 (sVEGFR1 and sVEGFR2 may influence angiogenesis. This prospective study examined the influence of open and video-assisted thoracic surgery (VATS lung resections for early stage non-small cell lung cancer (NSCLC on postoperative circulating angiogenic factors. Methods. Forty-three consecutive patients underwent major lung resection through either VATS (=23 or Open thoracotomy (=20 over an 8-month period. Blood samples were collected preoperatively and postoperatively on days (POD 1 and 3 for enzyme linked immunosorbent assay determination of angiogenic factors. Results. Patient demographics were comparable. For all patients undergoing major lung resection, postoperative Ang-1 and sVEGFR2 levels were significantly decreased, while Ang-2 and sVEGFR1 levels markedly increased. No significant peri-operative changes in VEGF levels were observed. Compared with open group, VATS had significantly lower plasma levels of VEGF (VATS 170±93 pg/mL; Open 486±641 pg/mL; =0.04 and Ang-2 (VATS 2484±1119 pg/mL; Open 3379±1287 pg/mL; =0.026 on POD3. Conclusions. Major lung resection for early stage NSCLC leads to a pro-angiogenic status, with increased Ang-2 and decreased Ang-1 productions. VATS is associated with an attenuated angiogenic response with lower circulating VEGF and Ang-2 levels compared with open. Such differences in angiogenic factors may be important in lung cancer biology and recurrence following surgery.

  8. A Panel of Genetic Polymorphism for the Prediction of Prognosis in Patients with Early Stage Non-Small Cell Lung Cancer after Surgical Resection.

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    Shin Yup Lee

    Full Text Available This study was conducted to investigate whether a panel of eight genetic polymorphisms can predict the prognosis of patients with early stage non-small cell lung cancer (NSCLC after surgical resection.We selected eight single nucleotide polymorphisms (SNPs which have been associated with the prognosis of lung cancer patients after surgery in our previous studies. A total of 814 patients with early stage NSCLC who underwent curative surgical resection were enrolled. The association of the eight SNPs with overall survival (OS and disease-free survival (DFS was analyzed.The eight SNPs (CD3EAP rs967591, TNFRSF10B rs1047266, AKT1 rs3803300, C3 rs2287845, HOMER2 rs1256428, GNB2L1 rs3756585, ADAMTSL3 rs11259927, and CD3D rs3181259 were significantly associated with OS and/or DFS. Combining those eight SNPs, we designed a prognostic index to predict the prognosis of patients. According to relative risk of death, a score value was assigned to each genotype of the SNPs. A worse prognosis corresponded to a higher score value, and the sum of score values of eight SNPs defined the prognostic index of a patient. When we categorized the patients into two groups based on the prognostic index, high risk group was significantly associated with worse OS and DFS compared to low risk group (aHR for OS = 2.21, 95% CI = 1.69-2.88, P = 8.0 x 10-9, and aHR for DFS = 1.58, 95% CI = 1.29-1.94, P = 1.0 x 10-5.Prognostic index using eight genetic polymorphisms may be useful for the prognostication of patients with surgically resected NSCLC.

  9. CyberKnife with tumor tracking: An effective alternative to wedge resection for high-risk surgical patients with stage I non-small cell lung cancer (NSCLC

    Directory of Open Access Journals (Sweden)

    Sean eCollins

    2012-02-01

    Full Text Available Published data suggests that wedge resection for stage I NSCLC results in improved overall survival compared to stereotactic body radiation therapy (SBRT. We report CyberKnife outcomes for high-risk surgical patients with biopsy-proven stage I NSCLC. PET/CT imaging was completed for staging. Three-to-five gold fiducial markers were implanted in or near tumors to serve as targeting references. Gross tumor volumes (GTVs were contoured using lung windows; the margins were expanded by 5 mm to establish the planning treatment volume (PTV. Treatment plans were designed using hundreds of pencil beams. Doses delivered to the PTV ranged from 42-60 Gy in 3 fractions. The 30-Gy isodose contour extended at least 1cm from the GTV to eradicate microscopic disease. Treatments were delivered using the CyberKnife system with tumor tracking. Examination and PET/CT imaging occurred at 3-month follow-up intervals. Forty patients (median age 76 with a median maximum tumor diameter of 2.6 cm (range, 1.4-5.0 cm and a mean post-bronchodilator percent predicted forced expiratory volume in 1 second (FEV1 of 57% (range, 21 - 111% were treated. A mean dose of 50 Gy was delivered to the PTV over 3 to 13 days (median, 7 days. The 30-Gy isodose contour extended a mean 1.9 cm from the GTV. At a median 44 months (range, 12 -72 months follow-up, the 3-year Kaplan-Meier locoregional control and overall survival estimates compare favorably with contemporary wedge resection outcomes at 91% and 75% , respectively. CyberKnife is an effective treatment approach for stage I NSCLC that is similar to wedge resection, eradicating tumors with 1 to 2 cm margins in order to preserve lung function. Prospective randomized trials comparing CyberKnife with wedge resection are necessary to confirm equivalence.

  10. Tim-3 expression by peripheral natural killer cells and natural killer T cells increases in patients with lung cancer--reduction after surgical resection.

    Science.gov (United States)

    Xu, Li-Yun; Chen, Dong-Dong; He, Jian-Ying; Lu, Chang-Chang; Liu, Xiao-Guang; Le, Han-Bo; Wang, Chao-Ye; Zhang, Yong-Kui

    2014-01-01

    The purpose of this study was to investigate Tim-3 expression on peripheral CD3-CD56+ natural killer (NK) cells and CD3+CD56+ natural killer T (NKT) cells in lung cancer patients. We analyzed Tim-3+CD3-CD56+ cells, Tim-3+CD3-CD56dim cells, Tim-3+CD3-CD56bright cells, and Tim- 3+CD3+CD56+ cells in fresh peripheral blood from 79 lung cancer cases preoperatively and 53 healthy controls by flow cytometry. Postoperative blood samples were also analyzed from 21 members of the lung cancer patient cohort. It was showed that expression of Tim-3 was significantly increased on CD3-CD56+ cells, CD3- CD56dim cells and CD3+CD56+ cells in lung cancer patients as compared to healthy controls (p=0.03, p=0.03 and p=0.04, respectively). When analyzing Tim-3 expression with cancer progression, results revealed more elevated Tim-3 expression in CD3-CD56+ cells, CD3-CD56dim cells and CD3+CD56+ cells in cases with advanced stages (III/IV) than those with stage I and II (p=0.02, p=0.04 and p=0.01, respectively). In addition, Tim-3 expression was significantly reduced on after surgical resection of the primary tumor (pnatural killer cells from fresh peripheral blood may provide a useful indicator of disease progression of lung cancer. Furthermore, it was indicated that Tim-3 might be as a therapeutic target.

  11. EGFR Mutations in Surgically Resected Fresh Specimens from 697 Consecutive Chinese Patients with Non-Small Cell Lung Cancer and Their Relationships with Clinical Features

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    Yuanyang Lai

    2013-12-01

    Full Text Available We aimed to reveal the true status of epidermal growth factor receptor (EGFR mutations in Chinese patients with non-small cell lung cancer (NSCLC after lung resections. EGFR mutations of surgically resected fresh tumor samples from 697 Chinese NSCLC patients were analyzed by Amplification Refractory Mutation System (ARMS. Correlations between EGFR mutation hotspots and clinical features were also explored. Of the 697 NSCLC patients, 235 (33.7% patients had tyrosine kinase inhibitor (TKIs sensitive EGFR mutations in 41 (14.5% of the 282 squamous carcinomas, 155 (52.9% of the 293 adenocarcinomas, 34 (39.5% of the 86 adenosquamous carcinomas, one (9.1% of the 11 large-cell carcinomas, 2 (11.1% of the 18 sarcomatoid carcinomas, and 2 (28.6% of the 7 mucoepidermoid carcinomas. TKIs sensitive EGFR mutations were more frequently found in female patients (p < 0.001, non-smokers (p = 0.047 and adenocarcinomas (p < 0.001. The rates of exon 19 deletion mutation (19-del, exon 21 L858R point mutation (L858R, exon 21 L861Q point mutation (L861Q, exon 18 G719X point mutations (G719X, including G719C, G719S, G719A were 43.4%, 48.1%, 1.7% and 6.8%, respectively. Exon 20 T790M point mutation (T790M was detected in 3 squamous carcinomas and 3 adenocarcinomas and exon 20 insertion mutation (20-ins was detected in 2 patients with adenocarcinoma. Our results show the rates of EGFR mutations are higher in all types of NSCLC in Chinese patients. 19-del and L858R are two of the more frequent mutations. EGFR mutation detection should be performed as a routine postoperative examination in Chinese NSCLC patients.

  12. Prognostic significance of the combined score of endothelial expression of nucleolin and CD31 in surgically resected non-small cell lung cancer.

    Directory of Open Access Journals (Sweden)

    Hongyun Zhao

    Full Text Available Nucleolin is implicated to play a role in angiogenesis, a vital process in tumor growth and metastasis. However, the presence and clinical relevance of nucleolin in human non small cell lung cancer (NSCLC remains largely unknown. In this study, we explored the expression and prognostic implication of nucleolin in surgically resected NSCLC patients. A cohort of 146 NSCLC patients who underwent surgical resection was selected for tissue microarray. In this tissue microarray, nucleolin expression was measured by immunofluorescence. Staining for CD31, a marker of endothelial cells, was performed to mark blood vessels. A Cox proportional hazards model was used to assess the prognostic significance of nucleolin. Nucleolin expression was observed in 34.2% of all patients, and 64.1% in high CD31 expression patients. The disease-free survival (DFS was significantly shorter in patients with high nucleolin (CD31(hiNCL(hi compared to patients with low tumor blood vessels (CD31(loNCL(lo (5 ys of DFS 24% vs 64%, p = 0.002. Such a difference was demonstrated in the following stratified analyses: stage I (p<0.001, squamous cell carcinoma and adenosquamous cell carcinoma (p = 0.028, small tumor (<5 cm, p = 0.008, and surgery alone (p = 0.015. Multivariate analysis further revealed that nucleolin expression independently predicted for worse survival (p = 0.003. This study demonstrates that nucleolin is associated with the clinical outcomes in postoperative NSCLC patients. Thus, the expression levels of nucleolin may provide a new prognostic marker to identify patients at higher risk for treatment failure, especially in some subgroups.

  13. Impact of the epidermal growth factor receptor mutation status on the post-recurrence survival of patients with surgically resected non-small-cell lung cancer.

    Science.gov (United States)

    Takenaka, Tomoyoshi; Takenoyama, Mitsuhiro; Yamaguchi, Masafumi; Toyozawa, Ryo; Inamasu, Eiko; Kojo, Miyako; Toyokawa, Gouji; Yoshida, Tsukihisa; Shiraishi, Yoshimasa; Morodomi, Yosuke; Hirai, Fumihiko; Taguchi, Kenichi; Shimokawa, Mototsugu; Seto, Takashi; Ichinose, Yukito

    2015-03-01

    The impact of epidermal growth factor receptor (EGFR) status and the use of EGFR-tyrosine kinase inhibitor (EGFR-TKI) therapy have not been well discussed only in recurrent non-small-cell lung cancer (NSCLC). The purpose of this study was to identify the prognostic factors associated with post-recurrence survival after surgical resection of NSCLC in terms of the EGFR mutation status and the use of EGFR-TKI therapy. From 2000 through 2011, 1237 consecutive patients with NSCLC underwent pulmonary resection at our institution. Of these patients, 280 experienced postoperative recurrence by the end of 2012. We reviewed the cases of recurrence and analysed the predictors and length of post-recurrence survival. The median post-recurrence survival time and the 5-year survival rate of all patients were 25 months and 20.8%, respectively. A multivariate analysis identified the Eastern Cooperative Oncology Group (ECOG) performance status (PS), brain metastasis, number of sites of recurrence and EGFR mutation status to be independent prognostic factors for post-recurrence survival. Among all cases, the median post-recurrence survival time according to the use of EGFR-TKI therapy was as follows: 49 months in the EGFR mutation-positive patients treated with EGFR-TKI therapy, 20 months in the EGFR wild or unknown cases treated with EGFR-TKI therapy and 17 months in the patients not treated with EGFR-TKI therapy. As to EGFR mutation-positive cases, the patients treated with EGFR-TKIs exhibited significantly longer post-recurrence survival time than the patients treated without EGFR-TKIs (49 vs 12 months). It is essential for recurrent NSCLC patients to be examined for the EGFR mutation status. Patients with a positive EGFR mutation status receive significant benefits from EGFR-TKI therapy. © The Author 2014. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

  14. Choice of Surgical Procedure for Patients With Non-Small-Cell Lung Cancer ≤ 1 cm or > 1 to 2 cm Among Lobectomy, Segmentectomy, and Wedge Resection

    DEFF Research Database (Denmark)

    Dai, Chenyang; Shen, Jianfei; Ren, Yijiu

    2016-01-01

    PURPOSE: According to the lung cancer staging project, T1a (≤ 2 cm) non-small-cell lung cancer (NSCLC) should be additionally classified into ≤ 1 cm and > 1 to 2 cm groups. This study aimed to investigate the surgical procedure for NSCLC ≤ 1 cm and > 1 to 2 cm. METHODS: We identified 15,760 patie...

  15. Spinal infarction related to the adjuvant chemotherapy for surgically resected non-small cell lung cancer: report of a case.

    Science.gov (United States)

    Matsutani, Noriyuki; Kawamura, Masafumi

    2013-05-01

    We report the development of spinal infarction during adjuvant chemotherapy with tegafur, gimeracil and oteracil (TS-1) after surgery for lung adenocarcinoma. A 69-year-old female had a left upper lobectomy for pulmonary adenocarcinoma, T2aN0M0. Six weeks after the surgery, tegafur, gimeracil and oteracil were administered orally as adjuvant chemotherapy for 1 year. After 10 months of adjuvant chemotherapy, the patient suddenly showed signs of numbness and weakness in both lower limbs. The patient did not have a previous medical history, and was receiving only tegafur, gimeracil and oteracil with the stomach medication. Neurological findings showed muscle weakness, numbness and a loss of tendon reflex in both lower limbs, as well as bladder and rectal disturbance. Blood tests, brain magnetic resonance imaging and chest computed tomography showed no signs of abnormalities or metastasis. Magnetic resonance imaging of the spine showed a hyperintense lesion between the Th12 and L1 spinal levels by T2-weighted image. A spinal fluid test indicated no abnormalities, and cytological diagnosis was class II. Anti-aquaporin 4, anti-ganglioside and anti-neuronal autoantibodies were all negative. These results indicated that the patient had a spinal infarction, rather than myelitis or paraneoplastic neurological syndrome. The patient was treated with heparin and steroid pulse treatment followed by rehabilitation, and recovered sufficiently to be able to walk using a cane after 2 months. The development of spinal infarction during anti-cancer chemotherapy has not been previously reported. In this case, an association of spinal infarction with the use of adjuvant chemotherapy was strongly indicated due to the lack of abnormalities in coagulability, atherosclerotic lesions and aortic disease.

  16. Preoperative evaluation for lung cancer resection

    Science.gov (United States)

    Spyratos, Dionysios; Porpodis, Konstantinos; Angelis, Nikolaos; Papaiwannou, Antonios; Kioumis, Ioannis; Pitsiou, Georgia; Pataka, Athanasia; Tsakiridis, Kosmas; Mpakas, Andreas; Arikas, Stamatis; Katsikogiannis, Nikolaos; Kougioumtzi, Ioanna; Tsiouda, Theodora; Machairiotis, Nikolaos; Siminelakis, Stavros; Argyriou, Michael; Kotsakou, Maria; Kessis, George; Kolettas, Alexander; Beleveslis, Thomas; Zarogoulidis, Konstantinos

    2014-01-01

    During the last decades lung cancer is the leading cause of death worldwide for both sexes. Even though cigarette smoking has been proved to be the main causative factor, many other agents (e.g., occupational exposure to asbestos or heavy metals, indoor exposure to radon gas radiation, particulate air pollution) have been associated with its development. Recently screening programs proved to reduce mortality among heavy-smokers although establishment of such strategies in everyday clinical practice is much more difficult and unknown if it is cost effective compared to other neoplasms (e.g., breast or prostate cancer). Adding severe comorbidities (coronary heart disease, COPD) to the above reasons as cigarette smoking is a common causative factor, we could explain the low surgical resection rates (approximately 20-30%) for lung cancer patients. Three clinical guidelines reports of different associations have been published (American College of Chest Physisians, British Thoracic Society and European Respiratory Society/European Society of Thoracic Surgery) providing detailed algorithms for preoperative assessment. In the current mini review, we will comment on the preoperative evaluation of lung cancer patients. PMID:24672690

  17. [Surgical resection of gliomas in 2008].

    Science.gov (United States)

    Carpentier, A C

    2008-11-01

    Surgical resection of gliomas is a well-established treatment. It allows a histo-genetic diagnosis, a mass effect reduction, an intracranial hypertension treatment, a recovery of an eventual neurological deficit induced by the mass effect, but mostly brings a significant survival. New imaging sequences are optimizing the surgical management of brain tumors by bringing precisions on the tumor morphology, on cortical/subcortical eloquent areas (functional and diffusion MRI), on histology (spectroscopic MR). If the tumor is located in eloquent area, surgery is performed under electrostimulation control to take into account cerebral plasticity and to avoid postoperative functional deficits. Neuronavigation, per-operative echography, and per-operative MRI are recognized tools for optimizing the tumor resection. Ongoing researches concern the adjunction of local treatments within the surgical field (photodynamic therapy, chemotherapy, convection immunotherapy...), but also the development of minimal invasive procedures (radiosurgery, high intensity focalized ultrasounds, laser interstitial thermal therapy).

  18. Surgical management of non-small-cell lung cancer

    Directory of Open Access Journals (Sweden)

    Bamousa Ahmed

    2008-10-01

    Full Text Available Surgery plays a major role in the management of patients with lung cancer. Surgery is not only the main curative treatment modality in patients with early-stage lung cancer but it also has a significant role in the initial workup for the diagnosis and staging of lung cancer. This article describes the surgical management of patients with lung cancer. Surgical resection for lung cancer is still regarded as the most effective method for controlling the primary tumor, provided it is resectable for cure and the risks of the procedure are low. The 5-year survival rare following complete resection (R0 of a lung cancer is stage dependent [Table 1]. [1-3] Incomplete resection (R1, R2 rarely, if ever, cures the patient.

  19. Prognostic value of MET gene copy number and protein expression in patients with surgically resected non-small cell lung cancer: a meta-analysis of published literatures.

    Directory of Open Access Journals (Sweden)

    Baoping Guo

    Full Text Available BACKGROUND: The prognostic value of the copy number (GCN and protein expression of the mesenchymal-epithelial transition (MET gene for survival of patients with non-small cell lung cancer (NSCLC remains controversial. This study aims to comprehensively and quantitatively asses the suitability of MET GCN and protein expression to predict patients' survival. METHODS: PubMed, Embase, Web of Science and Google Scholar were searched for articles comparing overall survival in patients with high MET GCN or protein expression with those with low level. Pooled hazard ratio (HR and 95% confidence intervals (CIs were calculated using the random and the fixed-effects models. Subgroup and sensitivity analyses were also performed. RESULTS: Eighteen eligible studies enrolling 5,516 patients were identified. Pooled analyses revealed that high MET GCN or protein expression was associated with poor overall survival (OS (GCN: HR = 1.90, 95% CI 1.35-2.68, p<0.001; protein expression: HR = 1.52, 95% CI 1.08-2.15, p = 0.017. In Asian populations (GCN: HR = 2.22, 95% CI 1.46-3.38, p<0.001; protein expression: HR = 1.89, 95% CI 1.34-2.68, p<0.001, but not in the non-Asian subset. For adenocarcinoma, high MET GCN or protein expression indicated decreased OS (GCN: HR = 1.49, 95% CI 1.05-2.10, p = 0.025; protein expression: HR = 1.69, 95% CI 1.31-2.19, p<0.001. Results were similar for multivariate analysis (GCN: HR = 1.61, 95% CI 1.15-2.25, p = 0.005; protein expression: HR = 2.18, 95% CI 1.60-2.97, p<0.001. The results of the sensitivity analysis were not materially altered and did not draw different conclusions. CONCLUSIONS: Increased MET GCN or protein expression was significantly associated with poorer survival in patients with surgically resected NSCLC; this information could potentially further stratify patients in clinical treatment.

  20. Surgical resection of a giant cardiac fibroma.

    Science.gov (United States)

    Stamp, Nikki L; Larbalestier, Robert I

    2016-05-01

    A 42-year-old woman presented to a regional hospital emergency room with palpitations and was found to be in ventricular tachycardia. Chest radiography demonstrated a massively enlarged cardiac silhouette. Echocardiography and cardiac magnetic resonance imaging demonstrated a mass within the left ventricular free wall, consistent with a cardiac fibroma. The patient proceeded to have surgical resection of the mass. Left ventricular function was preserved postoperatively.

  1. Bronchial resection margin and long-term survival in non-small-cell lung cancer.

    Science.gov (United States)

    Poullis, Michael; McShane, James; Shaw, Mathew; Page, Richard; Woolley, Steve; Shackcloth, Michael; Mediratta, Neeraj

    2012-08-01

    Clear resection margins are necessary for long-term survival of patients undergoing surgical resection. We aimed to determine whether bronchial resection margin is a factor determining long-term survival in patients undergoing R0 resections for non-small-cell lung cancer. There were 2695 consecutive pulmonary resections performed between October 2001 and September 2011 in our institution; 1795 were R0 resections for non-small-cell lung cancer and bronchial margin length data were available. Benchmarking against the 7th International Association for the Study of Lung Cancer dataset was performed. Cox multivariate and neuronal network analysis was undertaken. Benchmarking failed to reveal any significant differences between our data and the 7th International Association for the Study of Lung Cancer dataset. Cox regression demonstrated that age (pNeuronal network analysis confirmed these findings. Bronchial resection margin length has no impact on long-term survival.

  2. [Preoperative evaluation and predictors of mortality in lung cancer resection].

    Science.gov (United States)

    Rojas, Andrés; Opazo, Marcela; Hernández, Marcela; Ávila, Paulina; Villalobos, Daniel

    2015-06-01

    Surgical resection of lung cancer, the only available curative option today, is strongly associated with mortality. The goal during the perioperative period is to identify and evaluate appropriate candidates for lung resection in a more careful way and reduce the immediate perioperative risk and posterior disability. This is a narrative review of perioperative risk assessment in lung cancer resection. Instruments designed to facilitate decision-making have been implemented in recent years but with contradictory results. Cardiovascular risk assessment should be the first step before a potential lung resection, considering that most of these patients are old, smokers and have atherosclerosis. Respiratory mechanics determined by postoperative forced expiratory volume in the first second (FEV1), the evaluation of the alveolar-capillary membrane by diffusing capacity of carbon monoxide and cardiopulmonary function measuring the maximum O2 consumption, will give clues about the patient's respiratory and cardiac response to stress. With these assessments, the patient and its attending team can reach a treatment decision balancing the perioperative risk, the chances of survival and the pulmonary long-term disability.

  3. Varying recurrence rates and risk factors associated with different definitions of local recurrence in patients with surgically resected, stage I nonsmall cell lung cancer.

    Science.gov (United States)

    Varlotto, John M; Recht, Abram; Flickinger, John C; Medford-Davis, Laura N; Dyer, Anne-Marie; DeCamp, Malcolm M

    2010-05-15

    The objective of this study was to examine the effects of different definitions of local recurrence on the reported patterns of failure and associated risk factors in patients who undergo potentially curative resection for stage I nonsmall cell lung cancer (NSCLC). The study included 306 consecutive patients who were treated from 2000 to 2005 without radiotherapy. Local recurrence was defined either as 'radiation' (r-LR) (according to previously defined postoperative radiotherapy fields), including the bronchial stump, staple line, ipsilateral hilum, and ipsilateral mediastinum; or as 'comprehensive' (c-LR), including the same sites plus the ipsilateral lung and contralateral mediastinal and hilar lymph nodes. All recurrences that were not classified as "local" were considered to be distal. The median follow-up was 33 months. The proportions of c-LR and r-LR at 2 years, 3 years, and 5 years were 14%, 21%, and 29%, respectively, and 7%, 12%, and 16%, respectively. Significant risk factors for c-LR on multivariate analysis were diabetes, lymphatic vascular invasion, and tumor size; and significant factors for r-LR were resection of less than a lobe and lymphatic vascular invasion. The proportions of distant (non-local) recurrence using these definitions at 2 years, 3 years, and 5 years were 10%, 12%, and 18%, respectively, and 14%, 19%, and 29%, respectively. Significant risk factors for distant failure were histology when using the c-LR definition and tumor size when using the r-LR definition. Local recurrence increased nearly 2-fold when a broad definition was used instead of a narrow definition. The definition also affected which factors were associated significantly with both local and distant failure on multivariate analysis. Comparable definitions must be used when analyzing different series. (c) 2010 American Cancer Society.

  4. A prospective study of tumor suppressor gene methylation as a prognostic biomarker in surgically-resected stage I-IIIA non-small cell lung cancers

    Science.gov (United States)

    Drilon, Alexander; Sugita, Hirofumi; Sima, Camelia S.; Zauderer, Marjorie; Rudin, Charles M.; Kris, Mark G.; Rusch, Valerie W.; Azzoli, Christopher G.

    2014-01-01

    Introduction While retrospective analyses support an association between early tumor recurrence and tumor suppressor gene (TSG) promoter methylation in early-stage non-small cell lung cancers (NSCLCs), few studies have investigated this question prospectively. Methods Primary tumor tissue from patients with resected pathologic stage I-IIIA NSCLCs was collected at the time of surgery and analyzed for promoter methylation via methylation-specific reverse-transcriptase polymerase chain reaction (MethyLight). The primary objective was to determine an association between promoter methylation of 10 individual TSGs (CDKN2A, CDH13, RASSF1, APC, MGMT, GSTP1, DAPK1, WIF1, SOCS3, and ADAMTS8) and recurrence-free survival (RFS), with the secondary objectives of determining association with overall survival (OS), and relation to clinical or pathologic features. Results 107 patients had sufficient tumor tissue for successful promoter methylation analysis. Majority of patients were former/current smokers (88%) with lung adenocarcinoma (78%) and pathologic stage I disease (66%). Median follow-up was 4 years. When controlled for pathologic stage, promoter methylation of the individual genes CDKN2A, CDH13, RASSF1, APC, MGMT, GSTP1, DAPK1, WIF1, and ADAMTS8 was not associated with RFS. Promoter methylation of the same genes was not associated with OS except for DAPK1 which was associated with improved OS (p=0.03). The total number of genes with methylated promoters did not correlate with RFS (p=0.89) or OS (p=0.55). Conclusions Contrary to data established by previous retrospective series, TSG promoter methylation (CDKN2A, CDH13, RASSF1,APC, MGMT, GSTP1, DAPK1, WIF1, and ADAMTS8) was not prognostic for early tumor recurrence in this prospective study of resected NSCLCs. PMID:25122424

  5. Randomized controlled trial of resection versus radiotherapy after induction chemotherapy in stage IIIA-N2 non-small-cell lung cancer

    NARCIS (Netherlands)

    J.P. van Meerbeeck (Jan); G.W.P.M. Kramer (Gijs); P.E.Y. van Schil (Paul); C. Legrand; E.F. Smit (Egbert); F.M.N.H. Schramel (Franz); V.C.G. Tjan-Heijnen (Vivianne); B. Biesma (Bonne); C. Debruyne (Channa); N. van Zandwijk (Nico); T.A.W. Splinter (Ted); G. Giaccone (Giuseppe)

    2007-01-01

    textabstractBackground: Induction chemotherapy before surgical resection increases survival compared with surgical resection alone in patients with stage IIIA-N2 non - small-cell lung cancer (NSCLC). We hypothesized that, following a response to induction chemotherapy, surgical resection would be su

  6. Post-recurrence survival of elderly patients 75 years of age or older with surgically resected non-small cell lung cancer.

    Science.gov (United States)

    Takenaka, Tomoyoshi; Inamasu, Eiko; Yoshida, Tsukihisa; Toyokawa, Gouji; Nosaki, Kaname; Hirai, Fumihiko; Yamaguchi, Masafumi; Seto, Takashi; Takenoyama, Mitsuhiro; Ichinose, Yukito

    2016-04-01

    The purpose of this study was to evaluate the outcomes of elderly patients 75 years of age or older with recurrent non-small cell lung cancer (NSCLC). A total of 1237 consecutive patients with NSCLC underwent pulmonary resection at our institution. Of these patients, 280 experienced postoperative recurrence. The rate of the post-recurrence survival and predictors were analyzed independently in a group of younger patients (recurrence. The median post-recurrence survival time and the five-year survival rate of all cases were 25 months and 20.8%, respectively. There were no significant survival differences between the younger and elderly groups (p = 0.20). A univariate analysis determined that gender, Eastern Cooperative Oncology Group performance status, smoking status, histological type and epithelial growth factor receptor (EGFR) mutation status were factors influencing the post-recurrence survival among the elderly patients. In addition, a multivariate analysis determined the EGFR mutation status to be an independent prognostic factor for the post-recurrence survival. Elderly patients 75 years of age or older in this study achieved satisfactory long-term outcomes.

  7. Surgical treatment of T3 and T4 non-small cell lung cancer

    NARCIS (Netherlands)

    Pitz, Cordula Catharina Maria

    2004-01-01

    The primary goal of lung cancer therapy is complete eradication of the disease. Surgery remains the most curative modality for non-small cell lung cancer. The goal of surgical treatment is to perform a complete resection. Resectability is closely related to the stage of the disease. The thesis focu

  8. Surgical resection for esophageal carcinoma: Speaking the language

    Institute of Scientific and Technical Information of China (English)

    Robert J. Korst

    2005-01-01

    The terminology used to describe esophagectomy for carcinoma can be confusing, even for specialists in gastrointestinal disease. As a result, specific terms are often used out of their intended context. To simplify the nomenclature, two points regarding procedures for surgical resection of the esophagus are critical: the extent of resection (radical vs standard) and the operative approach (choice of incisions). It is important to understand that the radicality of the resection may have little to do with the operative approach, with the exception of esophagectomy without thoracotomy (transhiatal esophagectomy), which mandates the performance of a standard or non-radical resection. Esophagectomy has emerged as the standard curative treatment option for patients with esophageal carcinoma; however, unlike the surgical resection of other types of solid tumors, many different surgical options and/or approaches exist for these patients. This heterogeneity of care may result from the fact that the esophagus is accessible through more than one body cavity (left hemithorax, right hemithorax, abdomen).In addition, and partially as a result of its accessibility,different types of surgical specialists harbor this operation in their armamentarium, including general surgeons,thoracic surgeons, and surgical oncologists. Despite this enthusiasm amongst surgeons, little consensus exists as to which option is most oncologically sound. Further, the details of the various surgical approaches and procedures for resection of the esophagus are often difficult to comprehend, even for specialists in gastrointestinal disease, with much of the relevant terminology used out of its intended context. To facilitate the understanding of the surgical options for esophageal carcinoma, it is useful to view the operation from two angles: the extent of resection (Aradical@ vs Astandard@) and the operative approach (choice of incisions).

  9. Video-Assisted Thoracoscopic Surgery in Patients With Clinically Resectable Lung Tumors

    Directory of Open Access Journals (Sweden)

    H. Sakai

    1996-01-01

    Full Text Available To investigate the feasibility of thoracoscopic resection, a pilot study was performed in patients with clinically resectable lung tumors. In 40 patients, Video-assisted thoracic surgery (VATS was performed because of suspicion of malignancy. There were 29 men and 11 women with a median age of 54.8 years (range 18 to 78. Preoperative indications were suspected lung cancer and tumor in 27 patients, assessment of tumor resectability in 7 patients, and probability of metastatic tumors in 6 patients. The final diagnoses in the 27 patients with suspected lung cancer were 12 primary lung cancers, 6 lung metastases, and 9 benign lesions. The success rates for VATS (no conversion to thoracotomy were 1 of 12 (8.3% for resectable stage I lung cancer, 8 of 12 (66.7% for metastatic tumors, and 9 of 9 (100% for benign tumors. With VATS, 6 of 7 patients (85.7%, possible stage III non-small cell lung cancer, an explorative thoracotomy with was avoided, significantly reducing morbidity. The reasons for conversion to thoracotomy were 1 oncological (N2 lymph node dissection and prevention of tumor spillage and 2 technical (inability to locate the nodule, central localization, no anatomical fissure, or poor lung function requiring full lung ventilation. The ultimate diagnoses were 19 lung cancers, 12 metastatic lung tumors, and 9 benign lung tumors. Our data show the limitations of VATS for malignant tumors in general use. These findings, together with the fact that experience in performing thoracoscopic procedures demonstrates a learning curve, may limit the use of thoracoscopic resection as a routine surgical procedure, especially when strict oncological rules are respected.

  10. Lung Cancer Survival Improvement through Surgical Intervention in PUMCH Hospital

    Institute of Scientific and Technical Information of China (English)

    GUO Feng; ZHANG Zhiyong; CUI Yushang; LI Shanqing; LI Li; XU Xiaohui; GE Feng; GUO Huiqin; LI Zejian

    2006-01-01

    Objective: To investigate and evaluate improvement of lung cancer survival after surgical intervention in PUMC hospital during the last 15 years. Methods: From January 1989 to December 2003, 1574 lung cancer cases underwent surgical treatment and followed up. All cases in this series were divided into two groups according to time period: group A (1999-2003) and group B (1989-1998). The difference in the survival rate between groups A and B was compared. Results: The morbidity and mortality in group A was decreased significantly in comparison to group B (11.2% vs. 19.2%, 1.06% vs. 1.93%, respectively).However, the 3-year and 5-year survival rate was increased from 42.35% to 56.07%, and from 28.46% to38.99%, respectively. A significant improvement in survival was observed in patients with stage Ⅰ, Ⅱ and ⅢA, but not in those with stage ⅢB and Ⅳ. Also, patients with lobectomy had more satisfactory results than those receiving exploratory thoracotomy, limited resection, pneumonectomy and sleeve resection. Conclusion: Lobectomy plus systematic mediastinal lymph nodes dissection has become the standard mode for resectable lung cancer. Combination of complete resection along with lymph nodal dissection, and postoperative adjuvant chemotherapy based on platinum/3rd generation chemotherapy medicine, has preliminarily been justified, proving an important approach for effective improvement in long-term survival of non-small cell lung carcinoma.

  11. Surgical Treatment for Non-small Cell Lung Cancer Patients with Synchronous Solitary Brain Metastasis

    Directory of Open Access Journals (Sweden)

    Hao BAI

    2013-12-01

    Full Text Available Background and objective Brain metastases are common in non-small cell lung cancer. Usual treatments include radiotherapy and chemotherapy. However, these methods result in poor patient prognosis. The aim of this study is to assess the effectiveness of surgical resection in the multimodality management of non-small cell lung cancer patients with synchronous solitary brain metastasis. Methods The clinical data of 46 non-small cell lung cancer patients with synchronous solitary brain metastasis were retrospectively reviewed. All patients underwent surgical resection of primary lung tumor, followed by whole brain radiotherapy and chemotherapy. In addition, 13 out of the 46 patients underwent resection of brain metastasis, whereas the remaining 33 patients received stereotactic radiosurgery. Results The median survival time of the enrolled patients was 16.8 months. The 1-, 2-, and 3-year survival rates were 76.1%, 20.9%, and 4.7%, respectively. The median survival times of the patients with brain metastasis resection or stereotactic radiosurgery were 18.3 and 15.8 months, respectively (P=0.091,2. Conclusion Surgical resection of primary lung tumor and brain metastasis may improve prognosis of non-small cell lung cancer patients with synchronous solitary brain metastasis. However, the survival benefit of surgical resection over brain metastasis resection or stereotactic radiosurgery is uncertain.

  12. Predictors of prolonged postoperative endotracheal intubation in patients undergoing thoracotomy for lung resection.

    Science.gov (United States)

    Cywinski, Jacek B; Xu, Meng; Sessler, Daniel I; Mason, David; Koch, Colleen Gorman

    2009-12-01

    The aim of this study was to identify predictors of delayed endotracheal extubation defined as the need for postoperative ventilatory support after open thoracotomy for lung resection. An observational cohort investigation. A tertiary referral center. The study population consisted of 2,068 patients who had open thoracotomy for pneumonectomy, lobectomy, or segmental lung resection between January 1996 and December 2005. Not applicable. Preoperative and intraoperative variables were collected concurrently with the patient's care. Risk factors were identified using logistic regression with stepwise variable selection procedure on 1,000 bootstrap resamples, and a bagging algorithm was used to summarize the results. Intraoperative red blood cell transfusion, higher preoperative serum creatinine level, absence of a thoracic epidural catheter, more extensive surgical resection, and lower preoperative FEV(1) were associated with an increased risk of delayed extubation after lung resection. Most predictors of delayed postoperative extubation (ie, red blood cell transfusion, higher preoperative serum creatinine, lower preoperative FEV(1), and more extensive lung resection) are difficult to modify in the perioperative period and probably represent greater severity of underlying lung disease and more advanced comorbid conditions. However, thoracic epidural anesthesia and analgesia is a modifiable factor that was associated with reduced odds for postoperative ventilatory support. Thus, the use of epidural analgesia may reduce the need for post-thoracotomy mechanical ventilation.

  13. Haglund Deformity – Surgical Resection by the Lateral Approach

    OpenAIRE

    Natarajan, S; VL Narayanan

    2015-01-01

    The aim of this study was to analyse the outcome of surgical Haglund deformity is a prominence in the postero superolateral aspect of the calcaneum. Haglund deformity is a prominence in the postero superolateral aspect of the calcaneum, causing a painful bursitis, which may be difficult to treat by non-operative measures alone. Various surgical methods are available for effective treatment of refractory Haglund’s deformity. This study is to evaluate whether adequate resection of Haglund de...

  14. Validation of an algorithm for planar surgical resection reconstruction

    Science.gov (United States)

    Milano, Federico E.; Ritacco, Lucas E.; Farfalli, Germán L.; Aponte-Tinao, Luis A.; González Bernaldo de Quirós, Fernán; Risk, Marcelo

    2012-02-01

    Surgical planning followed by computer-assisted intraoperative navigation in orthopaedics oncology for tumor resection have given acceptable results in the last few years. However, the accuracy of preoperative planning and navigation is not clear yet. The aim of this study is to validate a method capable of reconstructing the nearly planar surface generated by the cutting saw in the surgical specimen taken off the patient during the resection procedure. This method estimates an angular and offset deviation that serves as a clinically useful resection accuracy measure. The validation process targets the degree to which the automatic estimation is true, taking as a validation criterium the accuracy of the estimation algorithm. For this purpose a manually estimated gold standard (a bronze standard) data set is built by an expert surgeon. The results show that the manual and the automatic methods consistently provide similar measures.

  15. Dilemmas in autoimmune pancreatitis. Surgical resection or not?

    Science.gov (United States)

    Hoffmanova, I; Gurlich, R; Janik, V; Szabo, A; Vernerova, Z

    Surgical treatment is not commonly recommended in the management of autoimmune pancreatitis. The article describes a dilemma in diagnostics and treatment of a 68-year old man with the mass in the head of the pancreas that mimicked pancreatic cancer and that was diagnosed as a type 1 autoimmune pancreatitis (IgG4-related pancreatitis) after a surgical resection. Diagnosis of the autoimmune pancreatitis is a real clinical challenge, as in the current diagnostic criteria exists some degree of overlap in the findings between autoimmune pancreatitis and pancreatic cancer (indicated by the similarity in radiologic findings, elevation of IgG4, sampling errors in pancreatic biopsy, and the possibility of synchronous autoimmune pancreatitis and pancreatic cancer). Despite the generally accepted corticosteroids as the primary treatment modality in autoimmune pancreatitis, we believe that surgical resection remains necessary in a specific subgroup of patients with autoimmune pancreatitis (Fig. 4, Ref. 37).

  16. A projective surgical navigation system for cancer resection

    Science.gov (United States)

    Gan, Qi; Shao, Pengfei; Wang, Dong; Ye, Jian; Zhang, Zeshu; Wang, Xinrui; Xu, Ronald

    2016-03-01

    Near infrared (NIR) fluorescence imaging technique can provide precise and real-time information about tumor location during a cancer resection surgery. However, many intraoperative fluorescence imaging systems are based on wearable devices or stand-alone displays, leading to distraction of the surgeons and suboptimal outcome. To overcome these limitations, we design a projective fluorescence imaging system for surgical navigation. The system consists of a LED excitation light source, a monochromatic CCD camera, a host computer, a mini projector and a CMOS camera. A software program is written by C++ to call OpenCV functions for calibrating and correcting fluorescence images captured by the CCD camera upon excitation illumination of the LED source. The images are projected back to the surgical field by the mini projector. Imaging performance of this projective navigation system is characterized in a tumor simulating phantom. Image-guided surgical resection is demonstrated in an ex-vivo chicken tissue model. In all the experiments, the projected images by the projector match well with the locations of fluorescence emission. Our experimental results indicate that the proposed projective navigation system can be a powerful tool for pre-operative surgical planning, intraoperative surgical guidance, and postoperative assessment of surgical outcome. We have integrated the optoelectronic elements into a compact and miniaturized system in preparation for further clinical validation.

  17. [A Case of Surgical Resection of Isolated Pulmonary Metastasis from Gastric Cancer].

    Science.gov (United States)

    Murata, Tomohiro; Koshiishi, Haruya; Imaizumi, Ken; Okuno, Keisuke; Nakata, Takuya; Hirano, Takayuki; Tokura, Michiyo; Matsuyama, Takatoshi; Hoshino, Mayumi; Kakimoto, Masaki; Goto, Hiroshi; Yoshimura, Tetsunori

    2015-11-01

    We report a rare case of surgical resection for pulmonary metastasis from gastric cancer. A 71-year-old man underwent total gastrectomy for gastric cancer in October 2012. After the operation, he received S-1 chemotherapy for 1 year. In January 2014, computed tomography of the chest showed a nodule shadow with a cavity at S3 in the right lung. Because it showed a tendency to gradually enlarge, we performed an operation in September 2014. The nodule was diagnosed as metastatic adenocarcinoma from gastric cancer on pathology. The patient is being treated with S-1 chemotherapy during follow-up. The pulmonary metastases of gastric cancer often develop along with carcinomatous lymphangiosis or carcinomatous pleurisy, and isolated pulmonary metastasis is rare. A consensus has not been reached about the usefulness of surgical resection, and the accumulation of further cases is required.

  18. Concomitant high gene copy number and protein overexpression of IGF1R and EGFR negatively affect disease-free survival of surgically resected non-small-cell-lung cancer patients

    Science.gov (United States)

    Flacco, A.; Bianconi, F.; Ragusa, M.; Vannucci, J.; Bellezza, G.; Chiari, R.; Minotti, V.; Pistola, L.; Tofanetti, F. R.; Siggillino, A.; Baldelli, E.; Sidoni, A.; Daddi, N.; Puma, F.; Varella-Garcia, M.; Crinò, L.

    2014-01-01

    Background Insulin-like growth factor 1 receptor (IGF1R) represents a novel molecular target in non-small-cell-lung cancer (NSCLC). IGF1R and epidermal growth factor receptor (EGFR) activation are essential to mediate tumor cell survival, proliferation, and invasion. This study investigates the prognostic role of IGF1R and EGFR in surgically resected NSCLC. Materials and methods IGF1R and EGFR copy number gain (CNG) were tested by fluorescence in situ hybridization (FISH) and protein expression by immunohistochemistry (IHC) in 125 stage I–II–IIIA NSCLC patients. Results Fourty-six tumors (40.3 %) were IGF1R FISH-positive (FISH+), and 76 (67.2 %) were EGFR FISH+. Tumors with concomitant IGF1R/EGFR FISH+ were observed in 34 cases (30.1 %). IGF1R and EGFR FISH+ were associated with SCC histology (p = 0.01 and p = 0.04, respectively). IGF1R and EGFR protein over-expression (IHC+) were detected in 45 (36.0 %) and 69 (55.2 %) cases, respectively. Tumors with concomitant IGF1R/EGFR IHC+ were detected in 31 (24.8 %) patients. IGF1R/EGFR FISH+ and IGF1R/EGFR IHC+ were significantly associated (χ2 = 4.02, p = 0.04). Patients with IGF1R/EGFR FISH+ and IGF1R/EGFR IHC+ were associated with shorter disease-free survival (DFS) (p = 0.05 and p = 0.05, respectively). Patients with concomitant IGF1R/EGFR FISH+/IHC+ had a worse DFS and overall survival (p = 0.005 and p = 0.01, respectively). The multivariate model confirmed that IGF1R/EGFR FISH+/IHC+ (hazard ratio (HR), 4.08; p = 0.01) and tumor stage (II–III vs I) (HR, 4.77; p = 0.003) were significantly associated with worse DFS. Conclusions IGF1R/EGFR FISH+ correlates with IGF1R/EGFR IHC+. IGF1R/EGFR FISH+/IHC+ is an independent negative prognostic factor for DFS in early NSCLC. These features may have important implications for future anti-IGF1R therapeutic approaches. PMID:23314677

  19. Role of surgical resection in treatment of pancreatic adenocarcinoma

    Directory of Open Access Journals (Sweden)

    Milošević Pavle

    2011-01-01

    Full Text Available Introduction. Pancreatic adenocarcinoma is the fifth leading cause of death from malignant diseases. The total five-year rate is bellow 5%, but in patients who underwent pancreatic resection, the fiveyear rate may be up to 20%. Surgical resection is still the only therapeutic option that offers the possibility of cure. In recent decades, the perioperative mortality rate has been significantly reduced in the institutions performing a number of these operations per year and has become less than 5%. Postoperative morbidity remains high. Material and Methods. The results of surgical resection in the treatment of pancreatic adenocarcinoma have been analyzed. A retrospective study included the patients operated at the Department for Abdominal, Endocrine and Transplantation surgery, Clinical Center of Vojvodina. Results. In the period from February 1st 1998 to February 1st 2007 a total of 67 patients with pancreatic adenocarcinoma underwent resection. The average age of patients was 58.81±1.42 years. There were 44 (65.7% male and 23 (34.3% female patients. The most common locations of cancer were the head, then the body and the tail of the pancreas and they were found in 57 (85.1% cases, 7 (10,4% cases and 3 (4,47% cases, respectively. The postoperative mortality appeared in 3 (4.47% cases and postoperative morbidity in 21 (31.3% cases. The average survival was 22.89± 3.87 months, the median being 9.0±2.18 months. The five-year survival rate was 13.5%. Conclusion. For patients with pancreatic cancer, surgical resection still remains the only chance of cure. These procedures are performed with acceptable postoperative mortality and morbidity rate. The percentage of cured patients is still unsatisfactorily low.

  20. Strain Assessment in Surgically Resected Inflammatory and Neoplastic Bowel Lesions

    DEFF Research Database (Denmark)

    Havre, R F; Leh, S; Gilja, O H

    2014-01-01

    Purpose: To investigate whether ultrasound-based strain imaging can discriminate between colorectal adenocarcinomas and stenotic Crohn's lesions in newly resected surgical specimens.Materials and Methods: Resected surgical specimens from 27 patients electively operated for colorectal tumors...... or stenotic lesions from Crohn's disease were prospectively examined with ultrasonography using a Hitachi HV 900 US scanner with real-time elastography (RTE). Three different methods were applied to assess tissue strain: A four-level categorical visual classification, a continuous visual analog scale (VAS, 0...... - 100) and a strain ratio (SR) measurement between the lesion and surrounding reference tissue. The imaged sections were marked and subsequently examined by a pathologist. Results from RTE were evaluated according to diagnosis, degree of fibrosis, inflammatory parameters, tumor stage and grade...

  1. ADENOSQUAMOUS LUNG CARCINOMA: CLINICAL CHARACTERISTICS,SURGICAL TREAMENT AND PROGNOSIS

    Institute of Scientific and Technical Information of China (English)

    贲勇; 于洪泉; 王振杰; 苗齐; 任华; 张志庸; 李泽坚

    2000-01-01

    Objective. The effectiveness of surgical resection of adennsqumnous carcinoma of the lung remains poorly defined because of the histology's relatively low frequency, the failure in most published series to separate adenesquamous carcinoma from the other variants of non-small cell lung carcinoma. To define the effectiveness of surgical treatment of adenosquamons carcinoma, we have retrospectively reviewed our hospital experience over a 12-year period. Methoods. Retrospectively reviewed 22 cases of adenosquamous carcinoma who were surgically treated,except one patient,in the PUMCH from Jan. 1985 to Aug. 1997.Tbis series constitutes the 1.9% of a total of 1245 patients with all types of surgical treatment for the primary lung cancer during the same time. Results. The adenosquanons carcinoma was mostly presented in the old patients with a mean age of 60 years and mostly located in the peripheral of lung(n = 20). The overall 5-year survival was 23%. Thoese with stage Ⅰ tumors survival was only 18 % (n = 13), stage Ⅱ 5 %. The survival in stage Ⅲ tumors was not longer than 25 months and in stage Ⅳ survival was not longer than 12 months. Conchtslbn. Our results suggest that adenosquamous carcinoma of lung was a virulent tumor, which exhibited highly aggressive biological behavior with early lymph nodes metastasis(46% ) and its prognosis was worse than that of both squamons cell carcinoma and adenocarcinoma.

  2. ADENOSQUAMOUS LUNG CARCINOMA: CLINICAL CHARACTERISTICS,SURGICAL TREAMENT AND PROGNOSIS

    Institute of Scientific and Technical Information of China (English)

    贲勇; 于洪泉; 王振杰; 苗齐; 任华; 张志庸; 李泽坚

    2000-01-01

    Objective. The effectiveness of surgical resection of adenosquamous carcinoma of the lung remains poorly defined because of the histology' s relatively low frequency, the failure in most published series to separate adenosquamous carcinoma from the other variants of non-small cell lung carcinoma. To define the effectiveness of surgical treatment of adenosquamous carcinoma, we have retrospectively reviewed our hospital experience over a 12-year period. Methods. Retrospectively reviewed 22 cases of adenosquamous carcinoma who were surgically treated, except one patient,in the PUMCH from Jan. 1985 to Aug. 1997.This series constitutes the 1.9% of a total of 1 245 patients with all types of surgical treatment for the primary lung cancer during the same time. Results. The adenosquanous carcinoma was mostly presented in the old patients with a mean age of 60 years and mostly located in the peripheral of lung(n= 20).The overall 5-year survival was 23%.Those with stage Ⅰ tumors survival was only 18%(n= 13), stage Ⅱ 5%. The survival in stage Ⅲ tumors was not longer than 25 months and in stage Ⅳ survival was not longer than 12 months. Conclusion. Our results suggest that adenosquamous carcinoma of lung was a virulent tumor, which exhibited highly aggressive biological behavior with early lymph nodes metastasis(46% ) and its prognosis was worse than that of both squamous cell carcinoma and adenocarcinoma.

  3. [Surgical treatment of lung cancer with carcinomatous pleuritis].

    Science.gov (United States)

    Yokoi, Kohei; Matsuguma, Haruhisa

    2013-07-01

    Carcinomatous pleuritis in patients with lung cancer is usually found to accompany frank malignant effusion and/or multiple pleural tumors and is associated with poor outcomes. The disease condition is now classified as stage IV (M1a) in the present TNM staging system and is generally considered to be a contraindication for surgical resection. However, this condition is sometimes discovered, with or without a small amount of pleural effusion, at thoracotomy in patients with resectable non-small cell lung cancer. The incidence was reported to be approximately 3%, and in such patients surgical treatment has been performed in some institutions. The surgical procedures employed are diverse, including limited resection, lobectomy, pneumonectomy, and extrapleural pneumonectomy. The median postoperative survival times and 5-year survival rates were reported to be 17-30 months and 13-24%, respectively. We performed extrapleural pneumonectomy in 23 patients from 1988 to 2012, and the median survival time and 5-year survival rate are 34 months and 34%, respectively. Among 12 patients with pathologic N0-1 disease, 6 patients are alive without disease 4 to 288 months after surgery, for a median survival time and 5-year survival rate of 126 months and 61%, respectively. Our results indicate that carefully selected patients with carcinomatous pleuritis may be candidates for curative extrapleural pneumonectomy.

  4. Surgical team turnover and operative time: An evaluation of operating room efficiency during pulmonary resection.

    Science.gov (United States)

    Azzi, Alain Joe; Shah, Karan; Seely, Andrew; Villeneuve, James Patrick; Sundaresan, Sudhir R; Shamji, Farid M; Maziak, Donna E; Gilbert, Sebastien

    2016-05-01

    Health care resources are costly and should be used judiciously and efficiently. Predicting the duration of surgical procedures is key to optimizing operating room resources. Our objective was to identify factors influencing operative time, particularly surgical team turnover. We performed a single-institution, retrospective review of lobectomy operations. Univariate and multivariate analyses were performed to evaluate the impact of different factors on surgical time (skin-to-skin) and total procedure time. Staff turnover within the nursing component of the surgical team was defined as the number of instances any nurse had to leave the operating room over the total number of nurses involved in the operation. A total of 235 lobectomies were performed by 5 surgeons, most commonly for lung cancer (95%). On multivariate analysis, percent forced expiratory volume in 1 second, surgical approach, and lesion size had a significant effect on surgical time. Nursing turnover was associated with a significant increase in surgical time (53.7 minutes; 95% confidence interval, 6.4-101; P = .026) and total procedure time (83.2 minutes; 95% confidence interval, 30.1-136.2; P = .002). Active management of surgical team turnover may be an opportunity to improve operating room efficiency when the surgical team is engaged in a major pulmonary resection. Copyright © 2016 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

  5. Chondrosarcoma of the hand: is a wide surgical resection necessary?

    Science.gov (United States)

    Mittermayer, Florian; Dominkus, Martin; Krepler, Petra; Schwameis, Eva; Sluga, Maria; Toma, Cyril; Lang, Susanna; Grampp, Stephan; Kotz, Rainer

    2004-07-01

    Chondrosarcomas of the hand are rare and generally treated with surgical resection. Thirteen patients with Grade 1 chondrosarcoma of the small bones of the hand were followed up for a mean of 99.8 months (range, 26-293 months). In eight patients (Group 1) curettage and reconstruction with cancellous bone was done and in five patients (Group 2) a wide resection was done. No patient experienced relapse in Group 2. In Group 1 one patient had a local relapse 18 months after intralesional resection. Using the Musculoskeletal Tumor Society score for evaluation, the clinical results showed an average of 98% and 95% of the normal function in Groups 1 and 2, respectively. None of the patients had evidence of systemic spread of the disease. With a relapse rate of 12.5% and no distant metastases after curettage, intralesional resection is the preferred method of treatment in Grade 1 chondrosarcoma of the hand, allowing the patient to avoid amputation and major loss of function.

  6. Surgical Management of Intramedullary Spinal Cord Tumors: Surgical Resection and Prognosis

    Institute of Scientific and Technical Information of China (English)

    Gui-huai Wang; Gui-huai Wang; Chung-cheng Wang; Chung-cheng Wang

    2003-01-01

    BACKGROUND & OBJECTIVE: The majority of intramedullary spinal cord tumors (IMSCT) are low-grade gliomas.Radical resection for IMSCTs remains challenging.Recently, improved neuroimaging and advanced microsurgical technique have made great success in surgical management of the intramedullary spinal cord tumors.METHODS & RESULTS: Twenty-nine patients with intramedullary spinal cord tumors were treated by radical resection during the past 4 years in our institute.The histological results were as follows: 12 ependymomas, 4 astrocytomas, 4 hemangioblastomas, 4 epidermoids, 1 cavernoma, 2 lipomas, 2 metastatics.A gross-total resection (> 95%) was achieved in 25 surgical procedures.Subtotal resections (80-95%) were performed in 4 cases.There was no surgical death.When comparing the preoperative and 3-month postoperative functional grades, 12 patients were stable 14 improved, and 3 deteriorated.Patients with either no deficit or only mild deficit before surgery were rarely impaired by the procedure, reinforcing the importance of early diagnosis and treatment.The major determinant of long-term survival was histological composition of the tumor.Patients in whom an IMSCT was only partially resected (< 80%) fared significantly worse.CONCLUSIONS: The long-term survival and quality of life for patients with low-grade gliomas treated by radical resection alone is comparable or superior to minimal resection plus radiotherapy.The optimal therapy for patients with high-grade glioma is yet to be determined.For benign lesion, such as hemangioblastoma and cavernoma could be cured by total resection of the tumor.For lipoma and epidermoid, fibrous adhesions to the cord make total removal difficult, and thus, removal is not the goal of surgery.The carbon dioxide laser is particularly useful during surgery for this lesion.

  7. Clinicoradiological outcomes of 33 cases of surgically resected pulmonary pleomorphic carcinoma: correlation with prognostic indicators

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    Nishida, Akifumi; Ashizawa, Kazuto [Nagasaki University Graduate School of Biomedical Sciences, Department of Clinical Oncology, Unit of Translational Medicine, Nagasaki (Japan); Abiru, Hajime [Saga National Hospital, Department of Radiology, Saga (Japan); Hayashi, Hideyuki; Uetani, Masataka [Nagasaki University Graduate School of Biomedical Sciences, Department of Radiological Science, Nagasaki (Japan); Matsumoto, Keitaro; Tsuchiya, Tomoshi; Yamasaki, Naoya; Nagayasu, Takeshi [Nagasaki University Graduate School of Biomedical Sciences, Department of Surgical Oncology, Nagasaki (Japan); Hayashi, Tomayoshi [Nagasaki Prefectural Shimabara Hospital, Department of Pathology, Shimabara (Japan); Kinoshita, Naoe [Nagasaki University Graduate School of Biomedical Sciences, Department of Pathology, Nagasaki (Japan); Honda, Sumihisa [Nagasaki University Graduate School of Biomedical Sciences, Department of Public Health, Nagasaki (Japan)

    2016-01-15

    To retrospectively review the clinical, radiological and pathological data in patients who underwent surgical resection for pulmonary pleomorphic carcinoma (PC), and to analyse the prognostic predictors of survival. The data were retrospectively examined for 33 consecutive patients (28 males and five females) who had undergone surgical resection for pulmonary PC. Cox's proportional-hazards model was used to analyse the prognostic predictors of survival. The size of the tumours ranged from 1.1 to 12.0 cm (mean 5.4 cm). The majority (26) of the tumours were located at the lung periphery, five tumours had cavitation, two had calcification and 14 had peritumoral ground-glass opacity. Most of the tumours showed heterogeneous enhancement and contained a low-density area (LDA) within the tumour. The 5-year overall survival of surgically resected PC was 36 % (standard error = 0.093). A multivariate analysis revealed the LDA grade [hazard ratio (HR), 2.019], pathological stage (HR, 7.552) and pathological N factor (HR, 0.370) to be significant predictors of a poorer prognosis. A greater component of LDA within the tumour on contrast-enhanced CT is associated with a poorer prognosis in patients with PC. (orig.)

  8. Margin Distance Does Not Influence Recurrence and Survival After Wedge Resection for Lung Cancer.

    Science.gov (United States)

    Maurizi, Giulio; D'Andrilli, Antonio; Ciccone, Anna Maria; Ibrahim, Mohsen; Andreetti, Claudio; Tierno, Simone; Poggi, Camilla; Menna, Cecilia; Venuta, Federico; Rendina, Erino Angelo

    2015-09-01

    The relationship between the free margin distance and the recurrence rate and overall survival after R0 wedge resection for non-small cell lung cancer (NSCLC) is still not clear. We retrospectively evaluated the long-term oncologic outcome of patients who had undergone wedge resection for NSCLC to assess the prognostic effect of margin distance in this setting. Between 2003 and 2013, 243 consecutive patients with a functional contraindication to major lung resection underwent wedge resection with systematic lymph node dissection for clinical stage I NSCLC. The study enrolled 182 patients with pathologic stage I and R0 resection and divided them into three subgroups according to margin distance of less than 1 cm (n = 30), 1 to 2 cm (n = 80), and more than 2 cm (n = 72). The histologic assessment was adenocarcinoma in 112 patients, squamous cell in 30, and other in 40. Postoperative morbidity was 18.7%, and postoperative mortality was 1.1%. The median follow-up was 31 months (range, 2 to 133 months). The locoregional (lung parenchyma, hilum, mediastinum) recurrence rate was 26.4% (n = 48). The distant recurrence rate was 11% (n = 20). Overall 5-year survival was 70.4%. Disease-free 5-year survival was 51.7%. There was no statistical difference in locoregional (p = 0.9) and distant (p = 0.3) recurrence rate and no difference in overall survival (p = 0.07) when the three groups were compared. Wedge resection is a viable option for the surgical treatment of stage I NSCLC when lobectomy is contraindicated. The distance between the tumor and the parenchymal suture margin does not influence recurrence or the survival rate when an R0 resection is achieved. Copyright © 2015 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  9. Comparison of surgical resection and transarterial chemoembolization for patients with intermediate stage hepatocellular carcinoma

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    Chih-Lin Lin

    2016-06-01

    Conclusions: Our results indicated that surgical resection provided superior survival benefit than TACE to patients with intermediate-stage HCC. This is in part attributable to advances in liver surgery which make the resection of intermediate-stage HCC possible. Surgical resection should be considered first for patients with preserved liver function.

  10. Pediatric pituitary resection: characterizing surgical approaches and complications.

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    Hanba, Curtis; Svider, Peter F; Shkoukani, Mahdi A; Sheyn, Anthony; Jacob, Jeffrey T; Eloy, Jean Anderson; Folbe, Adam J

    2017-01-01

    Although there has been extensive study evaluating adult pituitary surgery, there has been scant analysis among children. Our objective was to evaluate a population-based resource to characterize nationwide trends in surgical approach, hospital stay, and complications among children undergoing pituitary surgery. The Kids' Inpatient-Database (KID) files (2009/2012) were evaluated for pituitary gland excisions. Procedure, patient demographics, length of inpatient stay, inpatient costs, hospital setting, and surgical complications were analyzed. A weighted incidence of 1071 cases were analyzed; the majority (77.6%) underwent transsphenoidal resections. These patients had significantly decreased hospital costs and lengths of stay. Patients undergoing transfrontal approaches had significantly greater rates of postoperative diabetes insipidus (DI) (66.5%), panhypopituitarism (38.8%), hydrocephalus, and visual deficits. Among transsphenoidal patients, males had greater rates of postoperative hydrocephalus (5.5%) and panhypopituitarism (17.5%) than females, and patients ≤10 years old had greater rates of these 2 complications (14.5%, 19.4%, respectively) as well as DI (61.3%). A greater proportion of children undergo transfrontal approaches for pituitary lesions than in their adult counterparts. This difference may harbor a potential to influence future sellar resection approaches in children toward a transsphenoidal operation when surgically feasible. Patients undergoing transfrontal procedures have greater risks for many intraoperative and postoperative complications relative to individuals undergoing transsphenoidal resections. Among patients undergoing transsphenoidal approaches, males had significantly greater rates of postoperative hydrocephalus and panhypopituitarism, and younger children had greater rates of postoperative DI, hydrocephalus, and panhypopituitarism. These data reinforce the need for greater vigilance in the postoperative care of younger children

  11. Surgical resection of a solitary liver metastasis from nasopharyngeal carcinoma:a case report

    Institute of Scientific and Technical Information of China (English)

    Spiros Delis; Ioannis Biliatis; Antonia Bourli; Nikolaos Kapranos; Christos Dervenis

    2006-01-01

    BACKGROUND: Nasopharyngeal carcinoma (NPC) has a propensity to develop distant metastases at a high rate and with poor prognosis. Metastatic sites are usually multifocal and involve bones, lungs, liver and distant lymph nodes. Management of metastatic disease is essentially palliative and is based on chemotherapy. METHODS:A 50-year-old man with a solitary liver metastasis from a newly diagnosed NPC was treated by segmentectomy. Prior to surgery, neoadjuvant chemo-therapy followed by concurrent chemoradiotherapy was administered. RESULTS:Complete remission of the primary disease was achieved, although the size of the hepatic lesion was increased. After resection of the liver metastasis, no signs of local or distant recurrence was noted during the 6-month follow up. CONCLUSION:Although surgical treatment has a limited role in metastatic NPC, there are rare cases of localized disease with a reasonable outcome after resection.

  12. Radiologic Evaluation of Small Lepidic Adenocarcinomas to Guide Decision Making in Surgical Resection.

    Science.gov (United States)

    Wilshire, Candice L; Louie, Brian E; Manning, Kristin A; Horton, Matthew P; Castiglioni, Massimo; Gorden, Jed A; Aye, Ralph W; Farivar, Alexander S; Vallières, Eric

    2015-09-01

    The International Association for the Study of Lung Cancer/American Thoracic Society/European Respiratory Society classification of pulmonary adenocarcinomas identifies indolent lesions associated with low recurrence, superior survival, and the potential for sublobar resection. The distinction, however, is determined on the pathologic evaluation, limiting preoperative surgical planning. We sought to determine whether preoperative computed tomography (CT) characteristics could guide decisions about the extent of the pulmonary resection. We reviewed the preoperative CT scans for 136 patients identified to have adenocarcinomas with lepidic features on the final pathologic evaluation. The solid component on CT was substituted for the invasive component, and patients were radiologically classified as adenocarcinoma in situ, 3 cm or less with no solid component; minimally invasive adenocarcinoma, 3 cm or less with a solid component of 5 mm or less; or invasive adenocarcinoma, exceeding 3 cm or solid component exceeding 5 mm, or both. Analysis of variance, t test, χ(2) test, and Kaplan-Meier methods were used for analysis. The radiologic classification identified 35 adenocarcinomas in situ (26%) and 12 minimally invasive (9%) and 89 invasive adenocarcinoma (65%) lesions. At a 32-month median follow-up, patient outcomes associated with the radiologic classification were similar to the pathologic-based classification: the radiologic classification identified 14 of 16 patients with recurrent disease and all 6 who died of lung cancer. In addition, patients with radiologic adenocarcinoma in situ and minimally invasive adenocarcinoma who underwent sublobar resections had no recurrence and 100% disease-free and overall survival at 5 years. The radiologic classification of patients with lepidic adenocarcinomas is associated with similar oncologic and survival outcomes compared with the pathologic classification and may guide decision making in the approach to surgical resection

  13. Detected troponin elevation is associated with high early mortality after lung resection for cancer

    Directory of Open Access Journals (Sweden)

    Van Tornout Fillip

    2006-10-01

    Full Text Available Abstract Background Myocardial infarction can be difficult to diagnose after lung surgery. As recent diagnostic criteria emphasize serum cardiac markers (in particular serum troponin we set out to evaluate its clinical utility and to establish the long term prognostic impact of detected abnormal postoperative troponin levels after lung resection. Methods We studied a historic cohort of patients with primary lung cancer who underwent intended surgical resection. Patients were grouped according to known postoperative troponin status and survival calculated by Kaplan Meier method and compared using log rank. Parametric survival analysis was used to ascertain independent predictors of mortality. Results From 2001 to 2004, a total of 207 patients underwent lung resection for primary lung cancer of which 14 (7% were identified with elevated serum troponin levels within 30 days of surgery, with 9 (64% having classical features of myocardial infarction. The median time to follow up (interquartile range was 22 (1 to 52 months, and the one and five year survival probabilities (95% CI for patients without and with postoperative troponin elevation were 92% (85 to 96 versus 60% (31 to 80 and 61% (51 to 71 versus 18% (3 to 43 respectively (p T stage and postoperative troponin elevation remained independent predictors of mortality in the final multivariable model. The acceleration factor for death of elevated serum troponin after adjusting for tumour stage was 9.19 (95% CI 3.75 to 22.54. Conclusion Patients with detected serum troponin elevation are at high risk of early mortality with or without symptoms of myocardial infarction after lung resection.

  14. Cardiopulmonary exercise testing (CPET) as preoperative test before lung resection.

    Science.gov (United States)

    Kallianos, Anastasios; Rapti, Aggeliki; Tsimpoukis, Sotirios; Charpidou, Andriani; Dannos, Ioannis; Kainis, Elias; Syrigos, Konstantinos

    2014-01-01

    Lung resection is still the only potentially curative therapy for patients with localized non-small lung cancer (NSCLC). However, the presence of cardiovascular comorbidities and underlying lung disease increases the risk of postoperative complications. Various studies have evaluated the use of different preoperative tests in order to identify patients with an increased risk for postoperative complications, associated with prolonged hospital stay and increased morbidity and mortality. In this topic review, we discuss the role of cardiopulmonary exercise testing (CPET) as one of the preoperative tests suggested for lung cancer patients scheduled for lung resection. We describe different types of exercise testing techniques and present algorithms of preoperative evaluation in lung cancer patients. Overall, patients with maximal oxygen consumption (VO2max) VO2max <15 mL/kg/min and both postoperative FEV1 and DLCO<40% predicted, are at high risk for perioperative death and postoperative cardiopulmonary complications, and thus should be offered an alternative medical treatment option. Copyright © 2014 International Institute of Anticancer Research (Dr. John G. Delinassios), All rights reserved.

  15. Surgical Resection for Hepatoblastoma-Updated Survival Outcomes.

    Science.gov (United States)

    Sunil, Bhanu Jayanand; Palaniappan, Ravisankar; Venkitaraman, Balasubramanian; Ranganathan, Rama

    2017-09-30

    Hepatoblastoma is the most common liver malignancy in the pediatric age group. The management of hepatoblastoma involves multidisciplinary approach. Patients with hepatoblastoma who underwent liver resection between 2000 and 2013 were analyzed and survival outcomes were studied. The crude incidence rate of hepatoblastoma at the Madras Metropolitan Tumor Registry (MMTR) is 0.4/1,00,000 population per year. Twelve patients underwent liver resection for hepatoblastoma during the study period; this included eight males and four females. The median age at presentation was 1.75 years (Range 5 months to 3 years). The median serum AFP in the study population was 20,000 ng/ml (Range 4.5 to 1,40,000 ng/ml). Three patients had stage I, one patient had stage II, and eight patients had stage III disease as per the PRETEXT staging system. Two patients were categorized as high risk and ten patients were categorized as standard risk. Seven of these patients received two to four cycles of neoadjuvant chemotherapy (PLADO regimen), and one patient received neoadjuvant radiation up to 84 Gy. Major liver resection was performed in nine patients. Nine patients received adjuvant chemotherapy. The most common histological subtype was embryonal type. Microscopic margin was positive in three cases. One patient recurred 7 months after surgery and the site of failure was the lung. The 5-year overall survival of the case series was 91%. The median survival was 120 months. Liver resections can be safely performed in pediatric populations after neoadjuvant treatment. Patients undergoing surgery had good disease control and long-term survival.

  16. Haglund Deformity – Surgical Resection by the Lateral Approach

    Directory of Open Access Journals (Sweden)

    S Natarajan

    2015-03-01

    Full Text Available The aim of this study was to analyse the outcome of surgical Haglund deformity is a prominence in the postero superolateral aspect of the calcaneum. Haglund deformity is a prominence in the postero superolateral aspect of the calcaneum, causing a painful bursitis, which may be difficult to treat by non-operative measures alone. Various surgical methods are available for effective treatment of refractory Haglund’s deformity. This study is to evaluate whether adequate resection of Haglund deformity by a lateral approach provides good to excellent results. During the period from 2009 to 2012, 40 patients with 46 feet had undergone resection of Haglund deformity using lateral approach and the outcome was analysed using AOFAS Ankle-Hind Foot Scale. The mean AOFAS score at the follow up was 86/100, with the majority of patients reporting alleviation of pain at one year follow up. The lateral approach to calcaneal ostectomy can be an effective treatment for those suffering from refractory Haglund deformity. However, the patient must be made aware of the duration of recovery being long.

  17. Pneumonectomy combined with partial atrial resection for the treatment of lung cancer

    Institute of Scientific and Technical Information of China (English)

    张临友; 李刚; 谭佩林

    2000-01-01

    @@ The number of patients with lung cancer is increasing rapidly,cancers involving the lung are best treated by complete,en bloc resection.When they extend into the left atrium,lung cancers are recognized to be inoperable.Introduction of the techniques of cardiovascular surgery has made possible en bloc resection of the lung with part of the involved left atrium.

  18. Clinical study of simultaneous lung volume reduction surgery during resection of pulmonary or esophageal neoplasms

    Institute of Scientific and Technical Information of China (English)

    TANG Yi-jun; WANG Chao-yang; WANG Cheng-de; DONG Yao-zhong

    2009-01-01

    Background If the emphysema lesions are not symmetrical, unilateral lung volume reduction surgery (LVRS) can be carried out on the more severe side. The aim of this research was to evaluate the feasibility and effects of LVRS performed simultaneously with resection of pulmonary and esophageal neoplasms.Methods Forty-five patients with pulmonary neoplasm and 37 patients with esophageal neoplasm were randomly assigned to group A or group B. In group A, LVRS was performed simultaneously on the same side as thoracotomy. In group B, only tumor resection was performed. The nonfunctional lung area was determined by preoperative chest computed tomography and lung ventilation/perfusion scan. The lung volume removed was about 20% to 30% of the lobes on one side. Preoperative and postoperative indexes including pulmonary function testing variables, arterial blood gas analysis variables, dyspnea scale, 6-minute walk distance, etc., were compared between the groups.Results There were no surgical deaths in this study. The postoperative forced vital capacity in 1 second, PaO_2, PaCO_2,dyspnea scale, and 6-minute walk distance were improved significantly in group A, whereas these indexes did not change or decreased slightly in group B.Conclusions For tumor patients who have associated emphysema, simultaneous LVRS not only increases the chance of receiving surgical therapy, but also improves the postoperative quality of life of the patient. LVRS has expanded thesurgical indication for tumor patients.

  19. Body Mass Index as a Prognostic Factor in Resected Lung Cancer: Obesity or Underweight, Which Is the Risk Factor?

    Science.gov (United States)

    Matsunaga, Takeshi; Suzuki, Kenji; Imashimizu, Kota; Banno, Takamitsu; Takamochi, Kazuya; Oh, Shiaki

    2015-10-01

    In general, obesity is thought to be associated with increased surgical mortality and morbidity. On the other hand, low body mass index (BMI) has recently been reported as a poor prognostic factor for surgical candidates. This study investigated the effect of BMI on lung surgery. A retrospective study was conducted on 1,518 consecutive patients who had malignant pulmonary tumors resected between February 2008 and March 2013. BMI was used to classify patients according to the World Health Organization definition: BMI obese (OB). We defined surgical resection-related mortality as any patient who died within 90 days after resection or while in the hospital. We analyzed morbidity and surgical resection-related mortality, and logistic regression analysis was used to identify predictors for surgical resection-related mortality. Among the four groups, the incidence of cerebrovascular complications was 1.5% in UW, 0.4% in NW, 0% in OW, and 0% in OB, and that of pulmonary complications was 13.1% in UW, 8.4% in NW, 7.3% in OW, and 7.6% in OB. Surgical resection-related mortality was 2.9% in UW, 0.6% in NW, 1.7% in OW, and 0% in OB. Multivariate analysis revealed underweight, diffusing capacity of the lung for carbon monoxide, and male sex as the significant predictors. In this study, low BMI was an independent risk factor for mortality, and the incidence of cerebrovascular and pulmonary complications tended to be higher in patients with low BMI than in obese patients. Underweight patients should be closely monitored following pulmonary resection. Georg Thieme Verlag KG Stuttgart · New York.

  20. Surgical treatment of second primary lung cancer: report of eight cases.

    Science.gov (United States)

    Luh, S P; Lee, Y C; Sheh, J M; Hsu, K Y; Lee, C J

    1995-03-01

    Of 312 patients undergoing resection for lung cancer at National Taiwan University Hospital during 1980 to 1990, eight presented with second primary lung cancer. One patient had synchronous and seven patients had metachronous primaries. There were five males and three females with ages ranging from 41 to 77 years. In the metachronous group, two patients had a different histology between the first and the second tumor, and the intervals between the two tumors varied from 12 to 60 months. The initial resections included pneumonectomy in one and lobectomy in six patients. At the second operation, the surgical procedures included lobectomy in three, completed pneumonectomy in one, segmentectomy in another, and wedge resection in two patients. There was no operative mortality and all patients were regularly followed up from 6 months to 6 years after the second operation. Two patients died, one from repeated respiratory tract infection and the other from brain metastasis. Kaplan-Meier analysis showed 2-year and 3-year survivals of 80% and 60%, respectively. It can be concluded that surgical resection for second primary lung cancer is justified, as it can prolong the patient's survival. Lobectomy can be performed for patients with a second primary lung cancer and sufficient lung reserve, but limited resection should be chosen for patients with poor lung reserve.

  1. Preoperative pulmonary rehabilitation before lung cancer resection: results from two randomized studies.

    Science.gov (United States)

    Benzo, Roberto; Wigle, Dennis; Novotny, Paul; Wetzstein, Marnie; Nichols, Francis; Shen, Robert K; Cassivi, Steve; Deschamps, Claude

    2011-12-01

    Complete surgical resection is the most effective curative treatment for lung cancer. However, many patients with lung cancer also have severe COPD which increases their risk of postoperative complications and their likelihood of being considered "inoperable." Preoperative pulmonary rehabilitation (PR) has been proposed as an intervention to decrease surgical morbidity but there is no established protocol and no randomized study has been published to date. We tested two preoperative PR interventions in patients undergoing lung cancer resection and with moderate-severe COPD in a randomized single blinded design. Outcomes were length of hospital stay and postoperative complications. The first study tested 4 weeks of guideline-based PR vs. usual care: that study proved to be very difficult to recruit as patients and providers were reluctant to delay surgery. Nine patients were randomized and no differences were found between arms. The second study tested ten preoperative PR sessions using a customized protocol with nonstandard components (exercise prescription based on self efficacy, inspiratory muscle training, and the practice of slow breathing) (n=10) vs. usual care (n=9). The PR arm had shorter length of hospital stay by 3 days (p=0.058), fewer prolonged chest tubes (11% vs. 63%, p=0.03) and fewer days needing a chest tube (8.8 vs. 4.3 days p=0.04) compared to the controlled arm. A ten-session preoperative PR intervention may improve post operative lung reexpansion evidenced by shorter chest tube times and decrease the length of hospital stay, a crude estimator of post operative morbidity and costs. Our results suggest the potential for short term preoperative pulmonary rehabilitation interventions in patients with moderate-severe COPD undergoing curative lung resection. 4 weeks of conventional preoperative PR seems non feasible.

  2. Intrathoracic irrigation with arbekacin for methicillin-resistant Staphylococcus aureus empyema following lung resection

    Science.gov (United States)

    Ueno, Tsuyoshi; Toyooka, Shinichi; Soh, Junichi; Miyoshi, Kentaroh; Sugimoto, Seiichiro; Yamane, Masaomi; Oto, Takahiro; Miyoshi, Shinichiro

    2012-01-01

    OBJECTIVES Empyema is a well-known complication following lung resection. In particular, empyema caused by methicillin-resistant Staphylococcus aureus (MRSA) is difficult to treat. Here, we present our experience of MRSA empyema treated with local irrigation using arbekacin. METHODS Six patients consisted of 4 males and 2 females with an average age of 65.7 years. They developed MRSA empyema following lung resection and were treated at our institution between 2007 and 2011. Cases comprised four primary and one metastatic lung cancer, and 1 patient was a living lung transplantation donor. The surgical procedure consisted of four lobectomies, one segmentectomy and one wedge resection. After diagnosis of MRSA empyema, anti-MRSA drugs were administered intravenously in all cases. In addition, arbekacin irrigation at a dose of 100 mg dissolved in saline was performed after irrigation with saline only. RESULTS The average number of postoperative days for the diagnosis of MRSA empyema was 13 (range 4–19). The period of irrigation ranged from 6 to 46 days. Arbekacin irrigation did not induce nephrotoxicity or other complications, and no bacteria resistant to arbekacin was detected in the thoracic cavity. We re-operated on 1 case because he had pulmonary fistula and severe wound infection. At the time of removing the thoracic catheter, MRSA in the pleural effusion disappeared completely in 3 patients. The period until MRSA concentration in the pleural effusion became negative after starting arbekacin irrigation ranged from 4 to 9 days. In the remaining cases, in which MRSA did not disappear, the catheter was removed because of no inflammatory reaction after stopping irrigation and clamping the catheters. All patients were discharged from our institution without thoracic catheterization and no patients had relapsed during the follow-up period ranging from 6 to 44 months. CONCLUSIONS Irrigation of the thoracic cavity with arbekacin proved to be an effective, safe and

  3. Predicting postoperative exercise capacity after major lung resection.

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    Nagamatsu, Yoshinori; Sueyoshi, Susumu; Tsubuku, Tatsuji; Kawasaki, Masayuki; Akagi, Yoshito

    2015-12-01

    This study investigates whether postoperative exercise capacity can be predicted from preoperative lung perfusion scintigraphy and the number of subsegments resected. We studied 315 patients, with 158 being assigned odd numbers and 157 being assigned even numbers. In the 158 patients assigned odd numbers, the predicted postoperative VO2 max/m2 (ppo VO2 max/m2) was obtained from the results of lung perfusion scintigraphy and the number of subsegments scheduled for resection. We then examined correlations with the actual values, 2 weeks and 1 month postoperatively, to obtain a regression equation (Series 1). In the 157 patients assigned even numbers, the ppo VO2 max/m2 corrected by the regression equation derived from Series 1 (corrected-ppo VO2 max/m2) was compared with the actual values, 2 weeks and 1 month postoperatively, to establish whether the postoperative VO2 max/m2 could be predicted. The regression equation between the ppo VO2 max/m2 and its actual value was y = 0.83x + 103, 2 weeks postoperatively, and y = 0.923x + 82, 1 month postoperatively. The difference between the corrected-ppo VO2 max/m2 and the actual postoperative value was small. Calculating the residual [Formula: see text]o2 max/m2 preoperatively from the results of lung perfusion scintigraphy and the number of segments scheduled for resection is useful for predicting postoperative exercise capacity.

  4. Three dimensional model for surgical planning in resection of thoracic tumors

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    Min P. Kim

    2015-01-01

    Conclusion: Three-dimensional printed model provide better visualization of complex thoracic tumors, aid in counseling the patient about the surgical procedure and assisted in surgical resection of thoracic malignancy.

  5. TECHNIQUE AND SURGICAL OUTCOMES OF ANATOMICAL LIVER RESECTIONS FOR COLORECTAL CANCER LIVER METASTASES

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    D. V. Sidorov

    2013-01-01

    Full Text Available Technique and surgical outcomes of anatomical liver resections using ERBEJET2® water-jet dissector were described. Overall 98 patients with colorectal cancer liver metastases were included in this study. In 43 patients resections were performed using water-jet dissection technique. Water-jet dissection seems to be safe and effective technique for anatomical liver resections.

  6. Preoperative surgical planning for intracranial meningioma resection by virtual reality

    Institute of Scientific and Technical Information of China (English)

    TANG Hai-liang; WANG Dai-jun; ZHU Hong-da; TANG Wei-jun; FENG Xiao-yuan; CHEN Xian-cheng; ZHOU Liang-fu; SUN Hua-ping; GONG Ye; MAO Ying; WU Jing-song; ZHANG Xiao-luo; XIE Qing; XIE Li-qian; ZHENG Ming-zhe

    2012-01-01

    Background The Dextroscope system by Volume Interactions (Singapore) had been applied to minimally invasive neurosurgery in many units.This system enables the neurosurgeon to interact intuitively with the three-dimensional graphics in a direct manner resembling the way one communicates with the real objects.In the paper,we explored its values in pre-operation surgical planning for intracranial meningiomas resection.Methods Brain compuled tomography (CT),magnetic resonance imaging (MRI),and magnetic resonance venography (MRV) were performed on 10 patients with parasagittal and falcine meningiomas located on central groove area; brain CT,MRI and magnetic resonance angiography (MRA) were performed on 10 patients with anterior skull base meningiomas and 10 patients with sphenoid ridge meningiomas.All these data were transferred to Dextroscope virtual reality system,and reconstructed.Then meningiomas,skull base,brain tissue,drainage vein and cerebral arteries were displayed within the system,and their anatomic relationships were evaluated.Also,the simulation operations were performed.Results For parasagittal and falcine meningiomas,the relationships of tumor with drainage vein and superior sagittal sinus were clearly displayed in the Dextroscope system.For anterior skull base and sphenoid ridge meningiomas,the relationships of tumor with bilateral internal carotid arteries,anterior cerebral arteries,middle cerebral arteries and skull base were vividly displayed within the virtual reality system.Surgical planning and simulation operation of all cases were performed as well.The real operations of all patients were conducted according to the simulation with well outcomes.Conclusions According to the virtual reality planning,neurosurgeons could get more anatomic information about meningioma and its surrounding structures,especially important vessels,and choose the best approach for tumor resection,which would lead to better prognosis for patients.

  7. Using quantitative breath sound measurements to predict lung function following resection.

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    Morice, Rodolfo C; Jimenez, Carlos A; Eapen, Georgie A; Mehran, Reza J; Keus, Leendert; Ost, David

    2010-10-12

    Predicting postoperative lung function is important for estimating the risk of complications and long-term disability after pulmonary resection. We investigated the capability of vibration response imaging (VRI) as an alternative to lung scintigraphy for prediction of postoperative lung function in patients with intrathoracic malignancies. Eighty-five patients with intrathoracic malignancies, considered candidates for lung resection, were prospectively studied. The projected postoperative (ppo) lung function was calculated using: perfusion scintigraphy, ventilation scintigraphy, and VRI. Two sets of assessments made: one for lobectomy and one for pneumonectomy. Clinical concordance was defined as both methods agreeing that either a patient was or was not a surgical candidate based on a ppoFEV1% and ppoDLCO% > 40%. Limits of agreement between scintigraphy and VRI for ppo following lobectomy were -16.47% to 15.08% (mean difference = -0.70%;95%CI = -2.51% to 1.12%) and for pneumonectomy were -23.79% to 19.04% (mean difference = -2.38%;95%CI = -4.69% to -0.07%). Clinical concordance between VRI and scintigraphy was 73% for pneumonectomy and 98% for lobectomy. For patients who had surgery and postoperative lung function testing (n = 31), ppoFEV1% using scintigraphic methods correlated with measured postoperative values better than projections using VRI, (adjusted R2 = 0.32 scintigraphy; 0.20 VRI), however the difference between methods failed to reach statistical significance. Limits of agreement between measured FEV1% postoperatively and ppoFEV1% based on perfusion scintigraphy were -16.86% to 23.73% (mean difference = 3.44%;95%CI = -0.29% to 7.16%); based on VRI were -19.56% to 28.99% (mean difference = 4.72%;95%CI = 0.27% to 9.17%). Further investigation of VRI as an alternative to lung scintigraphy for prediction of postoperative lung function is warranted.

  8. Using quantitative breath sound measurements to predict lung function following resection

    Directory of Open Access Journals (Sweden)

    Keus Leendert

    2010-10-01

    Full Text Available Abstract Background Predicting postoperative lung function is important for estimating the risk of complications and long-term disability after pulmonary resection. We investigated the capability of vibration response imaging (VRI as an alternative to lung scintigraphy for prediction of postoperative lung function in patients with intrathoracic malignancies. Methods Eighty-five patients with intrathoracic malignancies, considered candidates for lung resection, were prospectively studied. The projected postoperative (ppo lung function was calculated using: perfusion scintigraphy, ventilation scintigraphy, and VRI. Two sets of assessments made: one for lobectomy and one for pneumonectomy. Clinical concordance was defined as both methods agreeing that either a patient was or was not a surgical candidate based on a ppoFEV1% and ppoDLCO% > 40%. Results Limits of agreement between scintigraphy and VRI for ppo following lobectomy were -16.47% to 15.08% (mean difference = -0.70%;95%CI = -2.51% to 1.12% and for pneumonectomy were -23.79% to 19.04% (mean difference = -2.38%;95%CI = -4.69% to -0.07%. Clinical concordance between VRI and scintigraphy was 73% for pneumonectomy and 98% for lobectomy. For patients who had surgery and postoperative lung function testing (n = 31, ppoFEV1% using scintigraphic methods correlated with measured postoperative values better than projections using VRI, (adjusted R2 = 0.32 scintigraphy; 0.20 VRI, however the difference between methods failed to reach statistical significance. Limits of agreement between measured FEV1% postoperatively and ppoFEV1% based on perfusion scintigraphy were -16.86% to 23.73% (mean difference = 3.44%;95%CI = -0.29% to 7.16%; based on VRI were -19.56% to 28.99% (mean difference = 4.72%;95%CI = 0.27% to 9.17%. Conclusions Further investigation of VRI as an alternative to lung scintigraphy for prediction of postoperative lung function is warranted.

  9. Recurrent Intrathoracic Locking of the Scapula after Lung Cancer Resection and Combined Rib Resection

    Directory of Open Access Journals (Sweden)

    Akinori Kimura

    2017-01-01

    Full Text Available We report a case of recurrent locking of the scapula in the thorax after combined lobectomy and thoracic wall resection for advanced lung cancer. The patient was a 52-year-old man with advanced spindle cell carcinoma in his right lung. He had undergone right lung lobectomy and thoracic wall excision (Th1–5. Intrathoracic repair had not been performed to address the defect in the thoracic wall. Two months after the operation he experienced sudden acute pain in the right shoulder. Three-dimensional computed tomography revealed locking of the scapula intrathoracically. The diagnosis was recurrent locking of the scapula in the thorax. He underwent conservative treatment. Because his symptoms were not alleviated and he continued to experience recurrent locking, we performed partial resection of the inferior part of the scapula. Although scapular locking diminished after this procedure, there were still some pain and “catching” between the scapula and the thoracic wall (T6 when he undertook certain movements. No further surgery could be performed, however, because the cancer from the primary lesion had recurred near the previously operated thoracic wall. A procedure for recurrent intrathoracic locking of the scapula was not successful in this case.

  10. [Uniportal VATS: a sublimation of micro-invasive lung cancer resection].

    Science.gov (United States)

    Liu, Chengwu; Liu, Lunxu

    2014-07-20

    Micro-invasive thoracic surgery, especially represented by video-assisted thoracic surgery (VATS), has become the mainstream of lung cancer resection. Traditional multi-portal VATS techniques, including four-port, three-port, and two-port VATS, have been widely used to perform nearly all kinds of lung cancer resections. However, how to make lung cancer resection less invasive is always the subject that all thoracic surgeons never stop pursuing. Compared with multi-portal VATS, uniportal VATS causes less postoperative pain and paresthesia because only one small incision is made and one intercoastal space is involved. In recent years, good clinical results have been obtained from uniportal VATS in lung cancer resections. In this paper, we'd like to present a brief summary about the progresses made in the application of uniportal VATS in lung cancer resection. Uniportal VATS is a sublimation of micro-invasive lung cancer resection.

  11. Local treatment of oligometastatic recurrence in patients with resected non-small cell lung cancer.

    Science.gov (United States)

    Yano, Tokujiro; Okamoto, Tatsuro; Haro, Akira; Fukuyama, Seiichi; Yoshida, Tsukihisa; Kohno, Mikihiro; Maehara, Yoshihiko

    2013-12-01

    We previously reported a retrospective study indicating the prognostic impact of the local treatment of oligometastatic recurrence after a complete resection for non-small cell lung cancer (NSCLC). In the present study, we prospectively observed postoperative oligometastatic patients and investigated the effects of local treatment on progression-free survival (PFS). Using a prospectively maintained database of patients with completely resected NSCLC treated between October 2007 and December 2011, we identified 52 consecutive patients with postoperative recurrence, excluding second primary lung cancer. Of these patients, 31 suffering from distant metastases alone without primary site recurrence were included in this study. According to the definition of 'oligometastases' as a limited number of distant metastases ranging from one to three, 17 patients had oligometastatic disease. Of those 17 patients, four patients with only brain metastasis were excluded from the analysis. The oligometastatic sites included the lungs in five patients, bone in four patients, the lungs and brain in two patients, the adrenal glands in one patient and soft tissue in one patient. Eleven of the 13 patients first received local treatment. Three patients (lung, adrenal gland, soft tissue) underwent surgical resection, and the remaining eight patients received radiotherapy. The median PFS was 20 months in the oligometastatic patients who received local treatment. There were five patients with a PFS of longer than two years. The metastatic sites in these patients varied, and one patient had three lesions. On the other hand, the two remaining patients first received a systemic chemotherapy of their own selection. The PFS of these two patients was five and 15 months, respectively. Local therapy is a choice for first-line treatment in patients with postoperative oligometastatic recurrence. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

  12. Prognostic Factors of Survival after Recurrence in Patients with Resected Lung Adenocarcinoma.

    Science.gov (United States)

    Hung, Jung-Jyh; Yeh, Yi-Chen; Jeng, Wen-Juei; Chien, Hong-Che; Wu, Yu-Chung; Chou, Teh-Ying; Hsu, Wen-Hu

    2015-09-01

    Recurrence after surgical resection is the most common cause of treatment failure in patients with non-small-cell lung cancer. The aim of the study is to investigate the prognostic factors of postrecurrence survival (PRS) in patients of resected lung adenocarcinoma. The clinicopathological characteristics of 179 patients with recurrence after complete resection of lung adenocarcinoma at Taipei Veterans General Hospital between 2004 and 2010 were retrospectively reviewed. The prognostic and predictive effects of these clinicopathological variables in PRS were analyzed. The pattern of recurrence included local only in 25 (15.4%), distant only in 56 (34.6%), and both local and distant in 81 (50.0%) of patients. The 2-year and 5-year PRS were 65.2% and 29.8%, respectively. The most common organ sites of metastasis were the contralateral lung (39.1%), followed by the brain (33.5%) and the bone (31.3%). Multivariate analysis revealed that micropapillary/solid predominant pattern group (versus acinar/papillary; hazard ratio = 2.615; 95% confidence interval: 1.395-4.901; p = 0.003) and no treatment for recurrence (p recurrence, micropapillary/solid predominant pattern group (versus acinar/papillary; hazard ratio = 2.570; 95% confidence interval: 1.357-4.865; p = 0.004) was a significant predictive factor of worse PRS. Treatment for recurrence with surgery (p = 0.067) tended to be a significant predictive factor of better PRS. In lung adenocarcinoma, micropapillary/solid predominant pattern group (versus acinar/papillary) was a significant poor prognostic factor for PRS.

  13. Efficacy of surgical resection in management of isolated extrahepatic metastases of hepatocellular carcinoma

    Institute of Scientific and Technical Information of China (English)

    Kun-Ming Chan; Ming-Chin Yu; Ting-Jung Wu; Chen-Fang Lee; Tse-Ching Chen; Wei-Chen Lee; Miin-Fu Chen

    2009-01-01

    AIM: To clarify the benefit of surgical excision for patients with extrahepatic metastases of hepatocellular carcinoma (HCC).METHODS: We retrospectively reviewed the medical records of 140 patients with pathologically proven extrahepatic metastases of HCC and evaluated the outcomes of those who had undergone surgical resection (SR) for extrahepatic metastatic lesions.Prognoses made on the basis of extrahepatic metastatic sites were also examined.RESULTS: The survival rates of patients who underwent SR of extrahepatic metastases were significantly better than those of patients who did not receive SR.For the SR group, 1- and 3-year survival rates were 24% and 7%, respectively, while for the non-resection group, the survival rates were 8% and 0%, respectively ( P < 0.0001).Survival rates related to metastatic sites were also significantly superior after SR of extrahepatic metastases: median survivals were 32 mo with lung metastasis, 10 mo with bone metastasis, 6.1 mo with brain metastasis.CONCLUSION: SR can provide survival benefits for patients with 1 or 2 isolated extrahepatic metastases and who concurrently exhibit good hepatic functional reserve and general performance status as well as successful treatment of intrahepatic HCC.

  14. Respiratory mechanics and fluid dynamics after lung resection surgery.

    Science.gov (United States)

    Miserocchi, Giuseppe; Beretta, Egidio; Rivolta, Ilaria

    2010-08-01

    Thoracic surgery that requires resection of a portion of lung or of a whole lung profoundly alters the mechanical and fluid dynamic setting of the lung-chest wall coupling, as well as the water balance in the pleural space and in the remaining lung. The most frequent postoperative complications are of a respiratory nature, and their incidence increases the more the preoperative respiratory condition seems compromised. There is an obvious need to identify risk factors concerning mainly the respiratory function, without neglecting the importance of other comorbidities, such as coronary disease. At present, however, a satisfactory predictor of postoperative cardiopulmonary complications is lacking; postoperative morbidity and mortality have remained unchanged in the last 10 years. The aim of this review is to provide a pathophysiologic interpretation of the main respiratory complications of a respiratory nature by relying on new concepts relating to lung fluid dynamics and mechanics. New parameters are proposed to improve evaluation of respiratory function from pre- to the early postoperative period when most of the complications occur.

  15. Preoperative pulmonary rehabilitation in lung cancer patients undergoing lung resection surgery

    OpenAIRE

    Sebio García, Raquel

    2016-01-01

    [Abstract] INTRODUCTION: Lung resection surgery (LRS) remains the treatment of choice for early stages of lung cancer but significant morbidity is associated, especially among patients with poor preoperative status. Preoperative exercise training (PET) has been proposed as an effective way of optimizing patients’ condition before surgery and enhancing postoperative recovery. However, it remains unknown whether or not similar results can be achieved after video-assisted thora...

  16. Preoperative pulmonary rehabilitation in lung cancer patients undergoing lung resection surgery

    OpenAIRE

    Sebio García, Raquel

    2016-01-01

    [Abstract] INTRODUCTION: Lung resection surgery (LRS) remains the treatment of choice for early stages of lung cancer but significant morbidity is associated, especially among patients with poor preoperative status. Preoperative exercise training (PET) has been proposed as an effective way of optimizing patients’ condition before surgery and enhancing postoperative recovery. However, it remains unknown whether or not similar results can be achieved after video-assisted thora...

  17. Severity of lung fibrosis affects early surgical outcomes of lung cancer among patients with combined pulmonary fibrosis and emphysema.

    Science.gov (United States)

    Mimae, Takahiro; Suzuki, Kenji; Tsuboi, Masahiro; Ikeda, Norihiko; Takamochi, Kazuya; Aokage, Keiju; Shimada, Yoshihisa; Miyata, Yoshihiro; Okada, Morihito

    2016-07-01

    Combined pulmonary fibrosis and emphysema (CPFE) is defined as upper lobe emphysema and lower lobe fibrosis, which are representative lung disorders that increase the prevalence of lung cancer. This unique disorder may affect the morbidity and mortality during the early period after surgery. The present study aimed to identify which clinicopathological features significantly affect early surgical outcomes after lung resection in nonsmall cell lung cancer (NSCLC) patients and in those with CPFE.We retrospectively assessed 2295 patients with NSCLC and found that 151 (6.6%) had CPFE. All were surgically treated between January 2008 and December 2010 at 4 institutions.The postoperative complication rates for patients with and without CPFE were 39% and 17%, respectively. The 90-day mortality rates were higher among patients with than without CPFE (7.9% vs 1%). Acute exacerbation of interstitial pneumonia was the main cause of death among 12 patients with CPFE who died within 90 days after surgery. Multivariate logistic regression analysis selected CPFE, gender, age, and clinical stage as independent predictive factors for postoperative complications, and CPFE, clinical stage, and sex for 90-day mortality. The severity of lung fibrosis on preoperative CT images was an independent predictive factor for 90-day mortality among patients with CPFE.The key predictive factor for postoperative mortality and complications of lung resection for NSCLC was CPFE. The severity of lung fibrosis was the principal predictor of early outcomes after lung surgery among patients with CPFE and NSCLC.

  18. Does surgical resection of hepatocellular carcinoma accelerate cancer dissemination?

    Institute of Scientific and Technical Information of China (English)

    I-Shyan Sheen; Yi-Chun Tsai; Tsu-Yen Wu; Kuo-Shyang Jeng; Shou-Chuan Shih; Po-Chuan Wang; Wen-Hsiung Chang; Horng-Yuan Wang; Li-Rung Shyung; Shee-Chan Lin; Chin-Roa Kao

    2004-01-01

    recurrence (58% vs.39%, P=0.093). The correlation between perioperative hAFP mRNA positivity and recurrence related mortality had no statistical significance (P=0.836).CONCLUSION: From our study, perioperative detection of hAFP mRNA in peripheral blood of patients has no clinical relevance and significant role in the prediction of HCC recurrence. Surgical resection itself may not accelerate cancer dissemination and does not increase postoperative recurrence significantly either.

  19. Is age a predisposing factor of postoperative complications after lung resection for primary pulmonary neoplasms?

    Science.gov (United States)

    Cañizares Carretero, Miguel-Ángel; García Fontán, Eva-María; Blanco Ramos, Montserrat; Soro García, José; Carrasco Rodríguez, Rommel; Peña González, Emilio; Cueto Ladrón de Guevara, Antonio

    2017-03-01

    Age has been classically considered as a determining factor for the development of postoperative complications related to lung resection for bronchogenic carcinoma. The Postoperative Complications Study Group of the Spanish Society of Thoracic Surgery has promoted a registry to analyze this factor. A total of 3,307 patients who underwent any type of surgical resection for bronchogenic carcinoma have been systematically and prospectively recorded in any of the 24 units that are part of the group. Several variables related to comorbidity and age, as well as postoperative complications, were analyzed. The mean age of patients was 65,44. Men were significantly more common than female. The most frequent complication was prolonged air leak, which was observed in more than one third of patients. In a univariant analysis, air leak presence and postsurgical atelectasis showed statistical association with patient age, when stratified in age groups. In a multivariate analysis, age was recognized as an independent prognostic factor in relation to air leak onset. However, this could not be confirmed for postoperative atelectasis. Age is a predisposing factor for the development of postoperative complications after lung resection. Other associated factors also influence the occurrence of these complications. Copyright © 2017 AEC. Publicado por Elsevier España, S.L.U. All rights reserved.

  20. CT-guided localization of small pulmonary nodules using adjacent microcoil implantation prior to video-assisted thoracoscopic surgical resection

    Energy Technology Data Exchange (ETDEWEB)

    Su, Tian-Hao; Jin, Long; He, Wen [Capital Medical University, Department of Radiology, Beijing Friendship Hospital, Beijing (China); Fan, Yue-Feng [Xiamen University, Department of Interventional Therapy, The First Affiliated Hospital, Xiamen, Fujian (China); Hu, Li-Bao [Peking University People' s Hospital, Department of Radiology, Beijing (China)

    2015-09-15

    To describe and assess the localization of small peripheral pulmonary nodules prior to video-assisted thoracoscopic surgical (VATS) resection using the implantation of microcoils. Ninety-two patients with 101 pulmonary nodules underwent computed tomography (CT)-guided implantation of microcoils proximal to each nodule. Patients were randomly assigned to undergo entire microcoil or leaving-microcoil-end implantations. The complications and efficacy of the two implantation methods were evaluated. VATS resection of lung tissue containing each pulmonary lesion and microcoil were performed in the direction of the microcoil marker. Histopathological analysis was performed for the resected pulmonary lesions. CT-guided microcoil implantation was successful in 99/101 cases, and the placement of microcoils within 1 cm of the nodules was not disruptive. There was no difference in the complications and efficacy associated with the entire implantation method (performed for 51/99 nodules) versus the leaving-microcoil-end implantation method (performed for 48/99 nodules). All nodules were successfully removed using VATS resection. Asymptomatic pneumothorax occurred in 16 patients and mild pulmonary haemorrhage occurred in nine patients. However, none of these patients required further surgical treatment. Preoperative localization of small pulmonary nodules using a refined percutaneous microcoil implantation method was found to be safe and useful prior to VATS resection. (orig.)

  1. Approach to the medical management of surgically resectable gastric cancer.

    Science.gov (United States)

    Tesfaye, Anteneh; Marshall, John L; Smaglo, Brandon G

    2016-02-01

    The optimal adjuvant management of patients with resectable gastric cancer remains a therapeutic challenge. Although the benefit of adjuvant therapy for these patients is clearly established, recurrence and mortality rates remain high despite such treatment. Moreover, surgical comorbidities and treatment toxicities result in high rates of failure to complete treatment after surgery. Two divergent approaches to adjuvant treatment have emerged as standard: postoperative chemoradiotherapy and perioperative chemotherapy. Because these approaches have never been compared directly, recommendations for adjuvant treatment require multidisciplinary discussion. During this discussion, the characteristics of the symptoms, the histology, location, and stage of the tumor, and the feasibility of the patient's completing all recommended therapy may be considered. In our own practice, we favor perioperative chemotherapy for patients with asymptomatic, proximal, higher-stage disease and adjuvant chemoradiotherapy for patients with symptomatic, distal, lower-stage disease. Herein, we summarize the available data for approaches to the adjuvant treatment of gastric cancer, with special consideration of the characteristics of the patients enrolled in the various studies. We also describe how we developed our paradigm for recommending a particular approach to adjuvant treatment for each patient.

  2. Impact of the oncogenic status on the mode of recurrence in resected non-small cell lung cancer.

    Science.gov (United States)

    Mizuno, Tetsuya; Yatabe, Yasushi; Kuroda, Hiroaki; Sakakura, Noriaki; Sakao, Yukinori

    2016-10-01

    Surgical resection is employed in patients with resectable non-small cell lung cancer. Despite complete resection, recurrence is sometimes observed. Oncogenic mutations promote initiation and progression of lung cancer, and mutation status predicts treatment outcome of advanced non-small cell lung cancer; however, their impact on the recurrence patterns remains poorly understood. We retrospectively studied 401 patients showing recurrence after complete resection of non-small cell lung cancer. Clinicopathological factors were reviewed for time to recurrence, and recurrence patterns were compared according to oncogenic status and examined according to EGFR mutational subtype. Among 401 patients, 185 with EGFR mutation, 46 with KRAS mutation, 15 with ALK rearrangement and 155 with triple-negative mutation were identified. Multivariate analysis following univariate analyses showed that younger age, well-moderately-differentiated histology, earlier pathologic stage and presence of EGFR or ALK mutation were favorable prognostic factors for time to recurrence. Locoregional recurrence was observed in 53.3% of ALK-positive patients, being significantly common in these patients than in EGFR- and KRAS-positive patients. EGFR-positive patients mostly experienced pleural recurrence, the incidence of which was significantly higher in triple-negative mutation patients. Adrenal recurrence was observed in 7.2% of triple-negative mutation patients, but it was rarely identified in EGFR-positive patients. Among EGFR-positive patients, the incidence of brain metastases was significantly higher in L858R cohort than in Del Ex19 cohort. In resected non-small cell lung cancer, younger age, well-moderately-differentiated histology, earlier pathologic stage and presence of EGFR or ALK mutation were favorable factors for TTR, and distinct recurrence patterns were revealed according to oncogenic mutation status and mutational EGFR subtype. Our results may provide suggestions for developing a

  3. Current innovations in sentinel lymph node mapping for the staging and treatment of resectable lung cancer.

    Science.gov (United States)

    Hachey, Krista J; Colson, Yolonda L

    2014-01-01

    Despite surgical resectability, early-stage lung cancer remains a challenge to cure. Survival outcomes are hindered by variable performance of adequate lymphadenectomy and the limitations of current pathologic nodal staging. Sentinel lymph node (SLN) mapping, a mainstay in the management of breast cancer and melanoma, permits targeted nodal sampling for efficient and accurate staging that can influence both intraoperative and adjuvant treatment decisions. Unfortunately, standard SLN identification techniques with blue dye and radiocolloid tracers have not been shown to be reproducible in lung cancer. In more recent years, intraoperative near-infrared image-guided lung SLN mapping has emerged as promising technology for the identification of the tumor-associated lymph nodes most likely to contain metastatic disease. Additionally, the clinical relevance of SLN mapping for lung cancer remains pressing, as the ability to identify micrometastatic disease in SLNs could facilitate trials to assess chemotherapeutic response and the clinical effect of occult nodal disease. This review outlines the status of lung cancer lymphatic mapping and techniques in development that may help close the gap between translational research in this field and routine clinical practice.

  4. Definitive Chemoradiation Therapy Following Surgical Resection or Radiosurgery Plus Whole-Brain Radiation Therapy in Non-Small Cell Lung Cancer Patients With Synchronous Solitary Brain Metastasis: A Curative Approach

    Energy Technology Data Exchange (ETDEWEB)

    Parlak, Cem, E-mail: cemparlak@gmail.com [Department of Radiation Oncology, Baskent University, Adana Medical Faculty, Adana (Turkey); Mertsoylu, Hüseyin [Department of Medical Oncology, Baskent University, Adana Medical Faculty, Adana (Turkey); Güler, Ozan Cem; Onal, Cem; Topkan, Erkan [Department of Radiation Oncology, Baskent University, Adana Medical Faculty, Adana (Turkey)

    2014-03-15

    Purpose/Objectives: The aim of this study was to evaluate the impact of definitive thoracic chemoradiation therapy following surgery or stereotactic radiosurgery (SRS) and whole-brain radiation therapy (WBRT) on the outcomes of patients with non-small cell lung cancer (NSCLC) with synchronous solitary brain metastasis (SSBM). Methods and Materials: A total of 63 NSCLC patients with SSBM were retrospectively evaluated. Patients were staged using positron emission tomography-computed tomography in addition to conventional staging tools. Thoracic radiation therapy (TRT) with a total dose of 66 Gy in 2 Gy fractions was delivered along with 2 cycles of cisplatin-based chemotherapy following either surgery plus 30 Gy of WBRT (n=33) or SRS plus 30 Gy of WBRT (n=30) for BM. Results: Overall, the treatment was well tolerated. All patients received planned TRT, and 57 patients (90.5%) were also able to receive 2 cycles of chemotherapy. At a median follow-up of 25.3 months (7.1-52.1 months), the median months of overall, locoregional progression-free, neurological progression-free, and progression-free survival were 28.6, 17.7, 26.4, and 14.6, respectively. Both univariate and multivariate analyses revealed that patients with a T1-T2 thoracic disease burden (P=.001), a nodal stage of N0-N1 (P=.003), and no weight loss (P=.008) exhibited superior survival. Conclusions: In the present series, surgical and radiosurgical treatments directed toward SSBM in NSCLC patients were equally effective. The similarities between the present survival outcomes and those reported in other studies for locally advanced NSCLC patients indicate the potentially curative role of definitive chemoradiation therapy for highly selected patients with SSBM.

  5. The impact of anaemia, leukocytosis and thrombocytosis on survival in patients with lung cancer resection

    Directory of Open Access Journals (Sweden)

    Tatjana N. Adžić

    2011-01-01

    Full Text Available SUMMARY.Intro duction: Previous studies have reported that preoperativeleukocytosis, anaemia and thrombocytosis are related to the prognosisof non-small cell lung cancer (NSCLC. The aim of this study was todetermine impact of these haematological parameters in patients ofdifferent ages with NSCLC. Materia l and methods: Among 2,050patients who underwent lung resection for NSCLC in the 5-year period2002-2007, 200 were reviewed, of whom 93 were aged above 70 years.Results: The frequency of preoperative leukocytosis, anaemia andthrombocytosis was 21% (42/200, 32.5% (65/200, 16.5% (33/200,respectively. The 5-year survival of the patients with and withoutleukocytosis, anaemia and thrombocytosis was 26.5% vs 27.4%, 28.9%vs 27.2% and 31.7% vs 26.6%, respectively. No significant differencewas observed in the 5-year survival according to either the presenceor absence of preoperative leukocytosis, anaemia and thrombocytosis,or the age group, <70 years and ≥70 years. Significant differencewas found in the haemoglobin (Hb level between the differentage groups, 3 (p=0.0025, 6 (p<0.001 and 12 (p=0.033 monthspostoperatively. Leukocytosis, anaemia and thrombocytosis werefrequently found in earlier stages of NSCLC and in connection withextended types of surgical resection. Co nclusions: Preoperativeanaemia, leukocytosis and thrombocytosis are not related with patientsurvival after lung resection for NSCLC, although the measurementis inexpensive and routinely used. An abnormal blood cell count inpatients with cancer is not always a tumour-related phenomenon.Pneumon 2011, 24(1:354-358.

  6. Surgical treatment for primary lung cancer combined with idiopathic pulmonary fibrosis.

    Science.gov (United States)

    Watanabe, Atsushi; Miyajima, Masayoshi; Mishina, Taijiro; Nakazawa, Junji; Harada, Ryo; Kawaharada, Nobuyoshi; Higami, Tetsuya

    2013-05-01

    Idiopathic pulmonary fibrosis (IPF) is defined as a specific form of chronic, progressive fibrosing interstitial pneumonia of unknown cause. IPF is associated with an increased risk of lung cancer, and lung cancer patients with IPF undergoing pulmonary resection for non-small cell lung cancer have increased postoperative morbidity and mortality. Especially, postoperative acute exacerbation of IPF (AEIPF) causes fatal status and long-term outcomes are worse than for patients without IPF, although certain subgroups have a good long-term outcome. A comprehensive review of the current literature pertaining to AEIPF and the late phase outcome after the context of a surgical intervention was performed.

  7. Non-small-cell lung cancer resectability: diagnostic value of PET/MR

    Energy Technology Data Exchange (ETDEWEB)

    Fraioli, Francesco; Menezes, Leon; Kayani, Irfan; Syed, Rizwan; O' Meara, Celia; Barnes, Anna; Bomanji, Jamshed B.; Punwani, Shonit; Groves, Ashley M. [University College London Hospitals NHS Foundation Trust, Department of Nuclear Medicine and Radiology, London (United Kingdom); Screaton, Nicholas J. [Papworth Hospital NHS Foundation Trust, Department of Radiology, Cambridge (United Kingdom); Janes, Samuel M. [University College London, Lungs for Living Research Centre, UCL Respiratory Division of Medicine, London (United Kingdom); Win, Thida [Lister Hospital, Respiratory Medicine, Stevenage (United Kingdom); Zaccagna, Fulvio [University of Rome ' ' Sapienza' ' , Department of Radiological Sciences, Rome (Italy)

    2015-01-15

    To assess the diagnostic performance of PET/MR in patients with non-small-cell lung cancer. Fifty consecutive consenting patients who underwent routine {sup 18}F-FDG PET/CT for potentially radically treatable lung cancer following a staging CT scan were recruited for PET/MR imaging on the same day. Two experienced readers, unaware of the results with the other modalities, interpreted the PET/MR images independently. Discordances were resolved in consensus. PET/MR TNM staging was compared to surgical staging from thoracotomy as the reference standard in 33 patients. In the remaining 17 nonsurgical patients, TNM was determined based on histology from biopsy, imaging results (CT and PET/CT) and follow-up. ROC curve analysis was used to assess accuracy, sensitivity and specificity of the PET/MR in assessing the surgical resectability of primary tumour. The kappa statistic was used to assess interobserver agreement in the PET/MR TNM staging. Two different readers, without knowledge of the PET/MR findings, subsequently separately reviewed the PET/CT images for TNM staging. The generalized kappa statistic was used to determine intermodality agreement between PET/CT and PET/MR for TNM staging. ROC curve analysis showed that PET/MR had a specificity of 92.3 % and a sensitivity of 97.3 % in the determination of resectability with an AUC of 0.95. Interobserver agreement in PET/MR reading ranged from substantial to perfect between the two readers (Cohen's kappa 0.646 - 1) for T stage, N stage and M stage. Intermodality agreement between PET/CT and PET/MR ranged from substantial to almost perfect for T stage, N stage and M stage (Cohen's kappa 0.627 - 0.823). In lung cancer patients PET/MR appears to be a robust technique for preoperative staging. (orig.)

  8. Non-small-cell lung cancer resectability: diagnostic value of PET/MR.

    Science.gov (United States)

    Fraioli, Francesco; Screaton, Nicholas J; Janes, Samuel M; Win, Thida; Menezes, Leon; Kayani, Irfan; Syed, Rizwan; Zaccagna, Fulvio; O'Meara, Celia; Barnes, Anna; Bomanji, Jamshed B; Punwani, Shonit; Groves, Ashley M

    2015-01-01

    To assess the diagnostic performance of PET/MR in patients with non-small-cell lung cancer. Fifty consecutive consenting patients who underwent routine (18)F-FDG PET/CT for potentially radically treatable lung cancer following a staging CT scan were recruited for PET/MR imaging on the same day. Two experienced readers, unaware of the results with the other modalities, interpreted the PET/MR images independently. Discordances were resolved in consensus. PET/MR TNM staging was compared to surgical staging from thoracotomy as the reference standard in 33 patients. In the remaining 17 nonsurgical patients, TNM was determined based on histology from biopsy, imaging results (CT and PET/CT) and follow-up. ROC curve analysis was used to assess accuracy, sensitivity and specificity of the PET/MR in assessing the surgical resectability of primary tumour. The kappa statistic was used to assess interobserver agreement in the PET/MR TNM staging. Two different readers, without knowledge of the PET/MR findings, subsequently separately reviewed the PET/CT images for TNM staging. The generalized kappa statistic was used to determine intermodality agreement between PET/CT and PET/MR for TNM staging. ROC curve analysis showed that PET/MR had a specificity of 92.3 % and a sensitivity of 97.3 % in the determination of resectability with an AUC of 0.95. Interobserver agreement in PET/MR reading ranged from substantial to perfect between the two readers (Cohen's kappa 0.646 - 1) for T stage, N stage and M stage. Intermodality agreement between PET/CT and PET/MR ranged from substantial to almost perfect for T stage, N stage and M stage (Cohen's kappa 0.627 - 0.823). In lung cancer patients PET/MR appears to be a robust technique for preoperative staging.

  9. Surgical resection versus radiofrequency ablation in treatment of small hepatocellular carcinoma

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    HE Xiuting

    2013-08-01

    Full Text Available ObjectiveTo compare clinical efficacy and recurrence between surgical resection and radiofrequency ablation (RFA in the treatment of small hepatocellular carcinoma (HCC. MethodsThe clinical data of 97 patients with small HCC, who underwent surgical resection or RFA as the initial treatment in The First Hospital of Jilin University from January 2002 to December 2008, were collected. Sixty-three cases, who survived 2 years after treatment, were followed up; of the 63 cases, 34 underwent surgical resection, and 29 underwent RFA. The recurrence of these patients was analyzed retrospectively. The measurement data were analyzed by chi-square test. The Cox regression analysis was used for determining the risk factors for recurrence. The log-rank test was used for disease-free survival (DFS difference analysis. ResultsThe 3-month, 1-year, and 2-year intrahepatic recurrence rates for the patients who underwent surgical resection were 15%, 38%, and 64%, respectively, versus 21%, 35%, and 45% for those who underwent RFA, without significant differences between the two groups of patients. The intrahepatic recurrence after initial treatment was not significantly associated with treatment method, sex, age, Child-Pugh grade, tumor size, number of nodules, presence of cirrhosis, and alpha-fetoprotein level. There was no significant difference in DFS between the two groups of patients. ConclusionRFA produces a comparable outcome to that by surgical resection in the treatment of small HCC. RFA holds promise as a substitute for surgical resection.

  10. The predictive and prognostic values of factors associated with visceral pleural involvement in resected lung adenocarcinomas

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    Zhang HB

    2016-04-01

    Full Text Available Huibiao Zhang,1 Chen Lu,2 Yingjie Lu,1 Bo Yu,2 Fanzhen Lv,1 Zhenghong Zhu1 1Department of Thoracic Surgery, 2Department of Pathology, Huadong Hospital, Fudan University, Shanghai, People’s Republic of China Background: The predictive and prognostic impact of factors associated with visceral pleural invasion (VPI on survival and recurrence in patients with resected lung adenocarcinomas is not clearly defined.Patients and methods: A total of 505 consecutive patients with stage Ia–IIIa lung adenocarcinomas treated with radical resection were included. The predominant growth pattern was classified according to the new classification system for lung adenocarcinoma proposed by the International Association for the Study of Lung Cancer, the American Thoracic Society, and the European Respiratory Society. The correlations of VPI with clinical and pathologic parameters were analyzed.Results: The incidence of VPI was significantly lower in lepidic predominant group (15.5% vs 4.5%, P<0.001 and higher in solid and micropapillary predominant group (28.6% vs 17.6%, P=0.004 and 14.7% vs 4.2%, P<0.001, respectively. VPI correlated with higher risk in regional postoperative recurrence (hazard ratio, 2.341; 95% confidence interval, 1.564–3.504 and distant recurrence (hazard ratio, 2.193; 95% confidence interval, 1.665–2.89 in surgically resected lung adenocarcinomas. However, when growth patterns of adenocarcinoma were lumped into multivariate analysis, VPI was not a significant independent predictive factor for survival (P=0.854 for overall survival [OS] and P=0.575 for disease-free survival [DFS] and recurrence (P=0.38 for regional recurrence and P=0.089 for distant recurrence. Of the 95 patients with stage Ib, those who received adjuvant chemotherapy had longer DFS and OS than the patients who received no chemotherapy after surgery. However, these differences in DFS and OS did not reach statistical significance (P=0.063 for DFS, P=0.85 for OS

  11. Resected pancreatic ductal adenocarcinomas with recurrence limited in lung have a significantly better prognosis than those with other recurrence patterns

    Science.gov (United States)

    Wangjam, Tamna; Zhang, Zhe; Zhou, Xian Chong; Lyer, Laxmi; Faisal, Farzana; Soares, Kevin C.; Fishman, Elliott; Hruban, Ralph H.; Herman, Joseph M.; Laheru, Daniel; Weiss, Matthew; Li, Min; De Jesus-Acosta, Ana; Wolfgang, Christopher L.; Zheng, Lei

    2015-01-01

    The majority of patients with curative resection of pancreatic ductal adenocarcinoma recur within 5 years of resection. However, the prognosis associated with different patterns of recurrence has not been well studied. A retrospective review of patients who underwent curative surgical resection of pancreatic cancer was performed. Of the 209 patients, 174 patients developed recurrent disease. Of these 174, 28(16.1%) had recurrent disease limited to lung metastases, 20(11.5%) had recurrence in the lung plus one or more other sites excluding the liver, 73(42.0%) had liver metastasis alone or liver metastasis with any other site except lung, 28(16.1%) local recurrence only, and 25(14.3%) peritoneal recurrence alone or together with local recurrence. Patients with recurrence limited to lung had a 8.5 months(Mo) median survival from recurrence to death, which was significantly better than the survival associated with recurrence in the liver(5.1Mo), in the peritoneum(2.3Mo) or locally(5.1Mo) in multivariable analyses. Among all groups, the time from surgery to the diagnosis of recurrence in patients who recurred in only in the lung was also the longest. However, 75% of patients were found to have indeterminate lung nodules on their surveillance CT scans prior to the diagnosis of recurrence in lung. This delayed diagnosis of lung recurrence may have a negative impact on survival after recurrence. In conclusion, pancreatic cancer with lung recurrence has a significantly better prognosis than recurrence in other sites. Further studies are needed to investigate how different diagnostic and treatment modalities affect the survival of this unique subpopulation of pancreatic cancer patients. PMID:26372811

  12. Initial single-port thoracoscopy to reduce surgical trauma during open en bloc chest wall and pulmonary resection for locally invasive cancer

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    Bayarri, Clara I.; de Guevara, Antonio Cueto Ladron; Martin-Ucar, Antonio E.

    2013-01-01

    OBJECTIVES En bloc pulmonary and chest wall resection is the preferred method of treatment for locally invasive lung carcinoma. However, it carries major trauma to the chest wall, especially in cases with chest wall involvement distant to the potential location of ‘traditional’ thoracotomies. We describe an alternative method of estimating the boundaries of chest wall resection employing video assisted thoracoscopic surgery (VATS) and hypodermic needles. METHODS VATS delineation of boundaries of chest wall involvement by lung cancer has been performed in six patients who gave written consent. In one case the single–port thoracoscopic examination revealed unexpected distant pleural metastases thus preventing from resection. The other 5 patients, three males and two females [median age of 60.5 (range 39 to 75) years] underwent en bloc anatomical lung resection in addition to chest wall excision and reconstruction for T3N0 lung cancer. RESULTS In these five cases the chest wall opening was restricted to the extent of the rib excision, and the pulmonary resection was performed via the existing chest wall opening without requiring extension of the thoracotomy or any rib spreading. DISCUSSION Minimally invasive techniques aid to delineate the boundaries of chest wall involvement of lung cancer and intraoperative staging. This helped tailoring the surgical approach and location of the thoracotomy, and prevented rib-spreading or additional thoracotomies in our cases. PMID:23592724

  13. Effect of lung resection on pleuro-pulmonary mechanics and fluid balance.

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    Salito, C; Bovio, D; Orsetti, G; Salati, M; Brunelli, A; Aliverti, A; Miserocchi, G

    2016-01-15

    The aim of the study was to determine in human patients the effect of lung resection on lung compliance and on pleuro-pulmonary fluid balance. Pre and post-operative values of compliance were measured in anesthetized patients undergoing resection for lung cancer (N=11) through double-lumen bronchial intubation. Lung compliance was measured for 10-12 cm H2O increase in alveolar pressure from 5 cm H2O PEEP in control and repeated after resection. No air leak was assessed and pleural fluid was collected during hospital stay. A significant negative correlation (r(2)=0.68) was found between compliance at 10 min and resected mass. Based on the pre-operative estimated lung weight, the decrease in compliance following lung resection exceeded by 10-15% that expected from resected mass. Significant negative relationships were found by relating pleural fluid drainage flow to the remaining lung mass and to post-operative lung compliance. Following lung re-expansion, data suggest a causative relationship between the decrease in compliance and the perturbation in pleuro-pulmonary fluid balance.

  14. Usefulness of lung perfusion scintigraphy before lung cancer resection in patients with ventilatory obstruction.

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    Mineo, Tommaso C; Schillaci, Orazio; Pompeo, Eugenio; Mineo, Davide; Simonetti, Giovanni

    2006-11-01

    The study was conducted to evaluate the efficacy of preoperative lung perfusion scintigraphy performed by planar acquisition and single-photon emission computed tomography (SPECT) in predicting postoperative pulmonary function of patients with resectable lung cancer and obstructive ventilatory defect. The study enrolled 39 patients (mean age, 67 +/- 2.1 years). All patients underwent preoperative and postoperative pulmonary function tests. Cut-off values for postoperative forced expiratory volume in 1 second (FEV1) were 65% of the predicted value for pneumonectomy and 45% for lobectomy. A semiquantitative analysis of planar and SPECT lung perfusion scintigraphy images was performed preoperatively to estimate postoperative predicted FEV1 (FEV1ppo). Relationships between FEV1ppo and measured postoperative FEV1 were tested by the Pearson correlation and Bland Altman agreement tests. Twenty-eight lobectomies and 11 pneumonectomies were performed. The FEV1ppo estimated by mean planar lung scintigraphy was 1.85 +/- 0.38 L, with a Pearson correlation coefficient to the measured FEV1 of 0.8632 (p lung scintigraphy and SPECT with FEV1 measured by spirometry. Both planar lung scintigraphy and SPECT can accurately predict postoperative FEV1 and can therefore be considered reliable tools in establishing operability of patients with lung cancer and ventilatory obstruction.

  15. A Phase 2 Trial of Stereotactic Radiosurgery Boost After Surgical Resection for Brain Metastases

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    Brennan, Cameron [Human Oncology and Pathogenesis Program, Memorial Sloan-Kettering Cancer Center, New York, New York (United States); Department of Neurosurgery, Memorial Sloan-Kettering Cancer Center, New York, New York (United States); Yang, T. Jonathan [Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York (United States); Hilden, Patrick; Zhang, Zhigang [Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, New York (United States); Chan, Kelvin; Yamada, Yoshiya [Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York (United States); Chan, Timothy A. [Human Oncology and Pathogenesis Program, Memorial Sloan-Kettering Cancer Center, New York, New York (United States); Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York (United States); Lymberis, Stella C. [Department of Radiation Oncology, New York University Langone Medical Center, New York, New York (United States); Narayana, Ashwatha [Department of Radiation Oncology, Greenwich Hospital, Greenwich, Connecticut (United States); Tabar, Viviane; Gutin, Philip H. [Department of Neurosurgery, Memorial Sloan-Kettering Cancer Center, New York, New York (United States); Ballangrud, Åse [Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, New York (United States); Lis, Eric [Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, New York (United States); Beal, Kathryn, E-mail: BealK@MSKCC.org [Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York (United States)

    2014-01-01

    Purpose: To evaluate local control after surgical resection and postoperative stereotactic radiosurgery (SRS) for brain metastases. Methods and Materials: A total of 49 patients (50 lesions) were enrolled and available for analysis. Eligibility criteria included histologically confirmed malignancy with 1 or 2 intraparenchymal brain metastases, age ≥18 years, and Karnofsky performance status (KPS) ≥70. A Cox proportional hazard regression model was used to test for significant associations between clinical factors and overall survival (OS). Competing risks regression models, as well as cumulative incidence functions, were fit using the method of Fine and Gray to assess the association between clinical factors and both local failure (LF; recurrence within surgical cavity or SRS target), and regional failure (RF; intracranial metastasis outside of treated volume). Results: The median follow-up was 12.0 months (range, 1.0-94.1 months). After surgical resection, 39 patients with 40 lesions were treated a median of 31 days (range, 7-56 days) later with SRS to the surgical bed to a median dose of 1800 cGy (range, 1500-2200 cGy). Of the 50 lesions, 15 (30%) demonstrated LF after surgery. The cumulative LF and RF rates were 22% and 44% at 12 months. Patients who went on to receive SRS had a significantly lower incidence of LF (P=.008). Other factors associated with improved local control include non-small cell lung cancer histology (P=.048), tumor diameter <3 cm (P=.010), and deep parenchymal tumors (P=.036). Large tumors (≥3 cm) with superficial dural/pial involvement showed the highest risk for LF (53.3% at 12 months). Large superficial lesions treated with SRS had a 54.5% LF. Infratentorial lesions were associated with a higher risk of developing RF compared to supratentorial lesions (P<.001). Conclusions: Postoperative SRS is associated with high rates of local control, especially for deep brain metastases <3 cm. Tumors ≥3 cm with superficial dural

  16. Feasibility and Effectiveness of a Home-Based Exercise Training Program Before Lung Resection Surgery

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    Valérie Coats

    2013-01-01

    Full Text Available BACKGROUND: Patients with lung cancer often experience a reduction in exercise tolerance, muscle weakness and decreased quality of life. Although the effectiveness of pulmonary rehabilitation programs is well recognized in other forms of cancers and in many pulmonary diseases, few researchers have studied its impact in patients with lung cancer, particularly in those awaiting lung resection surgery (LRS.

  17. Video-assisted Mini-thoracoscopy for Complete Resection of 28 Cases of Pleomorphic Carcinoma of the Lung

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    Xiangyang CHENG

    2010-08-01

    Full Text Available Background and objective Video-assisted mini-thoracoscopy (VAMT has been used for pulmonary lobectomy for 20 years, which has many merits including small wound, less pain and quick recovery. VAMT is the tendency of pectoral minimally invasive surgical treatment. The aim of this study is to evaluate the efficacy of video-assisted mini-thoracoscopy (VAMT for radical resection of pleomorphic carcinoma of the lung. Methods Complete resection of pleomorphic carcinoma of the lung was performed on 28 patients by VMAT. A 1.5 cm and a 6 cm to 8 cm incision was made during the operation. Both standard surgical instruments and thoracoscopic set were used to treat the pulmonary vessels, perform lobotomy, and remove the lymph nodes in the mediastinum and pulmonary portal. Results The operation was completed in all of the cases. No peri-operative death occurred. The total volume of hemorrhage was 200 mL to 450 mL (mean, 300 mL. The patients received chest drainage for 3 to 8 days after the operation (mean, 5 d. The time in hospital was 7 d-14 d (mean, 12 d. Five-year overall survival and disease-free survival were 39.2% and 47.1%, respectively. Follow-up was available in all 28 patients for up to 2 to 91 months. Among the 28 cases, only 2 patients died 2 months after the operation, the rest all live up over 1 year. 3-year survival rate was 60.7% (95%CI: 40.3%-81.1%. Conclusion VAMT is effective for radical resection of pleomorphic carcinoma of the lung in a short term. Combination the superiority of traditional procedure and VATS, so VAMT is safe and reliable for radical resection of pleomorphic carcinoma of the lung.

  18. Surgical resection for hepatocellular carcinoma in pregnancy: A case report

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    Chih-Chiang Hung

    2012-07-01

    Full Text Available Hepatocellular carcinoma (HCC occurring in pregnancy is very rare. The prognosis is usually poor because of unclear clinical presentation. A 30-year-old woman who suffered from HCC during pregnancy underwent hepatectomy twice, and resection for pulmonary metastasis once. A healthy infant was delivered after the first hepatectomy. Currently, she remains disease free 55 months after the second hepatectomy and 39 months after pulmonary metastatectomy. Moreover, she had another healthy infant 37 months after pulmonary metastatectomy. Aggressive resection of recurrent HCC may prolong life, and pregnancy should not alter the treatment strategy for HCC.

  19. Morphological computed tomography features of surgically resectable pulmonary squamous cell carcinomas: Impact on prognosis and comparison with adenocarcinomas

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    Koenigkam Santos, Marcel, E-mail: marcelk46@yahoo.com.br [Department of Diagnostic and Interventional Radiology, University of Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg (Germany); German Cancer Research Center (Deutsches Krebsforschungszentrum – DKFZ), Im Neuenheimer Feld 280, 69120 Heidelberg (Germany); Department of Radiology, University Hospital of the School of Medicine of Ribeirao Preto, University of Sao Paulo, Av. Bandeirantes 3900, Campus Universitario Monte Alegre, 14048 900 Ribeirao Preto, SP (Brazil); Muley, Thomas [Chest Clinic (Thoraxklinik) at University of Heidelberg, Amalienstr. 5, 69126 Heidelberg (Germany); Translational Lung Research Center (TLRC), Member of the German Center for Lung Research (DZL), Im Neuenheimer Feld 350, 69120 Heidelberg (Germany); Warth, Arne [Institute of Pathology, Heidelberg University, Im Neuenheimer Feld 224, 69120 Heidelberg (Germany); Paula, Wagner Diniz de [Department of Diagnostic and Interventional Radiology, University of Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg (Germany); Department of Radiology, University of Brasilia, Brasilia (Brazil); Lederlin, Mathieu [Department of Diagnostic and Interventional Radiology, University of Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg (Germany); Department of Thoracic and Cardiovascular Imaging, University of Bordeaux, Bordeaux (France); Schnabel, Philipp Albert [Institute of Pathology, Heidelberg University, Im Neuenheimer Feld 224, 69120 Heidelberg (Germany); Translational Lung Research Center (TLRC), Member of the German Center for Lung Research (DZL), Im Neuenheimer Feld 350, 69120 Heidelberg (Germany); Schlemmer, Heinz-Peter [German Cancer Research Center (Deutsches Krebsforschungszentrum – DKFZ), Im Neuenheimer Feld 280, 69120 Heidelberg (Germany); and others

    2014-07-15

    Objective: To characterize the morphological computed tomography (CT) features of pulmonary squamous cell carcinomas (SQCC) submitted to therapeutic resection; to correlate these features with patients’ outcomes; and to compare with pulmonary adenocarcinomas (ADC). Materials and methods: Two chest radiologists retrospectively evaluated CT exams of 123 patients with SQCC resected between 2002 and 2008. Tumors’ size, location (central vs. peripheral), shape, margins, attenuation, enhancement, presence of calcification, cavitation, internal air bronchograms and pleural tags were assigned by consensus. Prevalence of features was compared with patients’ survival data and a previously studied population of ADC surgically resected at the same time period. Results: Cavitation correlated negatively with overall (hazard ratio = 3.04), disease-specific (HR = 3.67) and disease-free survival (HR = 2.69), independent from age, gender, tumor pathological stage, size, and location. In relation to ADC, SQCC presented different shape, margins, attenuation, enhancement, with more cavitation, rare internal air bronchograms, and less pleural tags. Differences were also significant when comparing only the peripheral type of tumors. Conclusions: Cavitation at CT was an independent and negative predictive factor for SQCC. Different CT morphological features were described for SQCC and ADC. Image evaluation of lung lesions should go beyond measuring and addressing adjacent structures invasion. Adequate imaging characterization not only helps to differentiate benign versus malignant disease and to determine malignancy staging, it may also imply the histologic subtype and improve the prognostic assessment of lung cancer patients.

  20. Solitary Plasmacytoma of the Cecum and the Ascending Colon: Surgical Resection as a Treatment Modality

    Science.gov (United States)

    Dalgic, Tahsin; Bostanci, Erdal Birol; Cakir, Tebessum; Ozer, Ilter; Ulas, Murat; Aydog, Gulden; Akoglu, Musa

    2015-01-01

    Colonic solitary plasmacytoma is a rare disease, with few reports occurring in the literature. Solitary plasmacytoma is defined as a plasma cell tumour with no evidence of bone marrow infiltration. Plasmacytoma can present as a solitary tumour in bone or in other parts of the body. The gastrointestinal tract is rarely the site of the disease. We report on the case of a 51-year-old man presenting with a colonic symptomatic mass with unclear biopsy results. A resected specimen showed a solitary plasmacytoma. Surgical resection was an adequate treatment modality in this case. Endoscopic resection, radiotherapy, and chemotherapy are also preferred treatments in selected gastrointestinal plasmacytoma cases. PMID:25954564

  1. Solitary Plasmacytoma of the Cecum and the Ascending Colon: Surgical Resection as a Treatment Modality

    Directory of Open Access Journals (Sweden)

    Tahsin Dalgic

    2015-01-01

    Full Text Available Colonic solitary plasmacytoma is a rare disease, with few reports occurring in the literature. Solitary plasmacytoma is defined as a plasma cell tumour with no evidence of bone marrow infiltration. Plasmacytoma can present as a solitary tumour in bone or in other parts of the body. The gastrointestinal tract is rarely the site of the disease. We report on the case of a 51-year-old man presenting with a colonic symptomatic mass with unclear biopsy results. A resected specimen showed a solitary plasmacytoma. Surgical resection was an adequate treatment modality in this case. Endoscopic resection, radiotherapy, and chemotherapy are also preferred treatments in selected gastrointestinal plasmacytoma cases.

  2. MR and CT diagnosis of carotid pseudoaneurysm in children following surgical resection of craniopharyngioma.

    Science.gov (United States)

    Lakhanpal, S K; Glasier, C M; James, C A; Angtuaco, E J

    1995-01-01

    We report the cases of two children who underwent CT, MR, MRA and angiography in the diagnosis of postoperative aneurysmal dilatation of the supraclinoid carotid arteries following surgical resection of craniopharyngioma. Craniopharyngiomas are relatively common lesions, accounting for 6-7% of brain tumors in children. They are histologically benign, causing symptoms by their growth within the sella and suprasellar cistern with compression of adjacent structures, especially the pituitary gland, hypothalamus and optic nerves, chiasm, and tracts. Complete surgical resection, particularly of large tumors, is complicated by the fact that the lesions are usually found within the circle of Willis, with displacement and adherence to the adventitia of these vessels [1, 2]. Recent reports in the neurosurgical literature have described aneurysmal dilatation of the supraclinoid internal carotid arteries following aggressive surgical resection of craniopharyngioma [3, 4].

  3. Computational fluid dynamics as surgical planning tool: a pilot study on middle turbinate resection.

    Science.gov (United States)

    Zhao, Kai; Malhotra, Prashant; Rosen, David; Dalton, Pamela; Pribitkin, Edmund A

    2014-11-01

    Controversies exist regarding the resection or preservation of the middle turbinate (MT) during functional endoscopic sinus surgery. Any MT resection will perturb nasal airflow and may affect the mucociliary dynamics of the osteomeatal complex. Neither rhinometry nor computed tomography (CT) can adequately quantify nasal airflow pattern changes following surgery. This study explores the feasibility of assessing changes in nasal airflow dynamics following partial MT resection using computational fluid dynamics (CFD) techniques. We retrospectively converted the pre- and postoperative CT scans of a patient who underwent isolated partial MT concha bullosa resection into anatomically accurate three-dimensional numerical nasal models. Pre- and postsurgery nasal airflow simulations showed that the partial MT resection resulted in a shift of regional airflow towards the area of MT removal with a resultant decreased airflow velocity, decreased wall shear stress and increased local air pressure. However, the resection did not strongly affect the overall nasal airflow patterns, flow distributions in other areas of the nose, nor the odorant uptake rate to the olfactory cleft mucosa. Moreover, CFD predicted the patient's failure to perceive an improvement in his unilateral nasal obstruction following surgery. Accordingly, CFD techniques can be used to predict changes in nasal airflow dynamics following partial MT resection. However, the functional implications of this analysis await further clinical studies. Nevertheless, such techniques may potentially provide a quantitative evaluation of surgical effectiveness and may prove useful in preoperatively modeling the effects of surgical interventions.

  4. The Impact of Pleural Lavage Cytology Both Before and After Lung Resection on Recurrence of Non-Small Cell Lung Cancer.

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    Shoji, Fumihiro; Yamazaki, Koji; Kouso, Hidenori; Mori, Ryo; Takeo, Sadanori

    2016-06-01

    Pleural lavage cytology (PLC) involves cytologic examination during surgery for non-small cell lung cancer (NSCLC). The timing regarding the performance of PLC is potentially important; however, a consensus remains to be established. We sought to retrospectively analyze the impact of PLC both before (pre-PLC) and after (post-PLC) lung resection on recurrence in NSCLC. From July 1994 to December 2011, 700 consecutive patients with surgically resected NSCLC were selected. Both pre-PLC and post-PLC status was tested using univariate and multivariate Cox regression analyses of recurrence-free survival (RFS). By analyzing RFS, post-PLC status but not pre-PLC status together with pathologic N factor and pathologic stage, was identified as an independent factor for poor prognosis (p = 0.0040). A statistically significant association was observed between positive post-PLC status and pleural invasion, pathologic T factor, pathologic N factor, pathologic stage, and postoperative recurrence (p = 0.0004, p = 0.0033, p = 0.0001, p recurrence in patients with surgically resected NSCLC. Moreover, post-PLC status might be an additional factor not only for identifying a patient group with a high risk of postoperative recurrence, but also to avoid unnecessary treatment of patients with low risk of postoperative recurrence. Copyright © 2016 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  5. Improving Surgical Resection of Metastatic Liver Tumors With Near-Infrared Optical-Guided Fluorescence Imaging.

    Science.gov (United States)

    Barabino, Gabriele; Porcheron, Jack; Cottier, Michèle; Cuilleron, Muriel; Coutard, Jean-Guillaume; Berger, Michel; Molliex, Serge; Beauchesne, Brigitte; Phelip, Jean Marc; Grichine, Alexei; Coll, Jean-Luc

    2016-08-01

    Objective The aim of this study was to investigate the feasibility and future clinical applications of near-infrared (NIR) fluorescence imaging to guide liver resection surgery for metastatic cancer to improve resection margins. Summary Background Data A subset of patients with metastatic hepatic tumors can be cured by surgery. The degree of long-term and disease-free survival is related to the quality of surgery, with the best resection defined as "R0" (complete removal of all tumor cells, as evidenced by microscopic examination of the margins). Although intraoperative ultrasonography can evaluate the surgical margins, surgeons need a new tool to perfect the surgical outcome. Methods A preliminary study was performed on 3 patients. We used NIR imaging postoperatively "ex vivo" on the resected liver tissue. The liver tumors were preoperatively labelled by intravenously injecting the patient with indocyanine green (ICG), a NIR fluorescent agent (24 hours before surgery, 0.25 mg/kg). Fluorescent images were obtained using a miniaturized fluorescence imaging system (FluoStic, Fluoptics, Grenoble, France). Results After liver resection, the surgical specimens from each patient were sliced into 10-mm sections in the operating room and analyzed with the FluoStic. All metastatic tumors presented rim-type fluorescence. Two specimens had incomplete rim fluorescence. The pathologist confirmed the presence of R1 margins (microscopic residual resection), even though the ultrasonographic analysis indicated that the result was R0. Conclusions Surgical liver resection guided by NIR fluorescence can help detect potentially uncertain anatomical areas that may be missed by preoperative imaging and by ultrasonography during surgery. These preliminary results will need to be confirmed in a larger prospective patient series.

  6. Histopathologic approach to the surgical lung biopsy in interstitial lung disease.

    Science.gov (United States)

    Jones, Kirk D; Urisman, Anatoly

    2012-03-01

    Interpretation of lung biopsy specimens is an integral part in the diagnosis of interstitial lung disease (ILD). The process of evaluating a surgical lung biopsy for disease involves answering several questions. Unlike much of surgical pathology of neoplastic lung disease, arriving at the correct diagnosis in nonneoplastic lung disease often requires correlation with clinical and radiologic findings. The topic of ILD or diffuse infiltrative lung disease covers several hundred entities. This article is meant to be a launching point in the clinician's approach to the histologic evaluation of lung disease.

  7. Postoperative radiation therapy following the incomplete resection of a non-small cell lung cancer

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    Park, Jae Hyeon; Song, Si Yeol; Kim, Su Ssan [Asan Medical Center, University of Ulsan College of Medicine, Seoul (Korea, Republic of); and others

    2014-06-15

    To review the results of postoperative radiation therapy (PORT) for residual non-small cell lung cancer (NSCLC) following surgical resection and evaluate multiple clinicopathologic prognostic factors. A total of 58 patients, who completed scheduled PORT for positive resection margin, among 658 patients treated with PORT from January 2001 to November 2011 were retrospectively analyzed. Radiation therapy was started at 4 to 6 weeks after surgery. Chemotherapy was also administered to 35 patients, either sequentially or concurrently with PORT. The median age of patients was 63 years (range, 40 to 82 years). The postoperative pathological stage I NSCLC was diagnosed in 10 (17.2%), stage II in 18 (31.0%), and stage III in 30 patients (51.7%). Squamous cell carcinoma was identified in 43, adenocarcinoma in 10, large cell in 1, others in 4 patients. Microscopic residual disease (R1) was diagnosed in 55 patients (94.8%), and the remaining three patients were diagnosed with gross residual disease (R2). The median dose of PORT was 59.4 Gy (range, 50.0 to 64.8 Gy). Chemotherapy was administered to 35 patients (60%), and the median follow-up time was 22.0 months (range, 6.0 to 84.0 months). The 3-year locoregional relapse-free survival and distant metastasis-free survival rates were 82.1% and 52.9%, respectively. The median overall survival was 23.8 months (range, 6.0 to 84.1 months), and the 3-year overall survival rate was 58.2%. Chemotherapy did not influence the failure pattern or survival outcome. PORT is an effective modality for improving local tumor control in incompletely resected NSCLC patients. Major failure pattern was distant metastasis despite chemotherapy.

  8. [A case of resection of esophageal cancer infiltrating the left main bronchus following preoperative chemo-radiotherapy and resection of metachronous lung metastasis].

    Science.gov (United States)

    Fujisaki, Shigeru; Takashina, Motoi; Tomita, Ryouichi; Takayama, Tadatoshi; Ohmori, Kazumitsu; Tomiyama, Junji; Oyama, Kazuyuki

    2007-11-01

    We herein report a case of T4 esophageal carcinoma, which was resected after chemo-radiation therapy. In addition, the metachronous lung metastasis was also resected. A 59-year-old female with esophageal carcinoma, which invaded the left main bronchus, underwent chemo-radiation therapy (the combination of systemic chemotherapy of 5-FU/CDDP and external radiation therapy) from January 2004. After the therapy, although the imaging showed a downstaging of esophageal carcinoma, a severe esophageal stricture appeared with ingestion defective. So hyper-alimentation was performed. After the state of nutrition was improved, esophagectomy was performed on March 2004 without a complication. Histopathological study revealed that no viable cells remained. Nine months after esophagectomy, chest CT scan revealed that a solitary pulmonary tumor appeared in S6 of the right. The solitary tumor enlarged gradually. On August 2005, a surgical resection for the solitary pulmonary tumor was performed. Histopathologically, the lesion was compatible for metastasis from esophageal carcinoma. The patient is alive without recurrence more than 23 months after the last surgery.

  9. A cluster of Teflon pledgets manifesting as an intrathoracic cavitary mass following lung resection.

    Science.gov (United States)

    Lee, J-I; Park, K-Y; Park, C-H

    2010-06-01

    Teflon pledgets are widely used for hemostasis and the reinforcement of friable tissue in surgery. However, rare but serious complications caused by the erosion of Teflon pledgets have been reported. We present an unusual case of an intrathoracic cavitary mass that was formed by the erosion of a cluster of Teflon pledgets into the lung parenchyma eight years after a lung resection.

  10. Surgical resection without dural reconstruction of a lumbar meningioma in an elderly woman

    Science.gov (United States)

    Takahashi, Jun; Kato, Hiroyuki; Ebara, Sohei; Takahashi, Hideto

    2009-01-01

    Meningiomas of the spine occur in the thoracic spine in approximately 80%, followed in frequency by the cervical and lumbar regions. The treatment of spinal meningiomas is complete surgical resection. As intraspinal meningiomas are almost always adherent to the dura, extensive dural resection or diathermic treatment of the dural attachment is usually performed to prevent tumor recurrence. The authors present the case of lumbar spinal meningioma in 82-year-old woman. Successful resection with preservation of the dura mater using the technique of Saito et al. (Spine 26:1805-1808, 2001) is described: After lumbar laminectomy a small incision was made in the surface of the spinal dura. The dura mater was separated into its inner and outer layers, and the tumor was resected with inner layer alone, preserving the outer layer. The outer layer is simply closed to achieve a watertight seal. The pathologic diagnosis was metaplastic (osseous) meningioma. Almost full recovery of the neurologic deficit was attained. Neither complication nor tumor recurrence has occurred in the 5 years since surgery. Dural preservation during surgical resection of spinal meningioma obviates the need for dural reconstruction and should reduce surgical morbidity. However, the patient should be followed long-term to watch for recurrence. PMID:19219468

  11. Surgical resection and reconstruction for primary malignant sternal tumor.

    Science.gov (United States)

    Hirai, Shinji; Nobuto, Hiroaki; Yokota, Kazunori; Matsuura, Yosuke; Uegami, Shinnosuke; Sato, Katsutoshi; Mitsui, Norimasa; Sugita, Takashi; Hamanaka, Yoshiharu

    2009-06-01

    We report a very rare and successful surgery for primary malignant tumor of the sternum. A 73-year-old male, previously healthy, was admitted to our hospital because a chest computed tomography scan detected an abnormal shadow that suggested a sternal tumor destroying part of the sternum body. Aspiration needle biopsy demonstrated a primary sternal chondrosarcoma measuring 3 x 4 cm in diameter. The sternum below the second intercostal space was resected along with a 1-cm width of cartilage below the third rib on each side. Sternal reconstruction was performed with Composix mesh, titanium mesh, and Marlex mesh, using a right pectoralis major muscle flap translation. The patient was extubated just after surgery, and the postoperative course was uneventful. This procedure may be useful for repairing the detect after wide sternotomy.

  12. Radiation Therapy Alone in cT1-3N0 Non-small Cell Lung Cancer Patients Who Are Unfit for Surgical Resection or Stereotactic Radiation Therapy: Comparison of Risk-Adaptive Dose Schedules

    Science.gov (United States)

    Cho, Won Kyung; Noh, Jae Myoung; Ahn, Yong Chan; Oh, Dongryul; Pyo, Hongryull

    2016-01-01

    Purpose High dose definitive radiation therapy (RT) alone is recommended to patients with cT1-3N0 non-small cell lung cancer, who are unfit for surgery or stereotactic RT. This study was conducted to evaluate the clinical outcomes and cost-effectiveness following RT alone using two different modest hypofractionation dose schemes. Materials and Methods Between 2001 and 2014, 124 patients underwent RT alone. From 2001 till 2010, 60 Gy in 20 fractions was delivered to 79 patients (group 1). Since 2011, 60 Gy in 20 fractions (group 2, 20 patients), and 60 Gy in 15 fractions (group 3, 25 patients) were selectively chosen depending on estimated risk of esophagitis. Results At follow-up of 16.7 months, 2-year rates of local control, progression-free survival, and overall survival were 62.6%, 39.1%, and 59.1%, respectively. Overall survival was significantly better in group 3 (p=0.002). In multivariate analyses, cT3 was the most powerful adverse factor affecting clinical outcomes. Incidence and severity of radiation pneumonitis were not different among groups, while no patients developed grade 2 esophagitis in group 3 (p=0.003). Under current Korean Health Insurance Policy, RT cost per person was 22.5% less in group 3 compared with others. Conclusion The current study demonstrated that 60 Gy in 15 fractions instead of 60 Gy in 20 fractions resulted in comparable clinical outcomes with excellent safety, direct cost saving, and improved convenience to the patients with tumors located at ≥ 1.5 cm from the esophagus. PMID:26987393

  13. Critical care after lung resection: CALoR 1, a single-centre pilot study.

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    McCall, P J; Macfie, A; Kinsella, J; Shelley, B G

    2015-12-01

    Lung resection is associated with significant perioperative morbidity, and a proportion of patients will require intensive care following surgery. We set out to characterise this population, assess their burden of disease and investigate the influence of anaesthetic and surgical techniques on their admission rate. Over a two-year period, 1169 patients underwent surgery, with 30 patients (2.6%) requiring unplanned intensive care. Patients requiring support had a higher mortality (0.2% vs 26.7%, p < 0.001). Logistic regression (following adjustment for Thoracoscore) revealed that an open surgical approach was associated with higher likelihood of admission (p = 0.025, odds ratio = 5.25). There was also a trend towards increased likelihood of admission in patients who received volatile anaesthesia (p = 0.061, odds ratio = 2.08). This topic has been selected for further investigation as part of the 2015 Association of Cardiothoracic Anaesthetists (ACTA) second national collaborative audit, with this study providing pilot data before a multi-centre study. © 2015 The Association of Anaesthetists of Great Britain and Ireland.

  14. Improving Outcomes with Surgical Resection and Other Ablative Therapies in HCC

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    Rahul Deshpande

    2011-01-01

    Full Text Available With rising incidence and emergence of effective treatment options, the management of hepatocellular carcinoma (HCC is a complex multidisciplinary process. There is still little consensus and uniformity about clinicopathological staging systems. Resection and liver transplantation have been the cornerstone of curative surgical treatments with recent emergence of ablative techniques. Improvements in diagnostics, surgical techniques, and postoperative care have lead to dramatically improved results over the years. The most appropriate treatment plan has to be individualised and depends on a variety of patient and tumour-related factors. Very small HCCs discovered on surveillance have the best outcomes. Patients with advanced cirrhosis and tumours within Milan criteria should be offered transplantation. Resection is best for small solitary tumours with preserved liver function. Ablative techniques are suitable for low volume tumours in patients unfit for either resection or transplantation. The role of downstaging and bridging therapy is not clearly established.

  15. Cell cycle progression score is a marker for five-year lung cancer-specific mortality risk in patients with resected stage I lung adenocarcinoma

    Science.gov (United States)

    Eguchi, Takashi; Kadota, Kyuichi; Chaft, Jamie; Evans, Brent; Kidd, John; Tan, Kay See; Dycoco, Joe; Kolquist, Kathryn; Davis, Thaylon; Hamilton, Stephanie A.; Yager, Kraig; Jones, Joshua T.; Travis, William D.; Jones, David R.; Hartman, Anne-Renee; Adusumilli, Prasad S.

    2016-01-01

    Purpose The goals of our study were (a) to validate a molecular expression signature (cell cycle progression [CCP] score and molecular prognostic score [mPS; combination of CCP and pathological stage {IA or IB}]) that identifies stage I lung adenocarcinoma (ADC) patients with a higher risk of cancer-specific death following curative-intent surgical resection, and (b) to determine whether mPS stratifies prognosis within stage I lung ADC histological subtypes. Methods Formalin-fixed, paraffin-embedded stage I lung ADC tumor samples from 1200 patients were analyzed for 31 proliferation genes by quantitative RT-PCR. Prognostic discrimination of CCP score and mPS was assessed by Cox proportional hazards regression, using 5-year lung cancer–specific mortality as the primary outcome. Results In multivariable analysis, CCP score was a prognostic marker for 5-year lung cancer–specific mortality (HR=1.6 per interquartile range; 95% CI, 1.14–2.24; P=0.006). In a multivariable model that included mPS instead of CCP, mPS was a significant prognostic marker for 5-year lung cancer–specific mortality (HR=1.77; 95% CI, 1.18–2.66; P=0.006). Five-year lung cancer–specific survival differed between low-risk and high-risk mPS groups (96% vs 81%; P<0.001). In patients with intermediate-grade lung ADC of acinar and papillary subtypes, high mPS was associated with worse 5-year lung cancer–specific survival (P<0.001 and 0.015, respectively), compared with low mPS. Conclusion This study validates CCP score and mPS as independent prognostic markers for lung cancer–specific mortality and provides quantitative risk assessment, independent of known high-risk features, for stage I lung ADC patients treated with surgery alone. PMID:27153551

  16. Pseudo-tumoral hepatic tuberculosis discovered after surgical resection

    Directory of Open Access Journals (Sweden)

    Miloudi Nizar

    2012-02-01

    Full Text Available Pseudo-tumoral hepatic tuberculosis is rare. It is characterized by non-specific symptoms and radiological polymorphism. Diagnosis is problematic. This article presents three cases, each clinically different from each other, that illustrate how difficult diagnosis can be. The definitive diagnosis of pseudo-tumoral hepatic tuberculosis was reached on the basis of histological examination of surgical samples. Treatment of the disease based on appropriate anti-tubercular therapy generally gives a positive outcome.

  17. Clinicopathological Features of Cervical Esophageal Cancer: Retrospective Analysis of 63 Consecutive Patients Who Underwent Surgical Resection.

    Science.gov (United States)

    Saeki, Hiroshi; Tsutsumi, Satoshi; Yukaya, Takafumi; Tajiri, Hirotada; Tsutsumi, Ryosuke; Nishimura, Sho; Nakaji, Yu; Kudou, Kensuke; Akiyama, Shingo; Kasagi, Yuta; Nakashima, Yuichiro; Sugiyama, Masahiko; Sonoda, Hideto; Ohgaki, Kippei; Oki, Eiji; Yasumatsu, Ryuji; Nakashima, Torahiko; Morita, Masaru; Maehara, Yoshihiko

    2017-01-01

    The objectives of this retrospective study were to elucidate the clinicopathological features and recent surgical results of cervical esophageal cancer. Cervical esophageal cancer has been reported to have a dismal prognosis. Accurate knowledge of the clinical characteristics of cervical esophageal cancer is warranted to establish appropriate therapeutic strategies. The clinicopathological features and treatment results of 63 consecutive patients with cervical esophageal cancer (Ce group) who underwent surgical resection from 1980 to 2013 were analyzed and compared with 977 patients with thoracic or abdominal esophageal cancer (T/A group) who underwent surgical resection during that time. Among the patients who received curative resection, the 5-year overall and disease-specific survival rates of the Ce patients were significantly better than those of the T/A patients (overall: 77.3% vs 46.5%, respectively, P = 0.0067; disease-specific: 81.9% vs 55.8%, respectively, P = 0.0135). Although total pharyngo-laryngo-esophagectomy procedures were less frequently performed in the recent period, the rate of curative surgical procedures was markedly higher in the recent period (2000-1013) than that in the early period (1980-1999) (44.4% vs 88.9%, P = 0.0001). The 5-year overall survival rate in the recent period (71.5%) was significantly better than that in the early period (40.7%, P = 0.0342). Curative resection for cervical esophageal cancer contributes to favorable outcomes compared with other esophageal cancers. Recent surgical results for cervical esophageal cancer have improved, and include an increased rate of curative resection and decreased rate of extensive surgery.

  18. Extent of surgical resection predicts seizure freedom in low-grade temporal lobe brain tumors.

    Science.gov (United States)

    Englot, Dario J; Han, Seunggu J; Berger, Mitchel S; Barbaro, Nicholas M; Chang, Edward F

    2012-04-01

    Achieving seizure control in patients with low-grade temporal lobe gliomas or glioneuronal tumors remains highly underappreciated, because seizures are the most frequent presenting symptom and significantly impact patient quality-of-life. To assess how the extent of temporal lobe resection influences seizure outcome. We performed a quantitative, comprehensive systematic literature review of seizure control outcomes in 1181 patients with epilepsy across 41 studies after surgical resection of low-grade temporal lobe gliomas and glioneuronal tumors. We measured seizure-freedom rates after subtotal resection vs gross-total lesionectomy alone vs tailored resection, including gross-total lesionectomy with hippocampectomy and/or anterior temporal lobe corticectomy. Included studies were observational case series, and no randomized, controlled trials were identified. Although only 43% of patients were seizure-free after subtotal tumor resection, 79% of individuals were seizure-free after gross-total lesionectomy (OR = 5.00, 95% confidence interval [CI]: 3.33-7.14). Furthermore, tailored resection with hippocampectomy plus corticectomy conferred additional benefit over gross-total lesionectomy alone, with 87% of patients achieving seizure freedom (OR = 1.82, 95% CI: 1.23-2.70). Overall, extended resection with hippocampectomy and/or corticectomy over gross-total lesionectomy alone significantly predicted seizure freedom (OR = 1.18, 95% CI: 1.11-1.26). Age seizure outcome. Gross-total lesionectomy of low-grade temporal lobe tumors results in significantly improved seizure control over subtotal resection. Additional tailored resection including the hippocampus and/or adjacent cortex may further improve seizure control, suggesting dual pathology may sometimes allow continued seizures after lesional excision.

  19. Recent technological developments: in situ histopathological interrogation of surgical tissues and resection margins

    Directory of Open Access Journals (Sweden)

    Upile Tahwinder

    2007-03-01

    Full Text Available Abstract Objectives The tumour margin is an important surgical concept significantly affecting patient morbidity and mortality. We aimed in this prospective study to apply the microendoscope on tissue margins from patients undergoing surgery for oral cancer in vivo and ex vivo and compare it to the gold standard "paraffin wax", inter-observer agreement was measured; also to present the surgical pathologist with a practical guide to the every day use of the microendoscope both in the clinical and surgical fields. Materials and methods Forty patients undergoing resection of oral squamous cell carcinoma were recruited. The surgical margin was first marked by the operator followed by microendoscopic assessment. Biopsies were taken from areas suggestive of close or positive margins after microendoscopic examination. These histological samples were later scrutinized formally and the resection margins revisited accordingly when necessary. Results Using the microendoscope we report our experience in the determination of surgical margins at operation and later comparison with frozen section and paraffin section margins "gold standard". We were able to obtain a sensitivity of 95% and a specificity of 90%. Inter-observer Kappa scores comparing the microendoscope with formal histological analysis of normal and abnormal mucosa were 0.85. Conclusion The advantage of this technique is that a large area of mucosa can be sampled and any histomorphological changes can be visualized in real time allowing the operator to make important informed decisions with regards the intra-operative resection margin at the time of the surgery.

  20. Tissue expander placement and adjuvant radiotherapy after surgical resection of retroperitoneal liposarcoma offers improved local control.

    Science.gov (United States)

    Park, Hyojun; Lee, Sanghoon; Kim, BoKyong; Lim, Do Hoon; Choi, Yoon-La; Choi, Gyu Seong; Kim, Jong Man; Park, Jae Berm; Kwon, Choon Hyuck David; Joh, Jae-Won; Kim, Sung Joo

    2016-08-01

    Given that retroperitoneal liposarcoma (LPS) is extremely difficult to completely resect, and has a relatively high rate of recurrence, radiotherapy (RT) is the treatment of choice after surgical resection. However, it is difficult to obtain a sufficient radiation field because of the close proximity of surrounding organs. We introduce the use of tissue expanders (TEs) after LPS resection in an attempt to secure a sufficient radiation field and to improve recurrence-free survival.This study is a retrospective review of 53 patients who underwent surgical resection of LPS at Samsung Medical Center between January 1, 2005, and December 31, 2012, and had no residual tumor detected 2 months postoperatively. The median follow-up period was 38.9 months.Patients were divided into 3 groups. Those in group 1 (n = 17) had TE inserted and received postoperative RT. The patients in group 2 (n = 9) did not have TE inserted and received postoperative RT. Finally, those in group 3 (n = 27) did not receive postoperative RT. Multivariate analysis was performed to identify the risk factors associated with recurrence-free survival within 3 years. Younger age, history of LPS treatment, and RT after TE insertion (group 1 vs group 2 or 3) were significantly favorable factors influencing 3-year recurrence-free survival.TE insertion after LPS resection is associated with increased 3-year recurrence-free survival, most likely because it allows effective delivery of postoperative RT.

  1. Imaging in Lung Transplantation: Surgical Considerations of Donor and Recipient.

    Science.gov (United States)

    Backhus, Leah M; Mulligan, Michael S; Ha, Richard; Shriki, Jabi E; Mohammed, Tan-Lucien H

    2016-03-01

    Modifications in recipient and donor criteria and innovations in donor management hold promise for increasing rates of lung transplantation, yet availability of donors remains a limiting resource. Imaging is critical in the work-up of donor and recipient including identification of conditions that may portend to poor posttransplant outcomes or necessitate modifications in surgical technique. This article describes the radiologic principles that guide selection of patients and surgical procedures in lung transplantation.

  2. Pleuropulmonary Blastoma (PPB in an infant: Is the timing of an elective resection of neonatal lung lesions challenged?

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    Robert Simon

    2014-10-01

    Full Text Available Congenital Pulmonary Airway Malformations (CPAMs are abnormalities of lung parenchyma that are often diagnosed upon prenatal imaging as opposed to postnatal symptoms. With a clinical presentation identical to CPAMs, Pleuropulmonary Blastoma (PPB is a rare pulmonary neoplasm of highly malignant potential. We present a rare case of a female infant with a vague medical history of respiratory distress syndrome (RDS at birth, presenting with a tension pneumothorax at three months of age, thought initially to be secondary to CPAM, but found to be PPB upon surgical resection and histological analysis. PPB is a rare pulmonary neoplasm of childhood that originates from the primitive interstitium of the lung, resulting in lesions that can be highly malignant. It is classified as type I (cystic, type II (cystic/solid or type III (solid, with a progression of disease and worsening prognosis from type I to type III. Due to the cystic nature of CPAM and PPB it is difficult to differentiate on imaging alone; diagnosis must be made based on histological analysis. The highly malignant nature and potential for morbidity and mortality of PPB should make clinicians consider early resection of cystic lung lesions preferentially on an elective basis.

  3. Parenteral corticosteroids followed by early surgical resection of large amblyogenic eyelid hemangiomas in infants

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    El Essawy R

    2013-05-01

    Full Text Available Rania El Essawy,1 Rasha Essameldin Galal21Department of Ophthalmology, 2Department of Pediatrics, Faculty of Medicine, Cairo University, Cairo, EgyptBackground: The purpose of this study was to evaluate the results and complications of early surgical resection of large amblyogenic subdermal eyelid hemangiomas in infants after prior short-term parenteral administration of corticosteroids.Methods: Sixteen infants were given dexamethasone 2 mg/kg/day in two divided doses for three consecutive days prior to scheduled surgical excision of large eyelid hemangiomas. The lesions were accessed via an upper eyelid crease, subeyebrow incision, or a lower eyelid subciliary incision.Results: In all cases, surgical excision of the entire lesion was possible with no significant intraoperative or postoperative complications. The levator muscle/aponeurosis complex was involved in 31.25% of cases and was managed by reinsertion or repositioning without resection. A satisfactory lid position and contour with immediate clearing of the visual axis was achieved in all but one case (93.8%.Conclusion: Parenteral corticosteroids helped in reducing volume and blood flow from the hemangiomas, allowing for very early total excision of large subdermal infantile hemangiomas without significant intraoperative hemorrhage. This resulted in immediate elimination of any reason for occlusion amblyopia. Long-term follow-up of visual development in these patients would help to demonstrate the effectiveness of this strategy compared with more conservative measures.Keywords: large eyelid hemangiomas, early surgical resection, parenteral corticosteroids

  4. Enhanced Metastatic Recurrence Via Lymphatic Trafficking of a High-Metastatic Variant of Human Triple-Negative Breast Cancer After Surgical Resection in Orthotopic Nude Mouse Models.

    Science.gov (United States)

    Yano, Shuya; Takehara, Kiyoto; Tazawa, Hiroshi; Kishimoto, Hiroyuki; Kagawa, Shunsuke; Bouvet, Michael; Fujiwara, Toshiyoshi; Hoffman, Robert M

    2017-03-01

    We previously developed and characterized a highly invasive and metastatic triple-negative breast cancer (TNBC) variant by serial orthotopic implantation of MDA-MB-231 human breast cancer cells in nude mice. Eventually, a highly invasive and metastatic variant of human TNBC was isolated after lymph node metastases was harvested and orthotopically re-implanted into the mammary gland of nude mice for two cycles. The variant thereby isolated is highly invasive in the mammary gland and metastasized to lymph nodes in 10 of 12 mice compared to 2 of 12 of the parental cell line. In the present report, we observed that high-metastatic MDA-MB-231H-RFP cells produced significantly larger subcutaneous tumors compared with parental MDA-MB-231 cells in nude mice. Extensive lymphatic trafficking by high-metastatic MDA-MB-231 cells was also observed. High-metastatic MDA-MB-231 developed larger recurrent tumors 2 weeks after tumor resection compared with tumors that were not resected in orthotopic models. Surgical resection of the MDA-MB-231 high-metastatic variant primary tumor in orthotopic models also resulted in rapid and enhanced lymphatic trafficking of residual cancer cells and extensive lymph node and lung metastasis that did not occur in the non-surgical mice. These results suggest that surgical resection of high metastatic TNBC can greatly increase the malignancy of residual cancer. J. Cell. Biochem. 118: 559-569, 2017. © 2016 Wiley Periodicals, Inc.

  5. Long-term follow-up of surgical resection of microcystic meningiomas.

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    Kalani, M Yashar S; Cavallo, Claudio; Coons, Stephen W; Lettieri, Salvatore C; Nakaji, Peter; Porter, Randall W; Spetzler, Robert F; Feiz-Erfan, Iman

    2015-04-01

    Microcystic meningioma is a rare tumor with myxoid and microcystic features. Our objective was to evaluate the efficacy of surgical resection of microcystic meningioma. Between December 1985 and October 2000 we treated 25 microcystic meningioma patients with surgical resection. We retrospectively analyzed the results including the long-term follow-up of this patient population. We identified 15 women and 10 men with a mean age of 53.8 years (24-76 years) who had microcystic meningiomas treated with surgery. Based on the Simpson grade, we found four Grade I (16%), 16 Grade II (64%), three Grade III (12%) and two Grade IV (8%) resections. The mean preoperative Karnofsky Performance Scale (KPS) score was 80.3 (range 60-100). The mean postoperative KPS score was 90.4 (range 60-100). At a mean follow-up of 101.7 months (range 16-221) the KPS score improved to a mean of 93.8. The recurrence/progression free survival (RFS/PFS) rates at 3 and 5 years were 96% and 88%, respectively. The 3 and 5 year RFS/PFS rates based on the Simpson grade were evaluated. The 3 year RFS/PFS rates for Grade I, II, III and IV were 100%, 100%, 66.6% and 100%, respectively. The 5 year RFS/PFS rates were 66.6%, 90%, 66.6% and 100%, respectively. Microcystic meningioma is a rare tumor, which is characterized by extracellular microcystic spaces filled by edematous fluid and peritumoral edema. Following surgical resection these tumors have a positive prognosis with a benign course. The surgical outcomes seem to be associated with the risks related to the surgical procedure. Copyright © 2015 Elsevier Ltd. All rights reserved.

  6. Surgical resection of adrenal metastasis from primary liver tumors:a report of two cases

    Institute of Scientific and Technical Information of China (English)

    Durgatosh Pandey; Kai-Chah Tan

    2008-01-01

    BACKGROUND: Although the treatment of extrahepatic metastases from primary liver tumors is essentially palliative, solitary metastasis from such tumors offers a possibility of cure by surgical resection. The adrenal gland is an uncommon site for metastasis from primary liver tumors. METHOD: We report two cases of adrenalectomy for solitary adrenal metastasis: one from intrahepatic cholangiocarcinoma and the other from hepatocellular carcinoma. RESULTS: The patient with intrahepatic cholangiocar-cinoma had a synchronous adrenal metastasis and underwent simultaneous liver resection and adrenalectomy. However, he developed recurrent disease 17 months following surgery for which he is presently on palliative chemotherapy. The other patient underwent adrenalectomy for adrenal metastasis 3 months following liver transplantation for hepatocellular carcinoma. He is presently alive and disease-free 27 months after adrenalectomy. CONCLUSION: Carefully selected patients with solitary metastasis from primary liver tumors may be considered for resection.

  7. Surgical Treatment and Prognosis of Synchronous Double Primary Lung Cancer: a Report of 31 Cases

    Institute of Scientific and Technical Information of China (English)

    Feiyue Feng; Dechao Zhang; Xiangyang Liu; Yonggang Wang; Yousheng Mao

    2005-01-01

    OBJECTIVE The concept of double primary lung cancer (DPLC) has been generally accepted. Recently, an increasing incidence of synchronous DPLC has been reported, while the diagnostic standard and treatment strategies remain to be improved. This study was conducted to investigate effective surgical treatment and prognosis of synchronous DPLC.METHODS From January 1983 to April 2004, 31 patients with synchronous DPLC were operated in our department. Clinical data, such as surgical pattern, postoperative complications, and survival status, of all these patients were reviewed retrospectively.RESULTS The 31 patients with synchronous DPLC accounted for 0.67% of all the 4,649 patients operated for primary lung cancer in our department during the same period. Both tumors of the synchronous DPLC were resected with Iobectomy or pneumonectomy in 12 patients, while among the other 19 patients at least 1 tumor was treated with partial pulmonary resection. The postoperative morbidity was 29%(9/31), including 1 case of respiratory insufficiency, 3 cases of atelectasis, 2 cases of atrial fibrillation, 1 case of haemoptysis, 1 case of pleural effusion, and 1 case of wound fat necrosis.No deaths occurred during the operations or within 30 days postoperatively.The postoperative 1 -, 3-, and 5-year survival rates were 52%, 29%, and 20%, respectively.CONCLUSION The incidence of synchronous DPLC is low. An aggressive and reasonable surgical approach can achieve a satisfactory outcome in patients with synchronous DPLC. The postoperative morbidity is low. Some patients might achieve long-term survival.

  8. [Comparison between clinical and surgical-pathological TNM staging in patients with lung cancer].

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    Wei, Bo; Wang, Tianyou; Gong, Min; Lv, Kejie; Tian, Feng; Wang, Zhicheng

    2005-02-20

    The accuracy of clinical TNM staging correlates with appropriate treatment in patients with lung cancer. The aim of this study is to evaluate the agreement between clinical and surgical-pathological staging in patients with lung cancer and analyze its cause in detail. One hundred and fifty patients with lung cancer treated surgically from 2000 were enrolled randomly. Clinical and surgical-pathological staging of them were made respectively according to the International System for Staging Lung Cancer newly revised by UICC. Then concordance was determined between the two staging results with Kappa value, and difference in coincident rate was analyzed among subgroups of T staging. For T staging, the agreement was excellent (Kappa value=0.729), however, the coincident rate of T3 or T4 was significantly lower than that in T1 or T2 group (P conformity of TNM staging (Kappa value=0.287). Clinical T staging based on CT can indicate the location and size of primary tumor precisely. But the borderline may be difficult to estimate when tumor site is near chest wall or mediastinum, so some patients with clinical T4 still have chances to receive complete resection. The conformity of N staging is rather poor. The key point to improve the accuracy of clinical TNM staging should be to seek more reliable techniques for evaluating N status.

  9. Surgical Results of Non-small Cell Lung Cancer in Nepal

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    Binay Thakur

    2014-12-01

    Conclusions: Earlier stage (pI-II, R0 resection and pathological pNo-1 has the best five year overall survival in Nepalese patients with NSCLC as well. Keywords: lung cancer; NSCLC; pulmonary resection.

  10. Surgical resection of late solitary locoregional gastric cancer recurrence in stomach bed.

    Science.gov (United States)

    Watanabe, Masanori; Suzuki, Hideyuki; Maejima, Kentaro; Komine, Osamu; Mizutani, Satoshi; Yoshino, Masanori; Bo, Hideki; Kitayama, Yasuhiko; Uchida, Eiji

    2012-07-01

    Late-onset and solitary recurrence of gastric signet ring cell (SRC) carcinoma is rare. We report a successful surgical resection of late solitary locoregional recurrence after curative gastrectomy for gastric SRC carcinoma. The patient underwent total gastrectomy for advanced gastric carcinoma at age 52. Seven years after the primary operation, he visited us again with sudden onset of abdominal pain and vomiting. We finally decided to perform an operation, based on a diagnosis of colon obstruction due to the recurrence of gastric cancer by clinical findings and instrumental examinations. The laparotomic intra-abdominal findings showed that the recurrent tumor existed in the region surrounded by the left diaphragm, colon of splenic flexure, and pancreas tail. There was no evidence of peritoneal dissemination, and peritoneal lavage fluid cytology was negative. We performed complete resection of the recurrent tumor with partial colectomy, distal pancreatectomy, and partial diaphragmectomy. Histological examination of the resected specimen revealed SRC carcinoma, identical in appearance to the previously resected gastric cancer. We confirmed that the intra-abdominal tumor was a locoregional gastric cancer recurrence in the stomach bed. The patient showed a long-term survival of 27 months after the second operation. In the absence of effective alternative treatment for recurrent gastric carcinoma, surgical options should be pursued, especially for late and solitary recurrence.

  11. Resection of ictal high-frequency oscillations leads to favorable surgical outcome in pediatric epilepsy

    Science.gov (United States)

    Fujiwara, Hisako; Greiner, Hansel M.; Lee, Ki Hyeong; Holland-Bouley, Katherine D.; Seo, Joo Hee; Arthur, Todd; Mangano, Francesco T.; Leach, James L.; Rose, Douglas F.

    2012-01-01

    Summary Purpose Intracranial electroencephalography (EEG) is performed as part of an epilepsy surgery evaluation when noninvasive tests are incongruent or the putative seizure-onset zone is near eloquent cortex. Determining the seizure-onset zone using intracranial EEG has been conventionally based on identification of specific ictal patterns with visual inspection. High-frequency oscillations (HFOs, >80 Hz) have been recognized recently as highly correlated with the epileptogenic zone. However, HFOs can be difficult to detect because of their low amplitude. Therefore, the prevalence of ictal HFOs and their role in localization of epileptogenic zone on intracranial EEG are unknown. Methods We identified 48 patients who underwent surgical treatment after the surgical evaluation with intracranial EEG, and 44 patients met criteria for this retrospective study. Results were not used in surgical decision making. Intracranial EEG recordings were collected with a sampling rate of 2,000 Hz. Recordings were first inspected visually to determine ictal onset and then analyzed further with time-frequency analysis. Forty-one (93%) of 44 patients had ictal HFOs determined with time-frequency analysis of intracranial EEG. Key Findings Twenty-two (54%) of the 41 patients with ictal HFOs had complete resection of HFO regions, regardless of frequency bands. Complete resection of HFOs (n = 22) resulted in a seizure-free outcome in 18 (82%) of 22 patients, significantly higher than the seizure-free outcome with incomplete HFO resection (4/19, 21%). Significance Our study shows that ictal HFOs are commonly found with intracranial EEG in our population largely of children with cortical dysplasia, and have localizing value. The use of ictal HFOs may add more promising information compared to interictal HFOs because of the evidence of ictal propagation and followed by clinical aspect of seizures. Complete resection of HFOs is a favorable prognostic indicator for surgical outcome. PMID

  12. Endovascular embolization prior to surgical resection of symptomatic intralobar pulmonary sequestration in an adult

    OpenAIRE

    Jernej Avsenik; Tomaž Štupnik; Peter Popovič

    2015-01-01

    Intralobar pulmonary sequestration is a rare congenital malformation, conventionally managed by surgical resection. Recently, the endovascular embolization has been proposed for the definite treatment of this disease. Additionally, preoperative embolization of aberrant arteries to minimize the risk of serious intraoperative haemorrhage has also been described. We report the case of 43-year old female patient who presented with cough and haemoptysis, and was successfully treated with endovascu...

  13. MR and CT diagnosis of carotid pseudoaneurysm in children following surgical resection of craniopharyngioma

    Energy Technology Data Exchange (ETDEWEB)

    Lakhanpal, S.K. [Dept. of Radiology, Univ. of Arkansas for Medical Sciences and Arkansas Children`s Hospital, Little Rock, AR (United States); Glasier, C.M. [Dept. of Radiology, Univ. of Arkansas for Medical Sciences and Arkansas Children`s Hospital, Little Rock, AR (United States); James, C.A. [Dept. of Radiology, Univ. of Arkansas for Medical Sciences and Arkansas Children`s Hospital, Little Rock, AR (United States); Angtuaco, E.J.C. [Dept. of Radiology, Univ. of Arkansas for Medical Sciences and Arkansas Children`s Hospital, Little Rock, AR (United States)

    1995-06-01

    We report the cases of two children who underwent CT, MR, MRA and angiography in the diagnosis of postoperative aneurysmal dilatation of the supraclinoid carotid arteries following surgical resection of craniopharyngioma. Craniopharyngiomas are relatively common lesions, accounting for 6-7 % of brain tumors in children. They are histologically benign, causing symptoms by their growth within the sella and suprasellar cistern with compression of adjacent structures, especially the pituitary gland, hypothalamus and optic nerves, chiasm, and tracts. (orig.)

  14. Rapid development of an osteosarcoma after surgical resection of an osteochondroma.

    Science.gov (United States)

    Gomez-Brouchet, Anne; Accadbled, Franck; Rubie, Herve; Janka, Dora; Castex, Marie-Pierre; Thuille, Benedicte; Delattre, Olivier; Laurell, Henrick; Baunin, Christiane; de Gauzy, Jérôme Sales

    2007-09-01

    The rapid development of an osteosarcoma, after surgical resection of an osteochondroma, has not been yet reported. We present here the case of a 12-year-old girl that had, in less than 2 months, an osteosarcoma at the initial site of a treated osteochondroma. Comparative Genomic Hybridization analyses showed that the 2 tumors were genetically distinct, suggesting a distant, if any, relationship. The possible implication of a deregulated tissue homeostasis caused by the surgical intervention is discussed. Proangiogenic factors involved in the tissue healing could be the triggering factor favoring tumor angiogenesis and explaining the very rapid progression of the tumor.

  15. BRCA1: a novel prognostic factor in resected non-small-cell lung cancer.

    Directory of Open Access Journals (Sweden)

    Rafael Rosell

    Full Text Available BACKGROUND: Although early-stage non-small-cell lung cancer (NSCLC is considered a potentially curable disease following complete resection, patients have a wide spectrum of survival according to stage (IB, II, IIIA. Within each stage, gene expression profiles can identify patients with a higher risk of recurrence. We hypothesized that altered mRNA expression in nine genes could help to predict disease outcome: excision repair cross-complementing 1 (ERCC1, myeloid zinc finger 1 (MZF1 and Twist1 (which regulate N-cadherin expression, ribonucleotide reductase subunit M1 (RRM1, thioredoxin-1 (TRX1, tyrosyl-DNA phosphodiesterase (Tdp1, nuclear factor of activated T cells (NFAT, BRCA1, and the human homolog of yeast budding uninhibited by benzimidazole (BubR1. METHODOLOGY AND PRINCIPAL FINDINGS: We performed real-time quantitative polymerase chain reaction (RT-QPCR in frozen lung cancer tissue specimens from 126 chemonaive NSCLC patients who had undergone surgical resection and evaluated the association between gene expression levels and survival. For validation, we used paraffin-embedded specimens from 58 other NSCLC patients. A strong inter-gene correlation was observed between expression levels of all genes except NFAT. A Cox proportional hazards model indicated that along with disease stage, BRCA1 mRNA expression significantly correlated with overall survival (hazard ratio [HR], 1.98 [95% confidence interval (CI, 1.11-6]; P = 0.02. In the independent cohort of 58 patients, BRCA1 mRNA expression also significantly correlated with survival (HR, 2.4 [95%CI, 1.01-5.92]; P = 0.04. CONCLUSIONS: Overexpression of BRCA1 mRNA was strongly associated with poor survival in NSCLC patients, and the validation of this finding in an independent data set further strengthened this association. Since BRCA1 mRNA expression has previously been linked to differential sensitivity to cisplatin and antimicrotubule drugs, BRCA1 mRNA expression may provide additional

  16. Major intraoperative complications during video-assisted thoracoscopic anatomical lung resections

    DEFF Research Database (Denmark)

    Decaluwe, Herbert; Petersen, René Horsleben; Hansen, Henrik

    2015-01-01

    OBJECTIVES: A multicentre evaluation of the frequency and nature of major intraoperative complications during video-assisted thoracoscopic (VATS) anatomical resections. METHODS: Six European centres submitted their series of consecutive anatomical lung resections with the intention to treat by VATS....... Conversions to thoracotomy, vascular injuries and major intraoperative complications were studied in relation to surgeons' experience. Major complications included immediate life-threatening complications (i.e. blood loss of more than 2 l), injury to proximal airway or other organs or those leading...... complication. Surgeon's experience was related to non-oncological conversions, but not to vascular injuries or major complications in a multivariable logistic regression analysis. CONCLUSION: Major intraoperative complications during VATS anatomical lung resections are infrequent, seem not to be related...

  17. Treatment Strategy for Chylothorax after Resection for Lung Cancer-16 Case Report

    Institute of Scientific and Technical Information of China (English)

    Hongjing Jiang; Changli Wang; Zhenqing Zhao; Xiaolin Li; Daliang Qi; Liqun Gong

    2006-01-01

    OBJECTIVE To review the experience of iatrogenic chylothorax after pulmcnary resections for lung cancer and to evaluate our treatment strategy. METHODS From July 1997 through December 2003, a total of 1,546 patients underwent pulmonary resection (at least lobectomy) and systematic mediastinal lymph node dissection for lung cancer in our division. Sixteen patients had a postoperative chylothorax complication. All of these patients in this study were conservatively treated (closed drainage) with complete oral intake cessation and total parenteral nutrition.RESULTS All patients had their condition cured with conservative treatment. The duration of the treatment was 6-21 days. The patients were given normal diet for a mean of 9.8 days after chylothorax diagnosis.CONCLUSION If the correct treatment strategy is selected, most cases of chylothorax after pulmonary resection with systematic mediastinal lymph node dissection can be cured with a conservative strategy.

  18. Primary myoepithelial carcinoma of the lung: a rare entity treated with parenchymal sparing resection

    Directory of Open Access Journals (Sweden)

    Travis William D

    2011-03-01

    Full Text Available Abstract Primary lung myoepithelial carcinomas are rare neoplasms arising from the salivary glands of the respiratory epithelium. Given the rare occurrences and reports of these tumors, appropriate recommendations for resection are difficult to formulate. Although classified as low-grade neoplasms, these tumors have a significant rate of recurrence and distant metastasis.

  19. Conditions for NIR fluorescence-guided tumor resectioning in preclinical lung cancer model (Conference Presentation)

    Science.gov (United States)

    Kim, Minji; Quan, Yuhua; Choi, Byeong Hyun; Choi, Yeonho; Kim, Hyun Koo; Kim, Beop-Min

    2016-03-01

    Pulmonary nodule could be identified by intraoperative fluorescence imaging system from systemic injection of indocyanine green (ICG) which achieves enhanced permeability and retention (EPR) effects. This study was performed to evaluate optimal injection time of ICG for detecting cancer during surgery in rabbit lung cancer model. VX2 carcinoma cell was injected in rabbit lung under fluoroscopic computed tomography-guidance. Solitary lung cancer was confirmed on positron emitting tomography with CT (PET/CT) 2 weeks after inoculation. ICG was administered intravenously and fluorescent intensity of lung tumor was measured using the custom-built intraoperative color and fluorescence merged imaging system (ICFIS) for 15 hours. Solitary lung cancer was resected through thoracoscopic version of ICFIS. ICG was observed in all animals. Because Lung has fast blood pulmonary circulation, Fluorescent signal showed maximum intensity earlier than previous studies in other organs. Fluorescent intensity showed maximum intensity within 6-9 hours in rabbit lung cancer. Overall, Fluorescent intensity decreased with increasing time, however, all tumors were detectable using fluorescent images until 12 hours. In conclusion, while there had been studies in other organs showed that optimal injection time was at least 24 hours before operation, this study showed shorter optimal injection time at lung cancer. Since fluorescent signal showed the maximum intensity within 6-9 hours, cancer resection could be performed during this time. This data informed us that optimal injection time of ICG should be evaluated in each different solid organ tumor for fluorescent image guided surgery.

  20. Video-assisted mediastinoscopy (VAM for surgical resection of ectopic parathyroid adenoma

    Directory of Open Access Journals (Sweden)

    Lansdown Mark

    2007-10-01

    Full Text Available Abstract Background Ectopic mediastinal parathyroid adenomas or hyperplasia account for up to 25% of primary hyperparathyroidism (HPT. Two percent of them are not accessible by standard cervical surgical approaches. Surgical resection has traditionally been performed via median sternotomy or thoracotomy and more recently, via video assisted thoracoscopic surgery (VATS. We present our experience with the novel use of Video-Assisted Mediastinoscopy (VAM for resection of ectopic mediastinal parathyroid glands. Case presentation 4 patients underwent VAM for removal of an ectopic intramediastinal parathyroid gland. All of them had at least one previous unsuccessful neck exploration. In all cases histology confirmed complete resection of ectopic parathyroid glands (3 parathyroid adenomas and one parathyroid hyperplasia. Two of the patients required a partial sternal split to facilitate exploration. Conclusion The cervical approach for resection of ectopic parathyroid adenomas is frequently unsuccessful. Previously, the standard surgical approach in such cases was sternotomy and exploration of the mediastinum. Recently, a number of less invasive modalities have been introduced. We found that VAM has several advantages. It has a short theatre time does not require a complex anaesthetic and is performed with the patient in classic supine position utilising often a previous cervical scar with good cosmetic results. It offers a short hospital stay; it is cost effective with minimal use of fancy and pricy consumables with a comfortable incision and no violation of the pleural space. Additionally the use of digital Video imaging has increased the sensitivity of the mediastinoscopy and has added safety and confidence in performing a detailed mediastinal exploration with an additional great training value as well.

  1. Photodynamic therapy and the evolution of a lung-sparing surgical treatment for mesothelioma.

    Science.gov (United States)

    Friedberg, Joseph S; Mick, Rosemarie; Culligan, Melissa; Stevenson, James; Fernandes, Annemarie; Smith, Deborah; Glatstein, Eli; Hahn, Stephen M; Cengel, Keith

    2011-06-01

    Photodynamic therapy (PDT) is a light-based cancer treatment that acts to a depth of several millimeters into tissue. This study reviewed the results of patients who underwent a macroscopic complete resection, by two different surgical techniques, and intraoperative PDT as a treatment for malignant pleural mesothelioma. From 2004 to 2008, 28 patients with malignant pleural mesothelioma underwent macroscopic complete resection, 14 by modified extrapleural pneumonectomy (MEPP) and 14 by radical pleurectomy (RP) and intraoperative PDT. The surgical technique evolved over this period such that 13 of the last 16 patients underwent lung-sparing procedures, even in the setting of large-bulk tumors. Demographics in the MEPP and RP cohorts were similar in age, sex, stage, nodal status, histology, and adjuvant treatments. Stage III/IV disease was present in 12 of 14 patients (86%), with 50% or more with +N2 disease. The median overall survival for the MEPP group was 8.4 months, but has not yet been reached for the RP group at a median follow-up of 2.1 years. In addition to the inherent advantages of sparing the lung, RP plus PDT yielded a superior overall survival than MEPP plus PDT in this series. The overall survival for the RP plus PDT group was, for unclear reasons, superior to results reported in many surgical series, especially for a cohort with such advanced disease. Given these results, we believe RP plus PDT is a reasonable option for appropriate patients pursuing a surgical treatment for malignant pleural mesothelioma and that this procedure can serve as the backbone of surgically based multimodal treatments. Copyright © 2011 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  2. Extended surgical resections of advanced thymoma Masaoka stages III and IVa facilitate outcome.

    Science.gov (United States)

    Ried, Michael; Potzger, Tobias; Sziklavari, Zsolt; Diez, Claudius; Neu, Reiner; Schalke, Berthold; Hofmann, Hans-Stefan

    2014-03-01

    Extended thymoma resections including adjacent structures and pleurectomy/decortication (P/D) with hyperthermic intrathoracic chemotherapy (HITHOC) perfusion were performed in a multidisciplinary treatment regime. Between July 2000 and February 2012, 22 patients with Masaoka stage III (n = 9; 41%) and Masaoka stage IVa (n = 13; 59%) thymic tumors were included. Mean age was 55 years (25-84 years) and 50% (11 out of 22) of patients were female. World Health Organization histological classification was as follows: B2 (n = 15), A (n = 1), B1 (n = 1), B3 (n = 2), and thymic carcinoma (C; n = 3). Radical thymectomy and partial resection of the mediastinal pleura and pericardium were performed. Of the 13, 9 patients with pleural involvement (stage IVa) received radical P/D followed by HITHOC (cisplatin). Macroscopic complete resection (R0/R1) was achieved in 19 (86%) patients. All patients received multimodality treatment depending on tumor stage, histology, and completeness of resection. Thirty-day mortality was 0% and three (13.6%) patients needed operative revision. Recurrence of thymoma was documented in five (22.7%) patients (stage III, n = 1; stage IVa, n = 4). Mean disease-free interval of patients with complete resection (n = 14 out of 22) was 30.2 months. After a mean follow-up of 29 months, 18 out of the 22 (82%) patients are alive. After P/D and HITHOC, 89% (8 out of 9 patients) are alive (current median survival is 25 months) without recurrence. Extended surgical resection of advanced thymic tumors infiltrating adjacent structures (stage III) or with pleural metastases (stage IVa) is safe and feasible. It provides a low recurrence rate and an acceptable survival. Additional HITHOC in patients with pleural thymoma spread seems to offer a better local tumor control. Georg Thieme Verlag KG Stuttgart · New York.

  3. Carinal resection, left pneumonectomy, and right lung anastomosis for adenocystic basal cell carcinoma (cylindroma)

    Science.gov (United States)

    Thompson, Douglas T.; Doyle, Jorge A.; Roncoroni, Aquiles J.

    1969-01-01

    The surgical approach to, and resection of, a cylindroma of the left main bronchus involving the trachea and right main bronchus is described. The literature on bronchial adenoma and cylindroma is reviewed, both the pathogenesis and surgery being discussed. A plea for a more aggressive approach is made. Images PMID:4310817

  4. Resection of the mesopancreas (RMP: a new surgical classification of a known anatomical space

    Directory of Open Access Journals (Sweden)

    Konerding Moritz A

    2007-04-01

    Full Text Available Abstract Background Prognosis after surgical therapy for pancreatic cancer is poor and has been attributed to early lymph node involvement as well as to a strong tendency of cancer cells to infiltrate into the retropancreatic tissue and to spread along the peripancreatic neural plexuses. The objective of our study was to classify the anatomical-surgical layer of the mesopancreas and to describe the surgical principles relevant for resection of the mesopancreas (RMP. Immunohistochemical investigation of the mesopancreatic-perineural lymphogenic structures was carried out with the purpose of identifying possible routes of metastatic spread. Methods Resection of the mesopancreas (RMP was performed in fresh corpses. Pancreas and mesopancreas were separated from each other and the mesopancreas was immunohistochemically investigated. Results The mesopancreas strains itself dorsally of the mesenteric vessels as a whitish-firm, fatty tissue-like layer. Macroscopically, in the dissected en-bloc specimens of pancreas and mesopancreas nerve plexuses were found running from the dorsal site of the pancreatic head to the mesopancreas to establish a perineural plane. Immunohistochemical examinations revealed the lymphatic vessels localized in direct vicinity of the neuronal plexuses between pancreas and mesopancreas. Conclusion The mesopancreas as a perineural lymphatic layer located dorsally to the pancreas and reaching beyond the mesenteric vessels has not been classified in the anatomical or surgical literature before. The aim to ensure the greatest possible distance from the retropancreatic lymphatic tissue which drains the carcinomatous focus can be achieved in patients with pancreatic cancer only by complete resection of the mesopancreas (RMP.

  5. [Tubulo-villous rectal tumours. Results of surgical resection in relation to histotype (30 years' experience)].

    Science.gov (United States)

    Carditello, Antonio; Milone, Antonino; Paparo, Domenica; Anastasi, Giuliana; Mollo, Francesco; Stilo, Francesco

    2004-01-01

    Adenomas of the rectum are frequently found during endoscopic examination. We report on our 30 years of experience with the treatment of tubulo-villous adenomas based on histotype. Between 1971 and 2001, 104 villous tumours of the rectum were treated surgically. The patients' average age was 65 years. These were sessile tumours in 69% of cases, pedunculated in 17.5% and flowing tumours in 13.5%. The mean tumour size was 3 cm. They were associated with colon cancer in 15% of cases and with polyadenoma in 10%. They were located in the rectum within 0 to 6 cm of the anal margin in half the cases. These tumours were treated by local excision in 74 cases and by wide excision in 30 cases. The malignant potential of the tumours was 30%, including 10% invasive malignancy. There were no surgical fatalities, but a 6% medical fatality rate was registered. There was a 20% complication rate related to the surgical technique. Twenty patients were lost to follow-up. Out of 84 villous tumours, monitored over a mean survival period of 6.5 years, there were 24 recurrences: 18 underwent endoscopic excision and in 6 cases a wide resection. The various tumour resection techniques and the operative indications of variable difficulty are presented. It would seem, at present, that total resection of the rectum with a colo-anal anastomosis is the best treatment for large flowing villous tumours occupying almost the entire rectum. Thorough preoperative examination and the mastering of various surgical procedures should allow the most suitable choice of treatment for each individual case.

  6. Identifying the association between contrast enhancement pattern, surgical resection, and prognosis in anaplastic glioma patients

    Energy Technology Data Exchange (ETDEWEB)

    Wang, Yinyan; Jiang, Tao [Capital Medical University, Department of Neurosurgery, Beijing Tiantan Hospital, Beijing (China); Capital Medical University, Beijing Neurosurgical Institute, Beijing (China); Wang, Kai; Li, Shaowu; Ma, Jun [Capital Medical University, Department of Neuroradiology, Beijing Tiantan Hospital, Beijing (China); Wang, Jiangfei [Capital Medical University, Department of Neurosurgery, Beijing Tiantan Hospital, Beijing (China); Dai, Jianping [Capital Medical University, Beijing Neurosurgical Institute, Beijing (China); Capital Medical University, Department of Neuroradiology, Beijing Tiantan Hospital, Beijing (China)

    2016-04-15

    Contrast enhancement observable on magnetic resonance (MR) images reflects the destructive features of malignant gliomas. This study aimed to investigate the relationship between radiologic patterns of tumor enhancement, extent of resection, and prognosis in patients with anaplastic gliomas (AGs). Clinical data from 268 patients with histologically confirmed AGs were retrospectively analyzed. Contrast enhancement patterns were classified based on preoperative T1-contrast MR images. Univariate and multivariate analyses were performed to evaluate the prognostic value of MR enhancement patterns on progression-free survival (PFS) and overall survival (OS). The pattern of tumor contrast enhancement was associated with the extent of surgical resection in AGs. A gross total resection was more likely to be achieved for AGs with focal enhancement than those with diffuse (p = 0.001) or ring-like (p = 0.024) enhancement. Additionally, patients with focal-enhanced AGs had a significantly longer PFS and OS than those with diffuse (log-rank, p = 0.025 and p = 0.031, respectively) or ring-like (log-rank, p = 0.008 and p = 0.011, respectively) enhanced AGs. Furthermore, multivariate analysis identified the pattern of tumor enhancement as a significant predictor of PFS (p = 0.016, hazard ratio [HR] = 1.485) and OS (p = 0.030, HR = 1.446). Our results suggested that the contrast enhancement pattern on preoperative MR images was associated with the extent of resection and predictive of survival outcomes in AG patients. (orig.)

  7. Obesity does not increase complications after anatomic resection for non-small cell lung cancer.

    Science.gov (United States)

    Smith, Philip W; Wang, Hongkun; Gazoni, Leo M; Shen, K Robert; Daniel, Thomas M; Jones, David R

    2007-10-01

    The effect of obesity on complications after resection for lung cancer is unknown. We hypothesized that obesity is associated with increased complications after anatomic resections for non-small cell lung cancer. A review of our prospective general thoracic database identified 499 consecutive anatomic resections for non-small cell lung cancer from November 2002 to May 2006. Body mass index (BMI) was used to group patients as nonobese (BMI > 18.5 to obese (BMI > or = 30). Patient characteristics and oncologic and operative variables were compared between groups. Multivariable logistic regression models were fit with BMI included at every level. Outcomes examined included in-hospital morbidity, mortality, length of stay, and readmission. Seventy-five percent (372 of 499) were nonobese, and 25% (127 of 499) were obese. Preoperative variables were similar, except for a greater incidence of diabetes mellitus (p obese group. Overall mortality was 1.4% (7 of 499) and was not different between groups (p = 0.85). Thirty-day readmission rates (p = 0.76) and length of stay (p = 0.30) were similar. Obese patients had a higher incidence of acute renal failure (p = 0.001). A complication occurred in 33% (124 of 372) of nonobese and 31% (39 of 127) of obese patients (p = 0.59). Respiratory complications occurred in 22% (81 of 372) of nonobese and 14% (18 of 127) of obese patients (p = 0.06). Significant predictors of any complication include performance status, diffusing capacity, and tumor stage. Significant predictors of respiratory complications include performance status, diffusing capacity, chronic renal insufficiency, prior thoracic surgery, and chest wall resection. In contrast to our hypothesis, obesity does not increase the incidence of perioperative complications, mortality, or length of stay after anatomic resection for non-small cell lung cancer.

  8. Different surgical approaches for mesial temporal epilepsy: resection extent, seizure, and neuropsychological outcomes.

    Science.gov (United States)

    Malikova, Hana; Kramska, Lenka; Vojtech, Zdenek; Liscak, Roman; Sroubek, Jan; Lukavsky, Jiri; Druga, Rastislav

    2014-01-01

    Surgical therapy of intractable mesial temporal lobe epilepsy (MTLE) is an effective and well-established treatment. We compared two different surgical approaches, standard microsurgical anterior temporal resection (ATL) and stereotactic radiofrequency amygdalohippocampectomy (SAHE) for MTLE, with respect to the extent of resection or destruction, clinical outcomes, and complications. 75 MTLE patients were included: 41 treated by SAHE (11 right sided, 30 left sided) and 34 treated by ATL (21 right sided, 13 left sided). SAHE and ATL seizure control were comparable (Engel I in 75.6 and 76.5% 2 years after surgery and 79.3 and 76.5% 5 years after procedures, respectively). The neuropsychological results of SAHE patients were better than in ATL. In SAHE patients, no memory deficit was found. Hippocampal (60.6 ± 18.7%) and amygdalar (50.3 ± 21.9%) volume reduction by SAHE was significantly lower than by ATL (86.0 ± 12.7% and 80.2 ± 20.9%, respectively). The overall rate of surgical nonsilent complications without permanent neurological deficit after ATL was 11.8%, and another 8.8% silent infarctions were found on MRI. The rate of clinically manifest complications after SAHE was 4.9%. The rate of visual field defects after SAHE was expectably less frequent than after ATL. Seizure control by SAHE was comparable to ATL. However, SAHE was safer with better neuropsychological results. © 2014 S. Karger AG, Basel.

  9. Integrated Fluorine-18 Fluorodeoxyglucose (18F-FDG) PET/CT Compared to Standard Contrast-Enhanced CT for Characterization and Staging of Pulmonary Tumors Eligible for Surgical Resection

    Energy Technology Data Exchange (ETDEWEB)

    Quaia, E.; Tona, G.; Gelain, F.; Lubin, E.; Pizzolato, R.; Boscolo, E.; Bussoli, L. (Dept. of Radiology, Cattinara Hospital, Univ. of Trieste, Trieste (Italy))

    2008-11-15

    Background: Accurate staging is necessary to determine the appropriate therapy in patients with lung cancer. Few studies have compared integrated fluorine-18 fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) and contrast-enhanced CT in the characterization and staging of pulmonary tumors considered eligible for surgical resection. Purpose: To compare 18F-FDG PET/CT with standard contrast-enhanced CT for the diagnosis and staging of lung neoplasms eligible for surgical resection. Material and Methods: Seventy-six consecutive patients (56 male, 20 female; mean age+-SD, 63.4+-20 years) with 84 pulmonary tumors suspected for malignancy and considered eligible for surgical resection were prospectively enrolled. Seventy-three malignant (65 non-small-cell lung carcinomas, one small-cell lung cancer, two carcinoids, and five metastases) and 11 benign lung tumors (three hamartomas, two sarcoidosis, one amyloidosis, one Wegener granulomatosis, one tuberculosis, and three areas of scarring) were finally diagnosed by histology. Tumor staging was based on the revised American Joint Committee on Cancer. Results: In lesion characterization, the sensitivity and specificity of 18F-FDG PET/CT versus contrast-enhanced CT were 90% vs. 83% and 18% vs. 63% (P<0.05, McNemar test), respectively. In nodal staging, the sensitivity and specificity of 18F-FDG PET/CT versus contrast-enhanced CT were 78% vs. 46% and 80% vs. 93% (P<0.05), respectively. Conclusion: In patients with lung neoplasms considered eligible for surgical resection, 18F-FDG PET/CT versus contrast-enhanced CT revealed higher sensitivity in nodal staging, but lower specificity both in lesion characterization and nodal staging.

  10. Analysis of complications and outcomes after pulmonary resection in patients aged 80 years or over with non-small cell lung cancer

    Directory of Open Access Journals (Sweden)

    Wen-bing LI

    2014-10-01

    Full Text Available Objective To explore the therapeutic effect and degree of safety in patients aged 80 years or over with nonsmall cell lung cancer undergoing radical resection. Methods A retrospective survey of 97 elder patients aged 80 years or over, in whom non-small cell lung cancer was pathologically confirmed after partial resection of the lung in Chinese PLA General Hospital from Jan. 2003 to Dec. 2012. The peri-operative features were evaluated, including gender, age, history of smoking, pulmonary function, surgical procedure, histopathologic type, pathologic stage, etc. The relation of the postoperative complications and mortality with the factors mentioned above was analyzed. Results Among all patients, the surgical procedure comprised 36 lobectomies, 31 segmentectomies, and 30 wedge resections. The histopathologic diagnosis showed there were adenocarcinoma in 51 patients, squamous cell carcinoma in 29, large cell carcinoma in 9, adenosquamous cell carcinoma in 6 and neuro-endocrine cell carcinomas in 2. The disease stage was determined as ⅠA in 55 cases, ⅠB in 33, ⅡA in 7, ⅢA in 2. The post-operative complications (POC occurred in 14 of 97 patients (14.4%, and the most common complication was cardiovascular complication (9 cases, followed by pulmonary complication (5 cases. Only two patients died to the complications, one of them was post-operative pneumonia and respiratory failure, and the other one was acute myocardial infarction. The survival rate of the 97 patients was 91.7%, 70.2% and 52.8% at 1, 3 and 5 years, respectively, and in the patients with stage I disease, the survival rate was 93.9%, 73.6% and 54.1%, respectively. Conclusion Advanced age is not a contraindication to radical pulmonary resection in patients over 80 years old suffering from early stage non-small cell lung cancer. DOI: 10.11855/j.issn.0577-7402.2014.10.13

  11. Abdominoperineal Resection, Pelvic Exenteration, and Additional Organ Resection Increase the Risk of Surgical Site Infection after Elective Colorectal Surgery: An American College of Surgeons National Surgical Quality Improvement Program Analysis.

    Science.gov (United States)

    Kwaan, Mary R; Melton, Genevieve B; Madoff, Robert D; Chipman, Jeffrey G

    2015-12-01

    Determining predictors of surgical site infection (SSI) in a large cohort is important for the design of accurate SSI surveillance programs. We hypothesized that additional organ resection and pelvic exenterative procedures are associated independently with a higher risk of SSI. Patients in the American College of Surgeons National Surgical Quality Improvement Program® (ACS NSQIP®; American College of Surgeons, Chicago, IL) database (2005-2012) were identified (n=112,282). Surgical site infection (superficial or deep SSI) at 30 d was the primary outcome. Using primary and secondary CPT® codes (American Medical Association, Chicago, IL) pelvic exenteration was defined and additional organ resection was defined as: bladder resection/repair, hysterectomy, partial vaginectomy, additional segmental colectomy, small bowel, gastric, or diaphragm resection. Univariable analysis of patient and procedure factors identified significant (p40 (OR: 2.51), pulmonary comorbidities (OR: 1.22), smoking (OR: 1.24), bowel obstruction (OR: 1.40), wound classification 3 or 4 (OR: 1.18), and abdominoperineal resection (OR: 1.58). Laparoscopic or laparoscopically assisted procedures offered a protective effect against incision infection (OR: 0.55). Additional organ resection (OR: 1.08) was also associated independently with SSI, but the magnitude of the effect was decreased after accounting for operative duration. In the analysis that excludes operative duration, pelvic exenteration is associated with SSI (OR: 1.38), but incorporating operative duration into the model results in this variable becoming non-significant. In addition to other factors, obesity, surgery for bowel obstruction, abdominoperineal resection, and additional organ resection are independently associated with a higher risk of SSI. Surgical site infection risk in pelvic exenteration and multiple organ resection cases appears to be mediated by prolonged operative duration. In these established high-risk sub-groups of

  12. [Lobectomy for lung cancer using the Da Vinci surgical system].

    Science.gov (United States)

    Nakamura, Hiroshige

    2014-05-01

    Robot-assisted surgery using the da Vinci surgical system has attracted attention because of excellent operability without shaking by joint forceps under the clear vision of a three-dimensional high-definition camera in lung cancer surgery. Although this form of advanced medical care is not yet approved for insurance coverage, it is at the stage of clinical research and expected to be useful in hilar exposure, lymph node dissection, and suturing of the lung parenchyma or bronchus. Lung cancer surgery with the da Vinci system has the advantage of combining thoracotomy and minimally invasive surgery in video-assisted thoracic surgery. However, safety management, education, and significant cost are problems to be resolved. Several important issues such as sharing knowledge and technology of robotic surgery, education, training, development of new instruments, and acquisition of advanced medical insurance are discussed for the future development of robotic surgical systems.

  13. Solid Predominant Histologic Subtype in Resected Stage I Lung Adenocarcinoma Is an Independent Predictor of Early, Extrathoracic, Multisite Recurrence and of Poor Postrecurrence Survival

    Science.gov (United States)

    Ujiie, Hideki; Kadota, Kyuichi; Chaft, Jamie E.; Buitrago, Daniel; Sima, Camelia S.; Lee, Ming-Ching; Huang, James; Travis, William D.; Rizk, Nabil P.; Rudin, Charles M.; Jones, David R.; Adusumilli, Prasad S.

    2015-01-01

    Purpose To examine the significance of the proposed International Association for the Study of Lung Cancer, American Thoracic Society, and European Respiratory Society (IASLC/ATS/ERS) histologic subtypes of lung adenocarcinoma for patterns of recurrence and, among patients who recur following resection of stage I lung adenocarcinoma, for postrecurrence survival (PRS). Patients and Methods We reviewed patients with stage I lung adenocarcinoma who had undergone complete surgical resection from 1999 to 2009 (N = 1,120). Tumors were subtyped by using the IASLC/ATS/ERS classification. The effects of the dominant subtype on recurrence and, among patients who recurred, on PRS were investigated. Results Of 1,120 patients identified, 188 had recurrent disease, 103 of whom died as a result of lung cancer. Among patients who recurred, 2-year PRS was 45%, and median PRS was 26.1 months. Compared with patients with nonsolid tumors, patients with solid predominant tumors had earlier (P = .007), more extrathoracic (P recurrences. Multivariable analysis of primary tumor factors revealed that, among patients who recurred, solid predominant histologic pattern in the primary tumor (hazard ratio [HR], 1.76; P = .016), age older than 65 years (HR, 1.63; P = .01), and sublobar resection (HR, 1.6; P = .01) were significantly associated with worse PRS. Presence of extrathoracic metastasis (HR, 1.76; P = .013) and age older than 65 years at the time of recurrence (HR, 1.7; P = .014) were also significantly associated with worse PRS. Conclusion In patients with stage I primary lung adenocarcinoma, solid predominant subtype is an independent predictor of early recurrence and, among those patients who recur, of worse PRS. Our findings provide a rationale for investigating adjuvant therapy and identify novel therapeutic targets for patients with solid predominant lung adenocarcinoma. PMID:26261257

  14. Nutritional Status and Body Composition of Adult Patients with Brain Tumours Awaiting Surgical Resection.

    Science.gov (United States)

    McCall, Michele; Leone, Ashley; Cusimano, Michael D

    2014-09-01

    To measure the prevalence of malnutrition, risk factors for poor dietary intake and body composition in patients with brain tumours admitted to hospital for surgical resection. In this study, 316 patients admitted for brain tumour resection to the Neurosurgical service at St. Michael's Hospital were screened. Assessment tools included the Subjective Global Assessment (SGA) for nutritional status and Bioelectrical Impedance Analysis (BIA) for body composition. All measurements were performed by one research dietitian. Information regarding medical history, symptomology, and tumour pathology was recorded. One hundred and nine participants were recruited. Malnutrition was present in 17.6% of patients, of whom 94.7% were moderately malnourished (SGA-B) and 5.3% severely malnourished (SGA-C). Key symptoms contributing to malnutrition included weight loss, nausea, vomiting, dysphagia, headaches, and fatigue. Patients with malignant tumors were more likely to have weight loss and lower fat mass. This study demonstrated that patients admitted for brain tumour resection have a low prevalence of malnutrition compared with other cancer populations. Useful parameters for nutritional screening of inpatient admissions include weight loss >5% of usual weight, nausea, vomiting, dysphagia, and headaches.

  15. A comparison of three scoring systems for predicting complications after major lung resection.

    Science.gov (United States)

    Ferguson, Mark K; Durkin, Amy E

    2003-01-01

    Although complications occur frequently after major lung resection, current predictive models are not entirely satisfactory. We devised a new predictive scoring system and compared it to two existing systems. We performed an initial retrospective review of 400 patients who underwent major resection for lung cancer from 1980 to 1995. Predictive covariates (age, spirometry, diffusing capacity) associated with three or more complication groups were used to develop a scoring system. This system (EVAD) was then evaluated against the Physiological and Operative Severity Score for Enumeration of Mortality and Morbidity (POSSUM) and Cardiopulmonary Risk Index (CPRI) systems for patients operated between 1996 and 2001. Major resection for lung cancer included lobectomy (188) and pneumonectomy (30). Complication categories were: pulmonary (23; 10.5%); cardiovascular (24; 11.0%); infectious (8; 3.6%); other (29; 13.2%); nonfatal (45; 20.6%); and any (53; 24.2%). Death occurred in ten patients (4.6%). Mean EVAD scores were significantly different between groups with and without complications in all categories except infectious complications and death, whereas mean CPRI scores differed only for pulmonary complications, nonfatal complications, and death, and mean POSSUM scores did not appropriately differ for any complications. EVAD predicted incremental risk in all complication categories except cardiovascular, infectious, and death, whereas CPRI predicted incremental risk only for nonfatal and possibly any complications, and POSSUM did not predict incremental risk for any complication category. Receiver operating characteristic analysis demonstrated the EVAD system to be equivalent to or better than CPRI and POSSUM for all complication categories. A simple scoring system (EVAD) that utilizes pulmonary function test data and patient age predicts the likelihood of complications after major lung resection. It is easier to use and at least as accurate as other scoring systems

  16. Pancreatic Resection for Metastasis to the Pancreas from Colon and Lung Cancer, and Osteosarcoma

    OpenAIRE

    Konstantinos Lasithiotakis; Ioannis Petrakis; George Georgiadis; Stefanos Paraskakis; George Chalkiadakis; Emmanuel Chrysos

    2010-01-01

    Context Pancreatic resection for a metastatic colon, lung cancer or an osteosarcoma has rarely been reported in the literature and there is controversy regarding recurrence and the overall survival of these patients. We herein evaluate the outcome of three patients who underwent pancreaticoduodenectomy for the aforementioned metastatic tumors to the pancreas. Case reports Clinical presentation included pyloric stenosis and acute gastrointestinal bleeding. One patient was asymptomatic and was ...

  17. Operative Risk for Major Lung Resection Increases at Extremes of Body Mass Index.

    Science.gov (United States)

    Williams, Trevor; Gulack, Brian C; Kim, Sunghee; Fernandez, Felix G; Ferguson, Mark K

    2017-01-01

    Although body mass index (BMI) has been used in risk stratification for lung resection, many models only take obesity into account. Recent studies have demonstrated that underweight patients also experience increased postoperative complications. We explored the relationship of extremes of BMI to outcomes after lung resection for non-small cell cancer. Patients in the Society of Thoracic Surgeons General Thoracic Surgery Database (2009 to 2014) undergoing elective lung resection for cancer were evaluated. Multivariable logistic regression was used to adjust for potential confounders including functional status and spirometry. We evaluated 41,446 patients (median 68 years of age; 53% female) grouped by BMI: underweight (obese I (30 to 34.9 kg/m(2); 18.1%), obese II (35 to 39.9 kg/m(2); 6.4%), and obese III (≥40 kg/m(2); 3.6%). Pulmonary complication rates were higher in underweight and obese III patients compared to normal BMI patients (p Obese III patients had an increased risk of any major postoperative complication (adjusted OR: 1.18, 95% CI: 1.02 to 1.36). Overweight and obese class I to II patients had a lower risk of pulmonary complications and any postoperative event. BMI is associated with postoperative complications after lung resection for cancer. Being underweight or severely overweight is associated with an increased risk of complications, whereas being overweight or moderately obese appears to have a protective effect. Copyright © 2017 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  18. [The radicality of surgical resection in rectal cancer. Analysis of factors associated with incomplete mesorectal excision].

    Science.gov (United States)

    Ferko, A; Orhalmi, J; Nikolov, D H; Hovorková, E; Chobola, M; Vošmik, M; Cermáková, E

    2013-06-01

    Circumferential resection margin (pCRM) and the completeness of mesorectal excision (ME) are two independent prognostic factors significantly associated with the radicality of surgical treatment. Positive pCRM and incomplete mesorectal excision are associated with a significantly higher incidence of local recurrence and worse patient prognosis. The aim of this article is to analyze the risk factors associated with incomplete mesorectal excision. Patients operated on at the Department of Surgery, University Hospital Hradec Kralove between January 2011 and February 2013 were included in the study. The patients data were prospectively collected and entered in the Dg C20 registry. The following factors were analyzed: sex, age, BMI, cN, pT, clinical stage, the involved segment of the rectum, neoadjuvant therapy, circumferential tumour location, the type of surgical approach and the type of surgery. 168 patients were operated on during the above period. 9 (5.3%) palliative stomas and 159 (94.6%) resection procedures were performed in this group of 168 patients. 7 (4.4%) patients were excluded because the quality of excision was not assessed in them. 114 (75%) resections, including 5 intersphincteric resections, were performed in the group of the remaining 152 patients. 10 (7%) were Hartmanns procedures a 28 (18%) were amputation procedures. Out of 152 procedures, 69 (45%) were performed laparoscopically. Positive (y)pCRO was recorded in 26 (17%) patients, predominantly after abdominoperineal resection (APR) - 11 out of 27 (41%), and Hartmanns operation - 6 out of 10 (60%). Incomplete ME was observed in 45 patients (30%), complete ME in 81 patients (53%) and partially complete in 26 patients (17%). Univariate analysis confirmed statistically significant factors associated with incomplete mesorectal excision: (y)pT (P = 0.00027), type of surgery (P = 0.00001) and tumour location (P = 0.00001). Multivariate analysis then confirmed two independent prognostic factors

  19. Inability to perform bicycle ergometry predicts increased morbidity and mortality after lung resection.

    Science.gov (United States)

    Epstein, S K; Faling, L J; Daly, B D; Celli, B R

    1995-02-01

    The ability to successfully exercise has been used to assess the cardiopulmonary risk of thoracotomy for lung cancer. Because of musculoskeletal, neurologic, peripheral vascular, or behavioral problems, not all patients presenting for pulmonary resection are capable of exercising. Using a multifactorial cardiopulmonary risk index (CPRI) consisting of a cardiac risk index (CRI) and a pulmonary risk index, we studied 74 patients (60 capable of exercising and 14 incapable of exercising) who underwent thoracotomy for lung cancer resection. The groups were similar in reference to history of pulmonary disease, preoperative pulmonary function, and pulmonary risk index score. The no-exercise patients were more likely to have a history of cardiac disease (64 vs 28%; p CPRI of 4 or more, all eight suffered a POC (100%) and three died (38%). Using multiple logistic regression analysis, both the CPRI score and the inability to exercise were independently associated with increased risk for POCs. We conclude that patients unable to perform even minimal preoperative exercise are at substantially increased risk for morbidity and mortality after lung resection. This results both from greater identifiable preoperative cardiopulmonary risk factors (as assessed by the CPRI) and from an independent effect related to the inability to exercise.

  20. Surgical resection of a solitary para-aortic lymph node metastasis from hepatocellular carcinoma

    Institute of Scientific and Technical Information of China (English)

    Junji Ueda; Hiroshi Yoshida; Yasuhiro Mamada; Nobuhiko Taniai; Sho Mineta; Masato Yoshioka; Youichi Kawano

    2012-01-01

    Lymph node (LN) metastases from hepatocellular carcinoma (HCC) are considered uncommon.We describe the surgical resection of a solitary para-aortic LN metastasis from HCC.A 65-year-old Japanese man with B-type liver cirrhosis was admitted for the evaluation of a liver tumor.He had already undergone radiofrequency ablation,transcatheter arterial chemoemboliza tion,and percutaneous ethanol injection therapy for HCC.Despite treatment,viable regions remained in segments 4 and 8.We performed a right paramedian sectionectomy with partial resection of the left paramedian section of the liver.Six months later,serum concentrations of alpha-fetoprotein (189 ng/mL) and PIVKA-2 (507 mAU/mL) increased.Enhanced computed tomography of the abdomen revealed a tumor (20 mm in diameter) on the right side of the abdominal aorta.Fluorine-18 fluorodeoxyglucose positron emission tomography revealed an increased standard uptake value.There was no evidence of recurrence in other regions.Esophagogastroduodenoscopy and colonoscopy revealed no malignant tumor in the gastrointestinal tract.Para-aortic LN metastasis from HCC was thus diagnosed.We performed lymphadenectomy.Histopathological examination revealed that the tumor was largely necrotic,with poorly differentiated HCC on its surface,which confirmed the suspected diagnosis.After 6 mo tumor marker levels were normal,with no evidence of recurrence.Our experience suggests that a solitary para-aortic LN metastasis from HCC can be treated surgically.

  1. Factors associated with seizure freedom in the surgical resection of glioneuronal tumors.

    Science.gov (United States)

    Englot, Dario J; Berger, Mitchel S; Barbaro, Nicholas M; Chang, Edward F

    2012-01-01

    Gangliogliomas (GGs) and dysembryoplastic neuroepithelial tumors (DNETs) are low-grade brain tumors of glioneuronal origin that commonly present with seizures. Achieving seizure control in patients with glioneuronal tumors remains underappreciated, as tumor-related epilepsy significantly affects patients' quality-of-life. We performed a quantitative and comprehensive systematic literature review of seizure outcomes after surgical resection of GGs and DNETs associated with seizures. We evaluated 910 patients from 39 studies, and stratified outcomes according to several potential prognostic variables. Overall, 80% of patients were seizure-free after surgery (Engel class I), whereas 20% continued to have seizures (Engel class II-IV). We observed significantly higher rates of seizure-freedom in patients with ≤1 year duration of epilepsy compared to those with >1 year of seizures [odds ratio (OR) 9.48; 95% confidence interval (CI) 2.26-39.66], and with gross-total resection over subtotal lesionectomy (OR 5.34; 95% CI 3.61-7.89). In addition, the presence of secondarily generalized seizures preoperatively predicted a lower rate of seizure-freedom after surgery (OR 0.40; 95% CI 0.24-0.66). Outcomes did not differ significantly between adults and children, patients with temporal lobe versus extratemporal tumors, pathologic diagnosis of GG versus DNET, medically controlled versus refractory seizures, or with the use of electrocorticography (ECoG). Extended resection of temporal lobe tumors, with hippocampectomy and/or corticectomy, conferred additional benefit. These results suggest that early operative intervention and gross-total resection are critically important factors in achieving seizure-freedom, and thus improving quality-of-life, in patients with glioneuronal tumors causing epilepsy. Wiley Periodicals, Inc. © 2011 International League Against Epilepsy.

  2. Defining an optimal surgical strategy for synchronous colorectal liver metastases: staged versus simultaneous resection?

    Science.gov (United States)

    She, Wong Hoi; Chan, Albert Chi Yan; Poon, Ronnie Tung Ping; Cheung, Tan To; Chok, Kenneth Siu Ho; Chan, See Ching; Lo, Chung Mau

    2015-11-01

    We aimed to assess if simultaneous resection conferred any survival benefit in resection of synchronous colorectal liver metastases. From January 1990 to December 2008, 116 patients with synchronous colorectal liver metastases were identified. Among these 116 patients, 88 underwent staged resection (SR), while the remaining 28 patients underwent simultaneous resection (SIMR). Patients' follow-up data were reviewed. There were no significant differences between the groups in terms of patient and tumour characteristics. Major hepatectomy was performed in 54 patients (61%) undergoing SR, and 12 patients (43%) undergoing SIMR (P = 0.09). The median blood loss (SR 0.7 L versus SIMR 0.8 L) was similar. Post-operative morbidity rates and hospital mortality rates were not statistically different. The total length of hospital stay was shorter in SIMR patients (18.0 versus 11.5 days, P = 0.009). The 1-, 3- and 5-year overall survival for SR were 90.7%, 47.1% and 33.3%, whilst the corresponding survival rates for SIMR were 75.0%, 25.0% and 0%, respectively (P = 0.003). However, when the disease-free survival (DFS) was stratified according to the number of hepatic metastases, the survival benefit of SR and SIMR for solitary CRM were similar (3-year DFS: 28.3% versus 11.1%, P = 0.089). Our study showed that an operative strategy of SR generally offered better survival outcome than SIMR in the surgical management of CRM. © 2014 Royal Australasian College of Surgeons.

  3. Recurrent rhinosporidiosis: coblation assisted surgical resection-a novel approach in management.

    Science.gov (United States)

    Khan, Iram; Gogia, Shweta; Agarwal, Alok; Swaroop, Ajay

    2014-01-01

    Recurrent rhinosporidiosis is a chronic granulomatous disease with a known tendency to reoccur. Coblation EVAC 70 is a novel surgical tool which seems to provide excellent option in management of this notorious disease. We present an interesting case and the innovative approach in its management, using Coblation system. Introduction. Rhinosporidiosis seeberi causes a chronic granulomatous disease of upper airway, usually involving the nose and nasopharynx, and has a notorious tendency to reoccur. The current line of management is surgical excision of the lesion along with cauterization of the base, which does not prevent reoccurrence of the disease. Case Presentation. A 65-year-old male resident of rural India reported a history of breathing difficulty and change in voice. Patient is a Hindu priest by profession, who according to their rituals has to take bath in local pond or river. Conclusion. Rhinosporidiosis is a difficult to treat pathology due to its tendency to reoccur. Till date the management of the disease is far from satisfactory. Coblation system which has already found its roots in otorhinolaryngology can be used as a novel tool in surgical resection of recurrent rhinosporidiosis and has added advantage of low temperature dissection along with clear surgical field due to constant suctioning.

  4. Impact of medical therapy on patients with Crohn’s disease requiring surgical resection

    Science.gov (United States)

    Fu, YT Nancy; Hong, Thomas; Round, Andrew; Bressler, Brian

    2014-01-01

    AIM: To evaluate the impact of medical therapy on Crohn’s disease patients undergoing their first surgical resection. METHODS: We retrospectively evaluated all patients with Crohn’s disease undergoing their first surgical resection between years 1995 to 2000 and 2005 to 2010 at a tertiary academic hospital (St. Paul’s Hospital, Vancouver, Canada). Patients were identified from hospital administrative database using the International Classification of Diseases 9 codes. Patients’ hospital and available outpatient clinic records were independently reviewed and pertinent data were extracted. We explored relationships among time from disease diagnosis to surgery, patient phenotypes, medication usage, length of small bowel resected, surgical complications, and duration of hospital stay. RESULTS: Total of 199 patients were included; 85 from years 1995 to 2000 (cohort A) and 114 from years 2005 to 2010 (cohort B). Compared to cohort A, cohort B had more patients on immunomodulators (cohort A vs cohort B: 21.4% vs 56.1%, P < 0.0001) and less patients on 5-aminosalysilic acid (53.6% vs 29.8%, P = 0.001). There was a shift from inflammatory to stricturing and penetrating phenotypes (B1/B2/B3 38.8% vs 12.3%, 31.8% vs 45.6%, 29.4% vs 42.1%, P < 0.0001). Both groups had similar median time to surgery. Within cohort B, 38 patients (33.3%) received anti-tumor necrosis factor (TNF) agent. No patient in cohort A was exposed to anti-TNF agent. Compared to patients not on anti-TNF agent, ones exposed were younger at diagnosis (anti-TNF vs without anti-TNF: A1/A2/A3 39.5% vs 11.8%, 50% vs 73.7%, 10.5% vs 14.5%, P = 0.003) and had longer median time to surgery (90 mo vs 48 mo, P = 0.02). Combination therapy further extended median time to surgery. Using time-dependent multivariate Cox proportional hazard model, patients who were treated with anti-TNF agents had a significantly higher risk to surgery (adjusted hazard ratio 3.57, 95%CI: 1.98-6.44, P < 0.0001) compared to those

  5. Malformación arteriovenosa pulmonar: Características clínicas, diagnóstico y rol del tratamiento quirúrgico en pacientes tratados con cirugía resectiva pulmonar Pulmonary arteriovenous malformation: Clinical features, diagnosis and role of surgical management in patients with lung resection surgery

    Directory of Open Access Journals (Sweden)

    ROBERTO GONZÁLEZ L

    2011-03-01

    has a role only in selected cases. Our objectives are to describe clinical features, diagnostic methods and role of surgical treatment in patients with PA VM. Methods: Retrospective review of all patients with PA VM, in whom surgery was performed in our institution, from February 2005 to February 2010. The follow up controls were done through physician or telephone contact. Results: 8 patients, six females (3:1, aged between 16-68 years were analyzed. Most common sigiis and symptoms were dyspnea, cyanosis and clubbing. Right lower lobe was the most frequent location. Four had multiple PA VM and four met criteria for Rendu-Osler- Weber disease. Six patients had polycythemia and two anemia. Radiography was abnormal in all and computed tomography defined anatomy in seven. Angiography was performed in three, two had contrasted echocardiography and four had scintigraphy. Most common surgical treatment was lobectomy. Indications for surgery were the size of PA VM in five cases, failure of embolization in two and one because of intra-operative findings, without a previous diagrwsis. One had postoperative bleeding. Discharge was between day 2 and 10 days after surgery. There was no mortality. At their last control all patients were asymptomatic. Conclusion: PA VMpresents a wide and varied range of clinical and anatomical findings. They can cause major symptoms and serious complications, which justify their treatment. The preoperative study is based primarily on demonstrating the shunt and determining the anatomical characteristics of the lesion. In selected cases lung resection surgery is indicated.

  6. Complete Resection of Ampullary Paragangliomas Confined to the Submucosa on Endoscopic Ultrasound May Be Best Achieved by Radical Surgical Resection

    Directory of Open Access Journals (Sweden)

    Kevin A. Ghassemi

    2009-06-01

    Full Text Available Paragangliomas of the gastrointestinal tract generally are benign tumors usually found in the second portion of the duodenum. We present a case of paraganglioma of the ampulla of Vater confined to the submucosa on endoscopic ultrasound examination. This was initially treated by endoscopic resection, followed by pancreaticoduodenectomy after local resection margins were positive. Histopathology showed a well-differentiated ampullary paraganglioma confined to the submucosa, but with involvement of one regional lymph node. Only 25 prior cases of paraganglioma at the ampulla of Vater have been reported, and nine of these have demonstrated local or distant metastases. Because of their malignant potential, ampullary paragangliomas should be treated with radical resection if the goal is to achieve complete resection, even if preoperative imaging shows local confinement.

  7. Recurrence and Survival After Segmentectomy in Patients With Prior Lung Resection for Early-Stage Non-Small Cell Lung Cancer.

    Science.gov (United States)

    Brown, Lisa M; Louie, Brian E; Jackson, Nicole; Farivar, Alexander S; Aye, Ralph W; Vallières, Eric

    2016-10-01

    Lobectomy is the standard of care for patients with early-stage non-small cell lung cancer (NSCLC). However, the treatment of choice for patients with prior lung resection and a second primary NSCLC has not been established. We compared rates and patterns of recurrence and survival in patients with and without prior lung resection treated by segmentectomy and determined predictors of recurrence. This was a retrospective cohort study of 90 patients who underwent 91 consecutive segmentectomies for early-stage NSCLC between April 2004 and December 2014. Logistic regression was used to determine predictors of recurrence, and Kaplan-Meier curves were used to determine survival. Of the 91 segmentectomies, 21 (23%) had a prior lung cancer resection and 70 (77%) were primary resections. There were 18 recurrences (20%): 9 of 21 (43%) in those with prior lung resection and 9 of 70 (13%) in those without. The 90-day mortality was 0%. The recurrence-free survival and 5-year survival were 61% and 55% in those with prior lung resection (p = 0.09) and 84% and 65% in those without (p = 0.4). Close parenchymal margin and number of lymph nodes examined were significant modifiable predictors of recurrence. Segmentectomy is a reasonable option for patients with early-stage NSCLC who have had a prior lung resection. It results in similar survival but trends toward lower recurrence-free survival compared with patients undergoing primary resection. Copyright © 2016 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  8. Systemic inflammation, nutritional status and tumor immune microenvironment determine outcome of resected non-small cell lung cancer.

    Directory of Open Access Journals (Sweden)

    Marco Alifano

    Full Text Available BACKGROUND: Hypothesizing that nutritional status, systemic inflammation and tumoral immune microenvironment play a role as determinants of lung cancer evolution, the purpose of this study was to assess their respective impact on long-term survival in resected non-small cell lung cancers (NSCLC. METHODS AND FINDINGS: Clinical, pathological and laboratory data of 303 patients surgically treated for NSCLC were retrospectively analyzed. C-reactive protein (CRP and prealbumin levels were recorded, and tumoral infiltration by CD8+ lymphocytes and mature dendritic cells was assessed. We observed that factors related to nutritional status, systemic inflammation and tumoral immune microenvironment were correlated; significant correlations were also found between these factors and other relevant clinical-pathological parameters. With respect to outcome, at univariate analysis we found statistically significant associations between survival and the following variables: Karnofsky index, American Society of Anesthesiologists (ASA class, CRP levels, prealbumin concentrations, extent of resection, pathologic stage, pT and pN parameters, presence of vascular emboli, and tumoral infiltration by either CD8+ lymphocytes or mature dendritic cells and, among adenocarcinoma type, tumor grade (all p285 mg/L prealbumin levels and high (>96/mm2 CD8+ cell count had a 5-year survival rate of 80% [60.9-91.1] as compared to 18% [7.9-35.6] in patients with an opposite pattern of values. When stages I-II were considered alone, the prognostic significance of these factors was even more pronounced. CONCLUSIONS: Our data show that nutrition, systemic inflammation and tumoral immune contexture are prognostic determinants that, taken together, may predict outcome.

  9. Myofibroblastic tumor causing severe neonatal distress. Successful surgical resection after embolization.

    Science.gov (United States)

    Castañón, Montserrat; Saura, Laura; Weller, Santiago; Prat, Jordi; Thio, Marta; Sorolla, Juan P; Albert, Asteria; Morales, Lluís

    2005-06-01

    This report describes a case of a term male 3.1 kg, normal delivery, 38 weeks of gestation with a record of hydramnios by prenatal sonography. He had fetal acute suffering and respiratory distress. The first radiographic study showed a mass filling the whole left thorax cage causing erosion of the inferior edge of the third rib. The mediastinum was displaced to the right. Computed tomography scan confirmed a homogeneous tumor that filled the left thorax and displaced the mediastinum to the right without invasion. Surgical biopsy informed of a highly vascularized mesenchymal tumor. The tumor was embolized with Ivalon microparticles obtaining a nearly avascular mass. Complete surgical excision was made, including the whole mass and costal segments. Microscopically, it was an inflammatory myofibroblastic tumor. It was composed mainly of spindle-shaped cells without malignant features. On immunohistochemistry, the tumor showed positive staining for vimentin, whereas antidesmin antibodies and S-100 protein were negative. The aim of this article is to present an extremely uncommon case of neonatal distress caused by an intrathoracic, extrapulmonary myofibroblastic tumor. Complete surgical resection was possible after embolization.

  10. Android application for determining surgical variables in brain-tumor resection procedures.

    Science.gov (United States)

    Vijayan, Rohan C; Thompson, Reid C; Chambless, Lola B; Morone, Peter J; He, Le; Clements, Logan W; Griesenauer, Rebekah H; Kang, Hakmook; Miga, Michael I

    2017-01-01

    The fidelity of image-guided neurosurgical procedures is often compromised due to the mechanical deformations that occur during surgery. In recent work, a framework was developed to predict the extent of this brain shift in brain-tumor resection procedures. The approach uses preoperatively determined surgical variables to predict brain shift and then subsequently corrects the patient's preoperative image volume to more closely match the intraoperative state of the patient's brain. However, a clinical workflow difficulty with the execution of this framework is the preoperative acquisition of surgical variables. To simplify and expedite this process, an Android, Java-based application was developed for tablets to provide neurosurgeons with the ability to manipulate three-dimensional models of the patient's neuroanatomy and determine an expected head orientation, craniotomy size and location, and trajectory to be taken into the tumor. These variables can then be exported for use as inputs to the biomechanical model associated with the correction framework. A multisurgeon, multicase mock trial was conducted to compare the accuracy of the virtual plan to that of a mock physical surgery. It was concluded that the Android application was an accurate, efficient, and timely method for planning surgical variables.

  11. Scimitar syndrome: Anaesthetic management for pulmonary resection of the unaffected lung.

    Science.gov (United States)

    Fernández-Torres, B; Fernández-López, A; Congregado, M

    2017-05-26

    Scimitar syndrome is a rare congenital anomaly characterized by anomalous drainage of the right pulmonary veins in the inferior vena cava, frequently associated with right lung and pulmonary artery hypoplasia, dextrocardia and abnormal systemic arterial supply to the lower lobe. Pulmonary resection surgery on healthy lung is exceptional, and there are no published records of it, as far as we know. A man with scimitar syndrome diagnosed with a lung nodule with malignant features in the contralateral lung. This situation implies huge anaesthetic complexity, mainly for intraoperative ventilation. Although spirometry and stress test did not contraindicate the planned lobectomy, scintigraphy showed a hypoplastic right lung with an uptake of 15%. From an anaesthetic point of view we discarded selective ventilation of the right lung, since the shunt made it functionally non-existent. In consequence we proposed four anaesthetic possibilities. After the placement of an epidural catheter and left selective intubation, thoracoscopy with intermittent apnoeas was our first choice, and we could complete the extirpation and avoid excessive complexity. Copyright © 2017 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Publicado por Elsevier España, S.L.U. All rights reserved.

  12. Isolated metastasis of colon cancer to the scapula: is surgical resection warranted?

    Directory of Open Access Journals (Sweden)

    Onesti Jill K

    2011-10-01

    Full Text Available Abstract Background Distant metastases from colon cancer spread most frequently to the liver and the lung. Risk factors include positive lymph nodes and high grade tumors. Isolated metastases to the appendicular skeleton are very rare, particularly in the absence of identifiable risk factors. Case report The patient was a 55 year old male with no previous personal or family history of colon cancer. Routine screening revealed a sigmoid adenocarcinoma. He underwent resection with primary anastomosis and was found to have Stage IIA colon cancer. He declined chemotherapy as part of a clinical trial, and eight months later was found to have an isolated metastasis in his right scapula. This was treated medically, but grew to 12 × 15 cm. The patient underwent a curative forequarter amputation and is now more than four years from his original colon surgery. Discussion Stage IIA colon cancers are associated with a high five year survival rate, and chemotherapy is not automatically given. If metastases occur, they are likely to arise from local recurrence or follow lymphatic dissemination to the liver or lungs. Isolated skeletal metastases are quite rare and are usually confined to the axial skeleton. To our knowledge, this is the first reported case of an isolated scapular metastasis in a patient with node negative disease. The decision to treat the recurrence with radiation and chemotherapy did not reduce the tumor, and a forequarter amputation was eventually required. Conclusion This case highlights the importance of adequately analyzing the stage of colon cancer and offering appropriate treatment. Equally important is the early involvement of a surgeon in discussing the timing of the treatment for recurrence. Perhaps if the patient had received chemotherapy or earlier resection, he could have been spared the forequarter amputation. The physician must also be aware of the remote possibility of an unusual presentation of metastasis in order to pursue

  13. Co-creation of an ICT-supported cancer rehabilitation application for resected lung cancer survivors: design and evaluation

    NARCIS (Netherlands)

    Timmerman, Josien G.; Tönis, Thijs M.; Dekker-van Weering, Marit G.H.; Stuiver, Martijn M.; Wouters, Michel W.J.M.; Harten, van Wim H.; Hermens, Hermie J.; Vollenbroek-Hutten, Miriam M.R.

    2016-01-01

    Background: Lung cancer (LC) patients experience high symptom burden and significant decline of physical fitness and quality of life following lung resection. Good quality of survivorship care post-surgery is essential to optimize recovery and prevent unscheduled healthcare use. The use of Informati

  14. Indications for surgical resection of benign pancreatic tumors; Indikationen zur chirurgischen Therapie benigner Pankreastumoren

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    Isenmann, R.; Henne-Bruns, D. [Chirurgische Universitaetsklinik, Klinik fuer Allgemein-, Viszeral- und Transplantationschirurgie, Ulm (Germany)

    2008-08-15

    Benign pancreatic tumors should undergo surgical resection when they are symptomatic or - in the case of incidental discovery - bear malignant potential. This is the case for the majority of benign pancreatic tumors, especially for intraductal papillary mucinous neoplasms or mucinous cystic adenomas. In addition, resection is indicated for all tumors where preoperative diagnostic fails to provide an exact classification. Several different operative techniques are available. The treatment of choice depends on the localization of the tumor, its size and on whether there is evidence of malignant transformation. Partial duodenopancreatectomy is the oncological treatment of choice for tumors of the pancreatic head whereas for tumors of the pancreatic tail a left-sided pancreatectomy is appropriate. Middle pancreatectomy or duodenum-preserving resection of the pancreatic head is not a radical oncologic procedure. They should only be performed in cases of tumors without malignant potential. (orig.) [German] Die Indikationsstellung zur Resektion benigner Pankreastumoren ist gegeben, wenn es sich um einen symptomatischen Tumor handelt oder - bei einem Zufallsbefund - um einen Tumor mit Potenzial zur malignen Entartung. Dies besteht bei der Mehrzahl der benignen Pankreastumoren, insbesondere bei der intraduktalen papillaeren muzinoesen Neoplasie (IPMN) oder muzinoesen Zystadenomen. Operativer Abklaerung beduerfen auch Tumoren, die unter Ausschoepfung aller diagnostischer Moeglichkeiten nicht eindeutig klassifizierbar sind. An chirurgischen Therapieverfahren stehen verschiedene Techniken zur Verfuegung. Die Wahl des Verfahren haengt von der Groesse und Lokalisation des Tumors ab und von der Frage, ob eine maligne Entartung bereits stattgefunden hat. Das onkologisch korrekte Standardresektionsverfahren bei Tumoren des Pankreaskopfes ist die partielle Duodenopankreatektomie, bei Tumoren des Pankreasschwanzes die Pankreaslinksresektion. Eine segmentale Resektion des

  15. Impact of chronic obstructive pulmonary disease on postoperative recurrence in patients with resected non-small-cell lung cancer.

    Science.gov (United States)

    Qiang, Guangliang; Liang, Chaoyang; Xiao, Fei; Yu, Qiduo; Wen, Huanshun; Song, Zhiyi; Tian, Yanchu; Shi, Bin; Guo, Yongqing; Liu, Deruo

    2016-01-01

    This study aimed to determine whether the severity of chronic obstructive pulmonary disease (COPD) affects recurrence-free survival in non-small-cell lung cancer (NSCLC) patients after surgical resection. A retrospective study was performed on 421 consecutive patients who had undergone lobectomy for NSCLC from January 2008 to June 2011. Classification of COPD severity was based on guidelines of the Global Initiative for Chronic Obstructive Lung Disease (GOLD). Characteristics among the three subgroups were compared and recurrence-free survivals were analyzed. A total of 172 patients were diagnosed with COPD (124 as GOLD-1, 46 as GOLD-2, and two as GOLD-3). The frequencies of recurrence were significantly higher in patients with higher COPD grades (PRecurrence-free survival at 5 years was 78.1%, 70.4%, and 46.4% in non-COPD, mild COPD, and moderate/severe COPD groups, respectively (Precurrence-free survival. Multivariate analysis showed that older age, male, moderate/severe COPD, and advanced stage were independent risk factors associated with recurrence-free survival. NSCLC patients with COPD are at high risk for postoperative recurrence, and moderate/severe COPD is an independent unfavorable prognostic factor.

  16. Predictors of Wound Complications following Radiation and Surgical Resection of Soft Tissue Sarcomas

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    Drake G. LeBrun

    2017-01-01

    Full Text Available Wound complications represent a major source of morbidity in patients undergoing radiation therapy (RT and surgical resection of soft tissue sarcomas (STS. We investigated whether factors related to RT, surgery, patient comorbidities, and tumor histopathology predict the development of wound complications. An observational study of patients who underwent STS resection and RT was performed. The primary outcome was the occurrence of any wound complication up to four months postoperatively. Significant predictors of wound complications were identified using multivariable logistic regression. Sixty-five patients representing 67 cases of STS were identified. Median age was 59 years (range 22–90 and 34 (52% patients were female. The rates of major wound complications and any wound complications were 21% and 33%, respectively. After adjusting for radiation timing, diabetes (OR 9.6; 95% CI 1.4–64.8; P=0.02, grade ≥2 radiation dermatitis (OR 4.8; 95% CI 1.2–19.2; P=0.03, and the use of 3D conformal RT (OR 4.6; 95% CI 1.1–20.0; P=0.04 were associated with an increased risk of any wound complication on multivariable analysis. These data suggest that radiation dermatitis and radiation modality are predictors of wound complications in patients with STS.

  17. Prevalence of the CTNNB1 mutation genotype in surgically resected fibromatosis of the breast.

    Science.gov (United States)

    Kim, Taeeun; Jung, Eun Ah; Song, Ji Young; Roh, Ji Hyeon; Choi, Jong Sun; Kwon, Jee Eun; Kang, So Young; Cho, Eun Yoon; Shin, Jung Hee; Nam, Suk-Jin; Yang, Jung Hyun; Choi, Yoon-La

    2012-01-01

    To investigate CTNNB1 mutation and β-catenin expression in resected breast fibromatosis and to identify potential molecular markers of fibromatosis of the breast. We selected 12 patients with fibromatosis of the breast who underwent surgical resection and were confirmed by histological examination. Ultrasonography findings for 10 patients were reviewed and only two cases were suspicious for fibromatosis on imaging. On core needle biopsy for pre-operative diagnoses, only three cases were histologically suspicious for fibromatosis. Mutations in exon 3 of CTNNB1 were detected by direct DNA sequencing in nine (75.0%) cases: all were c.121G>A (p.T41A), which was much more frequent in breast fibromatoses than in other soft tissue lesions. Nuclear β-catenin expression was observed in all cases and the level of expression was higher in cases with mutation. In eight of nine cases, the matched biopsy specimen showed the same CTNNB1 mutation status as the pre-operative specimen. In the majority of cases, clinical presentation and breast imaging are highly suspicious for carcinoma. Definitive pre-operative pathological diagnosis by core needle biopsy is difficult. CTNNB1 mutation and nuclear β-catenin expression are frequently detected in sporadic breast fibromatoses, suggesting their potential as a useful tool to distinguish breast fibromatoses from other neoplasms. © 2011 Blackwell Publishing Limited.

  18. Primary malignant pericardial mesothelioma with increased serum mesothelin diagnosed by surgical pericardial resection: A case report.

    Science.gov (United States)

    Kurosawa, Takeyuki; Sugino, Keishi; Isobe, Kazutoshi; Hata, Yoshinobu; Fukasawa, Yuri; Homma, Sakae

    2016-11-01

    A 37-year-old female smoker without a history of exposure to asbestos was referred to our hospital with persistent pericardial effusion. Chest computed tomography imaging examination revealed an irregular thickened pericardium with large amounts of pericardial effusion and a small pleural effusion. Fluorodeoxyglucose (FDG) positron emission tomography imaging demonstrated intrapericardial FDG accumulation. Blood tests revealed an increase in serum mesothelin levels. Examination of a surgically resected specimen revealed a grayish-white thickening of the pericardium, with a straw-colored mucinous pericardial effusion. Histopathological examination confirmed the diagnosis of epithelioid malignant mesothelioma. Although the patient's condition temporarily improved, with decreased levels of serum mesothelin during chemotherapy with carboplatin and pemetrexed, she succumbed to cardiac tamponade 18 months after the initial onset of the symptoms. Primary malignant pericardial mesothelioma (PMPM) is an extremely rare and refractory disorder. Thus, an early definitive diagnosis and timely treatment are crucial for the management of PMPM.

  19. Existing general population models inaccurately predict lung cancer risk in patients referred for surgical evaluation.

    Science.gov (United States)

    Isbell, James M; Deppen, Stephen; Putnam, Joe B; Nesbitt, Jonathan C; Lambright, Eric S; Dawes, Aaron; Massion, Pierre P; Speroff, Theodore; Jones, David R; Grogan, Eric L

    2011-01-01

    Patients undergoing resections for suspicious pulmonary lesions have a 9% to 55% benign rate. Validated prediction models exist to estimate the probability of malignancy in a general population and current practice guidelines recommend their use. We evaluated these models in a surgical population to determine the accuracy of existing models to predict benign or malignant disease. We conducted a retrospective review of our thoracic surgery quality improvement database (2005 to 2008) to identify patients who underwent resection of a pulmonary lesion. Patients were stratified into subgroups based on age, smoking status, and fluorodeoxyglucose positron emission tomography (PET) results. The probability of malignancy was calculated for each patient using the Mayo and solitary pulmonary nodules prediction models. Receiver operating characteristic and calibration curves were used to measure model performance. A total of 189 patients met selection criteria; 73% were malignant. Patients with preoperative PET scans were divided into four subgroups based on age, smoking history, and nodule PET avidity. Older smokers with PET-avid lesions had a 90% malignancy rate. Patients with PET-nonavid lesions, PET-avid lesions with age less than 50 years, or never smokers of any age had a 62% malignancy rate. The area under the receiver operating characteristic curve for the Mayo and solitary pulmonary nodules models was 0.79 and 0.80, respectively; however, the models were poorly calibrated (p<0.001). Despite improvements in diagnostic and imaging techniques, current general population models do not accurately predict lung cancer among patients referred for surgical evaluation. Prediction models with greater accuracy are needed to identify patients with benign disease to reduce nontherapeutic resections. Copyright © 2011 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  20. Ultrasound and MRI predictors of surgical bowel resection in pediatric Crohn disease.

    Science.gov (United States)

    Rosenbaum, Daniel G; Conrad, Maire A; Biko, David M; Ruchelli, Eduardo D; Kelsen, Judith R; Anupindi, Sudha A

    2017-01-01

    Imaging predictors for surgery in children with Crohn disease are lacking. To identify imaging features of the terminal ileum on short-interval bowel ultrasound (US) and MR enterography (MRE) in children with Crohn disease requiring surgical bowel resection and those managed by medical therapy alone. This retrospective study evaluated patients 18 years and younger with Crohn disease undergoing short-interval bowel US and MRE (within 2 months of one another), as well as subsequent ileocecectomy or endoscopy within 3 months of imaging. Appearance of the terminal ileum on both modalities was compared between surgical patients and those managed with medical therapy, with the following parameters assessed: bowel wall thickness, mural stratification, vascularity, fibrofatty proliferation, abscess, fistula and stricture on bowel US; bowel wall thickness, T2 ratio, enhancement pattern, mesenteric edema, fibrofatty proliferation, abscess, fistula and stricture on MRE. A two-sided t-test was used to compare means, a Mann-Whitney U analysis was used for non-parametric parameter scores, and a chi-square or two-sided Fisher exact test compared categorical variables. Imaging findings in surgical patients were correlated with location-matched histopathological scores of inflammation and fibrosis using a scoring system adapted from the Simple Endoscopic Score for Crohn Disease, and a Spearman rank correlation coefficient was used to compare inflammation and fibrosis on histopathology. Twenty-two surgical patients (mean age: 16.5 years; male/female: 13/9) and 20 nonsurgical patients (mean age: 14.8; M/F: 8/12) were included in the final analysis. On US, the surgical group demonstrated significantly increased mean bowel wall thickness (6.1 mm vs. 4.7 mm for the nonsurgical group; P = 0.01), loss of mural stratification (odds ratio [OR] = 6.3; 95% confidence interval [CI]: 1.4-28.4; P = 0.02) and increased fibrofatty proliferation (P = 0.04). On MRE, the

  1. Ultrasound and MRI predictors of surgical bowel resection in pediatric Crohn disease

    Energy Technology Data Exchange (ETDEWEB)

    Rosenbaum, Daniel G. [NewYork-Presbyterian Hospital/Weill Cornell Medicine, Division of Pediatric Radiology, New York, NY (United States); Conrad, Maire A.; Kelsen, Judith R. [The Children' s Hospital of Philadelphia, Division of Gastroenterology, Hepatology and Nutrition, Philadelphia, PA (United States); Biko, David M.; Anupindi, Sudha A. [The Children' s Hospital of Philadelphia, Department of Radiology, Philadelphia, PA (United States); Ruchelli, Eduardo D. [The Children' s Hospital of Philadelphia, Division of Anatomic Pathology, Philadelphia, PA (United States)

    2017-01-15

    Imaging predictors for surgery in children with Crohn disease are lacking. To identify imaging features of the terminal ileum on short-interval bowel ultrasound (US) and MR enterography (MRE) in children with Crohn disease requiring surgical bowel resection and those managed by medical therapy alone. This retrospective study evaluated patients 18 years and younger with Crohn disease undergoing short-interval bowel US and MRE (within 2 months of one another), as well as subsequent ileocecectomy or endoscopy within 3 months of imaging. Appearance of the terminal ileum on both modalities was compared between surgical patients and those managed with medical therapy, with the following parameters assessed: bowel wall thickness, mural stratification, vascularity, fibrofatty proliferation, abscess, fistula and stricture on bowel US; bowel wall thickness, T2 ratio, enhancement pattern, mesenteric edema, fibrofatty proliferation, abscess, fistula and stricture on MRE. A two-sided t-test was used to compare means, a Mann-Whitney U analysis was used for non-parametric parameter scores, and a chi-square or two-sided Fisher exact test compared categorical variables. Imaging findings in surgical patients were correlated with location-matched histopathological scores of inflammation and fibrosis using a scoring system adapted from the Simple Endoscopic Score for Crohn Disease, and a Spearman rank correlation coefficient was used to compare inflammation and fibrosis on histopathology. Twenty-two surgical patients (mean age: 16.5 years; male/female: 13/9) and 20 nonsurgical patients (mean age: 14.8; M/F: 8/12) were included in the final analysis. On US, the surgical group demonstrated significantly increased mean bowel wall thickness (6.1 mm vs. 4.7 mm for the nonsurgical group; P = 0.01), loss of mural stratification (odds ratio [OR] = 6.3; 95% confidence interval [CI]: 1.4-28.4; P = 0.02) and increased fibrofatty proliferation (P = 0.04). On MRE, the surgical group showed

  2. Changes in cell-mediated immune response after lung resection surgery for MDR-TB patients.

    Science.gov (United States)

    Park, Seung-Kyu; Hong, Sunghee; Eum, Seok-Yong; Lee, In Hee; Shin, Donk Ok; Cho, Jang Eun; Cho, Sungae; Cho, Sang-Nae

    2011-07-01

    The immune responses of multidrug-resistant tuberculosis (MDR-TB) patients undergoing lung resection surgery were investigated in order to understand the mechanism of strong immune suppression in MDR-TB. We examined changes in cell-mediated immune response (CMI) of a total of sixteen MDR-TB patients, three of them extensively drug-resistant tuberculosis (XDR-TB) patients, after the removal of the heavily diseased lung section. The IFN-γ response to Mycobacterium tuberculosis culture filtrate proteins (Mtb-CFP), one of the most important CMI to defend TB, showed a statistically significant elevation in 2-4 months after operation when compared to the preoperative CMI in patients who were converted into AFB negative and cured in two years' follow-up, suggesting that the recovery of CMI may be one of the key factors in the successful treatment of MDR-TB. Interestingly, IL-10 response to Mtb-CFP was also elevated in 2-4 months after surgery in cured patients although both proliferative response and PBMC composition were not significantly changed. Infection with first- or second-line drugs resistant Mtb reduces the efficiency of chemotherapeutic treatment of MDR-TB to about 50%. Thus, this study suggests that chemotherapeutic treatment of MDR-TB may be more effective when combined with accompanying therapy that increases CMI, includes lung resection surgery.

  3. Postoperative Adjuvant Systemic Therapy in Completely Resected Non-Small-Cell Lung Cancer: A Systematic Review.

    Science.gov (United States)

    Bradbury, Penelope; Sivajohanathan, Duvaraga; Chan, Adrien; Kulkarni, Swati; Ung, Yee; Ellis, Peter M

    2017-05-01

    The purpose of the present review was to determine whether the use of postoperative adjuvant systemic therapy in patients with completely resected non-small-cell lung cancer (NSCLC) improves survival. Cancer Care Ontario's Program in Evidence-Based Care reviewed the evidence to update previously published recommendations for patients with completely resected NSCLC. Relevant studies were identified from a systematic MEDLINE, EMBASE, and Cochrane Database of Systematic Reviews search of studies published from 2010 to 2016. All phase III randomized controlled trials (RCTs) and relevant systematic reviews were included. Data on overall survival (OS), disease-free survival, adverse events, and quality of life were extracted from each of the studies. Two relevant systematic reviews, 13 RCTs, and a series of pooled analyses by Lung Adjuvant Cisplatin Evaluation-Biomarker were included in the present review. Adjuvant chemotherapy statistically significantly improved OS for resected stage II-IIIA NSCLC and is recommended. For patients with stage IB NSCLC, no significant improvement was seen in OS; however, the results from subgroup analyses indicate that it would be reasonable to consider adjuvant chemotherapy for patients with larger tumors (≥ 4 cm). The present data do not support the use of adjuvant novel therapies (ie, epidermal growth factor receptor tyrosine kinase inhibitor, bevacizumab, and immunotherapy) either as an addition to, or instead of, cytotoxic chemotherapy. No predictive biomarkers are available to select patients more likely to benefit from adjuvant chemotherapy. Cytotoxic chemotherapy remains the standard of care as adjuvant therapy for patients with resected stage II-IIIA NSCLC. Additional clinical trials are needed to evaluate targeted agents in molecularly defined subgroups before these agents can be recommended in the adjuvant setting. Copyright © 2016 Elsevier Inc. All rights reserved.

  4. Vibration-response imaging versus quantitative perfusion scintigraphy in the selection of patients for lung-resection surgery.

    Science.gov (United States)

    Comce, Fatma; Bingol, Zuleyha; Kiyan, Esen; Tanju, Serhan; Toker, Alper; Cagatay, Pembe; Ece, Turhan

    2011-12-01

    In patients being considered for lung-resection surgery, quantitative perfusion scintigraphy is used to predict postoperative lung function and guide the determination of lung-resection candidacy. Vibration-response imaging has been proposed as a noninvasive, radiation-free, and simpler method to predict postoperative lung function. We compared vibration-response imaging to quantitative perfusion scintigraphy for predicting postoperative FEV(1) and diffusing capacity of the lung for carbon monoxide (D(LCO)). We enrolled 35 candidates for lung resection. Twenty-five patients had preoperative FEV(1) and D(LCO) MEASUREMENTS: The vibration-response-imaging measurements showed strong correlation with the quantitative-perfusion-scintigraphy measurements of predicted postoperative FEV(1)% (r = 0.87, P scintigraphy and the actual postoperative FEV(1) (% and L) (r = 0.47, P = .048, r = 0.73, P scintigraphy. Neither the vibration-response imaging nor the quantitative perfusion scintigraphy predicted postoperative D(LCO)% values agreed with the actual postoperative D(LCO)% values. Vibration-response imaging may be a good alternative to quantitative perfusion scintigraphy in evaluating lung-resection candidacy.

  5. Role of quantitative CT in predicting postoperative FEV1 and chronic dyspnea in patients undergoing lung resection

    Directory of Open Access Journals (Sweden)

    Papageorgiou Chrysovalantis V

    2010-06-01

    Full Text Available Abstract Lung resection is the mainstay of treatment in patients with early stage non-small cell lung cancer. However, lung cancer patients often suffer from comorbidities and the respiratory reserve should be carefully evaluated preoperatively in order to avoid postoperative complications. Forced expiratory volume in 1 second (FEV1 is considered to be an index that depicts the patient's respiratory efficacy and its prediction has a key role in the preoperative evaluation of lung cancer patients with impaired lung function. Prediction of postoperative FEV1 is currently possible with the use of perfusion radionuclide lung scanning. Quantitative CT is the analysis of data acquired during normal chest CT scan using the system's software. By applying a dual threshold of -500 to -910 Hounsfield Units, functional lung volumes are estimated and postoperative FEV1 can be predicted by reducing the preoperative measurement by the fraction of the part to be resected. Studies have shown that preoperative predictions correlate well with the actual postoperative measurements. Additionally, quantitative CT results are in good agreement with perfusion scintigraphy predictions. Newer radiological techniques such as perfusion MRI and co-registered SPECT/CT have also been used in the preoperative evaluation with similar results. In conclusion, chest CT which is obligatory for staging, can be used for quantitative analysis of the already available data. It is technically simple, providing an accurate prediction of postoperative FEV1. Thus, quantitative CT appears to be a useful tool in the preoperative evaluation of lung cancer patients undergoing lung resection.

  6. [Surgical treatment of ptosis by resection of the superior tarsal muscle employing a cutaneous approach (author's transl)].

    Science.gov (United States)

    Morax, S

    1982-01-01

    A simple technique for resection of the superior tarsal muscle through a cutaneous approach, for the surgical treatment of ptosis, was employed in severe or moderate, congenital and acquired forms of the affection. Muller's muscle and the aponeurotic fascia are removed in a single piece, while conserving the tarsus.

  7. Operative Risk for Major Lung Resection Increases at Extremes of Body Mass Index

    Science.gov (United States)

    Williams, Trevor; Gulack, Brian C.; Kim, Sunghee; Fernandez, Felix G.; Ferguson, Mark K.

    2016-01-01

    Background Although body mass index (BMI) has been used in risk stratification for lung resection, many models only take obesity into account. Recent studies have demonstrated that underweight patients also experience increased postoperative complications. We explored the relationship of extremes of BMI to outcomes after lung resection for non-small cell cancer. Methods Patients in the Society of Thoracic Surgeons General Thoracic Surgery Database (2009 to 2014) undergoing elective lung resection for cancer were evaluated. Multivariable logistic regression was used to adjust for potential confounders including functional status and spirometry. Results We evaluated 41,446 patients (median 68 years of age; 53% female) grouped by BMI: underweight (<18.5 kg/m2; 3.0%), normal (18.5 to 24.9 kg/m2; 33.5%), overweight (25 to 29.9 kg/m2; 35.4%), obese I (30 to 34.9 kg/m2; 18.1%), obese II (35 to 39.9 kg/m2; 6.4%), and obese III (≥40 kg/m2; 3.6%). Pulmonary complication rates were higher in underweight and obese III patients compared to normal BMI patients (p < 0.001). On multivariable analysis, compared to patients with normal BMI, being underweight was associated with an increased risk of pulmonary complications (adjusted odds ratio [OR]: 1.41, 95% confidence interval [CI]: 1.16 to 1.70) and any postoperative event (adjusted OR: 1.44, 95% CI: 1.26 to 1.64). Obese III patients had an increased risk of any major postoperative complication (adjusted OR: 1.18, 95% CI: 1.02 to 1.36). Overweight and obese class I to II patients had a lower risk of pulmonary complications and any postoperative event. Conclusions BMI is associated with postoperative complications after lung resection for cancer. Being underweight or severely overweight is associated with an increased risk of complications, whereas being overweight or moderately obese appears to have a protective effect. PMID:27476820

  8. Multidisciplinary Management of a Giant Plexiform Neurofibroma by Double Sequential Preoperative Embolization and Surgical Resection

    Directory of Open Access Journals (Sweden)

    Roberto Vélez

    2013-01-01

    Full Text Available Plexiform neurofibromas are benign tumors originating from subcutaneous or visceral peripheral nerves, which are usually associated with neurofibromatosis type 1. Giant neurofibromas are very difficult to manage surgically as they are extensively infiltrative and highly vascularized. These types of lesions require complex preoperative and postoperative management strategies. This case report describes a 22-year-old female with a giant plexiform neurofibroma of the lower back and buttock who underwent pre-operative embolization and intraoperative use of a linear cutting stapler system to assist with haemostasis during the surgical resection. Minimal blood transfusion was required and the patient made a good recovery. This case describes how a multidisciplinary management of these large and challenging lesions is technically feasible and appears to be beneficial in reducing perioperative blood loss and morbidity. Giant neurofibroma is a poorly defined term used to describe a neurofibroma that has grown to a significant but undefined size. Through a literature review, we propose that the term “giant neurofibroma” be used for referring to those neurofibromas weighing 20% or more of the patient's total corporal weight.

  9. Surgical Planning by 3D Printing for Primary Cardiac Schwannoma Resection.

    Science.gov (United States)

    Son, Kuk Hui; Kim, Kun-Woo; Ahn, Chi Bum; Choi, Chang Hu; Park, Kook Yang; Park, Chul Hyun; Lee, Jae-Ik; Jeon, Yang Bin

    2015-11-01

    We report herein a case of benign cardiac schwannoma in the interatrial septum. A 42-year-old woman was transferred from a clinic because of cardiomegaly as determined by chest X-ray. A transthoracic echocardiography and chest computed tomography examination revealed a huge mass in the pericardium compressing the right atrium, superior vena cava (SVC), left atrium, and superior pulmonary vein. To confirm that the tumor originated from either heart or mediastinum, cine magnetic resonance imaging was performed, but the result was not conclusive. To facilitate surgical planning, we used 3D printing. Using a printed heart model, we decided that tumor resection under cardiopulmonary bypass (CPB) through sternotomy would be technically feasible. At surgery, a huge tumor in the interatrial septum was confirmed. By incision on the atrial roof between the aorta and SVC, tumor enucleation was performed successfully under CPB. Pathology revealed benign schwannoma. The patient was discharged without complication. 3D printing of the heart and tumor was found to be helpful when deciding optimal surgical approach.

  10. Surgical resection and vascularized bone reconstruction in advanced stage medication-related osteonecrosis of the jaw.

    Science.gov (United States)

    Caldroney, S; Ghazali, N; Dyalram, D; Lubek, J E

    2017-07-01

    A retrospective review of all patients with stage 3 medication-related osteonecrosis of the jaw (MRONJ), treated by surgical resection and immediate vascularized bone reconstruction at a tertiary care medical center, was performed. Eleven patients were included, seven female and four male; their mean age was 65.8 years (range 56-73 years). Mean follow-up was 25 months. Ten patients had received intravenous bisphosphonates. The most common pathology was breast cancer (4/11). Pain (n=8) and pathological fracture (n=7) were the most common presenting symptoms. Microvascular free flaps consisted of seven fibula osteocutaneous flaps and four scapula osteocutaneous free flaps. All patients reported resolution of symptoms, with complete bone union identified radiographically (100%). Complications occurred in three patients (27%). One patient required removal of hardware at 8 months postoperative. Dental implant rehabilitation was completed in two patients. Ten patients are tolerating an oral diet. Ten patients are alive without evidence of MRONJ at any of the surgical sites. One patient died 28 months after surgery from progression of metastatic disease. Advanced MRONJ can be successfully treated in patients using vascularized tissue transfer, including those patients with significant peripheral vascular disease. Dental rehabilitation is a viable option for advanced MRONJ patients treated by vascularized flap reconstruction. Copyright © 2017 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

  11. Impact of chronic obstructive pulmonary disease on postoperative recurrence in patients with resected non-small-cell lung cancer

    Directory of Open Access Journals (Sweden)

    Qiang GL

    2015-12-01

    Full Text Available Guangliang Qiang, Chaoyang Liang, Fei Xiao, Qiduo Yu, Huanshun Wen, Zhiyi Song, Yanchu Tian, Bin Shi, Yongqing Guo, Deruo Liu Department of Thoracic Surgery, China–Japan Friendship Hospital, Beijing, People’s Republic of China Purpose: This study aimed to determine whether the severity of chronic obstructive pulmonary disease (COPD affects recurrence-free survival in non-small-cell lung cancer (NSCLC patients after surgical resection.Patients and methods: A retrospective study was performed on 421 consecutive patients who had undergone lobectomy for NSCLC from January 2008 to June 2011. Classification of COPD severity was based on guidelines of the Global Initiative for Chronic Obstructive Lung Disease (GOLD. Characteristics among the three subgroups were compared and recurrence-free survivals were analyzed.Results: A total of 172 patients were diagnosed with COPD (124 as GOLD-1, 46 as GOLD-2, and two as GOLD-3. The frequencies of recurrence were significantly higher in patients with higher COPD grades (P<0.001. Recurrence-free survival at 5 years was 78.1%, 70.4%, and 46.4% in non-COPD, mild COPD, and moderate/severe COPD groups, respectively (P<0.001. By univariate analysis, the age, sex, smoking history, COPD severity, tumor size, histology, and pathological stage were associated with recurrence-free survival. Multivariate analysis showed that older age, male, moderate/severe COPD, and advanced stage were independent risk factors associated with recurrence-free survival.Conclusion: NSCLC patients with COPD are at high risk for postoperative recurrence, and moderate/severe COPD is an independent unfavorable prognostic factor. Keywords: lung neoplasms, surgery, pulmonary function test, prognosis

  12. Carcinoma lung: Clinical presentation, diagnosis, and its surgical management

    Directory of Open Access Journals (Sweden)

    Farooq Ahmad Ganie

    2013-01-01

    Full Text Available The aim of this article is to review the surgical management of lung carcinoma. Lung cancer is the most common cancer in the world, and a leading cause of death in men and women. By any conventional measure, the enormity of this global problem is immense. In some countries incidence and mortality rates have peaked and are beginning to decline. In many developing nations, the burden of disease is rising and will continue to rise because of aggressive tobacco industry marketing which is leading to a growing prevalence of cigarette smoking. This is also one of the major causes of cancer deaths in our Kashmir valley. The method of literature search was from articles published in PubMed and Google Scholar.

  13. Desferrioxamine attenuates minor lung injury following surgical acute liver failure.

    Science.gov (United States)

    Kostopanagiotou, G G; Kalimeris, K A; Arkadopoulos, N P; Pafiti, A; Panagopoulos, D; Smyrniotis, V; Vlahakos, D; Routsi, C; Lekka, M E; Nakos, G

    2009-06-01

    Acute liver failure (ALF) can be complicated by lung dysfunction. The aim of this study was to test the hypothesis that inhibition of oxidative stress through iron chelation with desferrioxamine (DFX) attenuates pulmonary injury caused by ALF. 14 adult female domestic pigs were subjected to surgical devascularisation of the liver and were randomised to a study group (DFX group, n = 7), which received post-operative intravenous infusion of DFX (14.5 mg x kg(-1) x h(-1) for the first 6 h post-operatively and 2.4 mg x kg(-1) x h(-1) until completion of 24 h), and a control group (n = 7). Post-operative lung damage was evaluated by histological and bronchoalveolar lavage fluid (BALF) analysis. DFX resulted in reduced BALF protein levels and tissue phospholipase (PL)A(2) activity. Plasma malondialdehyde and BALF nitrate and nitrite concentrations were lower, while catalase activity in the lung was higher after DFX treatment. PLA(2), platelet-activating factor acetylhydrolase and total cell counts in BALF did not differ between groups. Histological examination revealed reduced alveolar collapse, pneumonocyte necrosis and total lung injury in the DFX-treated animals. DFX reduced systemic and pulmonary oxidative stress during ALF. The limited activity of PLA(2) and the attenuation of pneumonocyte necrosis could represent beneficial mechanisms by which DFX improves alveolar-capillary membrane permeability and prevents alveolar space collapse.

  14. Pancreatic resection for metastasis to the pancreas from colon and lung cancer, and osteosarcoma.

    Science.gov (United States)

    Lasithiotakis, Konstantinos; Petrakis, Ioannis; Georgiadis, George; Paraskakis, Stefanos; Chalkiadakis, George; Chrysos, Emmanuel

    2010-11-09

    Pancreatic resection for a metastatic colon, lung cancer or an osteosarcoma has rarely been reported in the literature and there is controversy regarding recurrence and the overall survival of these patients. We herein evaluate the outcome of three patients who underwent pancreaticoduodenectomy for the aforementioned metastatic tumors to the pancreas. Clinical presentation included pyloric stenosis and acute gastrointestinal bleeding. One patient was asymptomatic and was diagnosed during follow-up for colon cancer. All the pancreatic lesions were located in the head of the pancreas, and the intervals between the diagnosis of the primary cancer and the pancreatic metastases were 6, 14 and 24 months. During exploration of the abdomen, additional metastatic lesions in the small intestine and liver were detected and resected in two patients. One patient died one month after surgery from massive gastrointestinal bleeding. The other two patients experienced relief from their symptoms but died from generalized carcinomatosis 16 and 27 months after pancreaticoduodenectomy. Pancreatic resection for metastatic disease may be suggested for selected patients, even those with limited extrapancreatic disease. In this setting, it may offer good palliation and may prolong survival. In cases of acute duodenal bleeding resistant to conservative measures, pancreaticoduodenectomy may represent the only alternative for survival; however, significant morbidity and mortality should be expected.

  15. Root resection under the surgical field employed for extraction of impacted tooth and management of external resorption

    Directory of Open Access Journals (Sweden)

    A R Vivekananda Pai

    2012-01-01

    Full Text Available This case report illustrates determination of prognosis and immediate resection carried out, before completing the endodontic therapy, during the surgery employed for managing a nonperiodontal problem. This case showed external pressure resorption in the distobuccal root of maxillary second molar caused by the impingement of impacted third molar. Extraction of third molar was decided when healing was not seen, despite initiating endodontic therapy in second molar. Following elevation of flap and extraction of third molar, the poor prognosis due to severe bone loss around the resorbed root was evident. But due to strategic value of second molar, it was found beneficial to employ resection. Therefore, immediate resection was carried out in the same surgical field before the completion of endodontic therapy. This prevented the need for another surgical entry with its associated trauma to carry out resection separately later. Resection followed by the completion of endodontic therapy and full crown assisted in salvaging the remaining functional portion of the tooth and prevented the occurrence of distal extension with its potential drawbacks.

  16. The Use of Robotic-Assisted Thoracic Surgery for Lung Resection: A Comprehensive Systematic Review.

    Science.gov (United States)

    Agzarian, John; Fahim, Christine; Shargall, Yaron; Yasufuku, Kazuhiro; Waddell, Thomas K; Hanna, Waël C

    2016-01-01

    The primary objective of this study is to systematically review all pertinent literature related to robotic-assisted lung resection. Robotic-assisted thoracic surgery (RATS) case series and studies comparing RATS with video-assisted thoracoscopic surgery (VATS) or thoracotomy were included in the search. In accordance with preferred reporting items for systematic reviews and meta-analyses guidelines, 2 independent reviewers performed the search and review of resulting titles and abstracts. Following full-text screening, a total of 20 articles met the inclusion criteria and are presented in the review. Amenable results were pooled and presented as a single outcome, and meta-analyses were performed for outcomes having more than 3 comparative analyses. Data are presented in the following 4 categories: technical outcomes, perioperative outcomes, oncological outcomes, and cost comparison. RATS was associated with longer operative time, but did not result in a greater rate of conversion to thoracotomy than VATS. RATS was superior to thoracotomy and equivalent to VATS for the incidence of prolonged air leak and hospital length-of-stay. Oncological outcomes like nodal upstaging and survival were no different between VATS and RATS. RATS was more costly than VATS, with most of the costs attributed to capital and disposable expenses of the robotic platform. Although limited by a lack of prospective analysis, lung resection via RATS compares favorably with thoracotomy and appears to be no different than VATS. Prospective studies are required to determine if there are outcome differences between RATS and VATS.

  17. [Surgical treatment of rectal prolapse with transanal resection according to Altemeier. Experience and results].

    Science.gov (United States)

    Carditello, Antonio; Milone, Antonino; Stilo, Francesco; Mollo, Francesco; Basile, Maurizio

    2003-01-01

    In recent years the number of patients with partial or total rectal prolapse has increased. Numerous techniques and surgical approaches have been described for its treatment. In this study we examine the main ones and stress the advantages of the transanal-perineal resection technique according to Altemeier and modified by Prasad, which we have used to treat the condition in the last 15 years. From 1988 to 2002, 269 patients with "haemorrhoidal prolapse" were referred to our department; 146 were females (54%), and the mean age was 58 years. Clinical examination and proctosigmoidoscopy revealed the presence of total rectal prolapse in 41 patients (15%, 32 F, 9 M), complicated in 4 cases by moderate incontinence and associated in 3 cases with post-haemorrhoidectomy stenosis. These 41 patients underwent transanal resection according to Altemeier. Thirty-four of them (83%) were operated on under local anaesthesia with sedation, 5 patients (12%) under peridural anaesthesia and 2 patients (5%) under narcosis. The mean hospital stay was 5 days and depended on the time of the first spontaneous evacuation. Check-ups were performed after 7 days, 1 months and every 3 months for 1 year. There was no postoperative mortality, and only 1 case of postoperative haemorrhage, which did not require reoperation, in a patient with a previous myocardial infarct who spontaneously continued to take salicylates up to 24 h before surgery. Thirty-three patients (80%) had their first postoperative evacuation within 48 h of surgery after taking sorbitol orally in the evening, 6 patients (15%) within 72 h, and 2 patients (5%) on postoperative day 4. No evacuative enemas were performed. We observed clinical healing in all patients 1 month after the operation, and regular, spontaneous evacuations without the use of oral laxatives. Stool or gas incontinence were never observed or reported. During the follow-up, only in 2% of cases did we observe partial recurrence of the prolapse. The choice

  18. Effect of pre-operative neoadjuvant chemo-radiotherapy and surgical treatment on resectable esophageal cancer: a Meta-analysis

    Directory of Open Access Journals (Sweden)

    Wei ZHU

    2011-08-01

    Full Text Available Objective To explore the effect of pre-operative adjuvant chemo-radiotherapy and surgical treatment on resectable esophageal cancer.Methods By searching Medline,CENTRAL(the Cochrane Central Register of Controlled trials,EMBASE,CBM(China Biology Medicine and CNKI(China National Knowledge Infrastructure by computer,the data of randomized controlled trials(RCTs of neoadjuvant chemoradiotherapy and surgical treatment for resectable esophageal cancer were selected and analyzed using Stata 11.0 statistical software.The study population was patients with resectable early or medium stage esophageal cancer,the intervention was neoadjuvant chemoradiotherapy(include sequential chemoradiotherapy and concurrent chemoradiotherapy followed with surgical resection,the outcome indices were 1-and 3-year survival rates and local recurrence rate.The combined odds ratio(OR,relative risk(RR and their 95% confidence interval(CI were calculated to estimate the results.Results Nine articles including a total of 1156 patients were finally analyzed in the Meta-analysis.Among all the patients,579 received neoadjuvant chemoradiotherapy(study group and 577 received surgical treatment only(control group.Compared the study group and control group,the OR of 1-and 3-year survival rate was 1.06(95%CI=0.94-1.19,Z=0.97,P=0.33 and 1.30(95%CI=1.07.-1.57,Z=2.67,P=0.008,respectively,and the RR of local recurrence rate was 0.75(95%CI=0.50-1.12,Z=1.40,P=0.162.Conclusions Neoadjuvant chemoradiotherapy could improve the 3-year survival rate of patients with resectable esophageal cancer,but could not decrease the local recurrence rate.

  19. Radiation Therapy Oncology Group Protocol 02-29: A Phase II Trial of Neoadjuvant Therapy With Concurrent Chemotherapy and Full-Dose Radiation Therapy Followed by Surgical Resection and Consolidative Therapy for Locally Advanced Non-small Cell Carcinoma of the Lung

    Energy Technology Data Exchange (ETDEWEB)

    Suntharalingam, Mohan, E-mail: msuntha@umm.edu [Marlene and Stewart Greenebaum Cancer Center, University of Maryland School of Medicine, Baltimore, Maryland (United States); Paulus, Rebecca [Radiation Therapy Oncology Group, Philadelphia, Pennsylvania (United States); Edelman, Martin J. [Marlene and Stewart Greenebaum Cancer Center, University of Maryland School of Medicine, Baltimore, Maryland (United States); Krasna, Mark [Cancer Center at St. Joseph Medical Center, Towson, Maryland (United States); Burrows, Whitney [Marlene and Stewart Greenebaum Cancer Center, University of Maryland School of Medicine, Baltimore, Maryland (United States); Gore, Elizabeth [Dept of Radiation Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin (United States); Wilson, Lynn D. [Dept of Radiation Oncology, Yale School of Medicine, New Haven, Connecticut (United States); Choy, Hak [Dept of Radiation Oncology, University of Texas Southwestern, Dallas, Texas (United States)

    2012-10-01

    Purpose: To evaluate mediastinal nodal clearance (MNC) rates after induction chemotherapy and concurrent, full-dose radiation therapy (RT) in a phase II trimodality trial (Radiation Therapy Oncology Group protocol 0229). Patients and Methods: Patients (n=57) with stage III non-small cell lung cancer (pathologically proven N2 or N3) were eligible. Induction chemotherapy consisted of weekly carboplatin (AUC = 2.0) and paclitaxel 50 mg/m{sup 2}. Concurrent RT was prescribed, with 50.4 Gy to the mediastinum and primary tumor and a boost of 10.8 Gy to all gross disease. The mediastinum was pathologically reassessed after completion of chemoradiation. The primary endpoint of the study was MNC, with secondary endpoints of 2-year overall survival and postoperative morbidity/mortality. Results: The grade 3/4 toxicities included hematologic 35%, gastrointestinal 14%, and pulmonary 23%. Forty-three patients (75%) were evaluable for the primary endpoint. Twenty-seven patients achieved the primary endpoint of MNC (63%). Thirty-seven patients underwent resection. There was a 14% incidence of grade 3 postoperative pulmonary complications and 1 30-day, postoperative grade 5 toxicity (3%). With a median follow-up of 24 months for all patients, the 2-year overall survival rate was 54%, and the 2-year progression-free survival rate was 33%. The 2-year overall survival rate was 75% for those who achieved nodal clearance, 52% for those with residual nodal disease, and 23% for those who were not evaluable for the primary endpoint (P=.0002). Conclusions: This multi-institutional trial confirms the ability of neoadjuvant concurrent chemoradiation with full-dose RT to sterilize known mediastinal nodal disease.

  20. High-resolution computed tomography findings of early mucinous adenocarcinomas and their pathologic characteristics in 22 surgically resected cases

    Energy Technology Data Exchange (ETDEWEB)

    Miyata, Naoko, E-mail: n.miyata@scchr.jp [Division of Thoracic Surgery, Shizuoka Cancer Center Hospital, 1007 Shimonagakubo, Nagaizumi, Sunto-gun, Shizuoka 411-8777 (Japan); Endo, Masahiro [Division of Diagnostic Radiology, Shizuoka Cancer Center Hospital (Japan); Nakajima, Takashi [Division of Pathology, Shizuoka Cancer Center Hospital (Japan); Kojima, Hideaki; Maniwa, Tomohiro; Takahashi, Shoji; Isaka, Mitsuhiro [Division of Thoracic Surgery, Shizuoka Cancer Center Hospital, 1007 Shimonagakubo, Nagaizumi, Sunto-gun, Shizuoka 411-8777 (Japan); Kameya, Toru [Division of Pathology, Shizuoka Cancer Center Hospital (Japan); Ohde, Yasuhisa [Division of Thoracic Surgery, Shizuoka Cancer Center Hospital, 1007 Shimonagakubo, Nagaizumi, Sunto-gun, Shizuoka 411-8777 (Japan)

    2015-05-15

    Highlights: • We clinicopathologically reviewed 22 cases of early mucinous adenocarcinoma. • Radiologically, all cases showed solid or part-solid nodules. • Lobular-bounded margins were observed in 7 cases. • The radiological features could be histologically attributed to mucin production. • One-third of the cases were preoperatively misdiagnosed as inflammatory nodules. - Abstract: Background: The pathological criteria of early-stage mucinous adenocarcinoma of the lung have recently been defined; however, its characteristic radiologic imaging findings are still poorly understood. Thus, this study aimed to clarify the radiologic and pathological findings of early-stage mucinous adenocarcinoma. Materials and methods: In this study, we clinicopathologically reviewed 22 cases of surgically resected mucinous adenocarcinoma in situ (AIS) and minimal invasive adenocarcinoma (MIA), and attempted to elucidate the characteristic radiologic features of early mucinous adenocarcinomas using high-resolution computed tomography (HRCT). Results: Radiologically, the mean value of the maximum diameter of 22 tumours was 2.1 cm (range, 1.0–2.9 cm). Based on the HRCT findings, the tumours were divided into part-solid ground glass nodules (n = 11) and solid nodules (n = 11). The mean CT attenuation value was 25.7 HU (range, 17–35 HU). All tumours, except 3 tumours pathologically diagnosed as AIS, showed air-containing features. According to the preoperative CT findings, 7 (35%) cases were diagnosed as inflammatory nodules. Of these, 4 cases had lobular-bounded margins, and 3 showed vaguely outlined ground glass shadows. Conclusion: The characteristic HRCT findings of mucinous AIS and MIA were solid or part-solid nodules with air-containing spaces. However, some AIS and MIA nodules showed lobular-bounded margins or marginally vaguely outlined ground glass shadows, and were difficult to differentiate from inflammatory nodules.

  1. Trends in surgical mortality following colorectal resection between 2002 and 2012: A single-centre, retrospective analysis.

    LENUS (Irish Health Repository)

    Stephens, I

    2017-06-01

    Surgical mortality is a commonly-used measurement of surgical risk. It is imperative that patients receive accurate, up-to-date information regarding operative risk. To date, studies investigating temporal changes in surgical mortality following colorectal resection in Ireland have been limited. This retrospective study investigates such trends in one of the eight centres for symptomatic and screen-detected colorectal cancers in Ireland, across an 11-year period. A steady decline in surgical mortality was found across this time, showing a significant difference in rates before and after centralisation of rectal cancer care and the advent of colorectal surgery as a surgical specialisation (5.2%, 1.52%). This has important implications for the organisation of colorectal cancer care in Ireland.

  2. External suction versus water seal after selective pulmonary resection for lung neoplasm: a systematic review.

    Science.gov (United States)

    Qiu, Tong; Shen, Yi; Wang, Ming-zhao; Wang, Yao-peng; Wang, Dong; Wang, Zi-zong; Jin, Xiang-feng; Wei, Yu-cheng

    2013-01-01

    To evaluate whether external suction is more advantageous than water seal in patients undergoing selective pulmonary resection (SPR) for lung neoplasm. Whether external suction should be routinely applied in postoperative chest drainage is still unclear, particularly for lung neoplasm patients. To most surgeons, the decision is based on their clinical experience. Randomized control trials were selected. The participants were patients undergoing SPR with lung neoplasm. Lung volume reduction surgery and pneumothorax were excluded. Suction versus non-suction for the intervention. The primary outcome was the incidence of persistent air leak (PAL). The definition of PAL was air leak for more than 3-7 days. The secondary outcomes included air leak duration, time of drainage, postoperative hospital stay and the incidence of postoperative pneumothorax. Studies were identified from literature collections through screening. Bias was analyzed and meta-analysis was used. From the 1824 potentially relevant trials, 6 randomized control trials involving 676 patients were included. There was no difference between external suction and water seal in decreasing the incidence of PAL [95% confidence interval (CI) 0.81-2.16; z = 1.10; P = 0.27]. Regarding secondary outcomes, there were no differences in time of drainage (95% CI-0.36-1.56, P = 0.22), postoperative hospital stay (95% CI -.31-.54, P = 0.87) or incidence of postoperative pneumothorax (95% CI 0.18-.02, P = 0.05) between external suction and water seal. For participants, no differences are identified in terms of PAL incidence, drainage time, length of postoperative hospital stay or incidence of postoperative pneumothorax between external suction and water seal. The bias analysis should be emphasized. To the limitations of the bias and methodological differences among the included studies, we have no recommendation on whether external suction should be routinely applied after lung neoplasm SPR. More high

  3. Prognostic significance of CD44s expression in resected non-small cell lung cancer

    Directory of Open Access Journals (Sweden)

    Ko Yoon

    2011-08-01

    Full Text Available Abstract Background CD44s is a cell adhesion molecule known to mediate cellular adhesion to the extracellular matrix, a prerequisite for tumor cell migration. CD44s plays an important role in invasion and metastasis of various cancers. In the present study, we sought to determine whether CD44s is involved in clinical outcomes of patients with resected non-small cell lung cancer (NSCLC. Methods Using immunohistochemical staining, we investigated CD44s protein expression using tissue array specimens from 159 patients with resected NSCLC (adenocarcinoma (AC; n = 82 and squamous cell carcinoma (SCC; n = 77. Additionally, the immunoreactivity of cyclooxygenase (COX-2 was also studied. The clinicopathological implications of these molecules were analyzed statistically. Results High CD44s expression was detected more frequently in NSCLC patients with SCC (66/72; 91.7% than in those with AC histology (P 0.001. Additionally, high CD44s expression was significant correlated with more advanced regional lymph node metastasis (P = 0.021. In multivariate analysis of survival in NSCLC patients with AC histology, significant predictors were lymph node metastasis status (P P = 0.046, and high CD44s expression (P = 0.014. For NSCLC patients with SCC histology, the significant predictor was a more advanced tumor stage (P = 0.015. No significant association was found between CD44s and clinical outcome (P = 0.311. Conclusions High CD44s expression was a negative prognostic marker with significance in patients with resected NSCLC, particularly those with AC histology, and was independent of tumor stage.

  4. Intratumour variation of biomarker expression by immunohistochemistry in resectable non-small cell lung cancer

    DEFF Research Database (Denmark)

    Jakobsen, Jan Nyrop; Santoni-Rugiu, Eric; Ravn, Jesper;

    2013-01-01

    BACKGROUND: Prognostic and predictive biomarkers are increasingly used to customise the treatment of patients with solid tumours. Intra- and inter-tumour heterogeneous distribution of biomarker expression is a potential confounder for the use of biomarkers, as small biopsies may not necessarily...... truly reflect the pattern of biomarker expression. It may also be an important factor in chemo resistance, as tumours with heterogeneous biomarker expression may potentially harbour chemo resistant tumour clones. MATERIALS AND METHODS: Immunohistochemical evaluation of the expression of excision repair...... cross complementation group 1 (ERCC1), epidermal growth factor receptor (EGFR), class III-β-tubulin (TUBB-3), thymidylate synthase (TS), Ki-67 and ribonucleotide reductase M1 (RRM1) was performed in 15 separate areas in each of six small microscopically completely resected adenocarcinomas of the lung...

  5. Adjuvant chemotherapy for resected non-small-cell lung cancer: future perspectives for clinical research

    Directory of Open Access Journals (Sweden)

    Bonomi Maria

    2011-12-01

    Full Text Available Abstract Adjuvant chemotherapy for non-small-cell lung carcinoma (NSCLC is a debated issue in clinical oncology. Although it is considered a standard for resected stage II-IIIA patients according to the available guidelines, many questions are still open. Among them, it should be acknowledged that the treatment for stage IB disease has shown so far a limited (if sizable efficacy, the role of modern radiotherapies requires to be evaluated in large prospective randomized trials and the relative impact of age and comorbidities should be weighted to assess the reliability of the trials' evidences in the context of the everyday-practice. In addition, a conclusive evidence of the best partner for cisplatin is currently awaited as well as a deeper investigation of the fading effect of chemotherapy over time. The limited survival benefit since first studies were published and the lack of reliable prognostic and predictive factors beyond pathological stage, strongly call for the identification of bio-molecular markers and classifiers to identify which patients should be treated and which drugs should be used. Given the disappointing results of targeted therapy in this setting have obscured the initial promising perspectives, a biomarker-selection approach may represent the basis of future trials exploring adjuvant treatment for resected NSCLC.

  6. Clinicopathological characteristics of resected adenosquamous cell carcinoma of the lung: Risk of coexistent double cancer

    Directory of Open Access Journals (Sweden)

    Hanagiri Takeshi

    2010-10-01

    Full Text Available Abstract Background adenosquamous carcinoma (ADSQ of non-small cell lung cancer (NSCLC is a rare disease and the biological behavior and clinicopathological characteristics have not yet been thoroughly described. Method This study reviewed the patient charts of 11 (1.6% ADSQ cases among 779 patients with primary lung cancer who underwent a lung resection. The characteristics and clinicopathological factors were evaluated retrospectively. Results Six of the 11 patients with ADSQ were male and five were female. The mean age was 67.3 years' olds. Three patients had pathological stage IA, one patient each had stage IB and IIA, five patients had stage IIIA, and one patient stage IIIB. Five patients had coexistent double cancer including 2 gastric, 1 rectal, 1 prostate and 1 bladder cancer. ADSQ was found less frequently in males than squamous cell carcinoma (SQ. ADSQ was found more frequently in older patients, with advanced stage, advanced T status, and lymph node metastases than adenocarcinoma (AD. The proportion with coexistent double cancer of AD, SQ, and ADSQ were 21.1, 17.6, and 45.5%, respectively. ADSQ had a significantly correlation with double cancer (ADSQ vs. non- ADSQ p = 0.03. A multivariate analysis showed no significant prognostic difference between the patients with ADSQ and non- ADSQ. Conclusions In this study, cases with ADSQ showed no significantly prognostic difference in comparison to AD and SQ. However, surgeons must be cautious of any coexistent double cancer because approximately half of all patients with ADSQ of the lung have double cancer.

  7. Chronic obstructive pulmonary disease in stage I non-small cell lung cancer that underwent anatomic resection: the role of a recurrence promoter.

    Science.gov (United States)

    Kuo, Chih-Hsi; Wu, Ching-Yang; Lee, Kang-Yun; Lin, Shu-Min; Chung, Fu-Tsai; Lo, Yu-Lun; Liu, Chien-Ying; Hsiung, Te-Chih; Yang, Cheng-Ta; Wu, Yi-Cheng

    2014-08-01

    Despite the use of anatomic resection, the post-surgical recurrence rate remains high in early-stage non-small cell lung cancer (NSCLC). Chronic inflammation plays a role in the mechanism that promotes tumor initiation. This study aimed to investigate the association between recurrence outcome and chronic inflammation-related co-morbidities in early-stage resected NSCLC. A review of medical records for recurrence outcome and co-morbidities, in terms of chronic obstructive pulmonary disease (COPD), DM, asthma and cardiovascular diseases, was performed with 181 patients with stage I NSCLC that underwent anatomic resection. Subjects with T descriptors as T2a disease (49.5 vs. 28.0%, p recurrence. Univariate analysis for recurrence-free survival showed T descriptor as T2a (21.5 months vs. NR, p recurrence-free survival in the Cox regression model. Patients with COPD were at higher risk of brain recurrence (OR: 7.88; 95% CI, 1.50-41.3, p recurrence in bone and liver (OR: 4.13; 95% CI, 1.08-15.8, p = 0.05). Subjects with COPD and T2a disease had a higher risk of recurrence. The role of COPD as a recurrence promoter merits further prospective investigation.

  8. Metformin exposure is associated with improved progression-free survival in diabetic patients after resection for early-stage non-small cell lung cancer.

    Science.gov (United States)

    Medairos, Robert A; Clark, James; Holoubek, Simon; Kubasiak, John C; Pithadia, Ravi; Hamid, Fatima; Chmielewski, Gary W; Warren, William H; Basu, Sanjib; Borgia, Jeffrey A; Liptay, Michael J; Seder, Christopher W

    2016-07-01

    There are little clinical data assessing the antineoplastic effect of metformin in patients with non-small cell lung cancer. We hypothesized that in diabetic patients undergoing pulmonary resection for early-stage non-small cell lung cancer, metformin exposure is associated with improved survival. An institutional database was used to identify patients with stage I or II non-small cell lung cancer who underwent pulmonary resection between 2004 and 2013. Patients were divided into 3 cohorts: type II diabetic patients with metformin exposure (cohort A, n = 81), type II diabetic patients without metformin exposure (cohort B, n = 57), and nondiabetic individuals (cohort C, n = 77). Univariate, multivariate, and propensity-matched analyses were performed to assess progression-free and overall survivals between groups. A total of 215 patients with stage I and II non-small cell lung cancer treated with surgical resection were identified for analysis with a median follow-up of 19.5 months. Patients in cohort A had lower T- and N-stage tumors than those in cohorts B or C. However, on multivariate analysis adjusting for age, gender, and T and N stage, progression-free survival was greater for cohort A than cohort B (hazard ratio [HR], 0.410; 95% confidence interval, 0.199-0.874; P = .022) or cohort C (HR, 0.415; 95% confidence interval, 0.201-0.887; P = .017). Likewise, when propensity-matched analyses were performed, cohort A demonstrated a trend toward improved progression-free survival compared with cohort B (P = .057; HR, 0.44; c-statistic = 0.832) and improved progression-free survival compared with cohort C (P = .02; HR, 0.41; c-statistic = 0.843). No differences were observed in overall survival. Metformin exposure in diabetic patients with early-stage non-small cell lung cancer may be associated with improved progression-free survival, but no effect was seen on overall survival. Further studies are warranted to evaluate if there is a therapeutic

  9. Meta-analysis of surgical resection and radiofrequency ablation for early hepatocellular carcinoma

    Directory of Open Access Journals (Sweden)

    Xu Gang

    2012-08-01

    Full Text Available Abstract Background There is no definite agreement on the better therapy (radiofrequency ablation (RFA versus surgical resection (SR for early hepatocellular carcinoma (HCC eligible for surgical treatments. The purpose of this study is to evaluate the evidence using meta-analytical techniques. Methods A literature search was undertaken until December 2011 to identify comparative studies evaluating survival rates, recurrence rates, and complications. Pooled odds ratios (OR and 95% confidence intervals (95% CI were calculated with either the fixed or random effect model. Results Thirteen articles, comprising two randomized controlled trials(RCTs, were included in the review, with a total of 2,535 patients (1,233 treated with SR and 1,302 with RFA. The overall survival rates were significantly higher in patients treated with SR than RFA after1, 3, and 5 years (respectively: OR, 0.60 (95% CI, 0.42 to 0.86; OR, 0.49 (95% CI, 0.36 to 0.65; OR, 0.60 (95% CI, 0.43 to 0.84. In the SR group, the 1, 3, and 5 years recurrence rates were significantly lower than the RFA group (respectively: OR, 1.48 (95% CI, 1.05 to 2.08; OR, 1.76 (95% CI, 1.49 to 2.08; OR, 1.68 (95% CI, 1.21 to 2.34. However, local recurrence between two groups did not exhibit significant difference. For HCC ≤ 3 cm in diameter, SR was better than RFA at the 1, 3, and 5 years overall survival rates (respectively: OR, 0.34 (95% CI, 0.13 to 0.89; OR, 0.56 (95% CI, 0.37 to 0.84; OR, 0.44 (95% CI, 0.31 to 0.62. This meta-analysis indicated that the complication of SR was higher than RFA (OR, 6.25 (95%CI, 3.12 to 12.52; P = 0.000. Conclusion Although local recurrence between two groups did not exhibit significant difference, SR demonstrated significantly improved survival benefits and lower complications for patients with early HCC, especially for HCC ≤ 3 cm in diameter. These findings should be interpreted carefully, owing to the lower level of evidence.

  10. HER2 testing on core needle biopsy specimens from primary breast cancers: interobserver reproducibility and concordance with surgically resected specimens

    Directory of Open Access Journals (Sweden)

    Yamamoto Sohei

    2010-10-01

    Full Text Available Abstract Background Accurate evaluation of human epidermal growth factor receptor type-2 (HER2 status based on core needle biopsy (CNB specimens is mandatory for identification of patients with primary breast cancer who will benefit from primary systemic therapy with trastuzumab. The aim of the present study was to validate the application of HER2 testing with CNB specimens from primary breast cancers in terms of interobserver reproducibility and comparison with surgically resected specimens. Methods A total of 100 pairs of archival formalin-fixed paraffin-embedded CNB and surgically resected specimens of invasive breast carcinomas were cut into sections. All 100 paired sections were subjected to HER2 testing by immunohistochemistry (IHC and 27 paired sections were subjected to that by fluorescence in situ hybridization (FISH, the results being evaluated by three and two observers, respectively. Interobserver agreement levels in terms of judgment and the concordance of consensus scores between CNB samples and the corresponding surgically resected specimens were estimated as the percentage agreement and κ statistic. Results In CNB specimens, the percentage interobserver agreement of HER2 scoring by IHC was 76% (κ = 0.71 for 3 × 3 categories (0-1+ versus 2+ versus 3+ and 90% (κ = 0.80 for 2 × 2 categories (0-2+ versus 3+. These levels were close to the corresponding ones for the surgically resected specimens: 80% (κ = 0.77 for 3 × 3 categories and 92% (κ = 0.88 for 2 × 2 categories. Concordance of consensus for HER2 scores determined by IHC between CNB and the corresponding surgical specimens was 87% (κ = 0.77 for 3 × 3 categories, and 94% (κ = 0.83 for 2 × 2 categories. Among the 13 tumors showing discordance in the mean IHC scores between the CNB and surgical specimens, the results of consensus for FISH results were concordant in 11. The rate of successful FISH analysis and the FISH positivity rate in cases with a HER2 IHC score of

  11. Reduce chest pain using modified silicone fluted drain tube for chest drainage after video-assisted thoracic surgery (VATS) lung resection

    Science.gov (United States)

    Li, Xin; Hu, Bin; Miao, Jinbai

    2016-01-01

    Background The aim of this study was to assess the feasibility, efficacy and safety of a modified silicone fluted drain tube after video-assisted thoracic surgery (VATS) lung resection. Methods The prospective randomized study included 50 patients who underwent VATS lung resection between March 2015 and June 2015. Eligible patients were randomized into two groups: experimental group (using the silicone fluted drain tubes for chest drainage) and control group (using standard drain tubes for chest drainage). The volume and characteristics of drainage, postoperative (PO) pain scores and hospital stay were recorded. All patients received standard care during hospital admission. Results In accordance with the exit criteria, three patients were excluded from study. The remaining 47 patients included in the final analysis were divided into two groups: experiment group (N=24) and control group (N=23). There was no significant difference between the two groups in terms of age, sex, height, weight, clinical diagnosis and type of surgical procedure. There was a trend toward less PO pain in experimental group on postoperative day (POD) 1, with a statistically significant difference. Patients in experimental group had a reduced occurrence of fever [temperature (T) >37.4 °C] compared to the control group. Conclusions The silicone fluted drain tube is feasible and safe and may relieve patient PO pain and reduce occurrence of fever without the added risk of PO complications. PMID:26941976

  12. Impact of compromised pulmonary function on major lung resection for non-small cell lung cancer: retrospective study of 127 cases

    Institute of Scientific and Technical Information of China (English)

    ZHANG Yi; JIANG Ge-ning; GAO Wen; CHEN Chang

    2012-01-01

    Background Radical lung resection is the best chance for cure in patients with anatomically resectable non-small cell lung cancer.A retrospective study was performed in an attempt to investigate general rules of major lung resection for non-small cell lung cancer in patients with compromised pulmonary function.Methods Between June 2002 and December 2008,major lung resection was performed in 127 non-small cell lung cancer patients at our institution,who met the criteria of compromised pulmonary function defined as preoperative forced vital capacity <50% of prediction or preoperative forced expiratory volume in one second <50% of prediction.Clinical data of the patients were retrospectively reviewed.Results The patients consisted of 108 males (85.0%) and 19 females (15.0%) with a mean age of 61.7 years.The morbidity rate was 44.1% (56/127) and the mortality rate was 4.7% (6/127).Multivariate analysis identified PaCO2 (P=0.023,OR=2.959,95% C/ 1.164-7.522),the percent predicted postoperative diffusing capacity of the lung for carbon monoxide (P=0.001,OR=0.176,95% C/ 0.064-0.480) and comprehensive preoperative preparation (P=0.048,OR=0.417,95% C/ 0.176-0.993) as the independent predictors of postoperative cardiopuimonary complications that were found in 45 cases.Overall 1-,3- and 5-year survival rates were 90%,55% and 37% respectively.For overall survival,multivariate analysis revealed that TNM staging (P=0.004,OR=1.585,95% C/ 1.154-2.178) was the only independent prognostic factor.Conclusions On the premise of integrated preoperative evaluation and comprehensive preoperative preparation,major lung resection provides an optimal therapeutic for selected non-small cell lung cancer patients with compromised pulmonary function.Hypercapnea and the percent predicted postoperative diffusing capacity of the lung for carbon monoxide <40% could be considered as the independent predictive factors for operative risk in those patients.Chin Med J

  13. New positron emission tomography derived parameters as predictive factors for recurrence in resected stage I non-small cell lung cancer.

    Science.gov (United States)

    Melloni, G; Gajate, A M S; Sestini, S; Gallivanone, F; Bandiera, A; Landoni, C; Muriana, P; Gianolli, L; Zannini, P

    2013-11-01

    The recurrence rate for stage I non-small cell lung cancer is high, with 20-40% of patients that relapse after surgery. The aim of this study was to evaluate new F-18 fluorodeoxyglucose (FDG) positron emission tomography (PET) derived parameters, such as standardized uptake value index (SUVindex), metabolic tumor volume (MTV) and total lesion glycolysis (TLG), as predictive factors for recurrence in resected stage I non-small cell lung cancer. We retrospectively reviewed 99 resected stage I non-small cell lung cancer patients that were grouped by SUVindex, TLG and MTV above or below their median value. Disease free survival was evaluated as primary end point. The 5-year overall survival and the 5-year disease free survival rates were 62% and 73%, respectively. The median SUVindex, MTL and TLG were 2.73, 2.95 and 9.61, respectively. Patients with low SUVindex, MTV and TLG were more likely to have smaller tumors (p ≤ 0.001). Univariate analysis demonstrated that SUVindex (p = 0.027), MTV (p = 0.014) and TLG (p = 0.006) were significantly related to recurrence showing a better predictive performance than SUVmax (p = 0.031). The 5-year disease free survival rates in patients with low and high SUVindex, MTV and TLG were 84% and 59%, 86% and 62% and 88% and 60%, respectively. The multivariate analysis showed that only TLG was an independent prognostic factor (p = 0.014) with a hazard ratio of 4.782. Of the three PET-derived parameters evaluated, TLG seems to be the most accurate in stratifying surgically treated stage I non-small cell lung cancer patients according to their risk of recurrence. Copyright © 2013 Elsevier Ltd. All rights reserved.

  14. [Current Status of Preoperative Professional Oral Care by Dentists for Elderly Patients Undergoing Lung Resection and Occurrence of Postoperative Pneumonia].

    Science.gov (United States)

    Hoshikawa, Yasushi; Tanda, Naoko; Matsuda, Yasushi; Katsumata, Hiroshi; Notsuda, Hirotsugu; Watanabe, Tatsuaki; Niikawa, Hiromichi; Noda, Masafumi; Sakurada, Akira; Kondo, Takashi; Okada, Yoshinori

    2016-01-01

    Pneumonia in elderly people is mainly caused by silent aspiration due to an age-related impairment of cough and swallowing reflexes. Because most of the patients with lung cancer are elderly people, we hypothesized that the age-related impairment of these protective reflexes might exist or occur in patients undergoing lung surgery, and cause postoperative pneumonia. We revealed that many elderly patients showed depressed swallowing reflex even before surgery and transient attenuation of cough reflex after surgery, and that postoperative pneumonia occurred only in the patients whose cough and/or swallowing reflex was abnormal postoperatively. Then, we prospectively showed that 30 elderly patients who received perioperative intensive oral care, including professional assessment of oral status, dental cleaning, and patient education for self-oral care by dentists, followed by intensive oral care by intensive care unit nurses, and encouragement of self-oral care by floor nurses, did not develop pneumonia after lung resection. In this study, we retrospectively reviewed the execution status of professional oral care by dentists and the occurrence of postoperative pneumonia in 159 consecutive patients aged 65 or older undergoing lung resection from 2013 to 2014. Thoracic surgeons in our institute asked dentists to provide professional oral care before lung resection only in 30.3% of the subjects in 2013, and 45.8% in 2014. Postoperative pneumonia occurred in 3 out of 76 subjects(3.9%)in 2013, and 1 out of 83(1.2%) in 2014. In 2013, 1 patient who did not receive preoperative professional oral care developed aspiration pneumonia postoperatively followed by acute exacerbation of idiopathic pulmonary fibrosis and in-hospital death. We need to make an effective system to provide preoperative professional oral care by dentists especially for elderly patients and high-risk patients before lung resection.

  15. Suction on chest drains following lung resection: evidence and practice are not aligned.

    Science.gov (United States)

    Lang, Peter; Manickavasagar, Menaka; Burdett, Clare; Treasure, Tom; Fiorentino, Francesca

    2016-02-01

    A best evidence topic in Interactive CardioVascular and Thoracic Surgery (2006) looked at application of suction to chest drains following pulmonary lobectomy. After screening 391 papers, the authors analysed six studies (five randomized controlled trials [RCTs]) and found no evidence in favour of postoperative suction in terms of air leak duration, time to chest drain removal or length of stay. Indeed, suction was found to be detrimental in four studies. We sought to determine whether clinical practice is consistent with published evidence by surveying thoracic units nationally and performing a meta-analysis of current best evidence. We systematically searched MEDLINE, EMBASE and CENTRAL for RCTs, comparing outcomes with and without application of suction to chest drains after lung surgery. A meta-analysis was performed using RevMan(©) software. A questionnaire concerning chest drain management and suction use was emailed to a clinical representative in every thoracic unit. Eight RCTs, published 2001-13, with 31-500 participants, were suitable for meta-analysis. Suction prolonged length of stay (weighted mean difference [WMD] 1.74 days; 95% confidence interval [CI] 1.17-2.30), chest tube duration (WMD 1.77 days; 95% CI 1.47-2.07) and air leak duration (WMD 1.47 days; 95% CI 1.45-2.03). There was no difference in occurrence of prolonged air leak. Suction was associated with fewer instances of postoperative pneumothorax. Twenty-five of 39 thoracic units responded to the national survey. Suction is routinely used by all surgeons in 11 units, not by any surgeon in 5 and by some surgeons in 9. Of the 91 surgeons represented, 62 (68%) routinely used suction. Electronic drains are used in 15 units, 10 of which use them routinely. Application of suction to chest drains following non-pneumonectomy lung resection is common practice. Suction has an effect in hastening the removal of air and fluid in clinical experience but a policy of suction after lung resection has not

  16. External suction versus water seal after selective pulmonary resection for lung neoplasm: a systematic review.

    Directory of Open Access Journals (Sweden)

    Tong Qiu

    Full Text Available OBJECTIVE: To evaluate whether external suction is more advantageous than water seal in patients undergoing selective pulmonary resection (SPR for lung neoplasm. SUMMARY OF BACKGROUND DATA: Whether external suction should be routinely applied in postoperative chest drainage is still unclear, particularly for lung neoplasm patients. To most surgeons, the decision is based on their clinical experience. METHODS: Randomized control trials were selected. The participants were patients undergoing SPR with lung neoplasm. Lung volume reduction surgery and pneumothorax were excluded. Suction versus non-suction for the intervention. The primary outcome was the incidence of persistent air leak (PAL. The definition of PAL was air leak for more than 3-7 days. The secondary outcomes included air leak duration, time of drainage, postoperative hospital stay and the incidence of postoperative pneumothorax. Studies were identified from literature collections through screening. Bias was analyzed and meta-analysis was used. RESULTS: From the 1824 potentially relevant trials, 6 randomized control trials involving 676 patients were included. There was no difference between external suction and water seal in decreasing the incidence of PAL [95% confidence interval (CI 0.81-2.16; z = 1.10; P = 0.27]. Regarding secondary outcomes, there were no differences in time of drainage (95% CI-0.36-1.56, P = 0.22, postoperative hospital stay (95% CI -.31-.54, P = 0.87 or incidence of postoperative pneumothorax (95% CI 0.18-.02, P = 0.05 between external suction and water seal. CONCLUSIONS: For participants, no differences are identified in terms of PAL incidence, drainage time, length of postoperative hospital stay or incidence of postoperative pneumothorax between external suction and water seal. The bias analysis should be emphasized. To the limitations of the bias and methodological differences among the included studies, we have no recommendation on

  17. Adjuvant chemotherapy for completely resected non-small-cell lung cancer

    Directory of Open Access Journals (Sweden)

    Toyooka,Shinichi

    2009-10-01

    Full Text Available For many years, surgery alone was the standard treatment for patients with stage I-IIIA non-small-cell lung cancer (NSCLC. However, recent studies have demonstrated that adjuvant chemotherapy provides a survival benefit. The first adjuvant chemotherapy for NSCLC was performed in the 1960s using a key drug known as cyclophosphamide. In the 1980s and early 1990s, a new anti-cancer drug, cisplatin, was developed. The first meta-analysis of this drug was conducted by the Non-small Cell Lung Cancer Collaborative Group in 1995. This analysis comparing surgery with surgery plus chemotherapy containing cisplatin produced a hazard ratio of 0.87 and suggested an absolute benefit of chemotherapy of 5% at 5 years;this difference was not statistically significant (p0.08. Several clinical trials of adjuvant chemotherapy were planned after the meta-analysis conducted in 1995, but the efficacy of adjuvant chemotherapy remained a matter of controversy. However, useful evidence was reported after 2003. The International Adjuvant Lung Cancer Collaborative Group Trial (IALT demonstrated a 4.1% improvement in survival for patients with stage I to III NSCLC. The JBR. 10 trial demonstrated a 15% improvement in 5-year survival for the adjuvant chemotherapy arm in stage IB or II (excluding T3N0 patients. The Adjuvant Navelbine International Trialist Association (ANITA trial reported that the overall survival at 5 years improved by 8.6% in the chemotherapy arm and that this survival rate was maintained at 7 years (8.4% in stage II and IIIA patients. A meta-analysis based on collected and pooled individual patient data from the 5 largest randomized trials was conducted by the Lung Adjuvant Cisplatin Evaluation (LACE. This analysis demonstrated that cisplatin-based adjuvant chemotherapy improved survival in patients with stage II or III cancer. Alterna-tively, uracil-tegafur has been developed and tested in Japan. The Japan Lung Cancer Research Group (JLCRG on Postsurgical

  18. [Long-term survival after surgical resection of a cancer of unknown primary site-a case report].

    Science.gov (United States)

    Tsukao, Yukiko; Moon, Jeong Ho; Kobayashi, Kenji; Hyuga, Satoshi; Chono, Teruhiro; Watanabe, Risa; Matsumoto, Takashi; Takemoto, Hiroyoshi; Takachi, Ko; Nishioka, Kiyonori; Aoki, Taro; Uemura, Yoshio

    2013-11-01

    We report a case of long-term survival after combination chemotherapy and surgical resection of a cancer of unknown primary site[ CUPs]. A septuagenarian female was identified as having high blood levels of carcinoembryonic antigen (CEA) during follow-up monitoring of asthma. Endoscopy and imaging studies including computed tomography (CT) and positron emission tomography (PET)-CT revealed a malignant lymph node adjacent to the abdominal aorta; however, no other lesion was detected. Therefore, we performed CT-guided biopsy and diagnosed the lesion to be a lymph node metastasis of poorly differentiated adenocarcinoma. As we considered this as a systemic disease, the patient received 2 courses of combination chemotherapy with 5-fluorouracil( 5-FU)/cisplatin( CDDP) and achieved a partial response (PR). Later, the patient received S-1 therapy as second-line chemotherapy and S-1/irinotecan( CPT-11) as third-line chemotherapy in an outpatient clinic. However, the tumor continued to grow, and therefore, we decided to perform surgical resection. Histopathological examination of the resected specimen yielded a diagnosis of metastatic adenocarcinoma of the lymph node. The patient has been well without any signs of recurrence for more than 9 years since surgery. As CUPs is generally associated with poor prognosis, this case raises the possibility that combination therapy might improve convalescence.

  19. Intraoperative application of thermal camera for the assessment of during surgical resection or biopsy of human's brain tumors

    Science.gov (United States)

    Kastek, M.; Piatkowski, T.; Polakowski, H.; Kaczmarska, K.; Czernicki, Z.; Bogucki, J.; Zebala, M.

    2014-05-01

    Motivation to undertake research on brain surface temperature in clinical practice is based on a strong conviction that the enormous progress in thermal imaging techniques and camera design has a great application potential. Intraoperative imaging of pathological changes and functionally important areas of the brain is not yet fully resolved in neurosurgery and remains a challenge. A study of temperature changes across cerebral cortex was performed for five patients with brain tumors (previously diagnosed using magnetic resonance or computed tomography) during surgical resection or biopsy of tumors. Taking into account their origin and histology the tumors can be divided into the following types: gliomas, with different degrees of malignancy (G2 to G4), with different metabolic activity and various temperatures depending on the malignancy level (3 patients), hypervascular tumor associated with meninges (meningioma), metastatic tumor - lung cancer with a large cyst and noticeable edema. In the case of metastatic tumor with large edema and a liquid-filled space different temperature of a cerebral cortex were recorded depending on metabolic activity. Measurements have shown that the temperature on the surface of the cyst was on average 2.6 K below the temperature of surrounding areas. It has been also observed that during devascularization of a tumor, i.e. cutting off its blood vessels, the tumor temperature lowers significantly in spite of using bipolar coagulation, which causes additional heat emission in the tissue. The results of the measurements taken intra-operatively confirm the capability of a thermal camera to perform noninvasive temperature monitoring of a cerebral cortex. As expected surface temperature of tumors is different from surface temperature of tissues free from pathological changes. The magnitude of this difference depends on histology and the origin of the tumor. These conclusions lead to taking on further experimental research, implementation

  20. Tips and tricks of the surgical technique for borderline resectable pancreatic cancer: mesenteric approach and modified distal pancreatectomy with en-bloc celiac axis resection.

    Science.gov (United States)

    Hirono, Seiko; Yamaue, Hiroki

    2015-02-01

    Borderline resectable (BR) pancreatic cancer involves the portal vein and/or superior mesenteric vein (PV/SMV), major arteries including the superior mesenteric artery (SMA) or common hepatic artery (CHA), and sometimes includes the involvement of the celiac axis. We herein describe tips and tricks for a surgical technique with video assistance, which may increase the R0 rates and decrease the mortality and morbidity for BR pancreatic cancer patients. First, we describe the techniques used for the "artery-first" approach for BR pancreatic cancer with involvement of the PV/SMV and/or SMA. Next, we describe the techniques used for distal pancreatectomy with en-bloc celiac axis resection (DP-CAR) and tips for decreasing the delayed gastric emptying (DGE) rates for advanced pancreatic body cancer. The mesenteric approach, followed by the dissection of posterior tissues of the SMV and SMA, is a feasible procedure to obtain R0 rates and decrease the mortality and morbidity, and the combination of this aggressive procedure and adjuvant chemo(radiation) therapy may improve the survival of BR pancreatic cancer patients. The DP-CAR procedure may increase the R0 rates for pancreatic cancer patients with involvement within 10 mm from the root of the splenic artery, as well as the CHA or celiac axis, and preserving the left gastric artery may lead to a decrease in the DGE rates in cases where there is more than 10 mm between the tumor edge and the root of the left gastric artery. The development of safer surgical procedures is necessary to improve the survival of BR pancreatic cancer patients. © 2014 Japanese Society of Hepato-Biliary-Pancreatic Surgery.

  1. Predictors of post-recurrence survival in patients with non-small-cell lung cancer initially completely resected.

    Science.gov (United States)

    Takahashi, Yusuke; Horio, Hirotoshi; Hato, Tai; Harada, Masahiko; Matsutani, Noriyuki; Kawamura, Masafumi

    2015-07-01

    Despite recent progress in diagnostic technology and therapeutic approaches to non-small-cell lung cancer (NSCLC), 30-75% of patients develop tumour recurrence after resection. However, the details of post-recurrence survival (PRS) are not well understood. We aimed to investigate the predictors of PRS in patients with NSCLC initially completely resected. A series of 568 NSCLC patients who had undergone complete resection between 2000 and 2009 were evaluated retrospectively. Patients who had developed recurrent NSCLC after complete resection were subjected to the current analysis. We examined PRS using the Kaplan-Meier method and multivariate Cox regression analyses. Of the 568 patients, 138 (24.3%) were identified as having disease recurrence. The 2-year and 5-year PRS rates were 44.6 and 25.9%, respectively, while the median PRS time was 22.5 months. Non-adenocarcinoma histology [hazard ratio (HR) = 2.825, 95% confidence interval (CI): 1.825-4.367, P recurrence ≥5.0 mg/dl (HR = 2.205, 95% CI: 1.453-3.344, P recurrence and no systemic chemotherapy were independent unfavourable post-recurrence prognostic factors. The current data can be informative for patient follow-up after complete resection and further clinical investigation may give us more information about PRS and accurate treatment strategy for recurrent NSCLC after initial complete resection. © The Author 2015. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

  2. Surveillance of the remaining nodules after resection of the dominant lung adenocarcinoma is an appropriate follow-up strategy

    Directory of Open Access Journals (Sweden)

    Massimo eCastiglioni

    2015-01-01

    Full Text Available IntroductionAdenocarcinomas, commonly present as a dominant lesion (DL with additional nodules in the ipsilateral or contralateral lung. We sought to determine the fate and management of the secondary nodules and to assess the risk of these nodules using the Lung CT Screening Reporting and Data System (Lung-RADS criteria and the National Comprehensive Cancer Network (NCCN guidelines to determine if surveillance is an appropriate strategy.MethodsWe retrospectively evaluated patients with lepidic growth pattern adenocarcinoma and secondary nodules from 2000 to 2013. Risk assessment of the additional lesions was completed with a simplified model of Lung-RADS and NCCN-Guidelines. ResultsEighty-seven patients underwent resection of 87 DLs (Group 1 concurrently with 60 additional pulmonary nodules (Group 2 while 157 non-DLs were radiologically surveyed over a median follow-up time of 3.2 years (Group 3. Malignancy was found in 29/60 (48% nodules in Group 2. Whereas, only 9/157 (6% of the lesions in Group 3 enlarged, 4 of which (2.5% of total were found to be malignant, and then treated, while the remaining nodules continued surveillance. After applying the Lung-RADS and NCCN simplified models, nodules in Group 2 were at higher risk for lung cancer than those in Group 3. ConclusionsIn patients with lepidic growth pattern adenocarcinoma associated with multiple secondary nodules, surveillance of the remaining nodules, after resection of the DL, is a reasonable strategy since these nodules exhibited a slow rate of growth and minimal malignancy. In contrast, nodules resected from the ipsilateral lung at the time of the DL, harbor malignancy in 48%. Risk assessment models may provide a useful and standardized tool for clinical assessment of pulmonary nodules.

  3. Reduced Circumferential Resection Margin Involvement in Rectal Cancer Surgery: Results of the Dutch Surgical Colorectal Audit

    NARCIS (Netherlands)

    Gietelink, L.; Wouters, M.W.; Tanis, P.J.; Deken, M.M.; Berge, M.G. Ten; Tollenaar, R.A.; Krieken, J.H.J.M. van; Noo, M.E. de

    2015-01-01

    BACKGROUND: The circumferential resection margin (CRM) is a significant prognostic factor for local recurrence, distant metastasis, and survival after rectal cancer surgery. Therefore, availability of this parameter is essential. Although the Dutch total mesorectal excision trial raised awareness ab

  4. Radiotherapy for locoregional recurrent tumors after resection of non-small cell lung cancer.

    Science.gov (United States)

    Kagami, Y; Nishio, M; Narimatsu, N; Mjoujin, M; Sakurai, T; Hareyama, M; Saito, A

    1998-04-01

    Thirty-two patients with locoregional recurrence without documented distant metastasis after resection of non-small cell lung cancer were treated with radiotherapy. There were 29 male patients and three female patients. The age range was 49-79 years (median 66 years). Twenty patients had squamous cell carcinoma, 11 patients adenocarcinoma and one patient large cell carcinoma. Ten patients had bronchial stump recurrence alone, 14 patients bronchial stump recurrence with mediastinal and/or supraclavicular fossa lymph nodes recurrence, and eight patients mediastinal and/or supraclavicular fossa lymph nodes recurrence without bronchial stump recurrence. The total dose delivered ranged from 47.5 to 65 Gy. We achieved good results on improving on subjective complaints. Eighty-nine percent (17/19) of patients indicated subjective improvement. Eight of 32 (25%) patients showed a complete response, and 13 of 32 (40.6%) patients showed a partial response. Only one of seven patients (14.3%) with less than 60 Gy showed a complete response, but seven of 25 patients (28%) with 60 Gy and more showed a complete response. The survival rate was 56.2% at 1 year and 12.5% at 5 years. Four patients have survived more than 5 years. The survival rate of the patients with complete response was 50% at 3 and 5 years, that of the patients with non-complete was 12.5% at 3 years and 0% at 5 years (Cox-Mantel test, P recurrent tumors after resection was effective for palliation and improved survival.

  5. Prognostic factors affecting disease-free survival rate following surgical resection of primary breast cancer

    Directory of Open Access Journals (Sweden)

    K Horita

    2009-12-01

    Full Text Available In order to identify the prognostic factors that significantly influence the disease-free survival rate after surgical resection of primary breast cancers, we determined tumour and lymph node grades, and immunohistochemical staining for estrogen and progesterone receptors (ER and PR, c-erbB-2, p53, bcl-2, bax and PCNA in 76 patients. Univariate analysis showed that increased grade of tumour and lymph nodes, negative immunostaining for ER, positive immunostaining for c-erbB-2, and a high PCNA index (³30% negatively influenced the disease- free survival rate, but PR, p53, bcl-2 and bax had no predictive value. Although p53 was not an independent prognostic factor by itself, the combination of p53, bcl-2, and bax proved to correlate with the disease-free survival, with the best prognosis noted in tumours negative for p53 and positive for both bcl-2 and bax, intermediate prognosis in tumours negative for p53 and positive for either bcl- 2 or bax and worst prognosis in tumors negative for p53 as well as bcl-2 and bax. Tumour grade correlated positively with PCNA index, while positive staining for ER correlated negatively with tumour grade as well as with PCNA index, although this was statistically insignificant. Immunostaining of breast cancers for Bcl-2 correlated negatively with tumour grade and PCNA index. Immunostaining for c-erbB-2 correlated positively with PCNA but not with tumour grade. Immunostaining for p53 tended to correlate positively with PCNA, but not with tumour grade. Immunostaining for PR and bax did not correlate with tumour grade and PCNA index. These results suggest that in addition to tumour size and lymph node involvement, immunostaining for ER, c-erbB-2, and a high PCNA index are important prognostic factors in human breast cancer. Wild-type p53 with preserved bcl-2 and bax gene products is also a favorable prognostic factor indicating breast cancer at an early stage of cancer progression.

  6. Preoperative Platelet Count Associates with Survival and Distant Metastasis in Surgically Resected Colorectal Cancer Patients

    Science.gov (United States)

    Wan, Shaogui; Lai, Yinzhi; Myers, Ronald E.; Li, Bingshan; Hyslop, Terry; London, Jack; Chatterjee, Devjani; Palazzo, Juan P.; Burkart, Ashlie L.; Zhang, Kejin; Xing, Jinliang

    2013-01-01

    Objective Platelets have been implicated in cancer metastasis and prognosis. No population-based study has been reported as to whether preoperative platelet count directly predicts metastatic recurrence of colorectal cancer (CRC) patients. Design Using a well-characterized cohort of 1,513 surgically resected CRC patients, we assessed the predictive roles of preoperative platelet count in overall survival, overall recurrence, as well as locoregional and distant metastatic recurrences. Results Patients with clinically high platelet count (≥400× 109/L) measured within 1 month before surgery had a significantly unfavorable survival (hazard ratio [HR]=1.66, 95 % confidence interval [CI] 1.34–2.05, P=2.6×10−6, Plog rank= 1.1×10−11) and recurrence (HR=1.90, 1.24–2.93, P=0.003, Plog rank=0.003). The association of platelet count with recurrence was evident only in patients with metastatic (HR=2.81, 1.67–4.74, P=1.1×10−4, Plog rank =2.6×10−6) but not locoregional recurrence (HR=0.59, 95 % CI 0.21–1.68, P= 0.325, Plog rank=0.152). The findings were internally validated through bootstrap resampling (P<0.01 at 98.6 % of resampling). Consistently, platelet count was significantly higher in deceased than living patients (P<0.0001) and in patients with metastatic recurrence than locoregional (P= 0.004) or nonrecurrent patients (P<0.0001). Time-dependent modeling indicated that the increased risks for death and metastasis associated with elevated preoperative platelet counts persisted up to 5 years after surgery. Conclusion Our data demonstrated that clinically high level of preoperative platelets was an independent predictor of CRC survival and metastasis. As an important component of the routinely tested complete blood count panel, platelet count may be a cost-effective and noninvasive marker for CRC prognosis and a potential intervention target to prevent metastatic recurrence. PMID:23549858

  7. Heat shock protein 70 as a predictive marker for platinum-based adjuvant chemotherapy in patients with resected non-small cell lung cancer.

    Science.gov (United States)

    Park, Tai Sun; Kim, Hye-Ryoun; Koh, Jae Soo; Jang, Seung Hun; Hwang, Yong Il; Yoon, Ho Il; Chung, Jin-Haeng; Kim, Cheol Hyeon; Kim, Sung-Soo; Kim, Woo Sung; Jo, Jungmin; Lee, Jae Cheol; Choi, Chang-Min

    2014-11-01

    Although adjuvant platinum-based chemotherapy improves survival in completely resected non-small cell lung cancer (NSCLC), its effect is limited. We evaluated whether the expression of heat shock protein 70 (Hsp70) is associated with clinical outcomes in patients with completely resected NSCLC who were treated with or without adjuvant platinum-based chemotherapy. Patients who underwent curative resection for NSCLC and diagnosed as stage IIA through IIIA were included. Immunohistochemical staining for Hsp70 was performed on surgical specimens and survival rates were compared by Hsp70 expression and adjuvant platinum-based chemotherapy. Of 327 enrolled patients, Hsp70 expression was positive in 220 (67.3%). For patients who did not receive adjuvant chemotherapy, Hsp70 expression did not significantly affect survival. However, for patients who received adjuvant chemotherapy, those with Hsp70-positive tumors had a longer disease-free survival outcome than cases with Hsp70-negative tumors (not reached vs. 27.3 months; P=0.002), although there was no significant difference in overall survival (97.0 vs. 58.9 months, P=0.080). In the adjuvant chemotherapy group, multivariate modeling showed that patients with Hsp70-postitive tumors had a lower risk of recurrence and death after adjusting for age, sex, performance status, pathologic stage, and histological type (disease-free survival: adjusted hazard ratio, 0.537; 95% CI, 0.362-0.796; P=0.002; overall survival: adjusted hazard ratio, 0.663; 95% CI, 0.419-1.051; P=0.080). Hsp70 is a positive predictive factor in completely resected NSCLC with received platinum-based adjuvant chemotherapy. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  8. 5-Fluorouracil and cisplatin therapy after palliative surgical resection of squamous cell carcinoma of the esophagus. A multicenter randomized trial. French Associations for Surgical Research.

    Science.gov (United States)

    Pouliquen, X; Levard, H; Hay, J M; McGee, K; Fingerhut, A; Langlois-Zantin, O

    1996-01-01

    BACKGROUND: The curative rate of surgical resection of squamous cell carcinoma of the esophagus is low. Reports on the efficacy of preoperative and postoperative chemotherapy are conflicting or have included limited disease or radical surgery alone. OBJECTIVE: The authors' objective was to study the results of chemotherapy on the duration and quality of survival in patients who have undergone palliative surgical resection for esophageal squamous cell carcinoma. PATIENTS AND METHODS: Of 124 patients with histologically proven esophageal squamous cell carcinoma situated more than 5 cm from the upper end of the esophagus, 4 patients were withdrawn for failure to comply with the protocol. The remaining 120 patients, 116 males and 4 females (mean age, 57 +/- 9 years), were randomly assigned to either a control group who were to receive no chemotherapy (68 patients) or to a group who were to be treated with chemotherapy (52 patients). Patients were subdivided into two strata as follows: (1) stratum I, complete resection of the tumor with lymph node involvement (62 patients) and (2) stratum ii, incomplete resection leaving macroscopic tumor tissue in situ or with metastases. Noninclusion criteria were histologically proven tracheobronchial involvement, esotracheal fistula, major alteration of general health status (Karnofsky score 30% of parenchyma) hepatic metastasis, peritoneal carcinomatosis, associated or previously treated upper airway cancer, or, conversely, complete resection of tumor without lymph node involvement. Chemotherapy was given in 5-day courses, every 28 days, with a maximum of 8 courses. Cisplatin was administered either as a single dose of 100 mg/m2 at the beginning of the course or as 20 mg/m2/day for 5 days given over 3 hours. 5- Fluorouracil (5-FU) (100 mg/m2/day) was infused over 24 hours for 5 days. The duration of treatment ranged from 6 to 8 months. The main aim was to establish median survival and actuarial survival curves. The subsidiary aim

  9. Surgical planning for resection of an ameloblastoma and reconstruction of the mandible using a selective laser sintering 3D biomodel.

    Science.gov (United States)

    Sannomiya, Eduardo Kazuo; Silva, Jorge Vicente L; Brito, Antonio Albuquerque; Saez, Daniel Martinez; Angelieri, Fernanda; Dalben, Gisele da Silva

    2008-07-01

    Ameloblastoma is a benign locally aggressive infiltrative odontogenic lesion. It is characterized by slow growth and painless swelling. The treatment for ameloblastoma varies from curettage to en bloc resection, and the reported recurrence rates after treatment are high; the safety margin of resection is important to avoid recurrence. Advances in technology brought about great benefits in dentistry; a new generation of computed tomography scanners and 3-dimensional images enhance the surgical planning and management of maxillofacial tumors. The development of new prototyping systems provides accurate 3D biomodels on which surgery can be simulated, especially in cases of ameloblastoma, in which the safety margin is important for treatment success. A case of mandibular follicular ameloblastoma is reported where a 3D biomodel was used before and during surgery.

  10. Surgical strategy to avoid ischemic complications of the pyramidal tract in resective epilepsy surgery of the insula: technical case report.

    Science.gov (United States)

    Ikegaya, Naoki; Takahashi, Akio; Kaido, Takanobu; Kaneko, Yuu; Iwasaki, Masaki; Kawahara, Nobutaka; Otsuki, Taisuke

    2017-06-09

    Surgical treatment of the insula is notorious for its high probability of motor complications, particularly when resecting the superoposterior part. Ischemic damage to the pyramidal tract in the corona radiata has been regarded as the cause of these complications, resulting from occlusion of the perforating arteries to the pyramidal tract through the insular cortex. The authors describe a strategy in which a small piece of gray matter is spared at the bottom of the periinsular sulcus, where the perforating arteries pass en route to the pyramidal tract, in order to avoid these complications. This method was successfully applied in 3 patients harboring focal cortical dysplasia in the posterior insula and frontoparietal operculum surrounding the periinsular sulcus. None of the patients developed permanent postoperative motor deficits, and seizure control was achieved in all 3 cases. The method described in this paper can be adopted for functional preservation of the pyramidal tract in the corona radiata when resecting epileptogenic pathologies involving insular and opercular regions.

  11. Surgical treatment of patients with lung cancer and limited lung function: Preoperative assessment, operative mortality and morbidity

    Directory of Open Access Journals (Sweden)

    Subotić Dragan

    2007-01-01

    Full Text Available Introduction: Lung resection in patients with limited lung function is one of the greatest challenges in general thoracic surgery. Objective. The aim of the study was to analyze the pattern of lung function changes after operation, operative morbidity and mortality and to compare them with control group of patients. Method. The study included 34 patients with limited lung function, operated for primary lung cancer in one-year period. All patients underwent preoperative desobstructive treatment. The type of ventilatory disorder was analyzed depending on preoperative radiographic and bronchoscopic aspect. Statistics: chisquare test, t-test. Results. In patients with lobectomy, the mean difference in forced expiratory volume in the first second (FEV1 between preoperative and postoperative values was 16.81%, whilst in the pneumonectomy group this difference was 39.51%. The mean change in forced vital capacity (FVC in the lobectomy and pneumonectomy group was 15.83% and 42.73% respectively. In the control group of 28 patients with lobectomy, the decrease in FVC and FEV1 was 19.9% and 24.18% respectively. In the control group of 28 patients with pneumonectomy, the decrease in FVC and FEV1 was 43.52% and 41.36% respectively. In patients with limited lung function and lobectomy, changes in FEV1 and VC after resection were significantly lower compared to the control group of patients with lobectomy and normal lung function. None of 34 operated patients with borderline lung function died inside 30 postoperative days. In the same period, of a total number of 344 patients without respiratory function impairment, operative mortality was 3.1%. In the analyzed group, operative morbidity was 32.35%. Cardiovascular and respiratory complications in the analyzed and control groups occurred in 14.7% and 6.1% of patients respectively (p>0.05. Conclusion. Surgery should not be excluded in patients with borderline lung function prior to preoperative treatment and

  12. Laparoscopic Colorectal Cancer Resection in High-Volume Surgical Centers: Long-Term Outcomes from the LAPCOLON Group Trial.

    Science.gov (United States)

    Huscher, Cristiano G S; Bretagnol, Frederic; Corcione, Francesco

    2015-08-01

    Strong evidence has confirmed the benefit of laparoscopy in colorectal cancer resection but remains a challenging procedure. It is not clear that such promising results in selected patients translate into a favorable risk-benefit balance in real practice. We conducted a multicenter national observational registry to assess operative and oncologic long-term outcomes following laparoscopic colorectal cancer resection. All patients with laparoscopic colorectal cancer resection between 2001 and 2004 were included. Data were extracted from the prospective Italian national database of 10 high-volume centers (≥40 colorectal cancer laparoscopic resections per year). Surgical technique and follow-up were standardized. Survivals were analyzed by Kaplan-Meier method. We reported 1832 patients with colon (58.5%) and rectal cancer (41.5%). TNM stage was 0-I-II in 1044 patients (57%) and III-IV in 788 patients (43%). Surgery included a totally laparoscopic procedure in 1820 patients (99.3%). Conversion was 10.5%. Postoperative morbidity and 30-day mortality rates were 17 and 1.2%, respectively. Clinical anastomotic leakage rate was 8.3% (n=152). R0 resection was 95%. With a median follow-up of 54.2 months, cancer recurrence rate was 13.3%. At 5 years, cancer-free survival was 86.7%. Upon multivariate analysis, age (P=0.001) and TNM stage (Pcancer-free survival. Predictive factors of cancer recurrence were gender (P=0.029) and TNM stage (Pcancer achieves good operative results with satisfactory long-term oncologic results. Even in the laparoscopy era, age, gender, and TNM stage remain the most powerful predictor of oncologic outcomes.

  13. Portal Vein Embolization as an Oncosurgical Strategy Prior to Major Hepatic Resection: Anatomic, Surgical and Technical Considerations for Successful Outcomes

    Directory of Open Access Journals (Sweden)

    Sonia Tewani Orcutt

    2016-03-01

    Full Text Available Preoperative portal vein embolization (PVE is used to extend the indications for major hepatic resection, and it has become the standard of care for selected patients with hepatic malignancies treated at major hepatobiliary centers. To date, various techniques with different embolic materials have been used with similar results in the degree of liver hypertrophy. Regardless of the specific strategy used, both surgeons and interventional radiologists must be familiar with each other’s techniques to be able to create the optimal plan for each individual patient. Knowledge of the segmental anatomy of the liver is paramount to fully understand the liver segments that need to be embolized and resected. Understanding the portal vein anatomy and the branching variations, along with the techniques used to transect the portal vein during hepatic resection, is important because these variables can affect the PVE procedure and the eventual surgical resection. Comprehension of the advantages and disadvantages of approaches to the portal venous system and the various embolic materials used for PVE is essential to best tailor the procedures for each patient and to avoid complications. Before PVE, meticulous assessment of the portal vein branching anatomy is performed with cross-sectional imaging, and embolization strategies are developed based on the patient’s anatomy. The PVE procedure consists of several technical steps, and knowledge of these technical tips, potential complications and how to avoid the complications in each step is of great importance for safe and successful PVE, and ultimately successful hepatectomy. Because PVE is used as an adjunct to planned hepatic resection, priority must always be placed on safety, without compromising the integrity of the future liver remnant, and close collaboration between interventional radiologists and hepatobiliary surgeons is essential to achieve successful outcomes.

  14. Portal Vein Embolization as an Oncosurgical Strategy Prior to Major Hepatic Resection: Anatomic, Surgical, and Technical Considerations.

    Science.gov (United States)

    Orcutt, Sonia T; Kobayashi, Katsuhiro; Sultenfuss, Mark; Hailey, Brian S; Sparks, Anthony; Satpathy, Bighnesh; Anaya, Daniel A

    2016-01-01

    Preoperative portal vein embolization (PVE) is used to extend the indications for major hepatic resection, and it has become the standard of care for selected patients with hepatic malignancies treated at major hepatobiliary centers. To date, various techniques with different embolic materials have been used with similar results in the degree of liver hypertrophy. Regardless of the specific strategy used, both surgeons and interventional radiologists must be familiar with each other's techniques to be able to create the optimal plan for each individual patient. Knowledge of the segmental anatomy of the liver is paramount to fully understand the liver segments that need to be embolized and resected. Understanding the portal vein anatomy and the branching variations, along with the techniques used to transect the portal vein during hepatic resection, is important because these variables can affect the PVE procedure and the eventual surgical resection. Comprehension of the advantages and disadvantages of approaches to the portal venous system and the various embolic materials used for PVE is essential to best tailor the procedures for each patient and to avoid complications. Before PVE, meticulous assessment of the portal vein branching anatomy is performed with cross-sectional imaging, and embolization strategies are developed based on the patient's anatomy. The PVE procedure consists of several technical steps, and knowledge of these technical tips, potential complications, and how to avoid the complications in each step is of great importance for safe and successful PVE and ultimately successful hepatectomy. Because PVE is used as an adjunct to planned hepatic resection, priority must always be placed on safety, without compromising the integrity of the future liver remnant, and close collaboration between interventional radiologists and hepatobiliary surgeons is essential to achieve successful outcomes.

  15. Resident training in urology: Bipolar transurethral resection of the prostate - a safe method in learning endoscopic surgical procedure

    Directory of Open Access Journals (Sweden)

    Alessandro Del Rosso

    2013-06-01

    Full Text Available Introduction: Modern medicine uses increasingly innovative techniques that require more and more capabilities for acquisition. In the urological department is increasing the presence of patients with lower urinary tract symptoms (LUTS and transurethral resection of the prostate (TURP is the standard of care in their surgical treatment. We report our surgical experience and learning curve of using bipolar plasmakinetic devices in the training of urological residents to benign prostatic hyperplasia (BPH treatment. Materials and Methods: 80 patients with benign prostatic enlargement due to BPH were enrolled in the study. TURP has been performed by three urological residents and by an expe- rienced urologist. Patients were evaluated before and 6 months after the endoscopic bipolar plasmakinetic resection using the International Prostate Symptom Score (IPSS, maximum uri- nary flow rate (Qmax, postvoid residual urine (PVR and prostate specific antigen (PSA. Results: Overall 60 procedures were performed, 18 PlasmaKinetic (PK-TURP procedures were completed by the three residents. In the other 42 cases the procedures were completed by the experienced urologist. In eight cases there was a capsular perforation and the experienced urol- ogist replaced the resident to complete the resection. No complications have been reported in the procedures completed by the senior urologist. All complications caused by the residents were man- aged intraoperatively without changing the course of the procedure. Statistical differences were observed regarding IPSS, quality of life (QoL, and PVR at 6-month follow-up when procedures completed by urological residents were compared to those completed by the senior urologist. Conclusion: Bipolar device represents appropriate tools to acquire endoscopic skills. It is safe and it can be used at the first experience of BPH treatment by a resident who has not previ- ously approached this endoscopic surgical procedure.

  16. Lung Volume Reduction in Chronic Obstructive Pulmonary Disease (COPD AND#8211; An Updated Review of Surgical and Endoscopic Procedures

    Directory of Open Access Journals (Sweden)

    Ramakant Dixit

    2012-08-01

    Full Text Available The conventional medical management of emphysema using bronchodilators and anti-inflammatory agents has a limited benefit in patients having advanced hyperinflation of lungs due to destruction of elastic tissue. The natural course of Chronic Obstructive Pulmonary Disease (COPD has been shown to be altered by only smoking cessation and oxygen therapy so far. The lung volume reduction surgery is viewed as another modality to change the natural history of emphysema in recent years. For patients with more generalized emphysema, resection of lung parenchyma improves elastic recoil and chest wall mechanics. An extensive literature search has demonstrated that carefully selected patients of emphysema (i.e. upper lobe predominant disease, low exercise capacity and Forced Expiratory Volume in First Second (FEV1 and DLco and #8804; 20% of predicted receive benefits in terms of symptomatic improvement and physiologic response following Lung Volume Reduction Surgery (LVRS. The resurgent interest in LVRS and National Emphysema Treatment Trial findings for emphysema have stimulated a range of innovative methods, to improve the outcome and reduce complications associated with current LVRS techniques. These novel approaches include surgical resection with compression/banding devices, endobronchial blockers, sealants, obstructing devices and valves and endobronchial bronchial bypass approaches. Experimental data and preliminary results are becoming available for some of these approaches. Most of the published studies so far have been uncontrolled and unblinded. Overall, extensive research in the near future will help to determine the potential clinical applicability of these new approaches to the treatment of emphysema symptoms. [Arch Clin Exp Surg 2012; 1(4.000: 249-257

  17. Predictive Value of Conventional Ultrasound and Contrast-Enhanced Ultrasound in Early Recurrence of Hepatocellular Carcinoma after Surgical Resection.

    Science.gov (United States)

    Wang, Yibin; Liao, Jintang; Qi, Wenjun; Xie, Lulu; Li, Yueyi

    2016-05-01

    The goals of the work described here were to study the pre-operative risk factors associated with early recurrence (ER) of hepatocellular carcinoma (HCC) after surgical resection and discuss the value of conventional ultrasound (US) and contrast-enhanced ultrasound (CEUS) in predicting ER of HCC, so as to provide more information for optimizing clinical treatment and improving prognosis. A retrospective analysis was conducted on 59 patients who underwent both US and CEUS examinations pre-operatively and surgical resection for HCC between December 2010 and January 2014 in our hospital. The patients' clinical data, laboratory examination data and ultrasonic imaging diagnostic data were collected. Univariate analysis and logistic regression analysis were performed to determine the independent risk factors for ER of HCC after surgical resection. Diagnostic values of independent risk factors in predicting ER were further evaluated. The 59 patients were divided into the ER group (27 cases) and ER-free group (32 cases). There were no significant differences in age and sex between the two groups (p > 0.05). Univariate analysis revealed that differences in pre-operative serum α-fetoprotein level ≥400 ng/mL (p = 0.008), tumor diameter ≥5 cm (p = 0.012), macroscopic vascular invasion (p = 0.040), "fast wash-out" enhancement pattern (p = 0.006) and inhomogeneous distribution of contrast agent (p = 0.031) statistically significantly differed between the two groups. Logistic regression analysis indicated that pre-operative serum AFP level ≥400 ng/mL (p = 0.024), tumor diameter ≥5 cm (p = 0.042) and "fast wash-out" enhancement pattern (p = 0.009) were independent risk factors for ER of HCC; macrovascular invasion (p = 0.095) and inhomogeneous distribution of contrast agent (p = 0.628) did not statistically significantly differ between two groups (p = 0.628). Predictive values of the independent risk factors were further evaluated. The sensitivity of a "fast wash

  18. Long-term survival after surgical resection for huge hepatocellular carcinoma: comparison with transarterial chemoembolization after propensity score matching.

    Science.gov (United States)

    Min, Yang Won; Lee, Jun Hee; Gwak, Geum-Youn; Paik, Yong Han; Lee, Joon Hyoek; Rhee, Poong-Lyul; Koh, Kwang Cheol; Paik, Seung Woon; Yoo, Byung Chul; Choi, Moon Seok

    2014-05-01

    Surgical resection (SR) and transarterial chemoembolization (TACE) have been commonly applied for patients with huge hepatocellular carcinoma (HCC). However, optimal treatment has not been established. Between 2000 and 2009, 267 patients with huge HCC (≥ 10 cm) underwent TACE and 84 underwent SR as the first treatment. Propensity score matching generated a matched cohort composed of 152 patients. We investigated overall survival and possible prognostic factors. At baseline, the surgery group showed a tendency to have solitary tumor (72.6% vs 39.3%, P huge HCC. © 2013 Journal of Gastroenterology and Hepatology Foundation and Wiley Publishing Asia Pty Ltd.

  19. Submental Artery Island Flap in Reconstruction of Harde Plate after wide Surgical Resection of Veruccous Carcinoma. Two case reports

    Directory of Open Access Journals (Sweden)

    Amin Rahpeyma

    2013-06-01

    Full Text Available Introduction: Reconstruction of intraoral soft tissue defects is important in restoring function and esthetic. In large defects, there will be demand for regional pedicle flaps or free flaps. Hard palate separates nasal and oral cavities. Due to the small surface area between flap and remaining palate after surgical resections, optimal blood supply of the flaps for hard palate reconstructions are needed. This article demonstrates immediate reconstruction of two edentulous hemimaxillectomy patients with submental artery Island flap and brief review of this flap discussed. 

  20. Strategies for clinical implementation of TNM-Immunoscore in resected nonsmall-cell lung cancer.

    Science.gov (United States)

    Donnem, T; Kilvaer, T K; Andersen, S; Richardsen, E; Paulsen, E E; Hald, S M; Al-Saad, S; Brustugun, O T; Helland, A; Lund-Iversen, M; Solberg, S; Gronberg, B H; Wahl, S G F; Helgeland, L; Fløtten, O; Pohl, M; Al-Shibli, K; Sandanger, T M; Pezzella, F; Busund, L T; Bremnes, R M

    2016-02-01

    Immunoscore is a prognostic tool defined to quantify in situ immune cell infiltrates and appears highly promising as a supplement to the tumor-node-metastasis (TNM) classification of various tumors. In colorectal cancer, an international task force has initiated prospective multicenter studies aiming to implement TNM-Immunoscore (TNM-I) in a routine clinical setting. In breast cancer, recommendations for the evaluation of tumor-infiltrating lymphocytes (TILs) have been proposed by an international working group. Regardless of promising results, there are potential obstacles related to implementing TNM-I into the clinic. Diverse methods may be needed for different malignancies and even within each cancer entity. Nevertheless, a uniform approach across malignancies would be advantageous. In nonsmall-cell lung cancer (NSCLC), there are several previous reports indicating an apparent prognostic importance of TILs, but studies on TILs in a TNM-I setting are sparse and no general recommendations are made. However, recently published data is promising, evoking a realistic hope of a clinical useful NSCLC TNM-I. This review will focus on the TNM-I potential in NSCLC and propose strategies for clinical implementation of a TNM-I in resected NSCLC. © The Author 2015. Published by Oxford University Press on behalf of the European Society for Medical Oncology. All rights reserved. For permissions, please email: journals.permissions@oup.com.

  1. Integrated mutation, copy number and expression profiling in resectable non-small cell lung cancer

    Directory of Open Access Journals (Sweden)

    Do Hongdo

    2011-03-01

    Full Text Available Abstract Background The aim of this study was to identify critical genes involved in non-small cell lung cancer (NSCLC pathogenesis that may lead to a more complete understanding of this disease and identify novel molecular targets for use in the development of more effective therapies. Methods Both transcriptional and genomic profiling were performed on 69 resected NSCLC specimens and results correlated with mutational analyses and clinical data to identify genetic alterations associated with groups of interest. Results Combined analyses identified specific patterns of genetic alteration associated with adenocarcinoma vs. squamous differentiation; KRAS mutation; TP53 mutation, metastatic potential and disease recurrence and survival. Amplification of 3q was associated with mutations in TP53 in adenocarcinoma. A prognostic signature for disease recurrence, reflecting KRAS pathway activation, was validated in an independent test set. Conclusions These results may provide the first steps in identifying new predictive biomarkers and targets for novel therapies, thus improving outcomes for patients with this deadly disease.

  2. P13.10SURGICAL TREATMENT FOR GLIOBLASTOMA MULTIFORME: OUTCOME AND ANALYSIS OF PROGNOSTIC FACTORS ESPECIALLY ORIENTED TO THE EXTENT OF SURGICAL RESECTION

    Science.gov (United States)

    Di Somma, L.; Iacoangeli, M.; Alvaro, L.; Di Rienzo, A.; Liverotti, V.; Della Costanza, M.; Brunozzi, D.; Polonara, G.; Scarpelli, M.; Scerrati, M.

    2014-01-01

    INTRODUCTION: The prognosis of Glioblastoma Multiforme (GBM) remains poor despite recent therapeutic advances. The surgical treatment of GBM (supported by functional imaging, neuronavigation and electrophysiological monitoring) remains a fundamental step. The methylation of the enzyme O6-methylguanine-DNA methyltransefrase (MGMT) seems to improve the effectiveness of alkylating agents on this tumour, but other factors can influence the survival. An evaluation of all prognostic factors is essential to individuate subgroups of patients for a better selection of different treatment modalities. Our study confirms the prognostic values of both new recognized factors (MGMT presence, IDH1, news schedule of TM2 etc.) and the well-recognized prognostic factors particularly to the extent of surgical removal with the help of new technologies and in the era where people is asking more and more a better quality of life. METHODS: We retrospectively analysed 172 operated patients (115 males and 57 females), 55 of which located in eloquent areas, between March 2008 and December 2012. For each patient age, sex, preoperative clinical evaluation (Karnofsky score, KPS), tumour location, extent of surgical removal, genetic and epigenetic profile (MGMT, IDH1,etc) and postoperative treatments were recorded. We used Kaplan Meier method for the univariate analysis and the Cox regression for the multivariate one. Surgical strategy was always planned for a total tumour resection, when allowed by the intrinsic characteristics of the tumour using the so called “extracapsular “ technique. RESULTS: Overall median survival time after surgery was 10 months. At univariate analysis the gross total removal (p70 (p<0,0001) and radiotherapy (p<0,0001) improve survivals. Deep structures involved or multifocal lesions (p<0,0001) resulted as negative factors in term of the quod vitam prognosis, whereas lesions arising in insula, deep structures or in primary motor cortex worse the quod valitudinem

  3. Modified Blalock clamp: a single-hand autostatic device for pulmonary vessel occlusion during lung cancer resection

    OpenAIRE

    Petrella, Francesco; Solli, Piergiorgio; Borri, Alessandro; Spaggiari, Lorenzo

    2011-01-01

    Vascular clamping during lung cancer resection may be difficult in patients with short vessels or large neoplasms preventing adequate and safe exposure. In addition, the physiological vicinity of some vessels to rigid structures like the bronchi may interfere with ideal clamp positioning even in ordinary procedures. We have modified the original Blalock clamp to facilitate the control of pulmonary vessels and physiologically compress the vessel walls, thereby allowing optimal vascular resecti...

  4. Skull reconstruction after resection of bone tumors in a single surgical time by the association of the techniques of rapid prototyping and surgical navigation.

    Science.gov (United States)

    Anchieta, M V M; Salles, F A; Cassaro, B D; Quaresma, M M; Santos, B F O

    2016-10-01

    Presentation of a new cranioplasty technique employing a combination of two technologies: rapid prototyping and surgical navigation. This technique allows the reconstruction of the skull cap after the resection of a bone tumor in a single surgical time. The neurosurgeon plans the craniotomy previously on the EximiusMed software, compatible with the Eximius Surgical Navigator, both from the company Artis Tecnologia (Brazil). The navigator imports the planning and guides the surgeon during the craniotomy. The simulation of the bone fault allows the virtual reconstruction of the skull cap and the production of a personalized modelling mold using the Magics-Materialise (Belgium)-software. The mold and a replica of the bone fault are made by rapid prototyping by the company Artis Tecnologia (Brazil) and shipped under sterile conditions to the surgical center. The PMMA prosthesis is produced during the surgical act with the help of a hand press. The total time necessary for the planning and production of the modelling mold is four days. The precision of the mold is submillimetric and accurately reproduces the virtual reconstruction of the prosthesis. The production of the prosthesis during surgery takes until twenty minutes depending on the type of PMMA used. The modelling mold avoids contraction and dissipates the heat generated by the material's exothermic reaction in the polymerization phase. The craniectomy is performed with precision over the drawing made with the help of the Eximius Surgical Navigator, according to the planned measurements. The replica of the bone fault serves to evaluate the adaptation of the prosthesis as a support for the perforations and the placement of screws and fixation plates, as per the surgeon's discretion. This technique allows the adequate oncologic treatment associated with a satisfactory aesthetic result, with precision, in a single surgical time, reducing time and costs.

  5. Primary tuberculous infection of breast: experiences of surgical resection for aged p.atients and review of literature

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    Primary mammary tuberculosis is a rare entity that usually occurs in female of reproductive age. Herein three such patients including two males with ages over 80 years, who underwent surgical resection, are reported. Fine needle biopsy failed to achieve specific diagnosis before surgical operation. All of their conditions got satisfactory improvement and anti-tuberculosis chemotherapy was administered postoperatively. Previous literature related to the epidemiology, diagnosis and treatment for mammary tuberculosis will be also reviewed. Mammary tuberculosis is usually related to breast feeding women and is extremely rare in aged man. The possible mechanisms resulting in this disease in our three patients, including direct extension, reactivation,or transmitted by staffs or peers of the nursing home, would also be discussed.

  6. Successful surgical management of osteonecrosis of the jaw due to RANK-ligand inhibitor treatment using fluorescence guided bone resection.

    Science.gov (United States)

    Otto, Sven; Baumann, Sebastian; Ehrenfeld, Michael; Pautke, Christoph

    2013-10-01

    Osteonecrosis of the jaw has recently been described in patients receiving subcutaneous administration of RANKL-inhibitors (denosumab). However, due to promising study results, more patients will receive denosumab in order to avoid skeletal complications due to metastatic bone disease and osteoporosis. Therefore, this has the potential to become a comparable challenge to the bisphosphonate induced jaw necrosis in the area of Oral and Maxillofacial Surgery. Indeed, so far no convincing surgical technique has been described to overcome the non-healing mucosal lesions with exposed bone due to RANKL-inhibitor therapy. In this technical note, we report two successful cases of surgical treatment of jaw-bone necrosis under RANKL-inhibitor treatment using fluorescence guided bone resection. In conclusion, the technique is suggested as treatment option for this entity of osteonecrosis of the jaw.

  7. Three-dimensional endoscope-assisted surgical approach to the foramen magnum and craniovertebral junction: minimizing bone resection with the aid of the endoscope.

    Science.gov (United States)

    Anichini, Giulio; Evins, Alexander I; Boeris, Davide; Stieg, Philip E; Bernardo, Antonio

    2014-12-01

    To evaluate objectively the anatomic areas of the cranial base exposed by a three-dimensional (3D) endoscope-assisted far lateral approach. A series of far lateral approaches with only condyle resection, with only jugular tubercle resection, with both partial condyle and total jugular tubercle resection, and without occipital condyle and jugular tubercle resection were performed on 10 cadaveric heads (20 sides). To assess properly the exposure of major anatomic and neurovascular structures, the intradural anatomy of the exposed craniocervical junction was divided into 8 compartments, including 3 superior cranial compartments, 3 inferior cranial compartments, and 2 spinal compartments. The anteromedial compartments toward the midline were difficult to explore using the microscope and required the aid of the endoscope. The 3D endoscope provided general circumferential visualization of the anatomic structures, even without resection of the jugular tubercle, and afforded good visualization of the more lateral compartments. Safe and optimal surgical corridors for insertion of the endoscope were also identified. Use of a 3D endoscope allows for minimal resection of the condyle and jugular tubercle, better visualization of the surgical compartments toward the midline, and better in-depth surgical exploration of each intradural compartment. However, the 3D probe is still too large and restricts surgical maneuverability. Copyright © 2014 Elsevier Inc. All rights reserved.

  8. Extended surgical resection for xanthogranulomatous cholecystitis mimicking advanced gallbladder carcinoma: A case report and review of literature

    Institute of Scientific and Technical Information of China (English)

    Antonino Spinelli; Sven Jonas; Jan M Langrehr; Peter Neuhaus; Guido Schumacher; Andreas Pascher; Enrique Lopez-Hanninen; Hussain Al-Abadi; Christoph Benckert; Igor M Sauer; Johann Pratschke; Ulf P Neumann

    2006-01-01

    Xanthogranulomatous cholecystitis (XGC) is a destructive inflammatory disease of the gallbladder, rarely involving adjacent organs and mimicking an advanced gallbladder carcinoma. The diagnosis is usually possible only after pathological examination. A 46 year-old woman was referred to our center for suspected gallbladder cancer involving the liver hilum, right liver lobe, right colonic flexure, and duodenum. Brushing cytology obtained by endoscopic retrograde cholangiography (ERC) showed high-grade dysplasia. The patient underwent an en-bloc resection of the mass, consisting of right lobectomy,right hemicolectomy, and a partial duodenal resection.Pathological examination unexpectedly revealed an XGC.Only six cases of extended surgical resections for XGC with direct involvement of adjacent organs have been reported so far. In these cases, given the possible coexistence of XGC with carcinoma, malignancy cannot be excluded, even after cytology and intraoperative frozen section investigation. In conclusion, due to the poor prognosis of gallbladder carcinoma on one side and possible complications deriving from highly aggressive inflammatory invasion of surrounding organs on the other side, it seems these cases should be treated as malignant tumors until proven otherwise. Clinicians should include XGC among the possible differential diagnoses of masses in liver hilum.

  9. Effects of different esophageal carcinoma resection on the lung function, inflammatory factor production and stress response

    Institute of Scientific and Technical Information of China (English)

    Guo-Cai Zhang; Fu-Chun Zeng

    2016-01-01

    Objective:To investigate the influence of thoracic minimally invasive laparoscopic surgery and conventional thoracotomy on lung function, inflammatory factor and stress response for esophageal cancer patients.Methods:In this study, 288 cases of esophageal cancer patients were collected in our hospital from January 2011 to January 2016. Patients were randomly divided into observation group (n=144) and control group (n=144), the observation group received thoracic minimally invasive laparoscopic surgery and control group underwent conventional open surgery. The levels of inflammatory cytokines indicators [tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), IL-8, IL-10] and stress response [white blood cell count (WBC), three free triiodothyronine (FT3), free thyroxine (FT4), C-reactive protein (CRP), cortisol] were detected 1 d, 3 d and 5 d after surgery. Lung function [percent predicted vital capacity (VC%), percentage of predicted forced expiratory volume (FEV%), forced expiratory volume in 1 second percentage of predicted value (FEV1%), FVC% predicted percentage (FVC%), accounted for the maximum ventilation per minute, percentage of predicted value (MVV%)] of patients in two groups were measured 1 month after surgery.Results:Compared with the control group, VC and FVC in the observation group were significantly higher 1 month after surgery; the levels of TNF-α in patients of observation group were significantly lower than the control group 1 d, 3 d and 5 d after surgery; the levels IL-6, IL-8 and IL-10 in patients of observation group were significantly lower than the control group 1 d and 3 d after surgery but not on Day5. No significant difference was found in WBC, FT3, FT4, CRP and cortisol levels between the two groups.Conclusion:Compared with conventional thoracotomy, thoracic minimally invasive laparoscopic surgery can effectively reduce surgical trauma and inhibit the release of inflammatory factors, bring less effect on lung function and improve the

  10. Natural Fissures of Lung- Anatomical Basis of Surgical Techniques and Imaging

    Directory of Open Access Journals (Sweden)

    Sumita Dutta

    2013-04-01

    Full Text Available Background The fissures in lung enhances uniform expansion.These fissures may be complete, incomplete or absent.A detailed knowledge of variations of classical and accessory fissures is necessary for proper radiological interpretation.It is a guide to cardiothoracic surgeons performing segmental lung resections, lobectomies to have an uncomplicated perioperative outcome. So,the cadaveric study was done to note the morphological variation of the fissures of lung in eastern Indian population and compare it with previous studies. Methods 102 lungs obtained during dissection of formalin fixed cadavers in Calcutta National Medical College,Kolkata and preserved in 10% formalin were thoroughly studied to note every morphological details of fissures present in the lungs. Results 44% of left lungs had classically complete oblique fissure compared to 26.92% on the right. No oblique fissure could be detected in 8% lungs of left and 11.54% of right side. Horizontal fissure was completely absent in 34.6%. Various degree of parenchymal fusion was more common on the right side.None of the oblique fissures had uniform depth. Conclusion Comparison with other studies shows wide regional variations in morphological patterns of lung fissures,implying environmental and genetic factors in its development .Present study unfolds that parenchymal fusion of various extent is a very common entity of oblique fissure of lung. So more lung parenchyma has to be dissected to reach the bronchi and pulmonary arteries during partial lung resection which naturally might lead to peroperative hemorrhage and more postoperative complications.This knowledge of anatomy of fissures of lung may also help clarifying confusing radiographic findings. [Natl J Med Res 2013; 3(2.000: 117-121

  11. An alternative method to achieve one-lung ventilation by surgical pneumothorax in difficult lung isolation patient: a case report.

    Science.gov (United States)

    Yeh, Pin-Hung; Hsu, Po-Kai

    2016-04-01

    It is challenging to establish one-lung ventilation in difficult airway patients. Surgical pneumothorax under spontaneous breathing to obtain well-collapsed lung is a feasible method for thoracic surgery. A 76-year-old man with right empyema was scheduled for decortication. The patient had limited mouth opening due to facial cellulitis extending from the left cheek to neck. Generally, lung isolation is achieved by double-lumen endotracheal tube or bronchial blocker. Double-lumen tube insertion is difficult for patients with limited mouth opening and right-side placement of bronchial blocker usually causes insufficient deflation. We introduce an alternative lung isolation technique by surgical pneumothorax under spontaneous breathing simply with an endotracheal tube placement. This technique has never been applied into the management of difficult one-lung ventilation. By this method, we provide an ideal surgical condition with safer, less time-consuming, and less skill-demanding anesthesia. It would be an alternative choice for management of one-lung ventilation in the difficult lung isolation patient.

  12. Ipsilateral pleural recurrence after diagnostic transthoracic needle biopsy in pathological stage I lung cancer patients who underwent curative resection.

    Science.gov (United States)

    Moon, Seong Mi; Lee, Dae Geun; Hwang, Na Young; Ahn, Soohyun; Lee, Hyun; Jeong, Byeong-Ho; Choi, Yong Soo; Shim, Young Mog; Kim, Tae Jeong; Lee, Kyung Soo; Kim, Hojoong; Kwon, O Jung; Lee, Kyung Jong

    2017-09-01

    The relationship between transthoracic needle biopsy (TTNB) and pleural recurrence of cancer after curative lung resection remains unclear. We aimed to assess whether TTNB increases the ipsilateral pleural recurrence (IPR) rate and identify other potential risk factors for pleural recurrence after surgery. This retrospective study included 392 patients with p-stage I non-small cell lung cancer with solid or part-solid nodules after curative lung resection in 2009-2010. Imbalances among the characteristics were adjusted using an inverse probability-weighted method based on propensity scoring. Multivariate Cox's regression analysis and the Kaplan-Meier method were used to determine independent risk factors for IPR. A total of 243 (62%) patients received TTNB, while 149 (38%) underwent an alternate, or no, diagnostic technique. IPR was significantly more frequent in the TTNB group (p=0.004), while total recurrence was similar between the groups (p=0.098). After applying the weighted model, diagnostic TTNB (hazard ratio [HR], 5.27; 95% confidence interval [CI], 1.49-18.69; p=0.010), microscopic visceral pleural invasion (HR, 2.76; 95% CI, 1.08-7.01; p=0.033) and microscopic lymphatic invasion (HR, 3.25; 95% CI, 1.30-8.10; p=0.012) were associated with an increased frequency of IPR. Among patients who received TTNB, microscopic lymphatic invasion was a risk factor for IPR (HR, 2.74; 95% CI, 1.10-6.79; p=0.030). The diagnostic TTNB procedure is associated with pleural recurrence but may be unrelated to overall recurrence-free survival in early lung cancer. Moreover, microscopic lymphatic invasion could be a risk factor for pleural recurrence. TTNB should be carefully considered before lung resection and close follow-up to detect if pleural recurrence is needed. Copyright © 2017 Elsevier B.V. All rights reserved.

  13. Radical hybrid video-assisted thoracic segmentectomy: long-term results of minimally invasive anatomical sublobar resection for treating lung cancer.

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    Okada, Morihito; Tsutani, Yasuhiro; Ikeda, Takuhiro; Misumi, Keizo; Matsumoto, Kotaro; Yoshimura, Masahiro; Miyata, Yoshihiro

    2012-01-01

    We analysed the results of radical segmentectomy achieved through a hybrid video-assisted thoracic surgery (VATS) approach that used both direct vision and television monitor visualization at a median follow-up of over 5 years. Between April 2004 and October 2010, 102 consecutive patients able to tolerate lobectomy to treat clinical T1N0M0 non-small cell lung cancer (NSCLC) underwent hybrid VATS segmentectomy in which we used electrocautery without a stapler to divide the intersegmental plane detected by selective jet ventilation in addition to the path of the intersegmental veins. Curative resection was achieved in all patients. The median surgical duration and blood loss during the surgery were 129 min (range, 60-275 min) and 50 ml (range, 10-350 ml), respectively. The complication rate was 9.8% (10/102) with the most frequent being prolonged air leak, and there was no case of in-hospital death or 30-day mortality post procedure. Five and seven patients developed locoregional and distant recurrences, respectively. The overall and disease-free 5-year survival rates were 89.8% and 84.7%, respectively. Radical hybrid VATS segmentectomy including atypical resection of (sub)segments is a useful option for clinical stage-I NSCLC. The exact identification of anatomical intersegmental plane followed by dissection using electrocautery is critical from oncological and functional perspectives.

  14. Prognostic factors of tumor recurrence in completely resected non-small cell lung cancer

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    Tantraworasin A

    2013-06-01

    Full Text Available Apichat Tantraworasin,1 Somcharean Seateang,1 Nirush Lertprasertsuke,2 Nuttapon Arreyakajohn,3 Choosak Kasemsarn,4 Jayanton Patumanond5 1General Thoracic Unit, Department of Surgery, Faculty of Medicine, Chiang Mai University Hospital, Chiang Mai, Thailand; 2Department of Pathology, Faculty of Medicine, Chiang Mai University Hospital, Chiang Mai, Thailand; 3Cardiovascular Thoracic Unit, Department of Surgery, Lampang Hospital, Lampang, Thailand; 4Cardiovascular Thoracic Unit, Department of Surgery, Chest Institute, Nonthaburi, Thailand; 5Department of Community Medicine, Faculty of Medicine, Chiang Mai University Hospital, Chiang Mai, Thailand Background: Patients with completely resected non-small cell lung cancer (NSCLC have an excellent outcome; however tumor recurs in 30%-77% of patients. This study retrospectively analyzed the clinicopathologic features of patients with any operable stage of NSCLC to identify the prognostic factors that influence tumor recurrence, including intratumoral blood vessel invasion (IVI, tumor size, tumor necrosis, and nodal involvement. Methods: From January 2002 to December 2011, 227 consecutive patients were enrolled in this study. They were divided into two groups: the “no recurrence” group and the “recurrence” group. Recurrence-free survival was analyzed by multivariable Cox regression analysis, stratified by tumor staging, chemotherapy, and lymphatic invasion. Results: IVI, tumor necrosis, tumor diameter more than 5 cm, and nodal involvement were identified as independent prognostic factors of tumor recurrence. The hazard ratio (HR of patients with IVI was 2.1 times higher than that of patients without IVI (95% confident interval [CI]: 1.4–3.2 (P = 0.001.The HR of patients with tumor necrosis was 2.1 times higher than that of patients without tumor necrosis (95% CI: 1.3–3.4 (P = 0.001. Patients who had a maximum tumor diameter greater than 5 cm had significantly higher risk of recurrence than

  15. Pre-operative embolization facilitating a posterior approach for the surgical resection of giant sacral neurogenic tumors.

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    Chen, Kangwu; Zhou, Ming; Yang, Huilin; Qian, Zhonglai; Wang, Genlin; Wu, Guizhong; Zhu, Xiaoyu; Sun, Zhiyong

    2013-07-01

    The present study aimed to assess a posterior approach for the surgical resection of giant sacral neurogenic tumors, and to evaluate the oncological and functional outcomes. A total of 16 patients with giant sacral neurogenic tumors underwent pre-operative embolization and subsequent posterior sacral resection between January 2000 and June 2010. Benign tumors were identified in 12 cases, while four cases exhibited malignant peripheral nerve sheath tumors (MPNSTs). An evaluation of the operative techniques used, the level of blood loss, any complications and the functional and oncological outcomes was performed. All tumor masses were removed completely without intra-operative shock or fatalities. The mean tumor size was 17.5 cm (range, 11.5-28 cm) at the greatest diameter. The average level of intra-operative blood loss was 1,293 ml (range, 400-4,500 ml). Wound complications occurred in four patients (25%), including three cases of cutaneous necrosis and one wound infection. The mean follow-up time was 59 months (range, 24-110 months). Tumor recurrence or patient mortality as a result of the disease did not occur in any of the patients with benign sacral neurogenic tumors. The survival rate of the patients with malignant lesions was 75% (3/4 patients) since 25 % (1/4 patients) had multiple local recurrences and succumbed to the disease. The patients with benign tumors scored an average of 92.8% on the Musculoskeletal Tumor Society (MSTS) score functional evaluation, while the patients with malignant tumors scored an average of 60.3%. A posterior approach for the surgical resection of giant sacral neurogenic tumors, combined with pre-operative embolization may be safely conducted with satisfactory oncological and functional outcomes.

  16. Adjuvant Radiation Therapy Improves Local Control After Surgical Resection in Patients With Localized Adrenocortical Carcinoma

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    Sabolch, Aaron [Department of Radiation Oncology, University of Michigan Hospital and Health Systems, Ann Arbor, Mchigan (United States); Else, Tobias [Division of Metabolism, Endocrinology, and Diabetes, Department of Internal Medicine, University of Michigan Hospital and Health Systems, Ann Arbor, Mchigan (United States); Griffith, Kent A. [Center for Cancer Biostatistics, School of Public Health, University of Michigan, Ann Arbor, Mchigan (United States); Ben-Josef, Edgar [Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania (United States); Williams, Andrew [University of Michigan Medical School, Ann Arbor, Mchigan (United States); Miller, Barbra S. [Division of Endocrine Surgery, Department of General Surgery, University of Michigan Hospital and Health Systems, Ann Arbor, Mchigan (United States); Worden, Francis [Division of Hematology/Oncology, Department of Internal Medicine, University of Michigan Hospital and Health Systems, Ann Arbor, Mchigan (United States); Hammer, Gary D. [Division of Metabolism, Endocrinology, and Diabetes, Department of Internal Medicine, University of Michigan Hospital and Health Systems, Ann Arbor, Mchigan (United States); Jolly, Shruti, E-mail: shrutij@med.umich.edu [Department of Radiation Oncology, University of Michigan Hospital and Health Systems, Ann Arbor, Mchigan (United States)

    2015-06-01

    Purpose: Adrenocortical carcinoma (ACC) is a rare malignancy known for high rates of local recurrence, though the benefit of postoperative radiation therapy (RT) has not been established. In this study of grossly resected ACC, we compare local control of patients treated with surgery followed by adjuvant RT to a matched cohort treated with surgery alone. Methods and Materials: We retrospectively identified patients with localized disease who underwent R0 or R1 resection followed by adjuvant RT. Only patients treated with RT at our institution were included. Matching to surgical controls was on the basis of stage, surgical margin status, tumor grade, and adjuvant mitotane. Results: From 1991 to 2011, 360 ACC patients were evaluated for ACC at the University of Michigan (Ann Arbor, MI). Twenty patients with localized disease received postoperative adjuvant RT. These were matched to 20 controls. There were no statistically significant differences between the groups with regard to stage, margins, grade, or mitotane. Median RT dose was 55 Gy (range, 45-60 Gy). Median follow-up was 34 months. Local recurrence occurred in 1 patient treated with RT, compared with 12 patients not treated with RT (P=.0005; hazard ratio [HR] 12.59; 95% confidence interval [CI] 1.62-97.88). However, recurrence-free survival was no different between the groups (P=.17; HR 1.52; 95% CI 0.67-3.45). Overall survival was also not significantly different (P=.13; HR 1.97; 95% CI 0.57-6.77), with 4 deaths in the RT group compared with 9 in the control group. Conclusions: Postoperative RT significantly improved local control compared with the use of surgery alone in this case-matched cohort analysis of grossly resected ACC patients. Although this retrospective series represents the largest study to date on adjuvant RT for ACC, its findings need to be prospectively confirmed.

  17. Surgical myectomy for hypertrophic cardiomyopathy in the 21st century, the evolution of the "RPR" repair: resection, plication, and release.

    Science.gov (United States)

    Swistel, Daniel G; Balaram, Sandhya K

    2012-01-01

    Since its first description in the 1950s, the pathophysiology of hypertrophic cardiomyopathy has been clarified by advanced echocardiographic technologies. Improved pharmacotherapy now successfully treats most afflicted individuals. Along with these advances, surgical management has also evolved, as the role of the mitral valve and the subvalvular structures in causing obstruction has been identified. Over the last 2 decades, a variety of options to surgically manage the complex patient with obstruction have been described. Successful surgical management is dependent on the complete evaluation of the causes of obstruction in the specific individual, as the heterogeneity of the anatomy may confound the direction of therapy. Mitral valve replacement may no longer be necessary in individuals who have a relatively thin septum and instead obstruct from an elongated mitral anterior leaflet or the presence of accessory papillary muscles and chords. Techniques for mitral valve plication have been successfully used with mid- to long-term success. A systematic strategy for the evaluation of obstruction in hypertrophic cardiomyopathy and the various surgical options are summarized in a procedure termed RPR for resection (extended myectomy), plication (mitral valve shortening), and release (papillary muscle manipulation).

  18. Use of free subcutaneous fat pad for reduction of intraoperative air leak in thoracoscopic pulmonary resection cases with lung cancer.

    Science.gov (United States)

    Shintani, Yasushi; Inoue, Masayoshi; Nakagiri, Tomoyuki; Okumura, Meinoshin

    2014-08-01

    Intraoperative alveolar air leaks occur in patients with non-small-cell lung cancer (NSCLC) following a pulmonary resection using thoracoscopic surgery. We showed the efficacy of covering damaged lung tissue with a subcutaneous fat pad for preventing postoperative air leak. Thoracoscopic surgery was performed for NSCLC patients with three incisions along with a 3-4 cm anterior utility incision. When an air leak originated from deep within the pulmonary parenchyma or was large, a subcutaneous fat pad ∼2 × 2 cm in size was harvested from the utility incision and placed on the damaged lung tissue with fibrin glue and 2-3 mattress sutures. Subcutaneous fat pads were used for 50 patients with NSCLC during thoracoscopic surgery procedures. There were no intraoperative complications in any of the patients. A prolonged air leak (>7 days) was noted in 3 (6%) of the 50 patients. Air leak was diminished at 1.5 ± 2.6 postoperative days and the chest tubes removed at 3.2 ± 2.8 postoperative days. Reinforcement of damaged lung tissues by use of subcutaneous free fat pads is a safe and intriguing procedure in NSCLC patients who underwent a pulmonary resection in thoracoscopic surgery.

  19. High prevalence of lung cancer in a surgical cohort of lung cancer patients a decade after smoking cessation

    Directory of Open Access Journals (Sweden)

    Mosenifar Zab

    2011-02-01

    Full Text Available Abstract Background This study was designed to assess the prevalence of smoking at time of lung cancer diagnosis in a surgical patient cohort referred for cardiothoracic surgery. Methods Retrospective study of lung cancer patients (n = 626 referred to three cardiothoracic surgeons at a tertiary care medical center in Southern California from January 2006 to December 2008. Relationships among years of smoking cessation, smoking status, and tumor histology were analyzed with Chi-square tests. Results Seventy-seven percent (482 had a smoking history while 11.3% (71 were current smokers. The length of smoking cessation to cancer diagnosis was Conclusions In a surgical lung cancer cohort, the majority of patients were smoking abstinent greater than one decade before the diagnosis of lung cancer.

  20. Surgical issues in lung transplantation: options, donor selection, graft preservation, and airway healing.

    Science.gov (United States)

    Daly, R C; McGregor, C G

    1997-01-01

    To present an overview of the surgical issues in lung transplantation, including the historical context and the rationale for choosing a particular procedure for a specific patient, we reviewed and summarized the current medical literature and our personal experience. Several surgical options are available, including single lung transplantation; double lung transplantation; heart-lung transplantation; bilateral, sequential single lung transplantation; and (recently) single lobe transplantation. Although single lung transplantation is preferred for maximal use of the available organs, bilateral lung transplantation is necessary for septic lung diseases and may be appropriate for pulmonary hypertension and bullous emphysema. Heart-lung transplantation is performed for Eisenmenger's syndrome and for primary pulmonary hypertension with severe right ventricular failure. General factors for consideration in assessment of compatibility of the donor and potential recipient include ABO blood group, height (the donor should be within +/- 20% of the recipient's height), and length of the lungs (determined on an anteroposterior chest roentgenogram). Graft preservation and minimal duration of ischemia are important. Complications associated with airway healing are related to ischemia of the donor bronchus. We have addressed the issue of donor bronchial ischemia by direct revascularization of the donor bronchial arteries with use of the recipient's internal thoracic artery. Currently, lung transplantation offers a realistic therapeutic option to patients with end-stage pulmonary parenchymal or vascular disease.

  1. Is preoperative physiotherapy/pulmonary rehabilitation beneficial in lung resection patients?

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    Nagarajan, Kumaresan; Bennett, Ashley; Agostini, Paula; Naidu, Babu

    2011-09-01

    A best evidence topic in thoracic surgery was written according to a structured protocol. The question addressed was whether preoperative physiotherapy/pulmonary rehabilitation is beneficial for patients undergoing lung resection. Ten papers were identified using the reported search, of which five represented the best evidence to answer the clinical question. In 2007 a report showed in 13 subjects receiving a preoperative rehabilitation programme (PRP) an improvement of maximum oxygen uptake consumption (VO(2) max) of an average 2.4 ml/kg/min (95% confidence interval 1-3.8; P=0.002). A report in 2008 showed in 12 patients with chronic obstructive pulmonary disease (COPD) and VO(2) max PRP could effect a mean improvement in VO(2) max of 2.8 ml/kg/min (PPRP for two weeks compared with a historical control of 60 patients with COPD. It was shown in 2006 that by using a cross-sectional design with historical controls that one day of chest physiotherapy comprising inspiratory and peripheral muscle training compared with routine nursing care was associated with a lower atelectasis rate (2% vs. 7.7%) and a median length of stay that was 5.73 days vs. 8.33 days (PPRP followed by two months of postoperative rehabilitation produced a better predicted postoperative forced expiratory volume in one second in the study group than in the control group at three months (lobectomy + 570 ml vs. -70 ml; pneumonectomy + 680 ml vs. -110 ml). We conclude that preoperative physiotherapy improves exercise capacity and preserves pulmonary function following surgery. Whether these benefits translate into a reduction in postoperative pulmonary complication is uncertain.

  2. Dural Tail Sign in the Resection of Ventral Foramen Magnum Meningiomas via a Far Lateral Approach: Surgical Implications.

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    Wu, Bo; Shen, Shang-Hang; Chen, Long-Yi; Liu, Wei-Dong

    2015-11-01

    To investigate the implications of dural tail sign (DTS) in the tailored far lateral approach for resection of ventral foramen magnum meningiomas (FMMs). Clinical data for 16 patients treated surgically for ventral FMMs over 5 years were reviewed retrospectively. The DTS was positive in 11 cases (68.8%) and negative in 5 cases (31.2%). The most frequent form was a single cranial tail (7 of 11), followed by multiple tails consisting of a cranial tail and a caudal tail (3 of 11), and multiple tails composed of a cranial tail and a contralateral tail (1 of 11). The retrocondylar approach was carried out in 5 cases without DTS characterized by a narrow dural attachment and a partial transcondylar approach in 11 cases with DTS featuring a broad and hypervascular dural attachment. Drilling ranged from approximately one fifth to one third of the condyle with reference to the DTS form and tumor size. Total tumor removal was achieved in 16 patients. Postoperative complications were encountered in 25% of patients, predominantly associated with cranial nerve impairment. Follow-up ranging from 8 to 56 months (mean 24.4 months) showed no tumor recurrence. In addition to tumor dural attachment and tumor size, we propose that DTS should be considered as another factor in planning the surgical approach for ventral FMMs. Differentiation between a positive and negative DTS plays a role in the neurosurgical planning of ventral FMMs. Bone removal is warranted in tumors with DTS, particularly the multiple form with contralateral tails, to facilitate the surgical procedure and achieve a more radical resection. Copyright © 2015 Elsevier Inc. All rights reserved.

  3. Clinical and pathological characteristics of septum pellucidum tumor and choice of surgical approaches for its resection

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    WANG Lei; ZHANG Mao-zhi; ZHANG Wei; ZHAO Shang-feng; ZHAO Ji-zong; JIA Jin-xiu

    2005-01-01

    Background Tumor involving the septum pellucidum is uncommon. Surgery as the main therapeutic procedure for this lesion is a challenge to neurosurgeons. We analyzed the clinical characteristics and pathological features of septum pellucidum tumor in 41 patients and compared the curative effects of frontal transcortical, trans-sulcal and interhemispheric transcallosal approaches. Methods Clinical characteristics and the pathological features of septum pellucidum tumor were investigated retrospectively in 41 patients. The differences in postoperative residual rates, extents of tumors and resection of normal brain tissues after use of the three approaches in these patients were analyzed statistically. Results Septum pellucidum tumor is more likely to attack young or middle-aged persons. The tumor mainly presents itself as a central neurocytoma or cerebral low-grade glioma in pathology and manifests as intracranial hypertension clinically. No difference was found in the extent of tumor resection but significant difference in the extent of normal brain tissue resection and in postoperative disability rate among the three approaches. The transcortical approach brought about the most serious injury to brain tissue and the highest disability rate, Whereas the frontal transcallosal approach the lightest injury and the lowest disability rate. The injury to brain tissue and the disability rate brought about by the front trans-sulcus approach were between the above two approaches. Conclusions Operation is still regarded the major treatment for septum pellucidum tumor. Transcallosal and trans-sulcus approaches are fit with the concept of minimally invasive surgery, and transcallosal approach is the first choice for septum pellucidum tumor.

  4. Detection of Recurrence Patterns After Wedge Resection for Early Stage Lung Cancer: Rationale for Radiologic Follow-Up.

    Science.gov (United States)

    Billè, Andrea; Ahmad, Usman; Woo, Kaitlin M; Suzuki, Kei; Adusumilli, Prasad; Huang, James; Jones, David R; Rizk, Nabil Pierre

    2016-10-01

    Wedge resection for selected patients with early stage non-small cell lung cancer is considered to be a valid treatment option. The aim of this study was to evaluate the recurrence patterns after wedge resection, to analyze the survival of patients under routine follow-up, and to recommend a follow-up regimen. A retrospective analysis was done of 446 consecutive patients between May 2000 and December 2012 who underwent a wedge resection for clinical stage I non-small cell lung cancer. All patients were followed up with a computed tomography scan with or without contrast. The recurrence was recorded as local (involving the same lobe of wedge resection), regional (involving mediastinal or hilar lymph nodes or a different lobe), or distant (including distant metastasis and pleural disease). Median follow-up for survivors (n = 283) was 44.6 months. In all, 163 patients died; median overall survival was 82.6 months. Thirty-six patients were diagnosed with new primary non-small cell lung cancer, and 152 with recurrence (79 local, 45 regional, and 28 distant). There was no difference in the incidence of recurrence detection detected by computed tomography scans with versus without contrast (p = 0.18). The cumulative incidence of local recurrences at 1, 2, and 3 years was higher than the cumulative incidence for local, regional, and distant recurrences: 5.2%, 11.1%, and 14.9% versus 3.7%, 6.6%, and 9.5% versus 2.3%, 4.7%, and 6.4%, respectively. Primary tumor diameter was associated with local recurrence in univariate analysis. Wedge resection for early stage non-small cell lung cancer is associated with a significant risk for local and regional recurrence. Long-term follow-up using noncontrast computed tomography scans at consistent intervals is appropriate to monitor for these recurrences. Copyright © 2016 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  5. Impact of Portal Vein Involvement from Pancreatic Cancer on Metastatic Pattern After Surgical Resection.

    Science.gov (United States)

    Mierke, Franz; Hempel, Sebastian; Distler, Marius; Aust, Daniela E; Saeger, Hans-Detlev; Weitz, Jürgen; Welsch, Thilo

    2016-12-01

    The present study aims to evaluate the long-term outcome and metastatic pattern of patients who underwent resection of a pancreatic ductal adenocarcinoma (PDAC) with portal or superior mesenteric vein (PV/SMV) resection. Patients who underwent a partial pancreatoduodenectomy or total pancreatectomy for PDAC between 2005 and 2015 were retrospectively analyzed. Three subgroups were generated, depending on PV/SMV resection (P(+)) and pathohistological PV/SMV tumor infiltration (I(+)): P(+)I(+), P(+)I(-), and P(-)I(-). Statistical analysis was performed using the R software package. The study cohort included 179 patients, 113 of whom underwent simultaneous PV/SMV resection. Thirty-six patients (31.9 %) had pathohistological tumor infiltration of the PV/SMV (P(+)I(+)), and were matched with 66 cases without PV/SMV infiltration (P(-)I(-)). The study revealed differences in overall median survival (11.9 [P(+)I(+)] vs. 16.1 [P(+)I(-)] vs. 20.1 [P(-)I(-)] months; p = 0.01). Multivariate survival analysis identified true invasion of the PV/SMV as the only significant, negative prognostic factor (p = 0.01). Whereas the incidence of local recurrence was comparable (p = 0.96), the proportion of patients with distant metastasis showed significant differences (75 % [P(+)I(+)] vs. 45.8 % [P(+)I(-)] vs. 54.7 % [P(-)I(-)], p = 0.01). Furthermore, the median time to progression was significantly shorter if the PV/SMV was involved (7.4 months [P(+)I(+)] vs. 10.9 months [P(+)I(-)] vs. 11.6 months [P(-)I(-)]). Initial liver metastases occurred in 33 % of the patients. True invasion of the PV/SMV is an independent risk factor for overall survival, and is associated with a higher incidence of distant metastasis and shorter progressive-free survival. Radical vascular resection cannot compensate for aggressive tumor biology.

  6. Pre-surgical integration of FMRI and DTI of the sensorimotor system in transcortical resection of a high-grade insular astrocytoma

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    Chelsea eEkstrand

    2016-03-01

    Full Text Available Herein we report on a patient with a WHO Grade III astrocytoma in the right insular region in close proximity to the internal capsule who underwent a right frontotemporal craniotomy. Total gross resection of insular gliomas remains surgically challenging based on the possibility of damage to the corticospinal tracts. However, maximizing the extent of resection has been shown to decrease future adverse outcomes. Thus, the goal of such surgeries should focus on maximizing extent of resection while minimizing possible adverse outcomes. In this case, pre-surgical planning included integration of functional magnetic resonance imaging (fMRI and diffusion tensor imaging (DTI, to localize motor and sensory pathways. Novel fMRI tasks were individually developed for the patient to maximize both somatosensory and motor activation simultaneously in areas in close proximity to the tumor. Information obtained was used to optimize resection trajectory and extent, facilitating gross total resection of the astrocytoma. Across all three motor-sensory tasks administered, fMRI revealed an area of interest just superior and lateral to the astrocytoma. Further, DTI analyses showed displacement of the corona radiata around the superior dorsal surface of the astrocytoma, extending in the direction of the activation found using fMRI. Taking into account these results, a transcortical superior temporal gyrus surgical approach was chosen in order to avoid the area of interest identified by fMRI and DTI. Total gross resection was achieved and minor post-surgical motor and sensory deficits were temporary. This case highlights the utility of comprehensive pre-surgical planning, including fMRI and DTI, to maximize surgical outcomes on a case-by-case basis.

  7. Resected pN1 non-small cell lung cancer: recurrence patterns and nodal risk factors may suggest selection criteria for post-operative radiotherapy.

    Science.gov (United States)

    Borghetti, Paolo; Barbera, Fernando; Bonù, Marco Lorenzo; Trevisan, Francesca; Ciccarelli, Stefano; Vitali, Paola; Maddalo, Marta; Triggiani, Luca; Pasinetti, Nadia; Pedretti, Sara; Bonetti, Bartolomea; Pariscenti, Gianluca; Tironi, Andrea; Caprioli, Alberto; Buglione, Michela; Magrini, Stefano Maria

    2016-09-01

    To describe the pattern of recurrence in resected pN1 non-small cell lung cancer (NSCLC) and to identify factors predicting an increased risk of locoregional recurrence (LR) or distant metastasis (DM) to define a selected population who may benefit from postoperative radiotherapy (PORT). 285 patients with resected pN1 NSCLC were identified. Patients with positive surgical margins, undergoing neoadjuvant treatment or PORT, were excluded. LR was defined as first event of recurrence at the surgical bed, ipsilateral hilum or mediastinum, and other sites were considered as DM. Kaplan-Meier actuarial estimates of overall survival (OS), progression-free survival (PFS), freedom from LR (FFLR) and freedom from DM (FFDM) in different subgroups were compared with the log-rank test. Multivariate analysis was calculated. 202 patients met the inclusion criteria, 24 % received adjuvant chemotherapy. The median follow-up was 39 months. The total number of recurrences was 118 (64.4 %): 44 (24 %) and 74 (40.4 %) for LR and DM, respectively. Five-year OS and PFS rates were 39.2 and 33.3 %, respectively. Extra capsular extension (ECE) (RR 2.10, p = 0.01) and lymph nodal ratio (LNR) >0:15 (RR 1.68, p = 0.015) were associated with a worse PFS. ECE and LNR >0.15 were significantly related to a worst FFLR (RR 3.04 and 4.42, respectively), and adenocarcinoma to an unfavorable FFDM (RR 1.97, p = 0.013). Nodal factors as high LNR and ECE can predict an increased risk of worse FFLR and PFS. Prospective data on selected patients, treated with modern radiotherapy techniques, need to be collected to re-evaluate the role of radiotherapy.

  8. Morphologic and biochemical changes in male rat lung after surgical and pharmacological castration

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    M.S. Ojeda

    2000-03-01

    Full Text Available The morphology of the rat lung was studied by light microscopy in different situations: after surgical and pharmacological castration and after administration of testosterone to the castrated rat to determine if the androgen is required to maintain the normal morphology of the lung. We also determined the effect of flutamide on the phospholipid composition of both the surfactant and microsomes of the lung. Rats were separated into five groups: I - control non-castrated rats, II - castrated rats sacrificed 21 days after castration, III - castrated rats that received testosterone daily from day 2 to day 21 after castration, IV - castrated rats that received testosterone from day 15 to day 21 after castration, and V - control rats injected with flutamide for 7 days. The amount of different phospholipids in the surfactant and microsomes of the lung was measured in group I and V rats. At the light microscopy level, the surgical and pharmacological castration provoked alterations in the morphology of the lung, similar to that observed in human lung emphysema. The compositions of surfactant and microsomes of the lung were similar to those previously reported by us for the surgically castrated rats. These results indicate that androgens are necessary for the normal morphology as well as for some metabolic aspects of the lung.

  9. Cardiac inflammatory myofibroblastic tumor: does it recur after complete surgical resection in an adult?

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    Yang Xuedong

    2012-05-01

    Full Text Available Abstract Inflammatory myofibroblastic tumor is currently considered to be a low-grade neoplasm, and it rarely involves the heart. We reported a rare case of a 59-year-old female who received cardiac surgery for complete resection of inflammatory myofibroblastic tumor in the left atrium. Five months after surgery, the patient presented with acute cardiogenic pulmonary edema and subsequent sudden death due to a left atrial tumor which protruded into the left ventricle through mitral annulus during diastole. The recurrence of inflammatory myofibroblastic tumor in the left atrium was strongly suggested clinically.

  10. Combining Carcinoembryonic Antigen and Platelet to Lymphocyte Ratio to Predict Brain Metastasis of Resected Lung Adenocarcinoma Patients

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    Wei Wang

    2017-01-01

    Full Text Available We aimed to evaluate the role of pretreatment carcinoembryonic antigen (CEA and platelet to lymphocyte ratio (PLR in predicting brain metastasis after radical surgery for lung adenocarcinoma patients. The records of 103 patients with completely resected lung adenocarcinoma between 2013 and 2014 were reviewed. Clinicopathologic characteristics of these patients were assessed in the Cox proportional hazards regression model. Brain metastasis occurred in 12 patients (11.6%. On univariate analysis, N2 stage (P = 0.013, stage III (P = 0.016, increased CEA level (P = 0.006, and higher PLR value (P = 0.020 before treatment were associated with an increased risk of developing brain metastasis. In multivariate model analysis, CEA above 5.2 ng/mL (P = 0.014 and PLR ≥ 120 (P = 0.036 remained as the risk factors for brain metastasis. The combination of CEA and PLR was superior to CEA or PLR alone in predicting brain metastasis according to the receiver operating characteristic (ROC curve analysis (area under ROC curve, AUC 0.872 versus 0.784 versus 0.704. Pretreatment CEA and PLR are independent and significant risk factors for occurrence of brain metastasis in resected lung adenocarcinoma patients. Combining these two factors may improve the predictability of brain metastasis.

  11. Inducing of complete necrosis of recurred lung cancer by cryoablation; A case report

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    Lee, Sun Hye; Ham, Soo Youn; Hwang, Sung Ho; Oh, Yu Hwan [Dept. of Radiology, Korea University Anam Hospital, College of Medicine, Korea University, Seoul (Korea, Republic of)

    2016-12-15

    Lung cancer is one of the most commonly diagnosed cancers, and the lungs are a common site of metastasis from extrathoracic malignancies. Surgical resection is the gold standard treatment for lung malignancies. However, some of the patients are poor surgical candidates due to various reasons. Currently, image-guided ablation is used as one of the lung cancer treatment modalities. Cryoablation has been adapted as one of the treatments of lung tumors and a growing body of literature has shown that it is a safe and effective option. We report a case of successful cryoablation for a metastatic lesion from surgically resected primary lung cancer.

  12. Real-time Video-Streaming to Surgical Loupe Mounted Head-Up Display for Navigated Meningioma Resection.

    Science.gov (United States)

    Diaz, Roberto; Yoon, Jang; Chen, Robert; Quinones-Hinojosa, Alfredo; Wharen, Robert; Komotar, Ricardo

    2017-04-30

    Wearable technology interfaces with normal human movement and function, thereby enabling more efficient and adaptable use.We developed a wearable display system for use with intra-operative neuronavigation for brain tumor surgery. The Google glass head-up display system was adapted to surgical loupes with a video-streaming integrated hardware and software device for display of the Stealth S7 navigation screen. Phantom trials of surface ventriculostomy were performed. The device was utilized as an alternative display screen during cranial surgery. Image-guided brain tumor resection was accomplished using Google Glass head-up display of Stealth S7 navigation images. Visual display consists of navigation video-streaming over a wireless network. The integrated system developed for video-streaming permits video data display to the operating surgeon without requiring movement of the head away from the operative field. Google Glass head-up display can be used for intra-operative neuronavigation in the setting of intracranial tumor resection.

  13. CT-guided brachytherapy as salvage therapy for intrahepatic recurrence of HCC after surgical resection.

    Science.gov (United States)

    Schnapauff, Dirk; Collettini, Federico; Hartwig, Kerstin; Wieners, Gero; Chopra, Sascha; Hamm, Bernd; Gebauer, Bernhard

    2015-01-01

    Prevalence of patients with unresectable recurrence of hepatocellular carcinoma (HCC) after previous resection is rising. The purpose of this study was to determine survival of patients undergoing computed tomography-guided brachytherapy (CT-HDRBT). Altogether 19 patients with unresectable HCC recurrence were treated with CT-HDRBT at our Institution. Patients underwent single-fraction high-dose irradiation by an iridium-192 source after CT fluoroscopy-guided catheter placement. The median tumor-enclosing target dose was 20 Gy. The median follow-up was 33 months. According to the Kaplan-Meier method, median overall survival after CT-HDRBT was 50 months, and median survival after first hepatic resection was 87 months. The median duration of local tumor control was 32 months and time to disease progression was 20 months. There were no serious complications after CT-HDRBT and no treatment-related deaths. CT-HDRBT is a safe, potentially life prolonging technique in patients with recurrence of HCC who have few therapeutic options. Copyright© 2015 International Institute of Anticancer Research (Dr. John G. Delinassios), All rights reserved.

  14. Diabetes mellitus increases the risk of intrahepatic recurrence of hepatocellular carcinoma after surgical resection.

    Science.gov (United States)

    Choi, Yunseon; Choi, YoungKil; Choi, Chang Soo; Lee, Yun-Han

    2017-05-12

    The relationship between cancer and metabolism has recently been receiving attention. We investigated the prognostic influence of type 2 diabetes mellitus in patients with hepatocellular carcinoma (HCC) treated with curative resection. The records of 58 patients who underwent curative resection for HCC pT1-2N0M0 between 2010 and 2014 were reviewed retrospectively. Fourteen patients (24.1%) had diabetes mellitus at diagnosis. Local control (LC) was defined as time to recurrence in the liver. The median follow-up was 23.3 months. Relapses occurred in 20 patients (34.5%) during the follow-up period; 17 of them developed intrahepatic recurrence, which was associated with diabetes mellitus (p = 0.013) and alpha fetoprotein (AFP) levels >500 ng/mL (p = 0.019). Overall relapses (n = 20) were related to T stage (p = 0.044), AFP level (p = 0.005), and diabetes (p = 0.044). The 3-year local control (intrahepatic control), disease-free survival, and overall survival rates were 56.7%, 50.5%, and 84.3%, respectively. LC was affected by diabetes mellitus (p = 0.046), Barcelona Clinic Liver Cancer staging (pDiabetes was also associated with reduced LC in the subgroup with hepatitis B-related HCC (n = 44, p = 0.028). Diabetes mellitus is correlated with intrahepatic HCC recurrence after surgery. Greater attention should be paid to managing patients with HCC and diabetes mellitus.

  15. [Surgical treatment of lung metastases of kidney cancer].

    Science.gov (United States)

    Matveev, V B; Volkova, M I; Turkin, I N; Allakhverdiev, A K; Klimov, A V

    2013-01-01

    The medical records of 60 patients who underwent surgery to remove the lung metastases of T1-4N0-2 kidney cancer were retrospectively analyzed. The age of patients ranged from 31 to 70 years. Synchronous lung metastases were diagnosed in 20 (33.3%) cases, metachronous - in 40 (66.7%). 53 (88.3%) patients had lesions in one lung, and 7 (11.7%) patients--in both lungs. Solitary metastases were present in 41 (68.3%) patients, multiple--in 19 (31.7%). In 69.4% of cases, the size of lung metastases was more than 2 cm. Metastasis at other sites at the time of surgery on the lungs were present in 1 patient (supraclavicular lymph nodes). The primary tumor was removed in 56 (93.3%) of 60 patients. All 60 patients underwent removal of lung metastases (radical--53 [88.3%]). One patient underwent a radical supraclavicular lymph node dissection. All tumor lesions were removed in 50 (83.3%) patients. Median followup period was 20 (3-155) months. Perioperative complication rate was 6.6%; no deaths caused by complications of treatment were registered. Histologically, metastases of renal cell carcinoma were verified in all removed lesions from the lungs; 3 (5%) patients had mediastinal lymph node metastases. Five- and 10-year overall, specific and recurrence free survival rates were 36.3 and 19.1%, 38.9% and 27.2, 20.4 and 11.7%, respectively. Univariate analysis demonstrated an adverse effect of pN + category, bilateral pulmonary lesions, the presence of mediastinal lymph nodes metastases and non-radical removal of malignant lesions of the lung on the specific survival. Multivariate analysis confirmed a significant effect of radical surgery on the survival.

  16. Surgical technique for lung retransplantation in the mouse

    Science.gov (United States)

    Li, Wenjun; Goldstein, Daniel R.; Bribriesco, Alejandro C.; Nava, Ruben G.; Spahn, Jessica H.; Wang, Xingan; Gelman, Andrew E.; Krupnick, Alexander S.

    2013-01-01

    Microsurgical cuff techniques for orthotopic vascularized murine lung transplantation have allowed for the design of studies that examine mechanisms contributing to the high failure rate of pulmonary grafts. Here, we provide a detailed technical description of orthotopic lung retransplantation in mice, which we have thus far performed in 144 animals. The total time of the retransplantation procedure is approximately 55 minutes, 20 minutes for donor harvest and 35 minutes for the implantation, with a success rate exceeding 95%. The mouse lung retransplantation model represents a novel and powerful tool to examine how cells that reside in or infiltrate pulmonary grafts shape immune responses. PMID:23825768

  17. Surgical treatment for lumbar hyperlordosis after resection of a spinal lipoma associated with spina bifida: A case report.

    Science.gov (United States)

    Sato, Tatsuya; Yonezawa, Ikuho; Onda, Shingo; Yoshikawa, Kei; Takano, Hiromitsu; Shimamura, Yukitoshi; Okuda, Takatoshi; Kaneko, Kazuo

    2017-09-01

    A hyperlordosis deformity of the lumbar spine is relatively rare, and surgical treatment has not been comprehensively addressed. In this case report, we describe the clinical presentation, surgical treatment, and medium-term follow-up of a patient presenting with a progressive lumbar hyperlordosis deformity after resection of a spinal lipoma associated with spina bifida. The patient was a 20-year-old woman presenting with a progressive hyperlordosis deformity of the lumbar spine associated with significant back pain (visual analog pain score of 89/100 mm), but with no neurological symptoms. The lumbar lordosis (LL), measured on standing lateral view radiographs, was 114°, with a sagittal vertical axis (SVA) of -100 mm. The patient had undergone excision of a lipoma, associated with spina bifida of the lumbar spine, at 7 months of age.She was first evaluated at our hospital at 18 years of age for progressive spinal deformity and lumbago. An in situ fusion, from T5 to S1, using pedicle screws with bone graft obtained from the iliac crest, was performed. Postoperatively, the LL decreased to 93°, and the SVA decreased to -50 mm. The decision to not correct the hyperlordosis deformity fully was intentional. Seven years and 1 month postsurgery, the patient had no limitations in standing and walking and reported a pain score of 8/100 mm; there was no evidence of a loss of correction. Lumbar hyperlordosis after resection of a spinal lipoma associated with spina bifida is rare. Posterior fixation provided an effective treatment in this case. As the lumbar hyperlordosis deformity is often high, correction can be difficult. In this case, although the correction and fusion were performed in situ, there was no progression of either the deformity or the lumbago. Early detection remains an essential component of effective treatment, allowing correction when the spinal deformity is easily reversible.

  18. Long-term Survival of Personalized Surgical Treatment of Locally Advanced Non-small Cell Lung Cancer Based on Molecular Staging

    Directory of Open Access Journals (Sweden)

    Qinghua ZHOU

    2011-02-01

    Full Text Available Background and objective Approximately 35%-40% of patients with newly diagnosed non-small cell Lung cancer have locally advanced disease. The average survival time of these patients only have 6-8 months with chemotherapy. The aim of this study is to explore and summarize the probability of detection of micrometastasis in peripheral blood for molecular staging, and for selection of indication of surgical treatment, and beneficiary of neoadjuvant chemotherapy and postoperative adjuvant therapy in locally advanced lung cancer; to summarize the long-time survival result of personalized surgical treatment of 516 patients with locally advanced non-small cell lung cancer based on molecular staging methods. Methods CK19 mRNA expression of peripheral blood samples was detected in 516 lung cancer patients by RT-PCR before operation for molecular diagnosis of micrometastasis, personalized molecular staging, and for selection of indication of surgical treatment and the beneficiary of neoadjuvant chemotherapy and postoperative adjuvant therapy in patients with locally advanced nonsmall cell lung cancer invaded heart, great vessels or both. The long-term survival result of personalized surgical treatment was retrospectively analyzed in 516 patients with locally advanced non-small cell lung cancer based on molecular staging methods. Results There were 322 patients with squamous cell carcinoma and 194 cases with adenocarcinoma in the series of 516 patients with locally advanced lung cancer involved heart, great vessels or both. There were 112 patients with IIIA disease and 404 cases with IIIB disease according to P-TNM staging. There were 97 patients with M-IIIA disease, 278 cases with M-IIIB disease and 141 cases with III disease according to our personalized molecular staging. Of the 516 patients, bronchoplastic procedures and pulmonary artery reconstruction was carried out in 256 cases; lobectomy combined with resection and reconstruction of partial left

  19. Patient-related independent clinical risk factors for early complications following Nd: YAG laser resection of lung cancer

    Directory of Open Access Journals (Sweden)

    Branislav Perin

    2012-01-01

    Full Text Available Introduction: Neodymium:yttrium aluminum garnet (Nd:YAG laser resection is one of the most established interventional pulmonology techniques for immediate debulking of malignant central airway obstruction (CAO. The major aim of this study was to investigate the complication rate and identify clinical risk factors for complications in patients with advanced lung cancer. Methods: In the period from January 2006 to January 2011, data sufficient for analysis were identified in 464 patients. Nd:YAG laser resection due to malignant CAO was performed in all patients. The procedure was carried out in general anesthesia. Complications after laser resection were defined as severe hypoxemia, global respiratory failure, arrhythmia requiring treatment, hemoptysis, pneumothorax, pneumomediastinum, pulmonary edema, tracheoesophageal fistulae, and death. Risk factors were defined as acute myocardial infarction within 6 months before treatment, hypertension, chronic arrhythmia, chronic obstructive pulmonary disease (COPD, stabilized cardiomyopathy, previous external beam radiotherapy, previous chemotherapy, and previous interventional pulmonology treatment. Results : There was 76.1% male and 23.9% female patients in the study, 76.5% were current smokers, 17.2% former smokers, and 6.3% of nonsmokers. The majority of patients had squamous cell lung cancer (70%, small cell lung cancer was identified in 18.3%, adenocarcinoma in 3.4%, and metastases from lung primary in 8.2%. The overall complication rate was 8.4%. Statistically significant risk factors were age (P = 0.001, current smoking status (P = 0.012, arterial hypertension (P < 0.0001, chronic arrhythmia (P = 0.034, COPD (P < 0.0001, and stabilized cardiomyopathy (P < 0.0001. Independent clinical risk factors were age over 60 years (P = 0.026, arterial hypertension (P < 0.0001, and COPD (P < 0.0001. Conclusion : Closer monitoring of patients with identified risk factors is advisable prior and immediately after

  20. Surgical resection of a giant primary liposarcoma of the anterior mediastinum

    Science.gov (United States)

    Mani, Vishnu R.; Ofikwu, Godwin; Safavi, Ali

    2015-01-01

    This case describes the incidental finding and surgical removal of an 1.8-kg liposarcoma in the anterior mediastinum. These tumors are very rare and would normally present with symptoms of intrathoracic compression; however, this patient was completely asymptomatic. The case presentation and treatment rationale are described along with a brief review of existing literature. PMID:26410831

  1. Surgical resection of a giant primary liposarcoma of the anterior mediastinum

    OpenAIRE

    Mani, Vishnu R.; Ofikwu, Godwin; Safavi, Ali

    2015-01-01

    This case describes the incidental finding and surgical removal of an 1.8-kg liposarcoma in the anterior mediastinum. These tumors are very rare and would normally present with symptoms of intrathoracic compression; however, this patient was completely asymptomatic. The case presentation and treatment rationale are described along with a brief review of existing literature.

  2. Surgical technique for lung retransplantation in the mouse

    OpenAIRE

    Li, Wenjun; Goldstein, Daniel R.; Bribriesco, Alejandro C.; Nava, Ruben G.; Spahn, Jessica H.; Wang, Xingan; Gelman, Andrew E.; Krupnick, Alexander S.; Kreisel, Daniel

    2013-01-01

    Microsurgical cuff techniques for orthotopic vascularized murine lung transplantation have allowed for the design of studies that examine mechanisms contributing to the high failure rate of pulmonary grafts. Here, we provide a detailed technical description of orthotopic lung retransplantation in mice, which we have thus far performed in 144 animals. The total time of the retransplantation procedure is approximately 55 minutes, 20 minutes for donor harvest and 35 minutes for the implantation,...

  3. Desmoid Fibromatosis of the Abdominal Wall: Surgical Resection and Reconstruction with Biological Matrix Egis®

    Directory of Open Access Journals (Sweden)

    Saveria Tropea

    2017-02-01

    Full Text Available Desmoid tumor is a rare monoclonal fibroblast proliferation that is regarded as benign. The clinical management of desmoid tumors is very complex and requires a multidisciplinary approach because of the unpredictable disease course. For those cases localized in the anterior abdominal wall, symptomatic and unresponsive to medical treatment, radical resection and reconstruction with a prosthetic device are indicated. We present here a case of desmoid fibromatosis of the left anterolateral abdominal wall with a marked increase of the mass that required a large excision followed by reconstruction with biological matrix. The fact that it can be incorporated in patient tissue without a fibrotic response and that it can resist future infections, together with a very competetive price, made the new collagen matrix Egis® our first choice.

  4. Evaluation of intraoperative radiotherapy for gastric carcinoma with D2 and D3 surgical resection

    Institute of Scientific and Technical Information of China (English)

    Huan-Long Qin; Chao-Hong Lin; Xiu-Long Zhang

    2006-01-01

    AIM: To study the proper sites and doses of intraoperative radiotherapy (IORT) for gastric carcinoma and the effects of this treatment.METHODS: A total of 106 patients with stage Ⅰ -Ⅳ gastric carcinoma who Received D2 or D3 radical operation combined with IORT were analyzed. Sixty-seven patients with gastric cancer of the antrum and body underwent distal gastrectomy. The sites of irradiation were at the celiac artery and hepatoduodenal ligment area. Another 39 patients with carcinoma of the cardia and upper part of the gastric body and whole stomach underwent proximal gastrectomy or total gastrectomy. The sites of irradiation for this group were the upper margin of the pancreas and the regional para-aorta. The therapeutic effects (including survival and complications) of these 106 cases Received operation combined with IORT (IORT group) were compared with 441 cases treated during the same time period by a radical operation alone (operation group).RESULTS: The radiation dose below 30 Gy was safe.The therapeutic method of the operation combined with IORT did not prolong the survival of patients with stage Ⅰ and Ⅳ gastric cancer, but the 5-year survival rates of patients with stage Ⅱ and Ⅲ gastric cancers were significantly improved. The 5-year survival rates of the stages Ⅲ cancer patients receiving D2 resection combined with IORT were markedly improved, while for those receiving D3 radical resection, only the postoperative 3- or 4-year survival rates were improved (P < 0.005-0.001). The 5-year survival rate for those patients was raised only by 4.7% (P > 0.05).CONCLUSION: The 5-year survival rates of patients lymphadenectomy combined with IORT were improved,and there was no influence on the postoperative complications and mortality.

  5. Does the sequence of pulmonary vasculature ligation have any oncological impact during an anatomical lung resection for non-small-cell lung cancer?

    Science.gov (United States)

    Toufektzian, Levon; Attia, Rizwan; Polydorou, Nicolaos; Veres, Lukacs

    2015-02-01

    A best evidence topic in thoracic surgery was written according to a structured protocol. The question addressed was 'in patients with primary lung carcinoma, does the sequence of pulmonary vasculature ligation during anatomical lung resection influence the oncological outcomes?' A total of 48 papers were found using the reported search, of which 7 represented the best evidence to answer the question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. Among six prospective studies included, five of them randomized patients to either pulmonary vein or artery occlusion first during anatomical lung resection, while one study was retrospective. Two reports did not find any difference between pulmonary vein and artery occlusion first during long-term follow-up in terms of either disease recurrence (51 vs 53%, P = 0.7), or 5-year overall survival (54 vs 50%, P = 0.82). One report did not find any difference with regard to circulating tumour cells either after thoracotomy (5.0 vs 3.9, P = 0.4), or after the completion of lobectomy (38.0 vs 70.0, P = 0.23). One report found a higher expression of CD44v6 (P = 0.008) and CK19 (P = 0.05) in patients undergoing pulmonary arterial occlusion first. One report found that pulmonary vein occlusion before that of the pulmonary arterial branches has a favourable outcome on circulating carcino-embryonic antigen (CEA) mRNA in the peripheral blood, while another one did not find a significant difference in circulating levels of CEA mRNA (P = 0.075) and CK19 mRNA (P = 0.086) with either method. Another study reported no correlation between circulating pin1 mRNA levels in peripheral blood after the completion of the resection and the sequence of ligation of pulmonary vessels (9.95 ± 0.91 vs 14.71 ± 1.64, P > 0.05). Based on the two studies assessing the long-term outcome of patients with primary lung cancer undergoing anatomical curative

  6. [Lung carcinosarcoma. A case report].

    Science.gov (United States)

    El Mezni, F; Mrabet, N; Smati, B; Smail, O; Kilani, T

    2004-09-01

    Carcinosarcoma of the lung is a rare highly malignant tumor of unknown histogenesis. There is an epithelial carcinomatous component and a malignant mesenchmatous component with heterologous tissue. Survival at two years after surgical resection is not greater than 10%. We report a case observed in a 71-year-old man who developed chest pain. Outcome was fatal at three months. Pathology examination of a transparietal biopsy provided the diagnosis which was confirmed by immunohistochemistry on the surgical resection specimen.

  7. {sup 18}F-FDG uptake at the surgical margin after hepatic resection: Patterns of uptake and differential diagnosis

    Energy Technology Data Exchange (ETDEWEB)

    Peungjesada, Silanath [University New Mexico, Department of Radiology, Albuquerque, NM (United States); Aloia, Thomas A. [University of Texas MD Anderson Cancer Center, Department of Surgical Oncology, Unit 444, Houston, TX (United States); Fox, Patricia [University of Texas MD Anderson Cancer Center, Department of Biostatistics, Unit 1411, Houston, TX (United States); Chasen, Beth [University of Texas MD Anderson Cancer Center, Department of Nuclear Medicine, Unit 1483, Houston, TX (United States); Shin, Sooyoung; Loyer, Evelyne M. [University of Texas MD Anderson Cancer Center, Department of Diagnostic Radiology, Unit 1473, Houston, TX (United States); Baiomy, Ali [Cairo University, National Cancer Center, Cairo (Egypt)

    2015-08-15

    To evaluate the patterns of {sup 18}F-FDG uptake at the surgical margin after hepatectomy to identify features that may differentiate benign and malignant uptake. Patients who had undergone a PET/CT after hepatectomy were identified. Delay between resection and PET/CT, presence of uptake at the surgical margin, pattern of uptake, and maximal standardized value were recorded. The PET/CT findings were correlated with contrast-enhanced CT or MRI. There were 26 patients with increased 18F-FDG uptake; uptake was diffuse in seven and focal in 19. Diffuse uptake was due to inflammation in all cases. Focal uptake was due to recurrence in 12 and inflammation in seven cases. Defining a focal pattern only as a positive for malignancy yielded 100 % sensitivity, 87 % specificity, 37 % false positive rate. As expected, SUV{sub max} was significantly higher for recurrence than inflammation, but did overlap. Contrast-enhanced CT allowed differentiation between malignant and benign uptake in all cases. F-FDG uptake after hepatectomy does not equate to recurrence and yields a high false positive rate. Diffuse uptake did not require additional evaluation in our sample. Focal uptake, however, may be due to recurrence; differentiating benign and malignant nodular uptake relies on optimal contrast-enhanced CT or MRI. (orig.)

  8. Surgical resection of a renal cell carcinoma involving the inferior vena cava: the role of the cardiothoracic surgeon

    LENUS (Irish Health Repository)

    Parissis, Haralabos

    2010-11-05

    Abstract Background The techniques for the resection of renal tumors with IVC extension are based on the experience of individual units. We attempt to provide a logical approach of the surgical strategies in a stepwise fashion. Methods Over 6-years 9 patients with renal cell carcinoma invading the IVC, underwent surgery. There were 6 males. The extension was at level IV in 4 and III in 5 cases. CPB used in 8 and hypothermia and circulatory arrest in all patients with level IV disease. The results and an algorithm of the plan of action, as per level of extension are presented. Results Plan of action: For level I-II disease: No Cardiothoracic involvement, For level III: Cardiopulmonary Bypass (CPB) & control of the cavo-atrial junction. For level IV: use of brief periods of Circulatory Arrest & repair of the Cavotomy with a pericardial patch. Postoperative morbidity: prolonged ICU stay, 3 patients (33.3%); tracheostomy, 1 (11.1%); Sepsis, 2 (22.2%); CVA 1, (11.1%). Mortality: 2 patients (22.2%) Conclusions Total clearance of the IVC from an adherent tumor is important, therefore extensive level IV disease presents a surgical challenge. We recommend CPB for level III and brief periods of Total Circulatory Arrest (TCA) for level IV disease.

  9. Impact of obesity on the surgical outcome following repeat hepatic resection in Japanese patients with recurrent hepatocellular carcinoma

    Institute of Scientific and Technical Information of China (English)

    Tohru Utsunomiya; Masahiro Okamoto; Toshihumi Kameyama; Ayumi Matsuyama; Manabu Yamamoto; Megumu Fujiwara; Masaki Mori; Shiomi Aimitsu; Teruyoshi Ishida

    2008-01-01

    AIM:To evaluate the impact of obesity on the postoperative outcome after hepatic resection in patients with hepatocellular carcinoma (HCC).METHODS:Data from 328 consecutive patients with primary HCC and 60 patients with recurrent HCC were studied.We compared the surgical outcomes between the non-obese group (body mass index:BHI<25 kg/m2)and the obese group(BHI≥25 kg/m2).RESULTS:Following curative hepatectomy in patients with primary HCC,the incidence of postoperative complications and the long-term prognosis in the nonobese group(n=240) were comparable to those in the obese group(n=88).Among patients with recurrent HCC,the incidence of postoperative complications after repeat hepatectomy was not significantly different between the non-obese group(n=44) and the obese group(n=16).However,patients in the obese group showed a significantly poorer long-term prognosis than those in the non-obese group(P<0.05,five-year survival rate;51.9% and 92.0%,respectively).CONCLUSION:Obesity alone may not have an adverse effect on the surgical outcomes of patients with primary HCC.However,greater caution seems to be required when planning a repeat hepatectomy for obese patients with recurrent HCC.

  10. Blocking Surgically Induced Lysyl Oxidase Activity Reduces the Risk of Lung Metastases

    Directory of Open Access Journals (Sweden)

    Chen Rachman-Tzemah

    2017-04-01

    Full Text Available Surgery remains the most successful curative treatment for cancer. However, some patients with early-stage disease who undergo surgery eventually succumb to distant metastasis. Here, we show that in response to surgery, the lungs become more vulnerable to metastasis due to extracellular matrix remodeling. Mice that undergo surgery or that are preconditioned with plasma from donor mice that underwent surgery succumb to lung metastases earlier than controls. Increased lysyl oxidase (LOX activity and expression, fibrillary collagen crosslinking, and focal adhesion signaling contribute to this effect, with the hypoxic surgical site serving as the source of LOX. Furthermore, the lungs of recipient mice injected with plasma from post-surgical colorectal cancer patients are more prone to metastatic seeding than mice injected with baseline plasma. Downregulation of LOX activity or levels reduces lung metastasis after surgery and increases survival, highlighting the potential of LOX inhibition in reducing the risk of metastasis following surgery.

  11. Impact of visceral pleural invasion and vessel invasion on initial recurrence site and prognosis in surgically resected non-small cell lung cancer%脏层胸膜侵犯和脉管癌栓对非小细胞肺癌术后初始复发部位及预后的影响

    Institute of Scientific and Technical Information of China (English)

    冯耀; 茅乃权; 王守峰; 杨立; 吴俊伟

    2016-01-01

    背景与目的:脏层胸膜侵犯(visceral pleural invasion,VPI)和脉管癌栓(vessel invasion,VI)是非小细胞肺癌(non-small cell lung cancer,NSCLC)患者预后的危险因素,前者的初始复发部位可能以局部复发为主,而后者可能以远处转移多见。本研究主要探讨VPI和VI对初始复发部位及术后生存率的影响。方法:回顾性分析广西医科大学附属肿瘤医院2007年1月—2013年12月期间住院的NSCLC手术治疗患者的完整资料共计290例。VPI患者51例,无VPI患者239例;有VI患者29例,无VI患者261例,分别比较其临床特征、总生存期(overall survival,OS)及无病生存期(disease-free survival,DFS)的差异。结果:VPI组与无VPI组的肿瘤大小、淋巴结转移、TNM病理分期和初始复发部位相比,差异有统计学意义(P 72.3%,P=0.001). Cox regression showed TNM stage was a significant prognostic factor for DFS, whereas lymph node metastasis and VPI were signiifcant prognostic factors in patients with NSCLC.Conclusion:The primary initial recurrence site in VPI patients is local recurrence. Patients with VPI or VI may need more postoperative therapy because of their poor prognosis.

  12. Basaloid large cell lung carcinoma presenting as cutaneous metastasis at the colostomy site after abdominoperineal resection for rectal carcinoma.

    Science.gov (United States)

    Sabater-Marco, Vicente; García-García, José Angel; Roig-Vila, José Vicente

    2013-08-01

    The occurrence of a tumor at the colostomy site after abdominoperineal resection for rectal carcinoma is rare and it may be related to a previously resected carcinoma or another primary tumor. We report a 61-year-old man who developed an ulcerated skin nodule at her colostomy site 6 years after resection of a rectal adenocarcinoma. Histopathologically, the skin nodule was composed of atypical large and pleomorphic cells with high mitotic rate and they were arranged in nests and within lymphatic channels in the dermis. The neoplastic cells were immunoreactive for cytokeratin (CK) AE1/3, CK7, CK34ßE12, epithelial membrane antigen and vimentin while detection of human papillomavirus and Epstein-Barr virus DNA was negative. A diagnosis of basaloid large cell carcinoma of pulmonary origin was suggested and it was confirmed by computed tomography-guided fine needle aspiration of a right subpleural mass. A metastatic tumor at the colostomy site is an exceptional finding and may be the first manifestation of lung cancer, especially if it consist of pleomorphic large cells with high mitotic rate and basaloid immunophenotype.

  13. ERCC1 and the efficacy of cisplatin in patients with resected non-small cell lung cancer.

    Science.gov (United States)

    Li, Chunhong; Liu, Meiyan; Yan, An; Liu, Wei; Hou, Junjun; Cai, Li; Dong, Xiaoqun

    2014-12-01

    Excision repair cross-complementing gene 1 (ERCC1) protein is proposed as a predictor for cisplatin efficacy in patients with non-small cell lung cancer (NSCLC). However, recent studies declare that ERCC1 is not associated with the response of platinum-based chemotherapy or clinical outcomes. The purpose of this study is to assess whether ERCC1 expression level is linked to cisplatin sensitivity and clinical outcomes in resected NSCLC patients. Paraffin-embedded cancer samples from 112 patients were used for immunohistochemical staining. Cancer cells isolated from fresh tumor tissues were used to determine the sensitivity to cisplatin by MTT assay. The association between ERCC1 expression and cisplatin sensitivity was tested by Spearman's rho test. The correlation of ERCC1 expression with clinicopathologic parameters was evaluated by the chi-square tests. The relationship between variables and survival was assessed by log-rank test. Overall survival (OS) and disease-free survival (DFS) curves were plotted by the Kaplan-Meier method. Cox proportional hazards model was used for multivariate analysis of survival. ERCC1 expression was significantly correlated with the sensitivity of cisplatin in vitro (p < 0.01, r = 0.37). ERCC1 was not associated with OS (p = 0.17) or DFS (p = 0.13) in patients with resected NSCLC. ERCC1 is not a sensible marker for the choice of treatment in clinical patients with resected NSCLC.

  14. 18F-FDG uptake as a biologic factor predicting outcome in patients with resected non-small-cell lung cancer

    Institute of Scientific and Technical Information of China (English)

    ZHANG Zhen-jiang; CHEN Jing-han; MENG Long; DU Jia-jun; ZHANG Lin; LIU Ying; DAI Hong-hai

    2007-01-01

    Background The outcome of surgical treatment of non-small-cell lung cancer (NSCLC) remains poor. In many patients the biological behavior of NSCLC does not follow a definite pattern, and can not be accurately predicted before treatment. 18F-fluoro-2-deoxy-glucose (18F-FDG) uptake on positron-emission tomography (PET) is associated with the aggressiveness of NSCLC. The present study focused on the role of 18F-FDG uptake in predicting the outcome of surgically treated patients with NSCLC.Methods A retrospective analysis was made of 82 patients who underwent complete resection and preoperative FDG PET. The maximum standardized uptake value (SUVmax), in addition to five clinicopathological factors and three biomolecular factors, which could possibly influence survival, was compared for possible association with patients' recurrence and survival, by the Log-rank test in univariate analysis and the Cox proportional hazards model in multivariate analysis. The association between SUVmax and other factors was also analyzed. Results Patients with SUVmax more than 11 had a disease-free survival and overall survival shorter than patients with SUVmax less than 11 in univariate analyses (P<0.001, P=0.002). In the multivariate analysis, SUVmax (dichotomized by 11) was the only significant predictor for tumor recurrence. TNM stage and SUVmax (dichotomized by 11) were independent predictors for the overall survival. Associations of SUVmax with p53 overexpression, proliferating cell nuclear antigen (PCNA) labeling index and microvascular density of the tumor were significant in the entire group. Conclusions 18F-FDG uptake on PET may be used to noninvasively assess biological aggressiveness of NSCLC in vivo, identifying the surgically-treated patients with poor prognosis who could benefit from additional therapy.

  15. The Changes of Blood Coagulation in Surgical Patients with Lung Cancer

    Directory of Open Access Journals (Sweden)

    Xiangning FU

    2010-02-01

    Full Text Available Background and objective Patients with malignant tumor are at high risk of thrombophilia, which contributes to thromboembolism. Surgical treatment is one of the critical risk factors. In this study, changes and clinical significances of blood coagulation of lung cancer patients pre- and post operation were investigated. Methods A prospective, controlled study were carried out in 74 lung disease patients, who were divided into lung cancer group and benign lung disease group. In each group, pre-and postoperative changes in prothrombin time (PT, activated partial thromboplastin time (APTT, platelet count (PLT, D-dimer (D-D and fibrinogen (Fib and clinical performances were observed and compared in intra- and intergroups. Results The concentration of Fib both in lung cancer group and its subgroup (adenocarcinoma of lung increased, preoperative differences between benign lung disease group and subgroup (squamous cell carcinoma of lung was significant (P < 0.05. PT(postoperative 1st to7th day in lung cancer group prolonged, APTT (postoperative 3rd to7th day reduced, Fib (postoperative 3rd to7th day and D-D (postoperative 1st to 7th day increased, PLT reduced on the 1st, 3rd day but then increased on the 5th, 7th day after operation, the difference between pre- and post-operation was significant (P < 0.05. D-D and PT in lung cancer group on the 7th day was longer than in benign lung disease group (P < 0.05. One pulmonary thromboembolism (PTE case in lung cancer group occurred, while in benign lung disease group none venous thromboembolism (VTE appeared. Conclusion Patients with lung cancer are in high hypercoagulable state, and prone to VTE. It is necessary to take some interventions to avoid VTE.

  16. Crizotinib Treatment Combined with Resection and Whole-brain Radiation Therapy 
in A ROS1 Rearranged Lung Adenocarcinoma with Brain Metastasis: 
Case Report and Literature Review

    Directory of Open Access Journals (Sweden)

    Min ZHANG

    2016-08-01

    Full Text Available Background and objective Lung cancer with brain metastasis had poor prognosis. Crizotinib had been confirmed to be used in ROS1 (C-ros oncogene 1 receptor tyrosine kinase rearranged lung adenocarcinoma, but its efficacy in lung cancer with brain metastasis was poor due to the blood brain barrier. In the present study, we reported one case of ROS1 fusion lung adenocarcinoma with symptomatic brain matastasis, who was treated with brain metastases resection, crizotinib, and whole brain radiotherapy plus boost to residual brain metastasis. The safety and efficacy was summarized. Methods At first, surgical resection was used to relive mass effect and to biopsy. Then crizotinib (250 mg, bid was chosen for the existence of ROS1 fusion gene. Whole brain radiotherapy plus boost to residual brain metastasis were used after surgery. Objective response was evaluated by Response Evaluation Criteriation in Solid Tumours (RECIST v1.1 and brain metastasis were evaluated by computer tomography (CT/magnetic resonance imaging (MRI image. Adverse events were evaluated according to Common Terminology Criteria for Adverse Events (CTC AE v4.0. Results After taking crizotinib for 3 months, the lung lesions were close to complete response (CR, the brain metastasis were partial response (PR, the abdomen metastasis were CR and the symptom of blurred vision relieved. Conclusion Crizotinib combined with palliative operation and radiation therapy (WBRT plus boost to residual brain metastasis in the treatment of ROS1 fusion gene positive lung adenocarcinoma with symptomatic brain metastases, can effectively control intracranial lesions with good tolerance.

  17. Surgical resection of a huge cemento-ossifying fibroma in skull base by intraoral approach.

    Science.gov (United States)

    Cheng, Xiao-Bing; Li, Yun-Peng; Lei, De-Lin; Li, Xiao-Dong; Tian, Lei

    2011-03-01

    Cemento-ossifying fibroma, also known as ossifying fibroma, usually occurs in the mandible and less commonly in the maxilla. The huge example in the skull base is even rare. We present a case of a huge cemento-ossifying fibroma arising below the skull base of a 30-year-old woman patient. Radiologic investigations showed a giant, lobulated, heterogeneous calcified hard tissue mass, which is well circumscribed and is a mixture of radiolucent and radiopaque, situated at the rear of the right maxilla to the middle skull base. The tumor expands into the right maxillary sinus and the orbital cavity, fusing with the right maxilla at the maxillary tuberosity and blocking the bilateral choanas, which caused marked proptosis and blurred vision. The tumor was resected successfully by intraoral approach, and pathologic examination confirmed the lesion to be a cemento-ossifying fibroma. This case demonstrates that cemento-ossifying fibroma in the maxilla, not like in the mandible, may appear more aggressive because the extensive growth is unimpeded by anatomic obstacles and that the intraoral approach can be used to excise the tumor in the skull base.

  18. [A surgically resected case of AFP and PIVKA-II producing gastric cancer with hepatic metastasis].

    Science.gov (United States)

    Tomono, Ayako; Wakahara, Tomoyuki; Kanemitsu, Kiyonori; Toyokawa, Akihiro; Teramura, Kazuhiro; Iwasaki, Takeshi

    2013-05-01

    A 78-year-old man was admitted for workup for a liver tumor. Both serum AFP and PIVKA-II levels were high (2260ng/ml and 806mAU/ml, respectively). Contrast-enhanced CT scan and MRI using Gd-EOB-DTPA demonstrated a liver tumor in segment 6 resembling the imaging patterns of hepatocellular carcinoma (HCC), while the upper gastrointestinal endoscopy revealed a type 2 gastric cancer in the gastric antrum. Although the liver metastasis of the gastric cancer was undeniable, we performed partial resection of segment 6 of the liver and distal gastrectomy under a preoperative diagnosis of double cancer. Histopathologically, gastric tumor consisted of two components, such as well differentiated adenocarcinoma and hepatoid adenocarcinoma. The histology of the liver tumor was similar to that of the hepatoid component in the stomach lesion. Immunohistochemical staining revealed both the gastric and the liver tumors to be positive for AFP and PIVKA-II, yielding a definite diagnosis of AFP and PIVKA-II producing gastric cancer with liver metastasis. Because many cases of this disease have liver metastases at presentation with confusing images with HCC, the diagnosis of liver tumors should be carefully differentiated in the gastric cancer patients with liver tumors, high serum AFP and PIVKA-II levels.

  19. Surgical treatment for early hepatocellular carcinoma: comparison of resection and liver transplantation.

    Science.gov (United States)

    Zhou, Jian; Wang, Zheng; Qiu, Shuang-Jian; Huang, Xiao-Wu; Sun, Jian; Gu, Wen; Fan, Jia

    2010-09-01

    The optimum strategy, hepatic resection (HR) or liver transplantation (LT), for treatment of early hepatocellular carcinoma (HCC) associated with liver diseases of Child-Pugh A is far from established. The aim of this study was to compare and determine which strategy is optimal for HCC fulfilling the Milan criteria. Consecutive data were collected in 1,018 HCC patients treated with HR and 89 HCC patients listed for LT (1 drop out for HCC progression) between January of 2003 and December of 2007. The independent prognostic factors identified by multivariate analysis were tumor size-plus-number, microscopic venous invasion, and operation type (LT or HR). When tumor size-plus-number was HR group. When tumor size-plus-number was >4 or microscopic venous invasion was present, OS was higher in the LT group. Since the pathological microscopic venous invasion was not easily available before operation which is limitation for widespread clinical use, thus in practice, we concluded that, for early HCC associated with Child-Pugh A cirrhosis, when tumor size-plus-number is >4, LT provides the best cure; when it is HR remains the initial treatment of choice.

  20. En bloc resection concept for endoscopic endonasal nasopharyngectomy: surgical anatomy and outcome

    Institute of Scientific and Technical Information of China (English)

    Hsu Ning-i; Shen Ping-hung; Chao Siew-shuen; Ong Yew-kwang; Li Cho-shun

    2014-01-01

    Background Nasopharyngeal carcinoma (NPC) patients have a 19%-56% locoregional recurrence rate after primary therapy.For those recurrent NPC (rNPC) patients,re-irradiation may cause some complications.In recent years,endoscopic endonasal nasopharyngectomy (EEN) has become a surgical option for rNPC patients.Here we introduce the concept of en bloc excision (EBE) technique for EEN,including the surgical technique and clinical outcomes.Methods A retrospective study was conducted covering September 2009 to May 2013,involving the collection of Iocoregional rNPC cases from two institutions (Kuang-Tien General Hospital (KTGH) in Taiwan and National University Health System (NUHS) in Singapore).These patients failed prior therapy and then underwent EEN.We reported the 2-year overall survival rate,the 2-year disease-free survival rate,and related complications.Results Nine patients (five from KTGH and four from NUHS) completed this study,with five,two,and two patients of recurrence tumors (rT1),rT2,and rT3,respectively.The mean age was 46.4 years (range 32-63); the mean follow-up period was 24.9 months (range 10-45).The 2-year survival rate and the 2-year disease-free rate were 100% and 80%,respectively,in five patients.No significant complications or cases of mortality occurred.Conclusions The EBE concept of EEN is suitable for early rT1 and has relatively encouraging short-term outcomes.In selected rT2,careful EBE can be performed by expanding the surgical field.A clear view of the internal carotid arteryrelated anatomy is indispensable.In the future,more series may be needed to determine the role of EEN in rNPC patients.

  1. Analysis of the learning curve for transurethral resection of the prostate. Is there any influence of musical instrument and video game skills on surgical performance?

    Science.gov (United States)

    Yamaçake, Kleiton Gabriel Ribeiro; Nakano, Elcio Tadashi; Soares, Iva Barbosa; Cordeiro, Paulo; Srougi, Miguel; Antunes, Alberto Azoubel

    2015-09-01

    To evaluate the learning curve for transurethral resection of the prostate (TURP) among urology residents and study the impact of video game and musical instrument playing abilities on its performance. A prospective study was performed from July 2009 to January 2013 with patients submitted to TURP for benign prostatic hyperplasia. Fourteen residents operated on 324 patients. The following parameters were analyzed: age, prostate-specific antigen levels, prostate weight on ultrasound, pre- and postoperative serum sodium and hemoglobin levels, weight of resected tissue, operation time, speed of resection, and incidence of capsular lesions. Gender, handedness, and prior musical instrument and video game playing experience were recorded using survey responses. The mean resection speed in the first 10 procedures was 0.36 g/min and reached a mean of 0.51 g/min after the 20(th) procedure. The incidence of capsular lesions decreased progressively. The operation time decreased progressively for each subgroup regardless of the difference in the weight of tissue resected. Those experienced in playing video games presented superior resection speed (0.45 g/min) when compared with the novice (0.35 g/min) and intermediate (0.38 g/min) groups (p=0.112). Musical instrument playing abilities did not affect the surgical performance. Speed of resection, weight of resected tissue, and percentage of resected tissue improve significantly and the incidence of capsular lesions reduces after the performance of 10 TURP procedures. Experience in playing video games or musical instruments does not have a significant effect on outcomes.

  2. Identification of subsets of patients with favorable prognosis after recurrence in completely resected non-small cell lung cancer.

    Science.gov (United States)

    Sonobe, Makoto; Yamada, Tetsu; Sato, Masaaki; Menju, Toshi; Aoyama, Akihiro; Sato, Toshihiko; Chen, Fengshi; Omasa, Mitsugu; Bando, Toru; Date, Hiroshi

    2014-08-01

    This retrospective study aimed to determine prognostic factors associated with postrecurrence survival of completely resected non-small cell cancer patients with postoperative recurrence. Characteristics, treatment modality, and postrecurrence survival of 234 patients (157 males and 77 females, mean age at recurrence: 68.7 years, 152 adenocarcinomas and 82 non-adenocarcinomas), who underwent complete resection for non-small cell lung cancer between 2003 and 2009 at our hospital and experienced recurrence, were analyzed for prognostic factors. Cox proportional hazard model was applied for multivariate analysis. Among 234 patients, the median survival time after the diagnosis of recurrence was 21 months, and the 5-year postrecurrence survival rate was 19.9 %. Eastern Cooperative Oncology Group Performance Status (ECOG PS) (hazard ratio [HR]: ECOG PS-0/PS-1/PS-2 = 1/3.313/7.622), time to recurrence after surgery (HR: >2 years/1-2 years/recurrent organs (HR: 1 organ/2 organs/3 or more organs = 1/1.896/2.818) were independent prognostic factors. Patients who received resection or stereotactic irradiation for limited number of brain metastases or solitary extracranial metastasis, and those who received mediastinal radiation or chemoradiation for recurrence at regional lymph nodes and/or resected stump had better survival (median survival time after recurrence: 34, 64, and 25 months, respectively). Poor ECOG PS, shorter time from initial surgery to recurrence, and increasing number of initial recurrent regions are associated with poor prognosis after recurrence. When the number of recurrent lesions is limited, intensive local treatment with curative intent should be applied for achieving long-term postrecurrence survival.

  3. The single institutional outcome of postoperative radiotherapy and concurrent chemoradiotherapy in resected non-small cell lung cancer

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Hyo Chun; Kim, Yeon Si; Oh, Se Jin; Lee, Yun Hee; Lee, Dong Soo; Song, Jin Ho; Kang, Jin Hyung; Park, Jae Ki [Seoul St. Mary' s Hospital, The Catholic University of Korea College of Medicine, Seoul (Korea, Republic of)

    2014-09-15

    This study was conducted to observe the outcomes of postoperative radiotherapy (PORT) with or without concurrent chemotherapy in resected non-small cell lung cancer (NSCLC) in single institution. From 2002 to 2013, 78 patients diagnosed with NSCLC after curative resection were treated with radiotherapy alone (RT, n = 48) or concurrent chemoradiation (CCRT, n = 30). The indications of adjuvant radiation therapy were N2 node positive (n = 31), close or involved resection margin (n = 28), or gross residual disease due to incomplete resection (n = 19). The median radiation dose was 57.6 Gy (range, 29.9 to 66 Gy). Median survival time was 33.7 months (range, 4.4 to 140.3 months). The 5-year overall survival (OS) rate was 49.5% (RT 46% vs. CCRT 55.2%; p = 0.731). The 3-year disease-free survival rate was 45.5% (RT 39.4% vs. CCRT 55.3%; p = 0.130). The 3-year local control rate was 68.1% (RT 64.4% vs. CCRT 77.7%; p = 0.165). The 3-year DMFS rate was 56.1% (RT 52.6% vs. CCRT 61.7%; p = 0.314). In multivariate analysis, age > or =66 years and pathologic stage III were significant poor prognostic factors for OS. Treatment failure occurred in 40 patients. Four patients had radiologically confirmed grade 3 radiation pneumonitis. In NSCLC, adjuvant RT or CCRT after curative surgery is a safe and feasible modality of treatment. OS gain was seen in patients less than 66 years. Postoperative CCRT showed a propensity of achieving better local control and improved disease-free survival compared to RT alone according to our data.

  4. Exploring Stage I non-small-cell lung cancer: development of a prognostic model predicting 5-year survival after surgical resection†.

    Science.gov (United States)

    Guerrera, Francesco; Errico, Luca; Evangelista, Andrea; Filosso, Pier Luigi; Ruffini, Enrico; Lisi, Elena; Bora, Giulia; Asteggiano, Elena; Olivetti, Stefania; Lausi, Paolo; Ardissone, Francesco; Oliaro, Alberto

    2015-06-01

    Despite impressive results in diagnosis and treatment of non-small-cell lung cancer (NSCLC), more than 30% of patients with Stage I NSCLC die within 5 years after surgical treatment. Identification of prognostic factors to select patients with a poor prognosis and development of tailored treatment strategies are then advisable. The aim of our study was to design a model able to define prognosis in patients with Stage I NSCLC, submitted to surgery with curative intent. A retrospective analysis of two surgical registries was performed. Predictors of survival were investigated using the Cox model with shared frailty (accounting for the within-centre correlation). Candidate predictors were: age, gender, smoking habit, morbidity, previous malignancy, Eastern Cooperative Oncology Group performance status, clinical N stage, maximum standardized uptake value (SUV(max)), forced expiratory volume in 1 s, carbon monoxide lung diffusion capacity (DLCO), extent of surgical resection, systematic lymphadenectomy, vascular invasion, pathological T stage, histology and histological grading. The final model included predictors with P fair discrimination ability (C-statistic = 0.69): the calibration of the model indicated a good agreement between observed and predicted survival. We designed an effective prognostic model based on clinical, pathological and surgical covariates. Our preliminary results need to be refined and validated in a larger patient population, in order to provide an easy-to-use prognostic tool for Stage I NSCLC patients. © The Author 2014. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

  5. Laparoscopic assisted central pancreatectomy with pancreaticogastrostomy reconstruction - An alternative surgical technique for central pancreatic mass resection

    Directory of Open Access Journals (Sweden)

    Iswanto Sucandy

    2010-09-01

    Full Text Available Context: Central pancreatectomy has gained popularity in the past decade as treatment of choice for low malignant potential tumor in the midpancreas due to its ability to achieve optimal preservation of pancreatic parenchyma. Simultaneously, advancement in minimally invasive approach has contributed to numerous novel surgical techniques with significantly lower morbidity and mortality. With the purpose of improving patient outcomes, we describe a laparoscopic assisted central pancreatectomy with pancreaticogastrostomy as an alternative method to the previously described open central pancreatectomy with roux-en-y pancreaticojejunostomy reconstruction. Case Report: A 39 year old man presented to our clinic with a 2.5 cm neuroendocrine tumor at the neck of the pancreas. Laparoscopic assisted central pancreatectomy with pancreaticogastrostomy reconstruction was successfully performed. Operative time was 210 minutes with blood loss of 200 ml. Postoperative course was uneventful except for a minimal pancreatic leak which was controlled by an intraoperatively placed closed suction drain. At 2 week follow up, patient was asymptomatic with well preserved pancreatic endo and exocrine functions. Permanent pathology findings showed a well differentiated neuroendocrine tumor with negative margins and nodes. Conclusions: Laparoscopic assisted central pancreatectomy with pancreaticogastrostomy reconstruction is feasible and safe for a centrally located tumor. Laparoscopic assisted technique facilitates application of minimally invasive approach by increasing surgical feasibility in typically complex pancreatic operations.

  6. Laparoscopic assisted central pancreatectomy with pancreaticogastrostomy reconstruction - An alternative surgical technique for central pancreatic mass resection

    Directory of Open Access Journals (Sweden)

    Iswanto Sucandy

    2010-01-01

    Full Text Available Context: Central pancreatectomy has gained popularity in the past decade as treatment of choice for low malignant potential tumor in the midpancreas due to its ability to achieve optimal preservation of pancreatic parenchyma. Simultaneously, advancement in minimally invasive approach has contributed to numerous novel surgical techniques with significantly lower morbidity and mortality. With the purpose of improving patient outcomes, we describe a laparoscopic assisted central pancreatectomy with pancreaticogastrostomy as an alternative method to the previously described open central pancreatectomy with roux-en-y pancreaticojejunostomy reconstruction. Case Report: A 39 year old man presented to our clinic with a 2.5 cm neuroendocrine tumor at the neck of the pancreas. Laparoscopic assisted central pancreatectomy with pancreaticogastrostomy reconstruction was successfully performed. Operative time was 210 minutes with blood loss of 200 ml. Postoperative course was uneventful except for a minimal pancreatic leak which was controlled by an intraoperatively placed closed suction drain. At 2 week follow up, patient was asymptomatic with well preserved pancreatic endo and exocrine functions. Permanent pathology findings showed a well differentiated neuroendocrine tumor with negative margins and nodes. Conclusions: Laparoscopic assisted central pancreatectomy with pancreaticogastrostomy reconstruction is feasible and safe for a centrally located tumor. Laparoscopic assisted technique facilitates application of minimally invasive approach by increasing surgical feasibility in typically complex pancreatic operations.

  7. Systematic review of surgical innovation reporting in laparoendoscopic colonic polyp resection.

    Science.gov (United States)

    Currie, A; Brigic, A; Blencowe, N S; Potter, S; Faiz, O D; Kennedy, R H; Blazeby, J M

    2015-01-01

    The IDEAL framework (Idea, Development, Exploration, Assessment, Long-term study) proposes a staged assessment of surgical innovation, but whether it can be used in practice is uncertain. This study aimed to review the reporting of a surgical innovation according to the IDEAL framework. Systematic literature searches identified articles reporting laparoendoscopic excision for benign colonic polyps. Using the IDEAL stage recommendations, data were collected on: patient selection, surgeon and unit expertise, description of the intervention and modifications, outcome reporting, and research governance. Studies were categorized by IDEAL stages: 0/1, simple technical preclinical/clinical reports; 2a, technique modifications with rationale and safety data; 2b, expanded patient selection and reporting of both innovation and standard care outcomes; 3, formal randomized controlled trials; and 4, long-term audit and registry studies. Each stage has specific requirements for reporting of surgeon expertise, governance details and outcome reporting. Of 615 abstracts screened, 16 papers reporting outcomes of 550 patients were included. Only two studies could be put into IDEAL categories. One animal study was classified as stage 0 and one clinical study as stage 2a through prospective ethical approval, protocol registration and data collection. Studies could not be classified according to IDEAL for insufficient reporting details of patient selection, relevant surgeon expertise, and how and why the technique was modified or adapted. The reporting of innovation in the context of laparoendoscopic colonic polyp excision would benefit from standardized methods. © 2015 BJS Society Ltd. Published by John Wiley & Sons Ltd.

  8. Perioperative Rehabilitation in Operable Lung Cancer Patients (PROLUCA)

    DEFF Research Database (Denmark)

    Sommer, Maja S.; Trier, Karen; Vibe-Petersen, Jette

    2016-01-01

    Introduction: Surgical resection in patients with non-small cell lung cancer (NSCLC) may be associated with significant morbidity, functional limitations, and decreased quality of life. Objectives: The safety and feasibility of a preoperative and early postoperative rehabilitation program...

  9. A Prospective Randomized Study of Adjuvant Chemotherapy in Completely Resected Stage Ⅲ-N2 Non Small Cell Lung Cancer

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    Objective: To evaluate the effect of postoperative adjuvant chemotherapy on survival after complete resection of stage Ⅲ-N2 non-small-cell lung cancer. Methods: From Jan. 1999 to Dec. 2003, one-hundred and fifty patients, who were diagnosed as stage Ⅲ-N2 non-small cell lung cancer after operation, were randomly devided into chemotherapy group and control group. The former received four cycles of chemotherapy with NVB (25 mg/m2,D1, D5)/paclitaxel (175 mg/m2, DI) and Carboplatin (AUC=5, D1). Results: In chemotherapy group, 75.8% (68/79) of patients had finished the 4 cycles of chemotherapy and no one died of toxic effects of chemotherapy.Twenty-five percent of the patients had grade 3-4 neutropenia and 2% had febrile neutropenia. The median survival for the entire 150 patients was 879 d, with 1-year survival rate of 81%, 2-year survival rate of 59% and 3-year survival rate of 43%. There was no significant difference in median survival between chemotherapy and control group (897 d vs 821 d, P=0.0527), but there was significant difference in the 1-year and 2-year overall survival (94.71%, 76.28% vs 512 d, P=0.122), but there was significant difference in the 2-year survival rate between two groups with brain metastases (66.7% vs 37.6% P<0.05). The median survival after brain metastasis appeared was 190 days. Conclusion: Postoperative adjuvant chemotherapy does not significantly improve median survival among patients with completely resected stage Ⅱ-N2 non-small-cell lung cancer, but significantly improves the 1-year and 2-year overall survival. It neither decreases the incidence of brain metastasis but put off the time of brain metastasis.

  10. Management of cannabis-induced periodontitis via resective surgical therapy: A clinical report.

    Science.gov (United States)

    Momen-Heravi, Fatemeh; Kang, Philip

    2017-03-01

    There is a lack of clinical research on the potential effect of cannabis use on the periodontium as well as its effect on treatment outcomes. The aim of this case report is to illustrate the clinical presentation of periodontal disease in a young woman who was a chronic cannabis user, as well as successful treatment involving motivating the patient to quit cannabis use and undergo nonsurgical and surgical therapy. A 23-year-old woman sought care at the dental clinic for periodontal treatment. During a review of her medical history, the patient reported using cannabis frequently during a 3-year period, which coincided with the occurrence of gingival inflammation. She used cannabis in the form of cigarettes that were placed at the mandibular anterior region of her mouth for prolonged periods. Localized prominent papillary and marginal gingival enlargement of the anterior mandible were present. The mandibular anterior teeth showed localized severe chronic periodontitis. The clinicians informed the patient about the potentially detrimental consequences of continued cannabis use; she was encouraged to quit, which she did. The clinicians performed nonsurgical therapy (scaling and root planing) and osseous surgery. The treatment outcome was evaluated over 6 months; improved radiographic and clinical results were observed throughout the follow-up period. Substantial availability and usage of cannabis, specifically among young adults, requires dentists to be vigilant about clinical indications of cannabis use and to provide appropriate treatments. Behavioral modification, nonsurgical therapy, and surgical therapy offer the potential for successful management of cannabis-related periodontitis. Copyright © 2017 American Dental Association. Published by Elsevier Inc. All rights reserved.

  11. Diagnostic performance of FDG PET/CT for surveillance in asymptomatic gastric cancer patients after curative surgical resection

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Jeong Won [Catholic Kwandong University College of Medicine, Department of Nuclear Medicine, International St. Mary' s Hospital, Incheon (Korea, Republic of); Lee, Sang Mi [Soonchunhyang University Hospital, Department of Nuclear Medicine, 23-20 Byeongmyeong-dong, Dongnam-gu, Chungcheongnam-do, Cheonan (Korea, Republic of); Son, Myoung Won; Lee, Moon-Soo [Soonchunhyang University Hospital, Department of Surgery, Cheonan (Korea, Republic of)

    2016-05-15

    The present study evaluated the diagnostic performance of 2-[{sup 18}F] fluoro-2-deoxy-d-glucose (FDG) positron emission tomography/computed tomography (PET/CT) for surveillance in asymptomatic gastric cancer patients after curative surgical resection. We retrospectively recruited 190 gastric cancer patients (115 early gastric cancer patients and 75 advanced gastric cancer patients) who underwent 1-year (91 patients) or 2-year (99 patients) postoperative FDG PET/CT surveillance, along with a routine follow-up program, after curative surgical resection. All enrolled patients were asymptomatic and showed no recurrence on follow-up examinations performed before PET/CT surveillance. All PET/CT images were visually assessed and all abnormal findings on follow-up examinations including FDG PET/CT were confirmed with histopathological diagnosis or clinical follow-up. During follow-up, 19 patients (10.0 %) developed recurrence. FDG PET/CT showed abnormal findings in 37 patients (19.5 %). Among them, 16 patients (8.4 %) were diagnosed as cancer recurrence. Of 153 patients without abnormal findings on PET/CT, three patients were false-negative and diagnosed as recurrence on other follow-up examinations. The sensitivity, specificity, positive predictive value, and negative predictive value of FDG PET/CT were 84.2 %, 87.7 %, 43.2 %, and 98.0 %, respectively. Among 115 early gastric cancer patients, PET/CT detected recurrence in four patients (3.5 %) and one patient with local recurrence. Among 75 advanced gastric cancer patients, PET/CT detected recurrence in 12 patients (16.0 %), excluding two patients experiencing peritoneal recurrence. In addition, FDG PET/CT detected secondary primary cancer in six (3.2 %) out of all the patients. Post-operative FDG PET/CT surveillance showed good diagnostic ability for detecting recurrence in gastric cancer patients. FDG PET/CT could be a useful follow-up modality for gastric cancer patients, especially those with advanced gastric cancer

  12. Risk Factors for Local and Distant Recurrence After Surgical Treatment in Patients With Non-Small-Cell Lung Cancer.

    Science.gov (United States)

    Dziedzic, Dariusz Adam; Rudzinski, Piotr; Langfort, Renata; Orlowski, Tadeusz

    2016-09-01

    The purpose of this study was to identify independent perioperative and pathologic variables associated with non-small-cell lung cancer (NSCLC) recurrence after complete surgical resection. A retrospective examination was performed of a prospectively maintained database of patients who underwent resection for NSCLC from January 2009 to January 2014 at a multi-institution. Clinicopathologic variables were evaluated for their influence on frequency of recurrence. Cox proportional regression hazard model analysis examined the association of recurrence in NSCLC. Of these patients, 2816 (19.3%) experienced recurrence of primary cancer. Local or distant recurrence was found in 20.5% and 79.5% of patients, respectively. Median follow-up was 27.9 months (range, 11.4-66.0 months). The analysis indicated independent effects of the following risk factors on the risk of recurrence: age 64-90 years (hazard ratio [HR], 1.136; 95% confidence interval [CI] 1.024-1.261), histologic type adenocarcinoma (HR, 1.117; 95% CI 1.005-1.24), blood vessel invasion (HR, 1.236; 95% CI, 1.124-1.359), lymphatic vessel invasion (HR, 1.287; 95% CI, 1.176-1.409), visceral pleural invasion (HR, 1.641; 95% CI, 1.215-2.218), N1 disease (HR, 1.142; 95% CI, 0.99-1.316), N2 disease (HR, 1.596; 95% CI, 1.271-1.649), tumor size of 20-30 mm (HR, 1.235; 95% CI, 1.081-1.41), 30-50 mm (HR, 1.544; 95% CI, 1.33-1.792), 50-70 mm (HR, 1.521; 95% CI, 1.275-1.815), and 70-100 mm (HR, 1.71; 95% CI, 1.385-2.11), pneumonectomy (HR, 1.08; 95% CI, 0.97-1.203), and sublobar resection (HR, 1.762; 95% CI, 1.537-2.019). In the largest series reported to date on postresection recurrence of NSCLC, increasing pathologic stage, advanced age, pneumonectomy, sublobar resection, lymphatic and blood vessel invasion, and visceral pleural invasion were independently associated with local and distant recurrence. Copyright © 2016 Elsevier Inc. All rights reserved.

  13. Surgical excision of lung metastases from squamous carcinoma of the cervix. A report of 2 cases

    Energy Technology Data Exchange (ETDEWEB)

    De Moor, N.G.; Berry, A.V.; Nissenbaum, M.M. (University of the Witwatersrand, Johannesburg (South Africa))

    1983-01-01

    These 2 case reports serve to emphasize two important points concerning carcinoma of the cervix: (i) blood-borne metastases are now frequently encountered in this disease; and (ii) in selected cases surgical excision of a secondary deposit in the lung is the treatment of choice and may even result in cure.

  14. Surgical excision of lung metastases from squamous carcinoma of the cervix. A report of 2 cases.

    Science.gov (United States)

    de Moor, N G; Berry, A V; Nissenbaum, M M

    1983-01-01

    These 2 case reports serve to emphasize two important points concerning carcinoma of the cervix: (i) blood-borne metastases are now frequently encountered in this disease; and (ii) in selected cases surgical excision of a secondary deposit in the lung is the treatment of choice and may even result in cure.

  15. Postoperative Complications, In-Hospital Mortality and 5-Year Survival After Surgical Resection for Patients with a Pancreatic Neuroendocrine Tumor: A Systematic Review.

    Science.gov (United States)

    Jilesen, Anneke P J; van Eijck, Casper H J; in't Hof, K H; van Dieren, S; Gouma, Dirk J; van Dijkum, Els J M Nieveen

    2016-03-01

    Studies on postoperative complications and survival in patients with pancreatic neuroendocrine tumors (pNET) are sparse and randomized controlled trials are not available. We reviewed all studies on postoperative complications and survival after resection of pNET. A systematic search was performed in the Cochrane Central Register of Controlled Trials, MEDLINE and EMBASE from 2000-2013. Inclusion criteria were studies of resected pNET, which described postoperative complications separately for each surgical procedure and/or 5-year survival after resection. Prospective and retrospective studies were pooled separately and overall pooled if heterogeneity was below 75%. The random-effect model was used. Overall, 2643 studies were identified and after full-text analysis 62 studies were included. Pancreatic fistula (PF) rate of the prospective studies after tumor enucleation was 45%; PF-rates after distal pancreatectomy, pancreatoduodenectomy, or central pancreatectomy were, respectively, 14-14-58%. Delayed gastric emptying rates were, respectively, 5-5-18-16%. Postoperative hemorrhage rates were, respectively, 6-1-7-4%. In-hospital mortality rates were, respectively, 3-4-6-4%. The 5-year overall survival (OS) and disease-specific survival (DSS) of resected pNET without synchronous resected liver metastases were, respectively, 85-93%. Heterogeneity between included studies on 5-year OS in patients with synchronous resected liver metastases was too high to pool all studies. The 5-year DSS in patients with liver metastases was 80%. Morbidity after pancreatic resection for pNET was mainly caused by PF. Liver resection in patients with liver metastases seems to have a positive effect on DSS. To reduce heterogeneity, ISGPS criteria and uniform patient groups should be used in the analysis of postoperative outcome and survival.

  16. Effect of lung resection and sham surgery on the frequency of infection in alloxan-diabetic rats

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    A.C. Seidel

    2003-03-01

    Full Text Available The present study was carried out in order to determine the effect of lung resection on the frequency of infections in alloxan-diabetic rats. Adult female Wistar rats were injected with alloxan (40 mg/kg, iv to induce diabetes mellitus (group D; N = 45 or with vehicle (1.0 ml/kg, iv to be used as controls (group C; N = 45. Thirty-six days after receiving alloxan both groups were randomly divided into three subgroups: no operation (NO; N = 15, sham operation (SO; N = 15, and left pneumonectomy (PE; N = 15. The rats were sacrificed 36 days after surgery and their lungs were examined microscopically and macroscopically. The occurrence of thoracic wall infection, thoracic wall abscess, lung abscess and pleural empyema was similar in groups D and C. In contrast, the overall infection rate was higher (P<0.05 in the diabetic rats (SO-D and PE-D subgroups, but not in the NO-D subgroup. Considering that the overall infection rate was similar in the SO-D and PE-D subgroups, we suggest that surgery but not pneumonectomy was related to the higher prevalence of infection in diabetic rats.

  17. The postoperative neutrophil-to-lymphocyte ratio and changes in this ratio predict survival after the complete resection of stage I non-small cell lung cancer

    Science.gov (United States)

    Jin, Feng; Han, Anqin; Shi, Fang; Kong, Li; Yu, Jinming

    2016-01-01

    Purpose Although numerous studies have demonstrated associations between the preoperative neutrophil-to-lymphocyte ratio (NLR) and long-term outcomes in patients with non-small cell lung cancer (NSCLC), the prognostic significance of postoperative NLR and change in NLR (ΔNLR) is unknown for patients who underwent complete resection of stage I NSCLC. The aim of this retrospective study was to evaluate the prognostic significance of postoperative NLR and ΔNLR in 123 patients with stage I NSCLC. Patients and methods This retrospective study included preoperative and postoperative data of 123 patients who underwent surgical resection for stage I NSCLC. The relationship between disease-free survival (DFS), overall survival (OS), and clinicopathological factors, including NLR, lymphocyte-to-monocyte ratio (LMR), platelet-to-lymphocyte ratio, and their changes, was analyzed using both univariate Kaplan–Meier and multivariate Cox regression methods. Results The 5-year DFS and OS rates in our cohort were 60.16% and 67.48%, respectively. Univariate analysis revealed that age (P=0.045), smoking status (P=0.033), preoperative NLR (P=0.032), postoperative NLR (P<0.001), ΔNLR (P=0.004), and change in LMR (ΔLMR) (P=0.025) were significant predictors of DFS and that age (P=0.039), smoking status (P=0.042), postoperative NLR (P<0.001), ΔNLR (P=0.004), and ΔLMR (P=0.011) were independent predictors of OS. Multivariate analysis confirmed that postoperative NLR (hazard ratio [HR] =2.435, P=0.001) and ΔNLR (HR =2.103, P=0.012) were independent predictors of DFS and that postoperative NLR (HR =2.747, P=0.001) and ΔNLR (HR =2.052, P=0.018) were significant prognostic factors of OS. Conclusion Our study reported for the first time that postoperative NLR and ΔNLR – but not preoperative NLR – were independent prognostic factors of DFS and OS in patients with stage I NSCLC who underwent complete resection. This easily available biomarker might be helpful in individual risk

  18. Combined Double Sleeve Lobectomy and Superior Vena Cava Resection for Non-small Cell Lung Cancer with Persistent Left Superior Vena Cava

    Institute of Scientific and Technical Information of China (English)

    Daxing ZHU; Xiaoming QIU; Qinghua ZHOU

    2015-01-01

    A 65-year-old man with right central type of lung squamous carcinoma was admitted to our department. Bronchoscopy displayed complete obstruction of right upper lobe bronchus and inifltration of the bronchus intermedius with tumor. Chest contrast computed tomography revealed the tumor invaded right pulmonary artery, superior vena cava, and the persistant letf superior vena cava lfowed into the coronary sinus. hTe tumor was successfully removed by means of bronchial and pulmonary artery sleeve resection of the right upper and middle lobes combined with resection and reconstruction of superior vena cava (SVC) utilizing ringed polytetralfuoroethylene gratf. To the best of our knowledge, this was the ifrst report of complete resection of locally advanced lung cancer involving superior vena cava, right pulmonary artery trunk and main bronchus with persistant letf superior vena cava.

  19. Extended mesometrial resection (EMMR): Surgical approach to the treatment of locally advanced cervical cancer based on the theory of ontogenetic cancer fields.

    Science.gov (United States)

    Wolf, Benjamin; Ganzer, Roman; Stolzenburg, Jens-Uwe; Hentschel, Bettina; Horn, Lars-Christian; Höckel, Michael

    2017-08-01

    Based on ontogenetic-anatomic considerations, we have introduced total mesometrial resection (TMMR) and laterally extended endopelvic resection (LEER) as surgical treatments for patients with cancer of the uterine cervix FIGO stages I B1 - IV A. For a subset of patients with locally advanced disease we have sought to develop an operative strategy characterized by the resection of additional tissue at risk for tumor infiltration as compared to TMMR, but less than in LEER, preserving the urinary bladder function. We conducted a prospective single center study to evaluate the feasibility of extended mesometrial resection (EMMR) and therapeutic lymph node dissection as a surgical treatment approach for patients with cervical cancer fixed to the urinary bladder and/or its mesenteries as determined by intraoperative evaluation. None of the patients received postoperative adjuvant radiotherapy. 48 consecutive patients were accrued into the trial. Median tumor size was 5cm, and 85% of all patients were found to have lymph node metastases. Complete tumor resection (R0) was achieved in all cases. Recurrence free survival at 5years was 54.1% (95% CI 38.3-69.9). The overall survival rate was 62.6% (95% CI 45.6-79.6) at 5years. Perioperative morbidity represented by grade II and III complications (determined by the Franco-Italian glossary) occurred in 25% and 15% of patients, respectively. We demonstrate in this study the feasibility of EMMR as a surgical treatment approach for patients with locally advanced cervical cancer and regional lymph node invasion without the necessity for postoperative adjuvant radiation. Copyright © 2017 Elsevier Inc. All rights reserved.

  20. The dynamic pattern of recurrence in curatively resected non-small cell lung cancer patients: Experiences at a single institution.

    Science.gov (United States)

    Yamauchi, Yoshikane; Muley, Thomas; Safi, Seyer; Rieken, Stefan; Bischoff, Helge; Kappes, Jutta; Warth, Arne; Herth, Felix J F; Dienemann, Hendrik; Hoffmann, Hans

    2015-11-01

    To investigate the hazard function of tumor recurrence in patients with completely (R0) resected non-small cell lung cancer. A total of 1374 patients treated between 2003 and 2009 with complete resection and systematic lymph node dissection were studied. The risk of recurrence at a given time after operation was studied utilizing the cause-specific hazard function. Recurrence was categorized as local recurrence or distant recurrence. The risk distribution was assessed using clinical and pathological factors. The hazard function for recurrence presented an early peak at approximately 10 months after surgery and maintained a tapered plateau-like tail extending up to 8 years. A similar risk pattern was detected for both local recurrence and distant recurrence, while the risk of distant recurrence was higher than that of local recurrence. The double-peaked pattern of hazard rate was present in several subgroups, such as p-stage IA patients. A comparison of histology and status of nodal involvement showed that pN1-2 adenocarcinoma patients demonstrated a high hazard rate of distant recurrence and that pN0 adenocarcinoma patients exhibited a small recurrent risk for a longer time. Squamous cell carcinoma patients showed only little difference in risk. The data may be useful to select patients at high risk of recurrence and may provide information for each patient to decide how to manage the postoperative follow-up individually. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  1. Laser resection of lung tissue: heat accumulation from adjacent laser application and how to cool it down.

    Science.gov (United States)

    Kirschbaum, Andreas; Rexin, Peter; Pehl, Anika; Bartsch, Detlef; Quint, Karl

    2014-06-01

    Heat accumulation might induce thermal damage of the surrounding lung tissue, especially when multiple lesions are resected in one session. The present study aimed to investigate whether heat accumulates in the immediate vicinity of the resection surface and leads to thermal damage of the lung parenchyma, and what is the most effective cooling strategy in this situation. In normothermic perfused paracardial swine lobes (n = 6), four punctiform laser lesions forming a square were created. Each lesion was lasered at a power of 100 W for 5 seconds. Two test conditions with square sides of either 1.0 or 0.5 cm were compared. Temperatures were recorded immediately after completing the laser procedure in the square center and in the corners using a thermal camera and continued during the cooling process at 10-second intervals until normothermia (37°C). We examined two cooling methods: rinsing with ice-cold (4°C) Ringer solution during the laser procedure (group B, n = 6) or submerging the lung in ice-cold water for 5 seconds immediately after laser application (group C, n = 6). In the control group A (n = 6), there was no cooling. In the 0.5 cm squares, mean temperature in the center immediately after laser application was 103.17 ± 8.56°C, significantly higher than in the corners (76.39 ± 2.87°C, p Laser application to the lung parenchyma causes considerable heat accumulation in closely related lesions. To prevent such cell damage, a distance of at least 1.0 cm between laser targets should be maintained. If no topical cooling method applied, sufficient time for spontaneous tissue cooling before additional laser application should be provided. The most effective cooling strategy against heat accumulation is submerging in ice-cold water for at least 5 seconds. Georg Thieme Verlag KG Stuttgart · New York.

  2. Circulating Tumor Cells Identify Early Recurrence in Patients with Non-Small Cell Lung Cancer Undergoing Radical Resection.

    Science.gov (United States)

    Bayarri-Lara, Clara; Ortega, Francisco G; Cueto Ladrón de Guevara, Antonio; Puche, Jose L; Ruiz Zafra, Javier; de Miguel-Pérez, Diego; Ramos, Abel Sánchez-Palencia; Giraldo-Ospina, Carlos Fernando; Navajas Gómez, Juan A; Delgado-Rodriguez, Miguel; Lorente, Jose A; Serrano, María Jose

    2016-01-01

    Surgery is the treatment of choice for patients with non-small cell lung cancer (NSCLC) stages I-IIIA. However, more than 20% of these patients develop recurrence and die due to their disease. The release of tumor cells into peripheral blood (CTCs) is one of the main causes of recurrence of cancer. The objectives of this study are to identify the prognostic value of the presence and characterization of CTCs in peripheral blood in patients undergoing radical resection for NSCLC. 56 patients who underwent radical surgery for previously untreated NSCLC were enrolled in this prospective study. Peripheral blood samples for CTC analysis were obtained before and one month after surgery. In addition CTCs were phenotypically characterized by epidermal growth factor receptor (EGFR) expression. 51.8% of the patients evaluated were positive with the presence of CTCs at baseline. A decrease in the detection rate of CTCs was observed in these patients one month after surgery (32.1%) (p = 0.035). The mean number of CTCs was 3.16 per 10 ml (range 0-84) preoperatively and 0.66 (range 0-3) in postoperative determination. EGFR expression was found in 89.7% of the patients at baseline and in 38.9% patients one month after surgery. The presence of CTCs after surgery was significantly associated with early recurrence (p = 0.018) and a shorter disease free survival (DFS) (p = .008). In multivariate analysis CTC presence after surgery (HR = 5.750, 95% CI: 1.50-21.946, p = 0.010) and N status (HR = 0.296, 95% CI: 0.091-0.961, p = 0.043) were independent prognostic factors for DFS. CTCs can be detected and characterized in patients undergoing radical resection for non-small cell lung cancer. Their presence might be used to identify patients with increased risk of early recurrence.

  3. Circulating Tumor Cells Identify Early Recurrence in Patients with Non-Small Cell Lung Cancer Undergoing Radical Resection.

    Directory of Open Access Journals (Sweden)

    Clara Bayarri-Lara

    Full Text Available Surgery is the treatment of choice for patients with non-small cell lung cancer (NSCLC stages I-IIIA. However, more than 20% of these patients develop recurrence and die due to their disease. The release of tumor cells into peripheral blood (CTCs is one of the main causes of recurrence of cancer. The objectives of this study are to identify the prognostic value of the presence and characterization of CTCs in peripheral blood in patients undergoing radical resection for NSCLC.56 patients who underwent radical surgery for previously untreated NSCLC were enrolled in this prospective study. Peripheral blood samples for CTC analysis were obtained before and one month after surgery. In addition CTCs were phenotypically characterized by epidermal growth factor receptor (EGFR expression.51.8% of the patients evaluated were positive with the presence of CTCs at baseline. A decrease in the detection rate of CTCs was observed in these patients one month after surgery (32.1% (p = 0.035. The mean number of CTCs was 3.16 per 10 ml (range 0-84 preoperatively and 0.66 (range 0-3 in postoperative determination. EGFR expression was found in 89.7% of the patients at baseline and in 38.9% patients one month after surgery. The presence of CTCs after surgery was significantly associated with early recurrence (p = 0.018 and a shorter disease free survival (DFS (p = .008. In multivariate analysis CTC presence after surgery (HR = 5.750, 95% CI: 1.50-21.946, p = 0.010 and N status (HR = 0.296, 95% CI: 0.091-0.961, p = 0.043 were independent prognostic factors for DFS.CTCs can be detected and characterized in patients undergoing radical resection for non-small cell lung cancer. Their presence might be used to identify patients with increased risk of early recurrence.

  4. Circulating Tumor Cells Identify Early Recurrence in Patients with Non-Small Cell Lung Cancer Undergoing Radical Resection

    Science.gov (United States)

    Cueto Ladrón de Guevara, Antonio; Puche, Jose L.; Ruiz Zafra, Javier; de Miguel-Pérez, Diego; Ramos, Abel Sánchez-Palencia; Giraldo-Ospina, Carlos Fernando; Navajas Gómez, Juan A.; Delgado-Rodriguez, Miguel; Lorente, Jose A.; Serrano, María Jose

    2016-01-01

    Background Surgery is the treatment of choice for patients with non-small cell lung cancer (NSCLC) stages I-IIIA. However, more than 20% of these patients develop recurrence and die due to their disease. The release of tumor cells into peripheral blood (CTCs) is one of the main causes of recurrence of cancer. The objectives of this study are to identify the prognostic value of the presence and characterization of CTCs in peripheral blood in patients undergoing radical resection for NSCLC. Patients and Methods 56 patients who underwent radical surgery for previously untreated NSCLC were enrolled in this prospective study. Peripheral blood samples for CTC analysis were obtained before and one month after surgery. In addition CTCs were phenotypically characterized by epidermal growth factor receptor (EGFR) expression. Results 51.8% of the patients evaluated were positive with the presence of CTCs at baseline. A decrease in the detection rate of CTCs was observed in these patients one month after surgery (32.1%) (p = 0.035). The mean number of CTCs was 3.16 per 10 ml (range 0–84) preoperatively and 0.66 (range 0–3) in postoperative determination. EGFR expression was found in 89.7% of the patients at baseline and in 38.9% patients one month after surgery. The presence of CTCs after surgery was significantly associated with early recurrence (p = 0.018) and a shorter disease free survival (DFS) (p = .008). In multivariate analysis CTC presence after surgery (HR = 5.750, 95% CI: 1.50–21.946, p = 0.010) and N status (HR = 0.296, 95% CI: 0.091–0.961, p = 0.043) were independent prognostic factors for DFS. Conclusion CTCs can be detected and characterized in patients undergoing radical resection for non-small cell lung cancer. Their presence might be used to identify patients with increased risk of early recurrence. PMID:26913536

  5. Clinical impact of different detection methods for disseminated tumor cells in bone marrow of patients undergoing surgical resection of colorectal liver metastases: a prospective follow-up study

    Directory of Open Access Journals (Sweden)

    Tanke Hans J

    2010-04-01

    Full Text Available Abstract Background Large number of patients with colorectal liver metastasis show recurrent disease after curative surgical resection. Identification of these high-risk patients may guide therapeutic strategies. The aim of this study was to evaluate whether the presence of disseminated tumor cells in bone marrow from patients undergoing surgical resection of colorectal liver metastases can predict clinical outcome. Methods Sixty patients with colorectal liver metastases were planned for a curative resection between 2001 and 2007. All patients underwent bone marrow aspiration before surgery. Detection of tumor cells was performed using immunocytochemical staining for cytokeratin (CK-ICC combined with automated microscopy or indirectly using reverse transcription-polymerase chain reaction (RT-PCR. Results Disseminated tumor cells were found in 15 of the 46 patients (33% using CK-ICC and in 9 of 44 of the patients (20% using RT-PCR. Patients with negative results for RT-PCR had a significant better disease-free survival after resection of their liver metastases (p = 0.02. This group also showed significant better overall survival (p = 0.002. CK-ICC did not predict a worse clinical outcome. Conclusions The presence of disseminated tumor cells in bone marrow detected using RT-PCR did predict a worse clinical outcome. The presence of cells detected with CK-ICC did not correlate with poor prognosis.

  6. Three-year and five-year outcomes of surgical resection for pancreatic ductal adenocarcinoma: Long-term experiences in one medical center.

    Science.gov (United States)

    Hsu, Chih-Po; Hsu, Jun-Te; Liao, Chien-Hung; Kang, Shih-Ching; Lin, Being-Chuan; Hsu, Yu-Pao; Yeh, Chun-Nan; Yeh, Ta-Sen; Hwang, Tsann-Long

    2016-12-20

    Pancreatic ductal adenocarcinoma is one of the most malignant types of cancer. This study evaluated the 3-year and 5-year surgical outcomes associated with the cancer and determined whether statistically identified factors can be used to predict survival. This retrospective review was conducted from 1995 to 2010. Patients who had resectable pancreatic ductal adenocarcinoma and received surgical treatment were included. Cases of hospital mortality were excluded. The relationships between several clinicopathological factors and the survival rate were analyzed. A total of 223 patients were included in this study. The 3-year and 5-year survival rates were 21.4% and 10.1%, respectively, and the median survival was 16.1 months. Tumor size, N status, and resection margins were independent predictive factors for 3-year survival. Tumor size independently predicted 5-year survival. Tumor size is the most important independent prognostic factor for 3-year and 5-year survival. Lymph node status and the resection margins also independently affected the 3-year survival. These patient outcomes might be improved by early diagnosis and radical resection. Future studies should focus on the tumor biology of this aggressive cancer. Copyright © 2016. Published by Elsevier Taiwan.

  7. Epidermal growth factor receptor and v-Ki-ras2 Kirsten rat sarcoma viral oncogen homologue-specific amino acid substitutions are associated with different histopathological prognostic factors in resected non-small-cell lung cancer.

    Science.gov (United States)

    Seitlinger, Joseph; Renaud, Stéphane; Falcoz, Pierre-Emmanuel; Schaeffer, Mickaël; Olland, Anne; Reeb, Jérémie; Santelmo, Nicola; Legrain, Michèle; Voegeli, Anne-Claire; Weingertner, Noëlle; Chenard, Marie-Pierre; Beau-Faller, Michèle; Massard, Gilbert

    2016-12-01

    Epidermal growth factor receptor (mEGFR) and v-Ki-ras2 Kirsten rat sarcoma viral oncogen homologue (mKRAS) mutations are the two main oncogenic drivers in resected non-small-cell lung cancer (NSCLC). We aimed to evaluate the correlation between histopathological prognostic factors and these mutations in resected NSCLC. We retrospectively reviewed data from 841 patients who underwent a surgical resection with a curative intent for NSCLC between 2007 and 2012. KRAS mutations were observed in 255 patients (32%) and mEGFR in 103 patients (12%). A correlation was observed between mKRAS patients and lymph node involvement [Cramer's V: 0.451, P V: 0.235, P = 0.02, OR: 3.04 (95% CI: 1.5-6.3), P = 0.004]. High lymph node ratio and angioinvasion were also significantly more frequent in mKRAS [Cramer's V: 0.373, P V: 0.269, P V: 0.459, P V: 0.45, P < 0.001 OR: 21.14 (95% CI: 9.2-48.3), P < 0.001, respectively]. We observed a correlation between mKRAS and negative histopathological prognostic factors and between mEGFR and positive prognostic factors. One can wonder whether histopathological prognostic factors are only clinical reflections of molecular alterations. © The Author 2016. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

  8. Prognostic factors for post-recurrence survival in patients with completely resected Stage I non-small-cell lung cancer.

    Science.gov (United States)

    Song, In Hag; Yeom, Sung Won; Heo, Seohee; Choi, Won Suk; Yang, Hee Chul; Jheon, Sanghoon; Kim, Kwhanmien; Cho, Sukki

    2014-02-01

    The clinical course from recurrence to cancer-related death after curative resection has not been clearly elucidated in non-small-cell lung cancer (NSCLC). This study examined the clinical outcomes after postoperative recurrence in patients with completely resected Stage I NSCLC. This study included patients who had recurrence after complete resection for pathological Stage I NSCLC between 2003 and 2009. Clinical data evaluated in this study included the diagnostic process of recurrence, recurrence pattern, treatment process and prognosis. A number of clinicopathological factors were analysed for post-recurrence survival by univariate and multivariate analyses. Seventy-two patients experienced recurrence during a median follow-up period of 37.5 months. Thirteen patients (18%) presented symptoms at the initial recurrence. Tumour markers, computed tomography (CT) and positron emission tomography/CT were chosen as the initial diagnostic tools and detected recurrences in 1 (1%), 51 (71%) and 7 (10%) patients, respectively. The mean recurrence-free interval (RFI) was 15.4 months (≤12 months in 34, >12 months in 38 patients). The patterns of recurrence were presented as loco-regional recurrence in 36 (50%) and distant metastasis in 36 patients (50%). Types of the initial treatment included operations in 28 (39%), chemotherapy and/or radiotherapy in 38 (53%) and radiofrequency ablation in 2 patients (3%). Four patients (6%) rejected treatment. Forty-three patients (62%) presented a good response to the initial treatment. Thirty-seven patients (51%) died, and the cause of death in all of these patients was cancer-related. The median survival duration after recurrence was 43.6 (1-136) months. Univariate analysis identified no recurrence of symptoms, a good response to treatment and a longer RFI as good prognostic factors, while a good response to treatment and a longer RFI were independent prognostic factors in multivariate analysis. Most postoperative recurrences were

  9. Surgical treatment of lung cancer in the elderly%老年肺癌的手术治疗

    Institute of Scientific and Technical Information of China (English)

    谭媛圆; 邹欣欣; 谢杨; 张雷

    2012-01-01

    Surgery is usually the first choice for patients with lung cancer,whereas the risk increases with age.A comprehensive evaluation of the patients should be applied in order to bring about the best outcome.By convention,the preoperative assessment includes neoplasm staging,cardio-respiratory function assessment, nutritional status assessment,and etc. The surgical planning includes limited resection,video-assisted thoracoscopic surgery and so on.%手术通常为肺癌患者首选的治疗方式,但其风险也随年龄增加而有所增大.对老年人肺癌治疗应全方位评估手术治疗的风险以使患者获得最好的治疗效果.通常的术前评估包括肿瘤分期、心肺功能评估、营养状况评估等,常采取的手术方案包括局部切除和电视辅助胸腔镜手术等.

  10. Predictors of circumferential resection margin involvement in surgically resected rectal cancer: A retrospective review of 23,464 patients in the US National Cancer Database

    Science.gov (United States)

    Al-Sukhni, Eisar; Attwood, Kristopher; Gabriel, Emmanuel; Nurkin, Steven J.

    2017-01-01

    Introduction The circumferential resection margin (CRM) is a key prognostic factor after rectal cancer resection. We sought to identify factors associated with CRM involvement (CRM+). Methods A retrospective review was performed of the National Cancer Database, 2004–2011. Patients with rectal cancer who underwent radical resection and had a recorded CRM were included. Multivariable analysis of the association between clinicopathologic characteristics and CRM was performed. Tumor patients, 13.3% were CRM+. Factors associated with CRM+ were diagnosis later in the study period, lack of insurance, advanced stage, higher grade, undergoing APR, and receiving radiation. Nearly half of CRM+ patients did not receive neoadjuvant therapy. CRM+ patients who did not receive neoadjuvant therapy were more likely to be female, older, with more comorbidities, smaller tumors, earlier clinical stage, advanced pathologic stage, and CEA-negative disease compared to those who received it. Conclusions Factors associated with CRM+ include features of advanced disease, undergoing APR, and lack of health insurance. Half of CRM+ patients did not receive neoadjuvant treatment. These represent cases where CRM status may be modifiable with appropriate pre-operative selection and multidisciplinary management. PMID:26906328

  11. Classification of 27 Tumor-Associated Antigens by Histochemical Analysis of 36 Freshly Resected Lung Cancer Tissues.

    Science.gov (United States)

    Kurosawa, Gene; Sugiura, Mototaka; Hattori, Yoshinobu; Tsuda, Hiroyuki; Kurosawa, Yoshikazu

    2016-11-08

    In previous studies, we identified 29 tumor-associated antigens (TAAs) and isolated 488 human monoclonal antibodies (mAbs) that specifically bind to one of the 29 TAAs. In the present study, we performed histochemical analysis of 36 freshly resected lung cancer tissues by using 60 mAbs against 27 TAAs. Comparison of the staining patterns of tumor cells, bronchial epithelial cells, and normal pulmonary alveolus cells and interalveolar septum allowed us to determine the type and location of cells that express target molecules, as well as the degree of expression. The patterns were classified into 7 categories. While multiple Abs were used against certain TAAs, the differences observed among them should be derived from differences in the binding activity and/or the epitope. Thus, such data indicate the versatility of respective clones as anti-cancer drugs. Although the information obtained was limited to the lung and bronchial tube, bronchial epithelial cells represent normal growing cells, and therefore, the data are informative. The results indicate that 9 of the 27 TAAs are suitable targets for therapeutic Abs. These 9 Ags include EGFR, HER2, TfR, and integrin α6β4. Based on our findings, a pharmaceutical company has started to develop anti-cancer drugs by using Abs to TfR and integrin α6β4. HGFR, PTP-LAR, CD147, CDCP1, and integrin αvβ3 are also appropriate targets for therapeutic purposes.

  12. Classification of 27 Tumor-Associated Antigens by Histochemical Analysis of 36 Freshly Resected Lung Cancer Tissues

    Directory of Open Access Journals (Sweden)

    Gene Kurosawa

    2016-11-01

    Full Text Available In previous studies, we identified 29 tumor-associated antigens (TAAs and isolated 488 human monoclonal antibodies (mAbs that specifically bind to one of the 29 TAAs. In the present study, we performed histochemical analysis of 36 freshly resected lung cancer tissues by using 60 mAbs against 27 TAAs. Comparison of the staining patterns of tumor cells, bronchial epithelial cells, and normal pulmonary alveolus cells and interalveolar septum allowed us to determine the type and location of cells that express target molecules, as well as the degree of expression. The patterns were classified into 7 categories. While multiple Abs were used against certain TAAs, the differences observed among them should be derived from differences in the binding activity and/or the epitope. Thus, such data indicate the versatility of respective clones as anti-cancer drugs. Although the information obtained was limited to the lung and bronchial tube, bronchial epithelial cells represent normal growing cells, and therefore, the data are informative. The results indicate that 9 of the 27 TAAs are suitable targets for therapeutic Abs. These 9 Ags include EGFR, HER2, TfR, and integrin α6β4. Based on our findings, a pharmaceutical company has started to develop anti-cancer drugs by using Abs to TfR and integrin α6β4. HGFR, PTP-LAR, CD147, CDCP1, and integrin αvβ3 are also appropriate targets for therapeutic purposes.

  13. Classification of 27 Tumor-Associated Antigens by Histochemical Analysis of 36 Freshly Resected Lung Cancer Tissues

    Science.gov (United States)

    Kurosawa, Gene; Sugiura, Mototaka; Hattori, Yoshinobu; Tsuda, Hiroyuki; Kurosawa, Yoshikazu

    2016-01-01

    In previous studies, we identified 29 tumor-associated antigens (TAAs) and isolated 488 human monoclonal antibodies (mAbs) that specifically bind to one of the 29 TAAs. In the present study, we performed histochemical analysis of 36 freshly resected lung cancer tissues by using 60 mAbs against 27 TAAs. Comparison of the staining patterns of tumor cells, bronchial epithelial cells, and normal pulmonary alveolus cells and interalveolar septum allowed us to determine the type and location of cells that express target molecules, as well as the degree of expression. The patterns were classified into 7 categories. While multiple Abs were used against certain TAAs, the differences observed among them should be derived from differences in the binding activity and/or the epitope. Thus, such data indicate the versatility of respective clones as anti-cancer drugs. Although the information obtained was limited to the lung and bronchial tube, bronchial epithelial cells represent normal growing cells, and therefore, the data are informative. The results indicate that 9 of the 27 TAAs are suitable targets for therapeutic Abs. These 9 Ags include EGFR, HER2, TfR, and integrin α6β4. Based on our findings, a pharmaceutical company has started to develop anti-cancer drugs by using Abs to TfR and integrin α6β4. HGFR, PTP-LAR, CD147, CDCP1, and integrin αvβ3 are also appropriate targets for therapeutic purposes. PMID:27834817

  14. A Randomized Controlled Trial of Postthoracotomy Pulmonary Rehabilitation in Patients with Resectable Lung Cancer

    NARCIS (Netherlands)

    Stigt, Jos A.; Uil, Steven M.; van Riesen, Susanne J. H.; Simons, Frans J. N. A.; Denekamp, Monique; Shahin, Ghada M.; Groen, Harry J. M.

    2013-01-01

    Introduction: Little is known about the effects of rehabilitation for patients with lung cancer after thoracotomy. The primary objective of this study was to evaluate the effect of a multidisciplinary rehabilitation program on quality of life (QOL) and secondary objectives were to determine its effe

  15. Is the predicted postoperative FEV1 estimated by planar lung perfusion scintigraphy accurate in patients undergoing pulmonary resection? Comparison of two processing methods.

    Science.gov (United States)

    Caglar, Meltem; Kara, Murat; Aksoy, Tamer; Kiratli, Pinar Ozgen; Karabulut, Erdem; Dogan, Riza

    2010-07-01

    Estimation of postoperative forced expiratory volume in 1 s (FEV1) with radionuclide lung scintigraphy is frequently used to define functional operability in patients undergoing lung resection. We conducted a study to outline the reliability of planar quantitative lung perfusion scintigraphy (QLPS) with two different processing methods to estimate the postoperative lung function in patients with resectable lung disease. Forty-one patients with a mean age of 57 +/- 12 years who underwent either a pneumonectomy (n = 14) or a lobectomy (n = 27) were included in the study. QLPS with Tc-99m macroaggregated albumin was performed. Both three equal zones were generated for each lung [zone method (ZM)] and more precise regions of interest were drawn according to their anatomical shape in the anterior and posterior projections [lobe mapping method (LMM)] for each patient. The predicted postoperative (ppo) FEV1 values were compared with actual FEV1 values measured on postoperative day 1 (pod1 FEV1) and day 7 (pod 7 FEV1). The mean of preoperative FEV1 and ppoFEV1 values was 2.10 +/- 0.57 and 1.57 +/- 0.44 L, respectively. The mean of Pod1FEV1 (1.04 +/- 0.30 L) was lower than ppoFEV1 (p lung disease and hilar tumors. No significant differences were observed between ppoFEV1 values estimated by ZM or by LMM (p > 0.05). PpoFEV1 values predicted by both the zone and LMMs overestimated the actual measured lung volumes in patients undergoing pulmonary resection in the early postoperative period. LMM is not superior to ZM.

  16. High-grade ureteroscopic biopsy is associated with advanced pathology of upper-tract urothelial carcinoma tumors at definitive surgical resection.

    Science.gov (United States)

    Clements, Thomas; Messer, Jamie C; Terrell, John D; Herman, Michael P; Ng, Casey K; Scherr, Douglas S; Scoll, Benjamin; Boorjian, Stephen A; Uzzo, Robert G; Wille, Mark; Eggener, Scott E; Lucas, Steven M; Lotan, Yair; Shariat, Shahrokh F; Raman, Jay D

    2012-04-01

    Accurate assessment of upper-tract urothelial carcinoma (UTUC) pathology may guide use of endoscopic vs extirpative therapy. We present a multi-institutional cohort of patients with UTUC who underwent surgical resection to characterize the association of ureteroscopic (URS) biopsy features with final pathology results. URS biopsy data were available in 238 patients who underwent surgical resection of UTUC. Biopsies were performed using a brush biopsy kit, mechanical biopsy device, or basket. Stage was classified as a positive brush, nonmuscle-invasive (biopsy, 88/238 (37%) patients had a positive brush, 140 (59%) had a diagnosis of non-MI, and 10 (4%) had MI disease. Biopsy results showed low-grade cancer in 140 (59%) and high-grade cancer in 98 (41%). Pathologic evaluation at surgical resection demonstrated non-MI tumors in 140 (59%) patients, MI in 98 (41%), and high-grade disease in 150 (63%). On univariate analysis, high URS biopsy grade was associated with high-grade (positive predictive value [PPV] 92%, Pbiopsy stage, however, was associated with surgical pathology grade (P=0.005), but not MI (P=0.16) disease. On multivariate analysis, high URS grade, but not biopsy stage, was associated with high final pathology grade (hazard ratio [HR] 16.6, 95% confidence interval [CI] 7.0-39.5, Pbiopsy grade, but not stage, is associated with adverse tumor pathology. This information may play a valuable role for risk stratification and in the appropriate selection of endoscopic management vs surgical extirpation for UTUC.

  17. Neodymium yttrium-aluminium-garnet laser resection significantly improves quality of life in patients with malignant central airway obstruction due to lung cancer.

    Science.gov (United States)

    Zaric, B; Kovacevic, T; Stojsic, V; Sarcev, T; Kocic, M; Urosevic, M; Kalem, D; Perin, B

    2015-07-01

    Neodymium yttrium-aluminium-garnet (Nd : YAG) laser resection is one of the mostly used interventional pulmonology techniques for urgent desobstruction of malignant central airway obstruction (CAO). The major aim of this trial was to evaluate potential influence of Nd : YAG laser resection on overall quality of life (QoL) in patients with central lung cancer. Patients with malignant CAO scheduled for Nd : YAG laser resection were prospectively recruited in the trial. All patients were given European Organization for Research and Treatment, Quality of Life questionnaire (EORTC QLQ-30 v.3) before the procedure and approximately 2 weeks after the treatment. There were 37 male and 10 female patients, average age 54 ± 10 years. Most common tumour type was adenocarcinoma diagnosed in 51% of patients. Majority of patients were diagnosed in stage IIIB (53.2%) and stage IV (25.5%). Most common Eastern Cooperative Oncology Group performance status was 1 (72.3%). Nd : YAG laser resection significantly improved (Plife, social activities and financial situation, we did not observe statistically significant improvement. Nd : YAG laser resection of malignant CAO significantly improves QoL and overall health in patients with lung cancer.

  18. Resection of the sidewall of superior vena cava using video-assisted thoracic surgery mechanical suture technique

    Science.gov (United States)

    Xu, Xin; Qiu, Yuan; Pan, Hui; Mo, Lili; Chen, Hanzhang

    2016-01-01

    Lung cancer invading the superior vena cava (SVC) is a locally advanced condition, for which poor prognosis is expected with conservative treatment alone. Surgical resection of the lesion can rapidly relieve the symptoms and significantly improve survival for some patients. Replacement, repair and partial resection of SVC via thoracotomy were generally accepted and used in the past. As the rapid development of minimally invasive techniques and devices, partial resection and repair of SVC are feasible via video-assisted thoracic surgery (VATS). However, few studies have reported the VATS surgical techniques. In this study, we reported the crucial techniques of partial resection of SVC via VATS. PMID:27076960

  19. Successfully Surgical Treatment of Lung Metastatic Hepatoblastoma: A Rare Case Report

    Directory of Open Access Journals (Sweden)

    Halim Bardi Taneh

    2017-08-01

    Full Text Available Background Hepatoblastoma is a common liver malignancy in children and commonly presents with primary tumors. In hepatoblastoma, lung is the most common place to metastasis. Chemotherapy have led to many improvements in the local control of hepatoblastoma. A main goal of treatment for hepatoblastoma is to achieve complete tumor resection. Case Presentation The patient was a 2.5 years old boy with abdominal distention and abdominal pain. Abdominal and pelvic ultrasound and thoracic and abdominal CT was performed for the patient and the results of them showed a large and hyperecho mass in the liver and several nodular lesions in lung segments. After doing some other tests, the diagnosis for the patient was hepatoblastoma. After chemothetapy the primary tumor was removed by surgery. Follow-up by CT scan after second chemotherapy showed that the lesions in the liver were removed, but lung masses were still unchanged and after second surgery, lung masses were removed too. The outcome has been favorable with no recurrence as of 20 months after the operation. Conclusion In our case, the patient did not respond to chemotherapy and as main treatment, surgery was carried out, that shows its importance in the treatment of hepatoblastoma.

  20. Correlation between the survival rate of the patients with synchronous hepatic metastases from gastric carcinoma after surgical resection and patient's index

    Institute of Scientific and Technical Information of China (English)

    YANG Xin-wei; LI Zhe; LIU Kai; FU Xiao-hui; YANG Jia-he; WU Meng-chao

    2012-01-01

    Background Many studies have reported the benefit of hepatic resection for solitary and metachronous metastases from gastric cancer.However,indications and surgical results for synchronous hepatic metastases from gastric carcinoma have not been clearly defined.This study was performed to assess the benefits and limits of simultaneous combined resection of both primary gastric cancer and synchronous hepatic metastases,as well as to identify prognostic factors affecting the survival.Methods Between January 2005 and June 2008,13 patients with synchronous hepatic metastases underwent simultaneous combined resection.The clinicopathologic features and the surgical results of the 13 patients were retrospectively analyzed.Patient,tumor (primary and metastatic carcinoma),and operative parameters were analyzed for their influence on survival.Results No patient died and two patients (15.4%) developed complications during peri-operative course.The actuarial 6-month,1-year,and 2-year survival rates after hepatic resection were 76.9%,38.5%,and 30.8%,respectively,and two patients survived for more than 2 years after surgery without any signs of recurrences until latest follow-up.In univariate analysis,hepatic tumor distribution (P=0.01) and number of hepatic metastases (P=0.003) were significant prognostic factors that influenced survival.Factors associated with the primary lesion were not significant prognostic factors.Conclusions Satisfactory survival may be achieved by simultaneous combined resection of both primary gastric cancer and synchronous hepatic metastases in strictly selected patients.The number of hepatic metastases and hepatic tumor distribution are significant prognostic determinants of survival.

  1. Potential usefulness of a topic model-based categorization of lung cancers as quantitative CT biomarkers for predicting the recurrence risk after curative resection

    Science.gov (United States)

    Kawata, Y.; Niki, N.; Ohmatsu, H.; Satake, M.; Kusumoto, M.; Tsuchida, T.; Aokage, K.; Eguchi, K.; Kaneko, M.; Moriyama, N.

    2014-03-01

    In this work, we investigate a potential usefulness of a topic model-based categorization of lung cancers as quantitative CT biomarkers for predicting the recurrence risk after curative resection. The elucidation of the subcategorization of a pulmonary nodule type in CT images is an important preliminary step towards developing the nodule managements that are specific to each patient. We categorize lung cancers by analyzing volumetric distributions of CT values within lung cancers via a topic model such as latent Dirichlet allocation. Through applying our scheme to 3D CT images of nonsmall- cell lung cancer (maximum lesion size of 3 cm) , we demonstrate the potential usefulness of the topic model-based categorization of lung cancers as quantitative CT biomarkers.

  2. Surgical techniques in the radical resection of hilar cholangiocarcinoma%肝门部胆管癌根治性切除手术技巧

    Institute of Scientific and Technical Information of China (English)

    彭淑牖; 钱浩然

    2010-01-01

    @@ 肝门部胆管癌是具有挑战性的疑难病症,其根治性切除一直是外科医生不断追求的目标之一.围手术期治疗策略的优化,影像学技术的提高,特别是手术器械的改进为肝门部胆管癌治疗的发展起到了重要的推动作用[1].肝门部胆管癌手术策略的制定以及规范化操作是获得满意远期疗效的基础.%Hilar cholangiocarcinoma remains a formi-dable challenge to hepatopancreatobiliary surgeons since the reported resection of a primary cancer originating at the hepatic duct confluence by Brown and Myers in 1954. Emerging evidence has indicated that aggressive surgery with a curative resection offers a better option for long-term survival compared with conservative therapy. Liver transplantation has also been considered as a management opportunity for the treatment of cholangiocarcinoma. However, the survival rate has been poor due to the high proportion of disease recurrence. This review highlights recent techniques in hilar cholangiocarcinoma resec-tion, with special attention to the management of the resection margin, clinical skills of liver resection, lymph node clearance, and portal vein or hepatic artery resection or reconstruction. In addition, technical advances have been proposed in hepatopan-creatoduodenectomy and liver transplantation for hilar cholangio-carcinoma treatment. In the current hepatic procedures, promis-ing survival outcomes have been obtained in patients with hilar cholangiocarcinoma, exhibiting a decreased operative mortality and a steady improvement in long-term survival. Overall, the correct clinical strategy and appropriate surgical techniques may provide an increased chance to cure patients with hilar cholan-giocarcinoma.

  3. The role of surgical intervention in lung cancer with carcinomatous pleuritis

    Science.gov (United States)

    Yokoi, Kohei

    2016-01-01

    Patients with non-small cell lung cancer (NSCLC) associated with carcinomatous pleuritis are currently classified as having stage IV disease per the 7th edition of the tumor-node-metastasis (TNM) system, which means that the disease is deemed incurable. In fact, the 5-year survival rate of these patients was only 2% in a large global cohort collected by the International Association for the Study of Lung Cancer. However, patients with carcinomatous pleuritis have heterogeneous conditions. Some have minimal pleural effusion, which is first detected at thoracotomy; some have numerous pleural nodules without any effusion; and others have massive effusion and nodules with symptoms. Several investigators have reported the contribution of surgical intervention to favorable outcomes of patients with carcinomatous pleuritis first detected at thoracotomy. These reports show a relatively higher 5-year survival rate of 15% to 37%. The extrapleural pneumonectomy (EPP) is a radical surgical procedure that is commonly employed in the treatment of malignant pleural mesothelioma. Two authors reported that they have successfully performed EPPs for the treatment of patients with carcinomatous pleuritis. Their 5-year survival rates were estimated to be 22% and 61%, a significantly improved outcome. Although the development of chemotherapeutic agents, including molecular targeted drugs, might have the potential to prolong the survival of patients with advanced lung cancer, surgical interventions including EPP might have a role in improving the survival of patients with carcinomatous pleuritis of minimal disease and those without massive effusion or numerous pleural nodules. PMID:27942413

  4. Effects of presurgical exercise training on quality of life in patients undergoing lung resection for suspected malignancy: a pilot study.

    Science.gov (United States)

    Peddle, Carolyn J; Jones, Lee W; Eves, Neil D; Reiman, Tony; Sellar, Christopher M; Winton, Timothy; Courneya, Kerry S

    2009-01-01

    The aim of this study was to explore the effects of presurgical exercise training on quality of life (QOL) in patients with malignant lung lesions. Using a single-group prospective design, patients were enrolled in supervised aerobic exercise training for the duration of surgical wait time (mean 59.7 days). Participants completed assessments of cardiorespiratory fitness (peak oxygen consumption) and QOL using the Functional Assessment of Cancer Therapy-Lung scales, including the trial outcome index (TOI) and the lung cancer subscale (LCS) at baseline, immediately presurgery, and postsurgery (mean, 57 days). 9 participants provided complete data. Repeated-measures analysis indicated a significant effect for time on TOI (P = .006) and LCS (P = .009). Paired analysis revealed that QOL was unchanged after exercise training (ie, baseline to presurgery), but there were significant and clinically meaningful declines from presurgery to postsurgery in the LCS (-3.6, P = .021) and TOI (-8.3, P = .018). Change in peak oxygen consumption from presurgery to postsurgery was significantly associated with change in the LCS (r = 0.70, P = .036) and TOI (r = 0.70, P = .035). Exercise training did not improve QOL from baseline to presurgery. Significant declines in QOL after surgery seem to be related to declines in cardiorespiratory fitness. A randomized controlled trial is needed to further investigate these relationships.

  5. Tratamiento combinado de los queloides mediante cirugía y braquiterapia Treatment of queloids with surgical resection and brachytherapy

    Directory of Open Access Journals (Sweden)

    J. Bisbal

    2009-12-01

    Full Text Available Presentamos nuestra experiencia en el tratamiento de los queloides mediante resección quirúrgica y radioterapia inmediata posterior. La radioterapia transforma el queloide en un tejido hipocelular, hipovascular e hipóxico, impidiendo la excesiva migración de fibroblastos. Si se administra la dosis adecuada de radiación, se consigue un equilibrio entre la formación de cicatriz y la proliferación excesiva de tejido, evitando la formación de queloide, sin impedir la cicatrización normal. Nuestro protocolo se divide en dos fases: la primera consiste en la exéresis del queloide mediante una incisión que sigue el trayecto del mismo, con un cuidadoso cierre en dos planos siendo siempre el superficial una sutura intradérmica. La segunda fase será la radioterapia, con dos modalidades posibles de tratamiento: 1- Braquiterapia (tratamiento a corta distancia, requiere la colocación de un catéter bajo la sutura, a través del cual se introduce una fuente radiactiva, normalmente Ir192. Se emplea especialmente en heridas longitudinales. 2- Radioterapia externa con electrones de baja energía. Se emplea en heridas complejas o extensas. Generalmente, dosis de 20 Gy. en 4 fracciones de 500 cGy, ofrecen excelentes resultados con mínimas secuelas o efectos secundarios. El volumen blanco debe incluir la herida quirúrgica más un margen de 4 mm. alrededor de ella. Con este procedimiento, hemos observado unos excelentes resultados, con un índice de recidivas inferior al 4%, y una mejora en los síntomas clínicos en el 100% de los casos. Como efectos secundarios observamos telangiectasias (15,4 % o cambios en la pigmentación cutánea (5,9%.We present our experience in treatment of keloid scars with surgical resection and immediately postoperative radiotherapy. Radiotherapy changes keloid into an hypocellular, hypovascular and hypotoxic tissue, avoiding the excessive migration of fibroblasts. If the suitable dose of radiation is delivered, balance

  6. Comprehensive review of post-liver resection surgical complications and a new universal classification and grading system

    Institute of Scientific and Technical Information of China (English)

    Masayuki; Ishii; Toru; Mizuguchi; Kohei; Harada; Shigenori; Ota; Makoto; Meguro; Tomomi; Ueki; Toshihiko; Nishidate; Kenji; Okita; Koichi; Hirata

    2014-01-01

    Liver resection is the gold standard treatment for certain liver tumors such as hepatocellular carcinoma and metastatic liver tumors. Some patients with such tumors already have reduced liver function due to chronic hepatitis, liver cirrhosis, or chemotherapy-associated steatohepatitis before surgery. Therefore, complications due to poor liver function are inevitable after liver resection. Although the mortality rate of liver resection has been reduced to a few percent in recent case series, its overall morbidity rate is reported to range from 4.1% to 47.7%. The large degree of variation in the post-liver resection morbidity rates reported in previous studies might be due to the lack of consen-sus regarding the definitions and classification of postliver resection complications. The Clavien-Dindo(CD) classification of post-operative complications is widely accepted internationally. However, it is hard to apply to some major post-liver resection complications because the consensus definitions and grading systems for posthepatectomy liver failure and bile leakage established by the International Study Group of Liver Surgery are incompatible with the CD classification. Therefore, a unified classification of post-liver resection complications has to be established to allow comparisons between academic reports.

  7. EFFICACY OF DIFFERENT RESECTIONS ON NON-MUSCLE-INVASIVE BLADDER CANCER AND ANALYSIS OF THE OPTIMAL SURGICAL METHOD.

    Science.gov (United States)

    Chen, G F; Shi, T P; Wang, B J; Wang, X Y; Zang, Q

    2015-01-01

    This study aimed to analyze the clinical efficacy of different resections in treating non-muscle-invasive bladder cancer (NMIBC), including partial cystectomy, transurethral resection of bladder tumor (TURBT) and holmium laser resection of bladder tumor. Two hundred and sixteen patients were recruited with NMIBC who were available for follow-up visits in hospital, including 62 cases treated with partial cystectomy, 90 cases treated with TURBT and 64 cases with holmium laser resection. Analysis was made on the cases with tumor relapse in the two years, on operation time, blood loss, time for indwelling urinary catheter, hospital stay and complications after operation. Results were compared to the clinical efficacy of these operation patterns. It was found that the two-year relapse rate for TURBT group, partial cystectomy group and Holmium laser resection group was 41%, 31%, and 33% respectively, and the difference had no statistical significance (p>0.05). Both the TURBT group and holmium laser resection group had shorter operation time, hospital stay and time for indwelling urinary catheter as well as much less blood loss when compared with the partial cystectomy group; the difference had statistical significance (pspasm. Therefore, this study presumes that holmium laser resection and TURBT are much safer and quicker for recovery and obviously superior to the partial cystectomy.

  8. Risk factors of brain metastases in completely resected pathological stage IIIA-N2 non-small cell lung cancer

    Directory of Open Access Journals (Sweden)

    Ding Xiao

    2012-07-01

    Full Text Available Abstract Background Brain metastases (BM is one of the most common failures of locally advanced non-small cell lung cancer (LA-NSCLC after combined-modality therapy. The outcome of trials on prophylactic cranial irradiation (PCI has prompted us to identify the highest-risk subset most likely to benefit from PCI. Focusing on patients with completely resected pathological stage IIIA-N2 (pIIIA-N2 NSCLC, we aimed to assess risk factors of BM and to define the highest-risk subset. Methods Between 2003 and 2005, the records of 217 consecutive patients with pIIIA-N2 NSCLC in our institution were reviewed. The cumulative incidence of BM was estimated using the Kaplan–Meier method, and differences between the groups were analyzed using log-rank test. Multivariate Cox regression analysis was applied to assess risk factors of BM. Results Fifty-three (24.4 % patients developed BM at some point during their clinical course. On multivariate analysis, non-squamous cell cancer (relative risk [RR]: 4.13, 95 % CI: 1.86–9.19; P = 0.001 and the ratio of metastatic to examined nodes or lymph node ratio (LNR ≥ 30 % (RR: 3.33, 95 % CI: 1.79–6.18; P = 0.000 were found to be associated with an increased risk of BM. In patients with non-squamous cell cancer and LNR ≥ 30 %, the 5-year actuarial risk of BM was 57.3 %. Conclusions In NSCLC, patients with completely resected pIIIA-N2 non-squamous cell cancer and LNR ≥ 30 % are at the highest risk for BM, and are most likely to benefit from PCI. Further studies are warranted to investigate the effect of PCI on this subset of patients.

  9. Sublobar Resection Margin Width Does Not Affect Recurrence of Clinical N0 Non-small Cell Lung Cancer Presenting as GGO-Predominant Nodule of 3 cm or Less.

    Science.gov (United States)

    Moon, Youngkyu; Lee, Kyo Young; Moon, Seok Whan; Park, Jae Kil

    2017-02-01

    Sublobar resection of lung cancer may benefit patients with lung cancer presenting as ground-glass opacity (GGO) nodules. The purpose of this study was to evaluate the effect of margin width on recurrence after sublobar resection in patients with clinical N0 non-small cell lung cancer presenting as GGO-predominant nodule. We conducted a retrospective chart review of 91 patients treated for clinical N0 non-small cell lung cancer ≤3 cm by sublobar resection with clear resection margins. We assigned them to two groups: GGO-predominant tumor and solid-predominant tumor. Each group was subdivided into two groups according to the margin width: resection margin ≤5 mm and resection margin >5 mm. We analyzed the clinicopathological findings and survival among these four groups. There was no recurrence in GGO-predominant tumors after sublobar resection. Margin width did not influence the recurrence in GGO-predominant tumors. In the cases of solid-predominant tumor, 5-year recurrence-free survival after sublobar resection according to margin width ≤5 and >5 mm was 24.2 and 79.6 %, respectively (p recurrence of solid-predominant tumors (hazard ratio 3.868, 95 % confidence interval 1.177-12.714, p = 0.026). The width between the tumor and resection margin does not affect the recurrence after R0 sublobar resection in patients with clinical N0 GGO-predominant lung cancer ≤3 cm. By contrast, margin width is a significant risk factor for recurrence after sublobar resection in patients with clinical N0 solid-predominant lung cancer.

  10. A Nomogram to Predict Recurrence and Survival of High-Risk Patients Undergoing Sublobar Resection for Lung Cancer: An Analysis of a Multicenter Prospective Study (ACOSOG Z4032).

    Science.gov (United States)

    Kent, Michael S; Mandrekar, Sumithra J; Landreneau, Rodney; Nichols, Francis; Foster, Nathan R; DiPetrillo, Thomas A; Meyers, Bryan; Heron, Dwight E; Jones, David R; Tan, Angelina D; Starnes, Sandra; Putnam, Joe B; Fernando, Hiran C

    2016-07-01

    Individualized prediction of outcomes may help with therapy decisions for patients with non-small cell lung cancer. We developed a nomogram by analyzing 17 clinical factors and outcomes from a randomized study of sublobar resection for non-small cell lung cancer in high-risk operable patients. The study compared sublobar resection alone with sublobar resection with brachytherapy. There were no differences in primary and secondary outcomes between the study arms, and they were therefore combined for this analysis. The clinical factors of interest (considered as continuous variables) were assessed in a univariate Cox proportional hazards model for significance at the 0.10 level for their impact on overall survival (OS), local recurrence-free survival (LRFS), and any recurrence-free survival (RFS). The final multivariable model was developed using a stepwise model selection. Of 212 patients, 173 had complete data on all 17 risk factors. Median follow-up was 4.94 years (range, 0.04 to 6.22). The 5-year OS, LRFS, and RFS were 58.4%, 53.2%, and 47.4%, respectively. Age, baseline percent diffusing capacity of lung for carbon monoxide, and maximum tumor diameter were significant predictors for OS, LRFS, and RFS in the multivariable model. Nomograms were subsequently developed for predicting 5-year OS, LRFS, and RFS. Age, baseline percent diffusing capacity of lung for carbon monoxide, and maximum tumor diameter significantly predicted outcomes after sublobar resection. Such nomograms may be helpful for treatment planning in early stage non-small cell lung cancer and to guide future studies. Copyright © 2016 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  11. Use of a midline mandibular osteotomy to improve surgical access for transoral robotic resection of the base of tongue in a patient with trismus.

    Science.gov (United States)

    Tay, Gerald; Ferrell, Jay; Andersen, Peter

    2017-09-01

    The utilization of transoral robotic surgery (TORS) in patients with trismus is limited because of poor surgical exposure. This report is about a 46-year-old man with a recurrent right base of tongue cancer who had severe postradiation trismus. We performed a midline mandibular osteotomy without a lip split and this resulted in a markedly improved surgical exposure. He underwent a TORS resection of the right base of the tongue with no significant complications. The midline mandibular osteotomy significantly improved the surgical exposure and facilitated exposure for TORS in a patient who otherwise would not be able to undergo TORS. Utilization of a midline mandibular osteotomy allowed for increased exposure for TORS in a patient with limited mouth opening from postradiation trismus. Postoperative hemorrhage remains a significant concern and appropriate measures to mitigate the catastrophic consequences of this should be considered. © 2017 Wiley Periodicals, Inc.

  12. 肺癌外科手术切口的演变与发展趋势%Evolution and Development Trend of Lung Cancer Surgical Incision

    Institute of Scientific and Technical Information of China (English)

    谢冬; 陈昶; 姜格宁

    2016-01-01

    微创、安全以及无瘤原则,是影响肺癌外科手术切口选择的最重要因素。近年来,随着微创技术的进步,逐步出现了单操作孔电视辅助胸腔镜手术(video-assisted thoracic surgery, VATS)、单孔VATS、机器人辅助胸腔镜切除术(robotic-assisted thoracoscopic resection, ARTS)、剑突下单孔VATS、双侧同期VATS肺切除术、跨纵隔单侧进胸双侧肺切除术等新兴入路,特别是单孔VATS,目前在国内外开展已呈燎原之势。本文回顾了肺癌手术切口演变趋势,并对近年来,肺癌外科手术切口的发展趋势予以总结。%Minimally invasive, safe and tumor-free are the main principles of the choice of surgical incision in lung cancer surgery. In recent years, with the advances in minimally invasive techniques, single-port video assisted thoracic surgery (VATS), robot-assisted thoracoscopic (ARTS), suboxiphoid single-port VATS, simultaneous bilateral VATS pulmonary resec-tion, are emerging approaches, single-port VATS has become one of the most exciting new developments in minimally invasive thoracic surgery in recent years. hTis paper reviews the evolution and trends of surgical incision in lung cancer surgery.

  13. Long-Term Survival after Resection of Lung Metastases from Hepatocellular Cancer: Report of a Case and Review of the Literature

    Science.gov (United States)

    Chelimeda, Sneha; Bejarano, Teresa; Lowe, Robert; Soliman, Mahmoud; Zhao, Qing; Hartshorn, Kevan L.

    2016-01-01

    Hepatocellular cancer (HCC) is increasing dramatically in incidence in Europe and the United States due mainly to the hepatitis C epidemic and, to a lesser extent, increased body mass index of the population. In the fairly recent past, HCC was largely considered as untreatable due to detection mainly at late stages and lack of effective drugs for treatment. Several advances have led to changes in the prognosis of HCC. Screening of high-risk populations has allowed for earlier detection in some studies. If found at an early stage, liver transplantation not only cures the usual underlying cirrhosis but has cure rates for HCC in the range of 60% in recent series. Larger lesions can sometimes be cured by partial hepatic resection assuming the remaining liver is not too damaged to sustain liver functions after surgery. Vaccination for hepatitis B has led to reduction in the incidence of HCC. Significant improvements in antiviral treatments for both hepatitis B and hepatitis C may be having an impact on the incidence of HCC as well. It is still generally held that a finding of metastases precludes cure of HCC. We here report the case of a patient who presented with a large HCC in the context of occult hepatitis C infection. The primary tumor was resected. Over a year later, he developed a lung metastasis that was resected as well. He has not shown recurrence for 6 years since the metastasectomy. We review the recent literature on resection of lung metastases from HCC.

  14. Coexpression of CXCR4 and MMP9 predicts lung metastasis and poor prognosis in resected osteosarcoma.

    Science.gov (United States)

    Ren, Zhiwu; Liang, Shoulei; Yang, Jilong; Han, Xiuxin; Shan, Luling; Wang, Biying; Mu, Tianyang; Zhang, Yanqin; Yang, Xueli; Xiong, Shunbin; Wang, Guowen

    2016-04-01

    Osteosarcoma is a highly aggressive bone disease with a tendency to metastasize to the lung. The 5-year survival of patients with metastatic osteosarcoma is only 20 %. Many studies have demonstrated SDF-1/CXCR4 and MMP9 play important roles in the metastasis of malignant tumors, including osteosarcoma. The aim of this study was to investigate the association of CXCR4 and MMP9 expression with clinicopathological features and pulmonary metastasis in osteosarcoma. Using tumor tissue microarrays, we analyzed the expression of CXCR4 and MMP9 among 34 primary osteosarcomas with pulmonary metastasis and 62 primary osteosarcomas without metastasis. A median time of 57.5 months (range: 6 to 171 months) follow-up was performed to evaluate tumor metastasis and the patient survival. The prognostic values were determined by univariate Kaplan-Meier survival analysis and multivariate Cox proportional hazard model analysis. The accuracy of oncologic outcome prediction was evaluated by receiver-operating characteristics (ROC) curves (AUC). The expression of CXCR4 and MMP9 was significantly correlated in tumor tissues (P = 0.026). Both CXCR4 and MMP9 were independent predictors for overall survival and metastasis-free survival by Cox multivariate analysis, and high expression for both CXCR4 and MMP9 were even more significant and better biomarkers for osteosarcoma metastasis and survival. The combination of CXCR4 and MMP9 high expression is very likely to be a valuable independent predictor of lung metastasis and survival in osteosarcoma patients.

  15. [Preoperative assessment of lung disease patients.].

    Science.gov (United States)

    Ramos, Gilson; Ramos Filho, José; Pereira, Edísio; Junqueira, Marcos; Assis, Carlos Henrique C

    2003-02-01

    Lung complications are the most frequent causes of postoperative morbidity-mortality, especially in lung disease patients. So, those patients should be preoperatively carefully evaluated and prepared, both clinically and laboratorially. This review aimed at determining surgical risk and at establishing preoperative procedures to minimize peri and postoperative morbidity-mortality in lung disease patients. Major anesthetic-surgical repercussions in lung function have already been described. Similarly, we tried to select higher-risk patients, submitted or not to lung resection. To that end, clinical and laboratorial propedeutics were used. Finally, a proposal of a preoperative algorithm was presented for procedures with lung resection. Lung disease patients, especially those with chronic evolution, need to be preoperatively thoroughly evaluated. ASA physical status and Goldmans cardiac index are important risk forecasting factors for lung disease patients not candidates for lung resection. Adding to these criteria, estimated postoperative max VO2, FEV1 and diffusion capacity are mandatory for some patients submitted to lung resection. beta2-agonists and steroids should be considered in the preoperative period of these patients.

  16. Establishment of a biomarker model for predicting bone metastasis in resected stage III non-small cell lung cancer

    Directory of Open Access Journals (Sweden)

    Zhou Zhen

    2012-04-01

    Full Text Available Abstract Background This study was designed to establish a biomarker risk model for predicting bone metastasis in stage III non-small cell lung cancer (NSCLC. Methods The model consists of 105 cases of stage III NSCLC, who were treated and followed up. The patients were divided into bone metastasis group (n = 45 and non-bone metastasis group (other visceral metastasis and those without recurrence (n = 60. Tissue microarrays were constructed for immunohistochemical study of 10 molecular markers associated with bone metastasis, based on which a model was established via logistic regression analysis for predicting the risk of bone metastases. The model was prospectively validated in another 40 patients with stage III NSCLC. Results The molecular model for predicting bone metastasis was logit (P = − 2.538 + 2.808 CXCR4 +1.629 BSP +0.846 OPN-2.939 BMP4. ROC test showed that when P ≥ 0.408, the sensitivity was up to 71% and specificity of 70%. Model validation in the 40 cases in clinical trial (NCT 01124253 demonstrated that the prediction sensitivity of the model was 85.7%, specificity 66.7%, Kappa: 0.618, with a high degree of consistency. Conclusion The molecular model combining CXCR4, BSP, OPN and BMP4 could help predict the risk of bone metastasis in stage IIIa and IIIb resected NSCLC.

  17. Preoperative thrombocytosis is a significant unfavorable prognostic factor for patients with resectable non-small cell lung cancer.

    Science.gov (United States)

    Kim, Miso; Chang, Hyun; Yang, Hee Chul; Kim, Yu Jung; Lee, Choon-Taek; Lee, Jae-Ho; Jheon, Sanghoon; Kim, Kwhanmien; Chung, Jin-Haeng; Lee, Jong Seok

    2014-02-12

    Previous studies have reported that pretreatment thrombocytosis is associated with poor outcomes in several cancer types. This study was designed to evaluate the prognostic significance of preoperative thrombocytosis in patients with non-small cell lung cancer (NSCLC) who undergo surgery. We retrospectively reviewed the records of 199 patients who underwent R0 resection for NSCLC between May 2003 and July 2006 at Seoul National University Bundang Hospital, Seongnam, Korea. The frequency of preoperative thrombocytosis was 7.5% (15/199). Patients with preoperative thrombocytosis had shorter overall survival (OS, P = 0.003) and disease-free survival (DFS, P = 0.005) than those without thrombocytosis. In multivariable analysis, patients with preoperative thrombocytosis had a significantly greater risk of death and recurrence than those without preoperative thrombocytosis (risk of death: hazard ratio (HR) 2.98, 95% confidence interval (CI) 1.39 to 6.37, P = 0.005; risk of recurrence: HR 2.47, 95% CI 1.22 to 5.01, P = 0.012). A tendency towards a shorter OS and DFS was observed in three patients with persistent thrombocytosis during the follow-up period when compared with those of patients who recovered from thrombocytosis after surgery. Preoperative thrombocytosis was valuable for predicting the prognosis of patients with NSCLC. Special attention should be paid to patients with preoperative and postoperative thrombocytosis.

  18. Complications following lung surgery in the Dutch-Belgian randomized lung cancer screening trial

    NARCIS (Netherlands)

    van't Westeinde, Susan C.; Horeweg, Nanda; De Leyn, Paul; Groen, Harry J. M.; Lammers, Jan-Willem J.; Weenink, Carla; Nackaerts, Kristiaan; van Klaveren, Rob J.

    2012-01-01

    To assess the complication rate in participants of the screen arm of the NELSON lung cancer screening trial who underwent surgical resection and to investigate, based on a literature review, whether the complication rate, length of hospital stay, re-thoracotomy and mortality rates after a surgical p

  19. Accuracy of Computed Tomography for Predicting Pathologic Nodal Extracapsular Extension in Patients With Head-and-Neck Cancer Undergoing Initial Surgical Resection

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    Prabhu, Roshan S., E-mail: roshansprabhu@gmail.com [Department of Radiation Oncology, Emory University, Atlanta, Georgia (United States); Winship Cancer Institute, Emory University, Atlanta, Georgia (United States); Magliocca, Kelly R. [Department of Pathology, Emory University, Atlanta, Georgia (United States); Winship Cancer Institute, Emory University, Atlanta, Georgia (United States); Hanasoge, Sheela [Department of Radiation Oncology, Emory University, Atlanta, Georgia (United States); Winship Cancer Institute, Emory University, Atlanta, Georgia (United States); Aiken, Ashley H.; Hudgins, Patricia A. [Department of Radiology and Imaging Sciences, Emory University, Atlanta, Georgia (United States); Winship Cancer Institute, Emory University, Atlanta, Georgia (United States); Hall, William A. [Department of Radiation Oncology, Emory University, Atlanta, Georgia (United States); Winship Cancer Institute, Emory University, Atlanta, Georgia (United States); Chen, Susie A. [Department of Radiation Oncology, University of Texas Southwestern, Dallas, Texas (United States); Eaton, Bree R.; Higgins, Kristin A. [Department of Radiation Oncology, Emory University, Atlanta, Georgia (United States); Winship Cancer Institute, Emory University, Atlanta, Georgia (United States); Saba, Nabil F. [Department of Hematology and Medical Oncology, Emory University, Atlanta, Georgia (United States); Winship Cancer Institute, Emory University, Atlanta, Georgia (United States); Beitler, Jonathan J. [Department of Radiation Oncology, Emory University, Atlanta, Georgia (United States); Winship Cancer Institute, Emory University, Atlanta, Georgia (United States)

    2014-01-01

    Purpose: Nodal extracapsular extension (ECE) in patients with head-and-neck cancer increases the loco-regional failure risk and is an indication for adjuvant chemoradiation therapy (CRT). To reduce the risk of requiring trimodality therapy, patients with head-and-neck cancer who are surgical candidates are often treated with definitive CRT when preoperative computed tomographic imaging suggests radiographic ECE. The purpose of this study was to assess the accuracy of preoperative CT imaging for predicting pathologic nodal ECE (pECE). Methods and Materials: The study population consisted of 432 consecutive patients with oral cavity or locally advanced/nonfunctional laryngeal cancer who underwent preoperative CT imaging before initial surgical resection and neck dissection. Specimens with pECE had the extent of ECE graded on a scale from 1 to 4. Results: Radiographic ECE was documented in 46 patients (10.6%), and pECE was observed in 87 (20.1%). Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were 43.7%, 97.7%, 82.6%, and 87.3%, respectively. The sensitivity of radiographic ECE increased from 18.8% for grade 1 to 2 ECE, to 52.9% for grade 3, and 72.2% for grade 4. Radiographic ECE criteria of adjacent structure invasion was a better predictor than irregular borders/fat stranding for pECE. Conclusions: Radiographic ECE has poor sensitivity, but excellent specificity for pECE in patients who undergo initial surgical resection. PPV and NPV are reasonable for clinical decision making. The performance of preoperative CT imaging increased as pECE grade increased. Patients with resectable head-and-neck cancer with radiographic ECE based on adjacent structure invasion are at high risk for high-grade pECE requiring adjuvant CRT when treated with initial surgery; definitive CRT as an alternative should be considered where appropriate.

  20. The Effect of Endoscopic Resection on Short-Term Surgical Outcomes in Patients with Additional Laparoscopic Gastrectomy after Non-Curative Resection for Gastric Cancer

    Science.gov (United States)

    Lee, Eun-Gyeong; Eom, Bang-Wool; Yoon, Hong-Man; Kim, Yong-Il; Cho, Soo-Jeong; Lee, Jong-Yeul; Kim, Young-Woo

    2017-01-01

    Purpose Endoscopic submucosal dissection (ESD) in early gastric cancer causes an artificial gastric ulcer and local inflammation that has a negative intraprocedural impact on additional laparoscopic gastrectomy in patients with noncurative ESD. In this study, we analyzed the effect of ESD on short-term surgical outcomes and evaluated the risk factors. Materials and Methods From January 2003 to January 2013, 1,704 patients of the National Cancer Center underwent laparoscopic gastrectomy with lymph node dissection because of preoperative stage Ia or Ib gastric cancer. They were divided into 2 groups: (1) with preoperative ESD or (2) without preoperative ESD. Clinicopathologic factors and short-term surgical outcomes were retrospectively evaluated along with risk factors such as preoperative ESD. Results Several characteristics differed between patients who underwent ESD-surgery (n=199) or surgery alone (n=1,505). The mean interval from the ESD procedure to the operation was 43.03 days. Estimated blood loss, open conversion rate, mean operation time, and length of hospital stay were not different between the 2 groups. Postoperative complications occurred in 23 patients (11.56%) in the ESD-surgery group and in 189 patients (12.56%) in the surgery-only group, and 3 deaths occurred among patients with complications (1 patient [ESD-surgery group] vs. 2 patients [surgery-only group]; P=0.688). A history of ESD was not significantly associated with postoperative complications (P=0.688). Multivariate analysis showed that male sex (P=0.008) and laparoscopic total or proximal gastrectomy (P=0.000) were independently associated with postoperative complications. Conclusions ESD did not affect short-term surgical outcomes during and after an additional laparoscopic gastrectomy.

  1. Successive Torsion of the Right Middle and Left Cranial Lung Lobes in a Dog

    OpenAIRE

    Breton, Luc; DiFruscia, Rocky; Olivieri, Michel

    1986-01-01

    This case report describes the torsion of two lung lobes in a dog. The animal was first presented for a torsion of the right middle lung lobe. Following the surgical resection of that lobe, the dog suffered another torsion of the left cranial lung lobe (cranial and caudal segments).

  2. Awake operative videothoracoscopic pulmonary resections.

    Science.gov (United States)

    Pompeo, Eugenio; Mineo, Tommaso C

    2008-08-01

    The authors' initial experience with awake videothoracoscopic lung resection suggests that these procedures can be easily and safely performed under sole thoracic epidural anesthesia with no mortality and negligible morbidity. One major concern was that operating on a ventilating lung would render surgical maneuvers more difficult because of the lung movements and lack of a sufficient operating space. Instead, the open pneumothorax created after trocar insertion produces a satisfactory lung collapse that does not hamper surgical maneuvers. These results contradict the accepted assumption that the main prerequisite for allowing successful thoracoscopic lung surgery is general anesthesia with one-lung ventilation. No particular training is necessary to accomplish an awake pulmonary resection for teams experienced in thoracoscopic surgery, and conversions to general anesthesia are mainly caused by the presence of extensive fibrous pleural adhesions or the development of intractable panic attacks. Overall, awake pulmonary resection is easily accepted and well tolerated by patients, as confirmed by the high anesthesia satisfaction score, which was better than in nonawake control patients. Nonetheless, thoracic epidural anesthesia has potential complications, including epidural hematoma, spinal cord injury, and phrenic nerve palsy caused by inadvertently high anesthetic level, but these never occurred in the authors' experience. Further concerns relate to patient participation in operating room conversations or risk for development of perioperative panic attacks. However, the authors have found that reassuring the patient during the procedure, explaining step-by-step what is being performed, and even showing the ongoing procedure on the operating video can greatly improve the perioperative wellness and expectations of patients, particularly if the procedure is performed for oncologic diseases. Panic attacks occurred in few patients and could be usually managed through

  3. Up-to-date surgical tactics in echinococcosis of the lungs

    Directory of Open Access Journals (Sweden)

    Bakhodir Sabirov

    2010-09-01

    Full Text Available The paper provides analysis of surgical treatment of 132 patients with echinococcosis or hydatid disease (86 patients with uncomplicated and 46 with complicated echinococcosis of the lungs. It was possible to perform echinococcectomy of the lungs through mini-invasive approaches in more than 2/3 patients and employment of endovisual technology made it possible to shorten the number of postoperative complications from 35.71 % to 4% and the terms of treatment from 14.2 to 6.4 days.In our opinion, echinococcectomy of the lungs through mini-invasive approach requires further technical improvement. It is easier and more effective to perform echinococcectomy through minithoracotomy approach. At the same time it should be acknowledged that echinococcectomy via thoracotomy approach is more often recommended in recurrent echinococcosis of the thoracic cavity and sometimes in complicated course of the disease. Simultaneous operations using mini-approaches in bilateral echinococcosis of the lungs or in combination with the liver are the operations of the choice and can be performed in patients with good functional indexes of the cardiovascular and the respiratory systems.

  4. Utility of surgical lung biopsy in critically ill patients with diffuse pulmonary infiltrates: a retrospective review.

    Science.gov (United States)

    Donaldson, L H; Gill, A J; Hibbert, M

    2016-11-01

    There are conflicting reports regarding the role of surgical lung biopsies in patients who present to the intensive care unit (ICU) with unexplained respiratory failure and diffuse pulmonary infiltrates on imaging. To describe the utility of surgical lung biopsies in patients presenting to the ICU with unexplained respiratory failure and diffuse pulmonary infiltrates. A retrospective cohort study was performed. All patients admitted to the ICU who underwent a surgical lung biopsy for the investigation of respiratory failure and unexplained pulmonary infiltrates between 1998 and 2012 were included. The primary outcome measures for this descriptive study were the biopsy histopathology, changes in patient management following biopsy and in-hospital mortality. A total of 30 patients was included in the review. Biopsies in 22 patients (73%) demonstrated diffuse alveolar damage (DAD), with 15 of these biopsies (50%) suggesting a specific underlying aetiology. In 73% of cases (n = 22), the biopsy finding was associated with a change in management, although this generally involved the escalation of an existing therapy rather than initiation of a new treatment. Biopsies were performed at a median 10 days after admission (interquartile range 5-17 days), with the majority of patients being treated empirically prior to the biopsy with systemic steroids and broad-spectrum antimicrobials. Mortality was 53%. In this series, DAD was the most frequent pathology. The biopsy result was associated with a change in management in a majority of the subjects, most frequently an escalation of prior empiric therapy. Mortality was high. © 2016 Royal Australasian College of Physicians.

  5. Prognosis of R1-resection at the bronchial stump in patients with non-small cell lung cancer

    Institute of Scientific and Technical Information of China (English)

    Lyu Jima; Hao Xuezhi; Hui Zhouguang; Liang Jun; Zhou Zongmei; Feng Qinfu; Xiao Zefen

    2014-01-01

    Background The prognosis of R1-resection at the bronchial stump in patients with non-small cell lung cancer (NSCLC) remains unclear.This study intends to identify the prognostic factors and to optimize treatments for these patients under update conditions.Methods The data of 124 NSCLC patients who underwent R1-resection at the bronchial stump was reviewed.There were 41 patients in the surgery group (S),21 in the postoperative radiotherapy (PORT) group (S+R),30 in the postoperative chemotherapy (POCT) group (S+C),and 32 in the PORT plus POCT group (S+R+C).The constitute proportion in different groups was tested using the X2 method,univariate analysis was performed using the Kaplan-Meier and log-rank method,and multivariate analysis was done using the Cox hazard regression with entry factors including age,sex,pathological type and stage,classification of the residual disease,and treatment procedure.The process was performed stepwise backward with a maximum iteration of 20 and an entry possibility of 0.05 as well as an excluded possibility of 0.10 at each step.Results In univariate analysis,survival was more favorable for patients with squamous cell carcinoma,early pathological T or N stage,and chemotherapy or radiotherapy.There was no significant difference in the survival for patients with different types of the residual disease,except for the difference between patients with carcinoma in situ and lymphangiosis carcinomatosa (P=0.030).The survival for patients receiving chemoradiotherapy was superior to that for those undergoing surgery alone (P=0.016).In multivariate analysis,the pathological type (HR 2.51,95% CI 1.59 to 3.96,P=0.000),pathological T (HR 1.29,95% CI 1.04 to 1.60,P=-0.021) or N stage (HR 2.04,95% CI 1.40 to 2.98,P=0.000),and chemotherapy (HR 0.24,95% CI 0.13 to 0.43,P=0.000) were independent prognostic factors.Conclusion Patients with squamous cell carcinoma,early pathological T or N stage,or receiving chemotherapy had a more favorable

  6. Microscopic N2 disease exhibits a better prognosis in resected non-small-cell lung cancer.

    Science.gov (United States)

    Garelli, Elena; Renaud, Stéphane; Falcoz, Pierre-Emmanuel; Weingertner, Noëlle; Olland, Anne; Santelmo, Nicola; Massard, Gilbert

    2016-08-01

    The management of pIIIA-N2 non-small-cell lung cancer (NSCLC) is still controversial. In particular, there are wide variations in overall survival (OS), suggesting the existence of subgroups among N2 patients. We aimed to evaluate the prognostic value of microscopic pN2 in NSCLC. Between 1996 and 2015, the data from all 982 pathologically stage IIIA-N2 patients who underwent surgery with curative intent for NSCLC were retrospectively reviewed. Microscopic pN2 disease was defined as a nodal metastasis ranging from 0.2 to 2 mm in size. With a median follow-up of 17 months (2-101), the 5-year OS for the whole cohort was 31%. Microscopic N2 was observed in 309 (31.5%) patients. Microscopic N2 was associated with better median OS compared with macroscopic N2 [42 months (95% CI 36.85-47.15) vs 23 months (95% CI 19.7-26.29), P microscopic N2 remained a favourable independent prognostic factor [HR 0.681 (95% CI 0.481-0.967), P = 0.03]. The median OS of microscopic N2 patients who benefitted from simple follow-up was significantly better than those who underwent chemotherapy, radiation therapy or both [43 months (95% CI 24.22-61.78) vs 22 months (95% CI 17.43-26.47) vs 31 months (95% CI 27.66-34.34) vs 16 months (95% CI 14.6-17.4), P = 0.008]. Microscopic N2 seems to be associated with better prognosis in patients with pIIIA-N2 NSCLC and these could benefit from a simple follow-up. Prospective cohort studies are necessary to confirm these preliminary results. © The Author 2016. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

  7. Second lung cancers in patients successfully treated for lung cancer.

    Science.gov (United States)

    Johnson, B E; Cortazar, P; Chute, J P

    1997-08-01

    The rate of developing second lung cancers and other aerodigestive tumors in patients who have been treated for both small cell lung cancer (SCLC) and non-small cell lung cancer (NSCLC) is approximately 10-fold higher than other adult smokers. The risk of second lung cancers in patients surviving resection of NSCLC is approximately 1% to 2% per year. The series reported show that the patients who develop second NSCLCs tend to have early-stage NSCLC (predominantly stage I and II). The survival of patients after the second resection of lung cancer is similar to that of patients presenting with initial NSCLC. The risk of second lung cancers in patients surviving SCLC is 2% to 14% per patient per year and increases two- to seven-fold with the passage of time from 2 to 10 years. The risk of second lung cancers in patients treated for SCLC appears to be higher than that found in patients with NSCLC who were treated only with surgical resection. In addition, the chances of successful resection of second primary NSCLCs in patients who were treated for SCLC is much less than that for patients with metachronous lung cancers after an initial NSCLC. Patients treated for SCLC who continue to smoke cigarettes increase their rate of developing second lung cancers. The contribution of chest radiation and chemotherapy administration to the risk of developing second lung tumors remain to be defined but may be responsible for some of the increased risk in patients treated for SCLC compared to patients undergoing a surgical resection for NSCLC.

  8. Investigations of initial airtightness after non-anatomic resection of lung parenchyma using a thulium-doped laser with different optical fibres.

    Science.gov (United States)

    Kirschbaum, Andreas; Höchsmann, N; Steinfeldt, T; Seyfer, P; Pehl, A; Bartsch, D K; Palade, E

    2016-08-01

    Lung metastases in healthy patients should be removed non-anatomically whenever possible. This can be done with a laser. Lung parenchyma can be cut very well, because of its high energy absorption at a wavelength of 1940 nm. A coagulation layer is created on the resected surface. It is not clear, whether this surface also needs to be sutured to ensure that it remains airtight even at higher ventilation pressures. It would be helpful, if suturing could be avoided, because the lung can become too puckered, especially with multiple resections, resulting in considerable restriction. We carried out our experiments on isolated and ventilated paracardiac lung lobes of pigs. Non-anatomic resection was carried out reproducibly using three different thulium laser fibres (230, 365 and 600 μm) at two different laser power levels (10 W, 30 W) and three different resection depths (0.5, 1.0 and 2.0 cm). Initial airtightness was investigated while ventilating at normal frequency. We also investigated the bursting pressures of the resected areas by increasing the inspiratory pressure. When 230- and 365-μm fibres were used with a power of 10 W, 70 % of samples were initially airtight up to a resection depth of 1 cm. This rate fell at depths of up to 2 cm. All resected surfaces remained airtight during ventilation when 600-μm fibres were used at both laser power levels (10 and 30 W). The bursting pressures achieved with 600-μm fibres were higher than with the other fibres used: 0.5 cm, 41.6 ± 3.2 mbar; 1 cm, 38.2 ± 2.5 mbar; 2 cm, 33.7 ± 4.8 mbar. As laser power and thickness of laser fibre increased, so the coagulation zone became thicker. With a 600-μm fibre, it measured 145.0 ± 8.2 μm with 10 W power and 315.5 ± 6.4 μm with 30 W power. Closure with sutures after non-anatomic resection of lung parenchyma is not necessary when a thulium laser is used provided a 600-μm fibre and adequate laser power (30 W) are employed. At deeper

  9. Does external pleural suction reduce prolonged air leak after lung resection? Results from the AirINTrial after 500 randomized cases.

    Science.gov (United States)

    Leo, Francesco; Duranti, Leonardo; Girelli, Lara; Furia, Simone; Billè, Andrea; Garofalo, Giuseppe; Scanagatta, Paolo; Giovannetti, Riccardo; Pastorino, Ugo

    2013-10-01

    External pleural suction is used after lung resection to promote lung expansion and minimize air leak duration. Published randomized trials failed to prove this advantage but they are limited in number and underpowered in many cases. The aim of the AirINTrial study was to test the hypothesis that external pleural suction may reduce the rate of prolonged air leak in a large, randomized cohort. All candidates for lung resection (with the exception of pneumonectomy) were considered eligible for this single-center study. At the end of operation, patients were stratified by the type of resection (anatomic versus nonanatomic) and randomly allocated into the external suction arm (-15 cmH2O, group A) or into the no external suction arm (control arm, group B) in a 1:1 ratio. Chest drains were maintained for 3 days and then they were either removed or connected to an Heimlich valve, when an air leak was present. The main endpoint was to compare groups in terms of prolonged air leak (defined as the rate of patients having a chest drain still in place by postoperative day 7). Starting on February 2011, 500 patients were randomized over a 21-month period, 250 in group A and 250 in group B. Twenty-one patients in group B (8.4%) required pleural suction owing to large pneumothorax or diffuse subcutaneous emphysema. On postoperative day 7, the chest drain was still in place in 25 patients in group A and in 34 patients in group B (10% and 14%, respectively; p = 0.2). Subgroup analysis showed that external pleural suction reduced the prolonged air leak rate in the subgroup of patients who underwent anatomic resection (n = 296, 9.6% in group A and 16.8% in group B; p = 0.05). Results from the AirINTrial showed that the routine use of external suction reduces the rate of prolonged air leak after anatomic lung resection. More accurate strategies of pleural suction based on the amount of air flow and the degree of lung expansion should be probably established to improve its

  10. Perioperative Allogeneic Blood Transfusion Is Associated With Surgical Site Infection After Abdominoperineal Resection-a Space for the Implementation of Patient Blood Management Strategies.

    Science.gov (United States)

    Kaneko, Kensuke; Kawai, Kazushige; Tsuno, Nelson H; Ishihara, Soichiro; Yamaguchi, Hironori; Sunami, Eiji; Watanabe, Toshiaki

    2015-05-01

    Allogeneic blood transfusion (ABT) has been reported as a major risk factor for surgical site infection (SSI) in patients undergoing colorectal surgery. However, the association of ABT with SSI in patients undergoing abdominoperineal resection (APR) and total pelvic exenteration (TPE) still remains to be evaluated. Here, we aim to elucidate this association. The medical records of all patients undergoing APR and TPE at our institution in the period between January 2000 and December 2012 were reviewed. Patients without SSI (no SSI group) were compared with patients who developed SSI (SSI group), in terms of clinicopathologic features, including ABT. In addition, data for 262 patients who underwent transabdominal rectal resection at our institution in the same period were also enrolled, and their data on differential leukocyte counts were evaluated. Multivariate analysis showed that intraoperative transfusion was an independent predictive factor for SSI after APR and TPE (P = 0.004). In addition, the first-operative day lymphocyte count of patients undergoing APR, TPE, and transabdominal rectal resection was significantly higher in nontransfusion patients compared with transfusion ones (P = 0.026). ABT in the perioperative period of APR and TPE may have an important immunomodulatory effect, leading to an increased incidence of SSI. This fact should be carefully considered, and efforts to avoid allogeneic blood exposure while still achieving adequate patient blood management would be very important for patients undergoing APR and TPE as well.

  11. A resected case of metachronous liver metastasis from lung cancer producing alpha-fetoprotein (AFP) and protein induced by vitamin K absence or antagonist II (PIVKA-II).

    Science.gov (United States)

    Oshiro, Yukio; Takada, Yasutsugu; Enomoto, Tsuyoshi; Fukao, Katashi; Ishikawa, Shigemi; Iijima, Tatsuo

    2004-01-01

    A resected case of huge liver metastasis of hepatoid adenocarcinoma of the lung is described. A 77-year-old man who presented a solitary huge liver tumor was admitted to our hospital. He had undergone right lower lobectomy of the lung for lung cancer one year before. The view of imaging studies was not a typical one of hepatocellular carcinoma. Serum levels of AFP and PIVKA-II were 334,500ng/mL and 3,890mAU/mL, respectively, and the proportion of AFP L3 was 97.9%. It was thought that they were strongly diagnostic for hepatocellular carcinoma. Extended right lobectomy of the liver was performed. Microscopically, it was poorly differentiated adenocarcinoma and diagnosed as liver metastasis from the formerly resected lung cancer. The tumor was composed of cells with both sheet-like growth and tubule formation. The neoplastic cells, in the sheet-like growth resembled hepatocellular carcinoma cells. By immunohistochemical staining with anti-AFP and anti-PIVKA-II antibodies, cancer cells of both the primary and metastatic lesions were positive. The patient eventually died of multiple liver and bone metastasis 6 months after the operation.

  12. Successful treatment of primary advanced gastric plasmacytoma using a combination of surgical resection and chemotherapy with bortezomib: A case report

    Directory of Open Access Journals (Sweden)

    Sotaro Fukuhara

    2016-01-01

    Conclusions: This is the first reported case of advanced gastric plasmacytoma using adjuvant chemotherapy involving bortezomib and auto-PBSCT after the resection, and the patient has maintained a good course over a year. This protocol could be a new way to treat these tumors.

  13. Impact of combined pulmonary fibrosis and emphysema on surgical complications and long-term survival in patients undergoing surgery for non-small-cell lung cancer

    Directory of Open Access Journals (Sweden)

    Hata A

    2016-06-01

    Full Text Available Atsushi Hata,1,2 Yasuo Sekine,1 Ohashi Kota,1 Eitetsu Koh,1 Ichiro Yoshino2 1Department of Thoracic Surgery, Tokyo Women’s Medical University Yachiyo Medical Centre, Yachiyo, 2Department of General Thoracic Surgery, Graduate School of Medicine, Chiba University, Chiba City, Chiba, Japan Purpose: The outcome of radical surgery for lung cancer was investigated in patients with combined pulmonary fibrosis and emphysema (CPFE. Methods: A retrospective chart review involved 250 patients with lung cancer who underwent pulmonary resection at Tokyo Women’s Medical University Yachiyo Medical Center between 2008 and 2012. Based on the status of nontumor-bearing lung evaluated by preoperative computed tomography (CT, the patients were divided into normal, emphysema, interstitial pneumonia (IP, and CPFE groups, and their clinical characteristics and surgical outcome were analyzed. Results: The normal, emphysema, IP, and CPFE groups comprised 124 (49.6%, 108 (43.2%, seven (2.8%, and eleven (4.4% patients, respectively. The 5-year survival rate of the CPFE group (18.7% was significantly lower than that of the normal (77.5% and emphysema groups (67.1% (P<0.0001 and P=0.0027, respectively but equivalent to that of the IP group (44.4% (P=0.2928. In a subset analysis of cancer stage, the 5-year overall survival rate of the CPFE group in stage I (n=8, 21.4% was also lower than that of the normal group and emphysema group in stage I (n=91, 84.9% and n=70, 81.1%; P<0.0001 and P<0.0001, respectively. During entire observation period, the CPFE group was more likely to die of respiratory failure (27.2% compared with the normal and emphysema groups (P<0.0001. Multivariate analysis of prognostic factors using Cox proportional hazard model identified CPFE as an independent risk factor (P=0.009. Conclusion: CPFE patients have a poorer prognosis than those with emphysema alone or with normal lung on CT finding. The intensive evaluation of preoperative CT images is

  14. Radiofrequency ablation versus surgical resection for the treatment of hepatocellular carcinoma conforming to the Milan criteria: systemic review and meta-analysis.

    Science.gov (United States)

    Yi, Hui-Ming; Zhang, Wei; Ai, Xi; Li, Kai-Yan; Deng, You-Bin

    2014-01-01

    Radiofrequency ablation (RFA) is a promising ablation technique and has become one of the best alternatives for hepatocellular carcinoma (HCC) patients. But whether RFA or surgical resection (SR) is the better treatment for HCC conforming to the Milan criteria has long been debated. A meta-analysis of trials that compared RFA versus SR was conducted regarding the survival rate and recurrence rate. Pooled odds ratios (OR) with 95% confidence intervals (95% CI) were calculated using fixed or random effects models. Nineteen studies, comprising 2 randomized controlled trials and 17 non-randomized controlled trials, were included with a total of 2895 patients. The 5 years overall survival rate for SR group was significantly higher than that for RFA group. In the SR group, the local recurrence rate was significantly lower when compared with the RFA group. This meta-analysis yielded no significant differences between laparoscopic RFA and SR in 5-year overall survival rate. In conclusion, surgical resection remains the better choice of treatment for HCC conforming to the Milan criteria, whereas RFA should be considered as an effective alternative treatment when surgery is not feasible. As for RFA technique, laparoscopic approach may be more effective than percutaneous approach for HCC conforming to Milan criteria.

  15. Resecting diffuse low-grade gliomas to the boundaries of brain functions: a new concept in surgical neuro-oncology.

    Science.gov (United States)

    Duffau, H

    2015-12-01

    The traditional dilemma making surgery for diffuse low-grade gliomas (DLGGs) challenging is underlain by the need to optimize tumor resection in order to significantly increase survival versus the risk of permanent neurological morbidity. Development of neuroimaging led neurosurgeons to achieve tumorectomy according to the oncological limits provided by preoperative or intraoperative structural and metabolic imaging. However, this principle is not coherent, neither with the infiltrative nature of DLGGs nor with the limited resolution of current neuroimaging. Indeed, despite technical advances, MRI still underestimates the actual spatial extent of gliomas, since tumoral cells are present several millimeters to centimeters beyond the area of signal abnormalities. Furthermore, cortical and subcortical structures may be still crucial for brain functions despite their invasion by this diffuse tumoral disease. Finally, the lack of reliability of functional MRI has also been demonstrated. Therefore, to talk about "maximal safe resection" based upon neuroimaging is a non-sense, because oncological MRI does not show the tumor and functional MRI does not show critical neural pathways. This review proposes an original concept in neuro-oncological surgery, i.e. to resect DLGG to the boundaries of brain functions, thanks to intraoperative electrical mapping performed in awake patients. This paradigmatic shift from image-guided resection to functional mapping-guided resection, based upon an accurate study of brain connectomics and neuroplasticity in each patient throughout tumor removal has permitted to solve the classical dilemma, by increasing both survival and quality of life in DLGG patients. With this in mind, brain surgeons should also be neuroscientists.

  16. External-beam radiation therapy after surgical resection and intraoperative electron-beam radiation therapy for oligorecurrent gynecological cancer. Long-term outcome

    Energy Technology Data Exchange (ETDEWEB)

    Sole, C.V. [Hospital General Universitario Gregorio Maranon, Department of Oncology, Madrid (Spain); Complutense University, School of Medicine, Madrid (Spain); Instituto de Radiomedicina, Service of Radiation Oncology, Santiago (Chile); Hospital General Universitario Gregorio Maranon, Institute of Research Investigation, Madrid (Spain); Calvo, F.A. [Hospital General Universitario Gregorio Maranon, Department of Oncology, Madrid (Spain); Complutense University, School of Medicine, Madrid (Spain); Hospital General Universitario Gregorio Maranon, Institute of Research Investigation, Madrid (Spain); Lozano, M.A.; Gonzalez-Sansegundo, C. [Hospital General Universitario Gregorio Maranon, Department of Oncology, Madrid (Spain); Hospital General Universitario Gregorio Maranon, Service of Radiation Oncology, Madrid (Spain); Hospital General Universitario Gregorio Maranon, Institute of Research Investigation, Madrid (Spain); Gonzalez-Bayon, L. [Hospital General Universitario Gregorio Maranon, Service of General Surgery, Madrid (Spain); Hospital General Universitario Gregorio Maranon, Institute of Research Investigation, Madrid (Spain); Alvarez, A. [Hospital General Universitario Gregorio Maranon, Service of Radiation Oncology, Madrid (Spain); Hospital General Universitario Gregorio Maranon, Institute of Research Investigation, Madrid (Spain); Lizarraga, S. [Hospital General Universitario Gregorio Maranon, Department of Gynecology, Madrid (Spain); Hospital General Universitario Gregorio Maranon, Institute of Research Investigation, Madrid (Spain); Garcia-Sabrido, J.L. [Complutense University, School of Medicine, Madrid (Spain); Hospital General Universitario Gregorio Maranon, Service of General Surgery, Madrid (Spain); Hospital General Universitario Gregorio Maranon, Department of Gynecology, Madrid (Spain)

    2014-02-15

    The goal of the present study was to analyze prognostic factors in patients treated with external-beam radiation therapy (EBRT), surgical resection and intraoperative electron-beam radiotherapy (IOERT) for oligorecurrent gynecological cancer (ORGC). From January 1995 to December 2012, 61 patients with ORGC [uterine cervix (52 %), endometrial (30 %), ovarian (15 %), vagina (3 %)] underwent IOERT (12.5 Gy, range 10-15 Gy), and surgical resection to the pelvic (57 %) and paraaortic (43 %) recurrence tumor bed. In addition, 29 patients (48 %) also received EBRT (range 30.6-50.4 Gy). Survival outcomes were estimated using the Kaplan-Meier method, and risk factors were identified by univariate and multivariate analyses. Median follow-up time for the entire cohort of patients was 42 months (range 2-169 months). The 10-year rates for overall survival (OS) and locoregional control (LRC) were 17 and 65 %, respectively. On multivariate analysis, no tumor fragmentation (HR 0.22; p = 0.03), time interval from primary tumor diagnosis to locoregional recurrence (LRR) < 24 months (HR 4.02; p = 0.02) and no EBRT at the time of pelvic recurrence (HR 3.95; p = 0.02) retained significance with regard to LRR. Time interval from primary tumor to LRR < 24 months (HR 2.32; p = 0.02) and no EBRT at the time of pelvic recurrence (HR 3.77; p = 0.04) showed a significant association with OS after adjustment for other covariates. External-beam radiation therapy at the time of pelvic recurrence, time interval for relapse ≥24 months and not multi-involved fragmented resection specimens are associated with improved LRC in patients with ORGC. As suggested from the present analysis a significant group of ORGC patients could potentially benefit from multimodality rescue treatment. (orig.)

  17. Comparison of long-term survival between temozolomide-based chemoradiotherapy and radiotherapy alone for patients with low-grade gliomas after surgical resection

    Science.gov (United States)

    Gai, Xiu-juan; Wei, Yu-mei; Tao, Heng-min; An, Dian-zheng; Sun, Jia-teng; Li, Bao-sheng

    2016-01-01

    Purpose This study was designed to compare the survival outcomes of temozolomide-based chemoradiotherapy (TMZ + RT) vs radiotherapy alone (RT-alone) for low-grade gliomas (LGGs) after surgical resection. Patients and methods In this retrospective analysis, we reviewed postoperative records of 69 patients with LGGs treated with TMZ + RT (n=31) and RT-alone (n=38) at the Shandong Cancer Hospital Affiliated to Shandong University between June 2011 and December 2013. Patients in the TMZ + RT group were administered 50–100 mg oral TMZ every day until the radiotherapy regimen was completed. Results The median follow-up since surgery was 33 months and showed no significant intergroup differences (P=0.06). There were statistically significant intergroup differences in the progression-free survival rate (P=0.037), with 83.9% for TMZ-RT group and 60.5% for RT-alone group. The overall 2-year overall survival (OS) rate was 89.86%. Age distribution (≥45 years and <45 years) and resection margin (complete resection or not) were significantly associated with OS (P=0.03 and P=0.004, respectively). Conclusion Although no differences were found in the 2-year OS between the TMZ + RT and RT-alone groups, there was a trend toward increased 2-year progression-free survival in the TMZ + RT group. With better tolerability, concurrent TMZ chemoradiotherapy may be beneficial for postoperative patients with LGGs. Age distribution and surgical margin are likely potential indicators of disease prognosis. The possible differences in long-term survival between the two groups and the links between prognostic factors and long-term survival may be worthy of further investigation. PMID:27574452

  18. Suggestion of optimal radiation fields in rectal cancer patients after surgical resection for the development of the patterns of care study

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Jong Hoon; Park, Jin Hong; Kim, Dae Yong [College of Medicine, Ulsan Univ., Seoul (Korea, Republic of)] [and others

    2003-06-01

    To suggest the optimal radiation fields after a surgical resection based on a nationwide survey on the principles of radiotherapy for rectal cancer in the Korean Patterns of Care Study. A consensus committee, composed of radiation oncologists from 18 hospitals in Seoul Metropolitan area, developed a survey format to analyze radiation oncologist's treatment principles for rectal cancer after a surgical resection. The survey format included 19 questions on the principles of defining field margins, and was sent to the radiation oncologists in charge of gastrointestinal malignancies in all Korean hospitals (48 hospitals). Thirty three (69%) oncologists replied. On the basis of the replies and literature review, the committee developed guidelines for the optimal radiation fields for rectal cancer. The following guidelines were developed: superior border between the lower tip of the L5 vertebral body and upper sacroiliac joint; inferior border 2-3 cm distal to the anastomosis in patient whose sphincter was saved, and 2-3 cm distal to the perineal scar in patients whose anal sphincter was sacrificed; anterior margin at the posterior tip of the symphysis pubis or 2-3 cm anterior to the vertebral body, to include the internal iliac lymph node and posterior margin 1.5-2 cm posterior to the anterior surface of the sacrum, to include the presacral space with enough margin. Comparison with the guidelines, the replies on the superior margin coincided in 23 cases (70%), the inferior margin after sphincter saving surgery in 13 (39%), the inferior margin after abdominoperineal resection in 32 (97%), the lateral margin in 32 (97%), the posterior margins in 32 (97%) and the anterior margin in 16 (45%). These recommendations should be tailored to each patient according to the clinical characteristics such as tumor location, pathological and operative findings, for the optimal treatment. The adequacy of these guidelines should be proved by following the Korean Patterns of Care

  19. Intraoperative use of diffusion tensor imaging-based tractography for resection of gliomas located near the pyramidal tract: comparison with subcortical stimulation mapping and contribution to surgical outcomes.

    Science.gov (United States)

    Vassal, F; Schneider, F; Nuti, C

    2013-10-01

    For gliomas, the goal of surgery is maximal tumour removal with the preservation of neurological function. We evaluated the contribution of the combination of diffusion tensor imaging-based fibre tracking (DTI-FT) of the pyramidal tract (PT) integrated to the navigation and subcortical direct electrical stimulations (DESs) to surgical outcomes. Ten patients underwent surgery for gliomas located in close relationship with the subcortical course of the PT. Preoperative DTI was performed with a three-Tesla magnetic resonance scanner applying an echo-planar sequence with 20 diffusion directions. DTI-FT data were systematically loaded into the navigation for intraoperative guidance. When the resection closely approached the PT as illustrated on navigation images, subcortical DESs were used to confirm the proximity of the PT by observing motor responses. The location of all subcortically stimulated points with positive motor response was correlated with the illustrated PT. Motor deficits were evaluated pre- and postoperatively, and compared with the extent of tumour removal. DTI-FT of the PT was successfully performed in all patients. A total of fifteen positive subcortical DESs were obtained in 8 of 10 patients; in these cases, the mean distance from the stimulated point to the PT was 6.2 ± 3.6 mm. The mean tumoural volumetric resection was 90.8 ± 10.4%, with a gross total resection in four patients. At one month after surgery, only one patient had a slight impairment of motor function (decreased fine motor hand skills). DTI-FT is an accurate technique to map the PT in the vicinity of brain tumours. By combining anatomical (DTI-FT) and functional (subcortical DES) studies for intraoperative localization of the PT, the authors achieved a good volumetric resection of tumours located in eloquent motor areas, with low morbidity. Careful use of this protocol requires the knowledge of some pitfalls, mainly the occurrence of brain shift during removal of large tumours.

  20. Long-term results of a randomized controlled trial evaluating preoperative chemotherapy in resectable non-small cell lung cancer

    Directory of Open Access Journals (Sweden)

    Chen ZW

    2013-06-01

    Full Text Available Zhiwei Chen,* Qingquan Luo,* Hong Jian, Zhen Zhou, Baijun Cheng, Shun Lu, Meilin LiaoShanghai Lung Tumor Clinical Medical Center, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, People’s Republic of China *These authors contributed equallyObjective: We aimed to evaluate whether preoperative chemotherapy provides benefits in the survival and prognosis of patients with non-small cell lung cancer (NSCLC in resectable stages I to IIIA, except T1N0. Methods: In this randomized, controlled trial, 356 patients with stage I (except for T1N0, II and IIIA NSCLC were assigned to either the preoperative chemotherapy plus surgery arm (179 patients or the primary surgery arm (177 patients. Both treatments were followed by adjuvant chemotherapy. The end point of this study included overall survival (OS, progression-free survival (PFS, and survival rate associated with clinical remission. Results: Statistical survival difference was found between the preoperative chemotherapy plus surgery arm and the surgery-alone arm. However, the median survival time (MST in the preoperative chemotherapy arm was lower than that of surgery-alone arm (MST, 45.42 months vs 57.59 months (P = 0.016. When comparing the effect of preoperative chemotherapy at each stage of NSCLC, a statistical survival difference was found in stage II NSCLC but not in stage I and IIIA (MST 40.86 months vs 80.81 months (P = 0.044. However, no statistically significant difference in PFS was noticed between the two arms, except for stage I NSCLC (hazard radio [HR] = 0.87; 95% CI, 0.561−1.629; P = 0.027. The survival rate was higher for patients who had clinical remission after preoperative chemotherapy, but the differences did not reach statistical significance (MST 42.10 months vs 35.33 months (P = 0.630. Conclusion: Preoperative chemotherapy did not show benefits in OS and PFS for stage I-IIIA NSCLC patients. Keywords: NSCLC, neoadjuvent, mitomycin, cisplatin, vindesine

  1. Comparison of concurrent chemoradiotherapy versus sequential radiochemotherapy in patients with completely resected non-small cell lung cancer

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Hwan Ik; Noh, O Kyu; Oh, Young Taek; Chun, Mi Son; Kim, Sang Won; Cho, O Yeon; Heo, Jae Sung [Ajou University School of Medicine, Suwon (Korea, Republic of)

    2016-09-15

    Our institution has implemented two different adjuvant protocols in treating patients with non-small cell lung cancer (NSCLC): chemotherapy followed by concurrent chemoradiotherapy (CT-CCRT) and sequential postoperative radiotherapy (PORT) followed by postoperative chemotherapy (POCT). We aimed to compare the clinical outcomes between the two adjuvant protocols. From March 1997 to October 2012, 68 patients were treated with CT-CCRT (n = 25) and sequential PORT followed by POCT (RT-CT; n = 43). The CT-CCRT protocol consisted of 2 cycles of cisplatin-based POCT followed by PORT concurrently with 2 cycles of POCT. The RT-CT protocol consisted of PORT followed by 4 cycles of cisplatin-based POCT. PORT was administered using conventional fractionation with a dose of 50.4–60 Gy. We compared the outcomes between the two adjuvant protocols and analyzed the clinical factors affecting survivals. Median follow-up time was 43.9 months (range, 3.2 to 74.0 months), and the 5-year overall survival (OS), locoregional recurrence-free survival (LRFS), and distant metastasis-free survival (DMFS) were 53.9%, 68.2%, and 51.0%, respectively. There were no significant differences in OS (p = 0.074), LRFS (p = 0.094), and DMFS (p = 0.490) between the two protocols. In multivariable analyses, adjuvant protocol remained as a significant prognostic factor for LRFS, favouring CT-CCRT (hazard ratio [HR] = 3.506, p = 0.046) over RT-CT, not for OS (HR = 0.647, p = 0.229). CT-CCRT protocol increased LRFS more than RT-CT protocol in patients with completely resected NSCLC, but not in OS. Further studies are warranted to evaluate the benefit of CCRT strategy compared with sequential strategy.

  2. Comparison of concurrent chemoradiotherapy versus sequential radiochemotherapy in patients with completely resected non-small cell lung cancer

    Science.gov (United States)

    Kim, Hwan-Ik; Noh, O Kyu; Oh, Young-Taek; Chun, Mison; Kim, Sang-Won; Cho, Oyeon; Heo, Jaesung

    2016-01-01

    Purpose Our institution has implemented two different adjuvant protocols in treating patients with non-small cell lung cancer (NSCLC): chemotherapy followed by concurrent chemoradiotherapy (CT-CCRT) and sequential postoperative radiotherapy (PORT) followed by postoperative chemotherapy (POCT). We aimed to compare the clinical outcomes between the two adjuvant protocols. Materials and Methods From March 1997 to October 2012, 68 patients were treated with CT-CCRT (n = 25) and sequential PORT followed by POCT (RT-CT; n = 43). The CT-CCRT protocol consisted of 2 cycles of cisplatin-based POCT followed by PORT concurrently with 2 cycles of POCT. The RT-CT protocol consisted of PORT followed by 4 cycles of cisplatin-based POCT. PORT was administered using conventional fractionation with a dose of 50.4–60 Gy. We compared the outcomes between the two adjuvant protocols and analyzed the clinical factors affecting survivals. Results Median follow-up time was 43.9 months (range, 3.2 to 74.0 months), and the 5-year overall survival (OS), locoregional recurrence-free survival (LRFS), and distant metastasis-free survival (DMFS) were 53.9%, 68.2%, and 51.0%, respectively. There were no significant differences in OS (p = 0.074), LRFS (p = 0.094), and DMFS (p = 0.490) between the two protocols. In multivariable analyses, adjuvant protocol remained as a significant prognostic factor for LRFS, favouring CT-CCRT (hazard ratio [HR] = 3.506, p = 0.046) over RT-CT, not for OS (HR = 0.647, p = 0.229). Conclusion CT-CCRT protocol increased LRFS more than RT-CT protocol in patients with completely resected NSCLC, but not in OS. Further studies are warranted to evaluate the benefit of CCRT strategy compared with sequential strategy. PMID:27730801

  3. Randomized, Double-Blind, Placebo-Controlled, Phase III Chemoprevention Trial of Selenium Supplementation in Patients With Resected Stage I Non–Small-Cell Lung Cancer: ECOG 5597

    Science.gov (United States)

    Karp, Daniel D.; Lee, Sandra J.; Keller, Steven M.; Wright, Gail Shaw; Aisner, Seena; Belinsky, Steven Alan; Johnson, David H.; Johnston, Michael R.; Goodman, Gary; Clamon, Gerald; Okawara, Gordon; Marks, Randolph; Frechette, Eric; McCaskill-Stevens, Worta; Lippman, Scott M.; Ruckdeschel, John; Khuri, Fadlo R.

    2013-01-01

    Purpose Selenium has been reported to have chemopreventive benefits in lung cancer. We conducted a double-blind, placebo-controlled trial to evaluate the incidence of second primary tumors (SPTs) in patients with resected non–small-cell lung cancer (NSCLC) receiving selenium supplementation. Patients and Methods Patients with completely resected stage I NSCLC were randomly assigned to take selenized yeast 200 μg versus placebo daily for 48 months. Participation was 6 to 36 months postoperatively and required a negative mediastinal node biopsy, no excessive vitamin intake, normal liver function, negative chest x-ray, and no other evidence of recurrence. Results The first interim analysis in October 2009, with 46% of the projected end points accumulated, showed a trend in favor of the placebo group with a low likelihood that the trial would become positive; thus, the study was stopped. One thousand seven hundred seventy-two participants were enrolled, with 1,561 patients randomly assigned. Analysis was updated in June 2011 with the maturation of 54% of the planned end points. Two hundred fifty-two SPTs (from 224 patients) developed, of which 98 (from 97 patients) were lung cancer (38.9%). Lung and overall SPT incidence were 1.62 and 3.54 per 100 person-years, respectively, for selenium versus 1.30 and 3.39 per 100 person-years, respectively, for placebo (P = .294). Five-year disease-free survival was 74.4% for selenium recipients versus 79.6% for placebo recipients. Grade 1 to 2 toxicity occurred in 31% of selenium recipients and 26% of placebo recipients, and grade ≥ 3 toxicity occurred in less than 2% of selenium recipients versus 3% of placebo recipients. Compliance was excellent. No increase in diabetes mellitus or skin cancer was detected. Conclusion Selenium was safe but conferred no benefit over placebo in the prevention of SPT in patients with resected NSCLC. PMID:24002495

  4. Randomized, double-blind, placebo-controlled, phase III chemoprevention trial of selenium supplementation in patients with resected stage I non-small-cell lung cancer: ECOG 5597.

    Science.gov (United States)

    Karp, Daniel D; Lee, Sandra J; Keller, Steven M; Wright, Gail Shaw; Aisner, Seena; Belinsky, Steven Alan; Johnson, David H; Johnston, Michael R; Goodman, Gary; Clamon, Gerald; Okawara, Gordon; Marks, Randolph; Frechette, Eric; McCaskill-Stevens, Worta; Lippman, Scott M; Ruckdeschel, John; Khuri, Fadlo R

    2013-11-20

    Selenium has been reported to have chemopreventive benefits in lung cancer. We conducted a double-blind, placebo-controlled trial to evaluate the incidence of second primary tumors (SPTs) in patients with resected non-small-cell lung cancer (NSCLC) receiving selenium supplementation. Patients with completely resected stage I NSCLC were randomly assigned to take selenized yeast 200 μg versus placebo daily for 48 months. Participation was 6 to 36 months postoperatively and required a negative mediastinal node biopsy, no excessive vitamin intake, normal liver function, negative chest x-ray, and no other evidence of recurrence. The first interim analysis in October 2009, with 46% of the projected end points accumulated, showed a trend in favor of the placebo group with a low likelihood that the trial would become positive; thus, the study was stopped. One thousand seven hundred seventy-two participants were enrolled, with 1,561 patients randomly assigned. Analysis was updated in June 2011 with the maturation of 54% of the planned end points. Two hundred fifty-two SPTs (from 224 patients) developed, of which 98 (from 97 patients) were lung cancer (38.9%). Lung and overall SPT incidence were 1.62 and 3.54 per 100 person-years, respectively, for selenium versus 1.30 and 3.39 per 100 person-years, respectively, for placebo (P = .294). Five-year disease-free survival was 74.4% for selenium recipients versus 79.6% for placebo recipients. Grade 1 to 2 toxicity occurred in 31% of selenium recipients and 26% of placebo recipients, and grade ≥ 3 toxicity occurred in less than 2% of selenium recipients versus 3% of placebo recipients. Compliance was excellent. No increase in diabetes mellitus or skin cancer was detected. Selenium was safe but conferred no benefit over placebo in the prevention of SPT in patients with resected NSCLC.

  5. The Effects of Microwave Ablation and Surgical Resection on Hematogenous Dissemination of Cancer Cells in Treating Patients with Small Primary Hepatocellular Carcinoma

    Institute of Scientific and Technical Information of China (English)

    Chaoyang Wen; Baowei Dong; Ping Liang; Xiaoling Yu; Li Su; Dejiang Yu; Hongtian Xia

    2006-01-01

    OBJECTIVE To conduct a comparative study of the effects of treatment using microwave ablation versus surgical resection on hematogenous dissemination of cancer cells, and on the level of immune cells of the peripheral blood in patients with small primary hepatocellular carcinoma (PHC, ≤5 cm).METHODS Forty patients with small PHC (maximal diameter ≤5 cm) were divided into a microwave group (19 cases) and a surgical operation group (21 cases). A real-time (RT) quantitative nested RT-PCR examination was performed for peripheral blood alpha-fetoprotein (AFP) mRNA. Studies were conducted to determine the level of CD3, CD4, CD8 and CD4/CD8 cells and for liver function at 30 min before, and 30 min,1 day and 3 days after the treatment.RESULTS Compared to the value before ablation, no obvious changes of CD3, CD4, CD8 and CD4/CD8 cells were found in patients of the microwave group within 7 days after ablation, but CD3, CD4 and CD4/CD8 cells in the operation group were lower compared to that before operatioh. The copy number of AFP mRNA in the peripheral blood samples of the patients of the 2 groups before operation was determined in 67.5% of the patients (27/40). There was an rise in the expression after treatment but no statistical difference was found in comparing the 2 groups. Follow-up of the patients was conducted for 1 to 16 months. For patients with continuous expression of peripheral blood AFP mRNA, the possibility of relapse and metastasis was increased.CONCLUSION Surgical resection or microwave ablation can cause more exfoliation of hepatoma carcinoma cells in the peripheral blood of patients with small PHC. The immune function of peripheral blood cells decreased in the patients after surgical resection, however, the immune function was better protected following microwave ablation. Microwave ablation causes minor reduction in liver function, and the treatment method presents a definite value for PHC therapy.

  6. Lung abscess mimicking lung cancer developed around staples in a patient with permanent tracheostoma.

    Science.gov (United States)

    Watanabe, Yui; Aoki, Masaya; Suzuki, Soichi; Umehara, Tadashi; Harada, Aya; Wakida, Kazuhiro; Nagata, Toshiyuki; Kariatsumari, Kota; Nakamura, Yoshihiro; Sato, Masami

    2015-11-01

    A 68-year-old male with a tracheostoma due to hypopharyngeal cancer was admitted because his chest computed tomography (CT) showed a small nodule in the right middle lobe. Following a partial resection of the right middle lobe, histopathological diagnosis of the resected sample was that of organizing pneumonia. Eleven months later, chest CT showed a mass with pleural indentation and spiculation in the right middle lobe. 18-Fluorodeoxyglucose-positron emission tomography showed significant accumulation in the middle lobe tumor mass shadow. The abnormal chest shadow that had developed around surgical staples suggested inadequate resection and tumor recurrence. As the abnormal radiological shadow was enlarging, middle lobectomy was carried out. Histological examination revealed that the tumor was a lung abscess without malignant features. This is a unique case of lung abscess mimicking lung cancer which developed around staples used during partial resection of the lung.

  7. Risk factors for locoregional recurrence in patients with resected N1 non-small cell lung cancer: a retrospective study to identify patterns of failure and implications for adjuvant radiotherapy

    Science.gov (United States)

    2013-01-01

    Background Meta-analysis of randomized trials has shown that postoperative radiotherapy (PORT) had a detrimental effect on overall survival (OS) in patients with resected N1 non–small cell lung cancer (NSCLC). Conversely, the locoregional recurrence (LR) rate is reported to be high without adjuvant PORT in these patients. We have evaluated the pattern of failure, actuarial risk and risk factors for LR in order to identify the subset of N1 NSCLC patients with the highest risk of LR. These patients could potentially benefit from PORT. Methods We conducted a retrospective study on 199 patients with pathologically confirmed T1–3N1M0 NSCLC who underwent surgery. None of the patients had positive surgical margins or received preoperative therapy or PORT. The median follow-up was 53.8 months. Complete mediastinal lymph node (MLN) dissection and examination was defined as ≥3 dissected and examined MLN stations; incomplete MLN dissection or examination (IMD) was defined as 10% were significantly associated with lower FFLR rates (P < 0.05). Multivariate analyses further confirmed positive lymph nodes at station 10 and IMD as risk factors for LR (P < 0.05). The 5-year LR rate was highest in patients with both these risk factors (48%). Conclusions The incidence of LR in patients with surgically resected T1–3N1M0 NSCLC is high. Patients with IMD and positive lymph nodes at station 10 have the highest risk of LR, and may therefore benefit from adjuvant PORT. Further investigations of PORT in this subset of patients are warranted. PMID:24321392

  8. Survival Analyses for Patients With Surgically Resected Pancreatic Neuroendocrine Tumors by World Health Organization 2010 Grading Classifications and American Joint Committee on Cancer 2010 Staging Systems.

    Science.gov (United States)

    Yang, Min; Ke, Neng-wen; Zeng, Lin; Zhang, Yi; Tan, Chun-lu; Zhang, Hao; Mai, Gang; Tian, Bo-le; Liu, Xu-bao

    2015-12-01

    In 2010, World Health Organization (WHO) reclassified pancreatic neuroendocrine tumors (p-NETs) into 4 main groups: neuroendocrine tumor G1 (NET G1), neuroendocrine tumor G2 (NET G2), neuroendocrine carcinoma G3 (NEC G3), mixed adeno and neuroendocrine carcinoma (MANEC). Clinical value of these newly updated WHO grading criteria has not been rigorously validated. The authors aimed to evaluate the clinical consistency of the new 2010 grading classifications by WHO and the 2010 tumor-node metastasis staging systems by American Joint Committee on Cancer (AJCC) on survivals for patients with surgically resected p-NETs. Moreover, the authors would validate the prognostic value of both criteria for p-NETs.The authors retrospectively collected the clinicopathologic data of 120 eligible patients who were all surgically treated and histopathologically diagnosed as p-NETs from January 2004 to February 2014 in our single institution. The new WHO criteria were assigned to 4 stratified groups with a respective distribution of 62, 35, 17, and 6 patients. Patients with NET G1 or NET G2 obtained a statistically better survival compared with those with NEC G3 or MANEC (P systems were respectively defined in 61, 36, 12, and 11 patients for each stage. Differences of survivals of stage I with stage III and IV were significant (P systems were both significant in univariate and multivariate analysis (P systems could consistently reflect the clinical outcome of patients with surgically resected p-NETs. Meanwhile, both criteria could be independent predictors for survival analysis of p-NETs.

  9. A Phase II Study of a Paclitaxel-Based Chemoradiation Regimen With Selective Surgical Salvage for Resectable Locoregionally Advanced Esophageal Cancer: Initial Reporting of RTOG 0246

    Energy Technology Data Exchange (ETDEWEB)

    Swisher, Stephen G., E-mail: sswisher@mdanderson.org [Department of Thoracic and Cardiovascular Surgery, University of Texas M. D. Anderson Cancer Center, Houston, Texas (United States); Winter, Kathryn A. [Headquarters, Radiation Therapy Oncology Group Statistical Center, Philadelphia, Pennsylvania (United States); Komaki, Ritsuko U. [Department of Radiation Oncology, University of Texas M. D. Anderson Cancer Center, Houston, Texas (United States); Ajani, Jaffer A. [Department of Gastrointestinal Medical Oncology, University of Texas M. D. Anderson Cancer Center, Houston, Texas (United States); Wu, Tsung T. [Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota (United States); Hofstetter, Wayne L. [Department of Thoracic and Cardiovascular Surgery, University of Texas M. D. Anderson Cancer Center, Houston, Texas (United States); Konski, Andre A. [Radiation Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania (United States); Willett, Christopher G. [Radiation Oncology, Duke University Medical Center, Durham, North Carolina (United States)

    2012-04-01

    Purpose: The strategy of definitive chemoradiation with selective surgical salvage in locoregionally advanced esophageal cancer was evaluated in a Phase II trial in Radiation Therapy Oncology Group (RTOG)-affiliated sites. Methods and Materials: The study was designed to detect an improvement in 1-year survival from 60% to 77.5% ({alpha} = 0.05; power = 80%). Definitive chemoradiation involved induction chemotherapy with 5-fluorouracil (5-FU) (650 mg/mg{sup 2}/day), cisplatin (15 mg/mg{sup 2}/day), and paclitaxel (200 mg/mg{sup 2}/day) for two cycles, followed by concurrent chemoradiation with 50.4 Gy (1.8 Gy/fraction) and daily 5-FU (300 mg/mg{sup 2}/day) with cisplatin (15 mg/mg{sup 2}/day) over the first 5 days. Salvage surgical resection was considered for patients with residual or recurrent esophageal cancer who did not have systemic disease. Results: Forty-three patients with nonmetastatic resectable esophageal cancer were entered from Sept 2003 to March 2006. Forty-one patients were eligible for analysis. Clinical stage was {>=}T3 in 31 patients (76%) and N1 in 29 patients (71%), with adenocarcinoma histology in 30 patients (73%). Thirty-seven patients (90%) completed induction chemotherapy followed by concurrent chemoradiation. Twenty-eight patients (68%) experienced Grade 3+ nonhematologic toxicity. Four treatment-related deaths were noted. Twenty-one patients underwent surgery following definitive chemoradiation because of residual (17 patients) or recurrent (3 patients) esophageal cancer,and 1 patient because of choice. Median follow-up of live patients was 22 months, with an estimated 1-year survival of 71%. Conclusions: In this Phase II trial (RTOG 0246) evaluating selective surgical salvage after definitive chemoradiation in locoregionally advanced esophageal cancer, the hypothesized 1-year RTOG survival rate (77.5%) was not achieved (1 year, 71%; 95% confidence interval< 54%-82%).

  10. Risk factors for superficial surgical site infection after elective rectal cancer resection: a multivariate analysis of 8880 patients from the American College of Surgeons National Surgical Quality Improvement Program database.

    Science.gov (United States)

    Sutton, Elie; Miyagaki, Hiromichi; Bellini, Geoffrey; Shantha Kumara, H M C; Yan, Xiaohong; Howe, Brett; Feigel, Amanda; Whelan, Richard L

    2017-01-01

    Superficial surgical site infection (sSSI) is one of the most common complications after colorectal resection. The goal of this study was to determine the comorbidities and operative characteristics that place patients at risk for sSSI in patients who underwent rectal cancer resection. The American College of Surgeons National Surgical Quality Improvement Program database was queried (via diagnosis and Current Procedural Terminology codes) for patients with rectal cancer who underwent elective resection between 2005 and 2012. Patients for whom data concerning 27 demographic factors, comorbidities, and operative characteristics were available were eligible. A univariate and multivariate analysis was performed to identify possible risk factors for sSSI. A total of 8880 patients met the entry criteria and were included. sSSIs were diagnosed in 861 (9.7%) patients. Univariate analysis found 14 patients statistically significant risk factors for sSSI. Multivariate analysis revealed the following risk factors: male gender, body mass index (BMI) >30, current smoking, history of chronic obstructive pulmonary disease (COPD), American Society of Anesthesiologists III/IV, abdominoperineal resection (APR), stoma formation, open surgery (versus laparoscopic), and operative time >217 min. The greatest difference in sSSI rates was noted in patients with COPD (18.9 versus 9.5%). Of note, 54.2% of sSSIs was noted after hospital discharge. With regard to the timing of presentation, univariate analysis revealed a statistically significant delay in sSSI presentation in patients with the following factors and/or characteristics: BMI Multivariate analysis suggested that only laparoscopic surgery (versus open) and preoperative RT were risk factors for delay. Rectal cancer resections are associated with a high incidence of sSSIs, over half of which are noted after discharge. Nine patient and operative characteristics, including smoking, BMI, COPD, APR, and open surgery were found to be

  11. Relationship between Expression of TGF-β1, Smad2, Smad4 and Prognosis 
of Patients with Resected Non-small Cell Lung Cancer

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    Mian XIE

    2015-09-01

    Full Text Available Background and objective It has been proven that any changes of transforming growth factor β (TGF-β-Smad signal transduction pathway will lead to abnormalities of signal transmission and the out of control during cell growth and differentiation, resulting in cancer development. The aim of this study is to investigate the prognostic values of TGF-β1, Smad2 and Smad4 in resected non-small cell lung cancer (NSCLC. Methods The expression of TGF-β1, Smad2, and Smad4 was evaluated by immunohistochemistry in 85 patients with NSCLC. The relationships among the expression of these proteins, clinicopathological factors, and prognosis were also analyzed. Results TGF-β1 positive expression was significantly correlated with the late stage and lymph node involvement. No significant association existed between the expression of Smad2 and the clinicopathological characteristics. The lack of Smad4 expression was associated with the advanced tumor stage (P=0.014. Multivariate analysis indicated that lymph node involvement (P=0.001 was an independent prognostic factor in the 85 NSCLC patients. The positive expression levels of TGF-β1 (P=0.032 and N stage (P=0.028 were demonstrated to be independent risk factors for survival among 47 lung adenocarcinoma patients. Adenocarcinoma patients with TGF-β1 positive expression demonstrated an unfavorable survival outcome (P=0.0376. Conclusion TGF-β1 may be an independent predictor of survival in resected lung adenocarcinoma patients.

  12. Utility of Transbronchial vs Surgical Lung Biopsy in the Diagnosis of Suspected Fibrotic Interstitial Lung Disease.

    Science.gov (United States)

    Sheth, Jamie S; Belperio, John A; Fishbein, Michael C; Kazerooni, Ella A; Lagstein, Amir; Murray, Susan; Myers, Jeff L; Simon, Richard H; Sisson, Thomas H; Sundaram, Baskaran; White, Eric S; Xia, Meng; Zisman, David; Flaherty, Kevin R

    2017-02-01

    Surgical lung biopsy (SLB) is invasive and not possible in all patients with undiagnosed interstitial lung disease (ILD). We hypothesized that transbronchial biopsy (TBB) findings combined with clinical and high-resolution CT (HRCT) data leads to a confident diagnosis congruent to SLB and therefore avoids the need for SLB in some patients. We evaluated 33 patients being investigated for suspected ILD who underwent HRCT, TBB, and SLB. First, clinicians, radiologists, and a pathologist reviewed the clinical information and HRCT and TBB findings. Clinicians were asked to provide a diagnosis and were also asked if SLB was needed for a more confident diagnosis. Subsequently, the clinical, HRCT, and SLB data were reviewed, and the same participants were asked to provide a final diagnosis. Clinician consensus and overall agreement between TBB- and SLB-based diagnoses were calculated. Four patients had definite usual interstitial pneumonia (UIP) on HRCT and would not be considered for biopsy using current guidelines. Of the 29 patients without a definitive HRCT diagnosis, the clinicians felt confident of the diagnosis (ie, would not recommend SLB) in six cases. In these cases, there was 100% agreement between TBB and SLB diagnoses. UIP was the most common diagnosis (n = 3) and was associated with an HRCT diagnosis of possible UIP/nonspecific interstitial pneumonia-like. Agreement was poor (33%) between TBB and SLB diagnoses when confidence in the TBB diagnosis was low. Information from TBB, when combined with clinical and HRCT data, may provide enough information to make a confident and accurate diagnosis in approximately 20% to 30% of patients with ILD. Copyright © 2016 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

  13. A New Surgical Technique of Pancreaticoduodenectomy with Splenic Artery Resection for Ductal Adenocarcinoma of the Pancreatic Head and/or Body Invading Splenic Artery: Impact of the Balance between Surgical Radicality and QOL to Avoid Total Pancreatectomy

    Directory of Open Access Journals (Sweden)

    Ryosuke Desaki

    2014-01-01

    Full Text Available For pancreatic ductal adenocarcinoma (PDAC of the head and/or body invading the splenic artery (SA, we developed a new surgical technique of proximal subtotal pancreatectomy with splenic artery and vein resection, so-called pancreaticoduodenectomy with splenic artery resection (PD-SAR. We retrospectively reviewed a total of 84 patients with curative intent pancreaticoduodenectomy (PD for PDAC of the head and/or body. These 84 patients were classified into the two groups: conventional PD (n=66 and PD-SAR (n=18. Most patients were treated by preoperative chemoradiotherapy (CRT. Postoperative MDCT clearly demonstrated enhancement of the remnant pancreas at 1 and 6 months in all patients examined. Overall survival rates were very similar between PD and PD-SAR (3-year OS: 23.7% versus 23.1%, P=0.538, despite the fact that the tumor size and the percentages of UICC-T4 determined before treatment were higher in PD-SAR. Total daily insulin dose was significantly higher in PD-SAR than in PD at 1 month, while showing no significant differences between the two groups thereafter. PD-SAR with preoperative CRT seems to be promising surgical strategy for PDAC of head and/or body with invasion of the splenic artery, in regard to the balance between operative radicality and postoperative QOL.

  14. Role of {sup 18}F-FDG PET/CT in the prediction of gastric cancer recurrence after curative surgical resection

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    Lee, Jeong Won [Jeju National University Hospital, Department of Nuclear Medicine, Jeju (Korea, Republic of); Lee, Sang Mi [Soonchunhyang University Hospital, Department of Nuclear Medicine, Cheonan, Chungcheongnam-do (Korea, Republic of); Lee, Moon-Soo [Soonchunhyang University Hospital, Department of Surgery, Cheonan (Korea, Republic of); Shin, Hyeong Cheol [Soonchunhyang University Hospital, Department of Radiology, Cheonan (Korea, Republic of)

    2012-09-15

    The study evaluated the role of preoperative {sup 18}F-fluorodeoxyglucose (FDG) positron emission tomography (PET)/CT in the prediction of recurrent gastric cancer after curative surgical resection. A total of 271 patients with gastric cancer who underwent {sup 18}F-FDG PET/CT and subsequent curative surgical resection were enrolled. All patients underwent follow-up for cancer recurrence with a mean duration of 24 {+-} 12 months. {sup 18}F-FDG PET/CT images were visually assessed and, in patients with positive {sup 18}F-FDG cancer uptake, the maximum standardized uptake value (SUV{sub max}) of cancer lesions was measured. {sup 18}F-FDG PET/CT findings were tested as prognostic factors for cancer recurrence and compared with conventional prognostic factors. Furthermore, {sup 18}F-FDG PET/CT findings were assessed as prognostic factors according to histopathological subtypes. Of 271 patients, 47 (17 %) had a recurrent event. Positive {sup 18}F-FDG cancer uptake was shown in 149 patients (55 %). Tumour size, depth of invasion, presence of lymph node metastasis, positive {sup 18}F-FDG uptake and SUV{sub max} were significantly associated with tumour recurrence in univariate analysis, while only depth of invasion, positive {sup 18}F-FDG uptake and SUV{sub max} had significance in multivariate analysis. The 24-month recurrence-free survival rate was significantly higher in patients with negative {sup 18}F-FDG uptake (95 %) than in those with positive {sup 18}F-FDG uptake (74 %; p < 0.0001). In subgroup analysis, {sup 18}F-FDG uptake was a significant prognostic factor in patients with tubular adenocarcinoma (p = 0.003) or poorly differentiated adenocarcinoma (p = 0.0001). However, only marginal significance was shown in patients with signet-ring cell carcinoma and mucinous carcinoma (p = 0.05). {sup 18}F-FDG uptake of gastric cancer is an independent and significant prognostic factor for tumour recurrence. {sup 18}F-FDG PET/CT could provide effective information on the

  15. Factors Associated with Abducens Nerve Recovery in Patients Undergoing Surgical Resection of Sixth Nerve Schwannoma: A Systematic Review and Case Illustration.

    Science.gov (United States)

    Sun, Hai; Sharma, Kanika; Kalakoti, Piyush; Thakur, Jai Deep; Patra, Devi Prasad; Konar, Subhas; Maiti, Tanmoy; Akbarian-Tefaghi, Hesam; Bollam, Papireddy; Notarianni, Christina; Nanda, Anil

    2017-08-01

    Limited or no literature exists identifying factors associated with functional nerve recovery in patients undergoing resection of sixth cranial nerve (CN VI) schwannomas. A systematic review of literature was performed on CN VI schwannomas that were treated surgically. Synthesizing the findings pooled from the literature, we investigated associations of patient demographics and clinical characteristics with postsurgical CN VI functional recovery in multivariable regression models. In addition, we present the findings of an adolescent woman surgically managed for intracavernous CN VI schwannoma. Complete encasement of the cavernous segment of the internal carotid artery is unique to our case. We synthesized data of 32 patients from 29 studies, and our index case. Overall, the mean age of the patients was 44.0 ± 16.5 years, and approximately 52% (n = 17) were female. Most tumors were left-sided (n = 18; 54.5%), with an average size of 3.46 ± 1.71 cm. The most common location was cisternal (n = 11; 33%), followed by cavernous sinus (CS) proper (n = 9; 27%), cisterocavernous (n = 8; 24%), orbital (n = 4; 12%) and caverno-orbital (n = 1; 3%). CN VI recovery was reported in less than half the cohort (n = 14; 45%). Tumor extension in the CS was significantly associated with lesser likelihood (odds ratio [OR], 0.07; 95% confidence interval [CI], 0.01-0.98; P = 0.048) of postsurgical CN VI recovery. Although female gender (OR, 0.86; 95% CI, 0.07-10.09; P = 0.906), large tumor size (>2.5 cm) (OR, 0.45; 95% CI, 0.07-2.89; P = 0.397), and solid consistency (OR, 0.37; 95% CI, 0.03-4.19; P = 0.421) were associated with lesser odds for recovery, these were not statistically significant. Likewise, although gross total resection (OR, 6.28; 95% CI, 0.33-118.25; P = 0.220) was associated with higher odds of nerve recovery, the estimates were statistically insignificant. CS involvement is associated with lesser odds for functional nerve recovery in patients undergoing

  16. Analysis of the Role of PET/CT SUVmax in Prognosis and Its Correlation with 
Clinicopathological Characteristics in Resectable Lung Squamous Cell Carcinoma

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    Hongliang REN

    2016-04-01

    Full Text Available Background and objective Lung cancer is the leading cause of cancer death in men and women in the world, more than one-half of cases are diagnosed at a advanced stage, and the overall 5-year survival rate for lung cancer is 18%. Lung cancer is divided into non-small cell lung carcinoma (NSCLC and small cell lung carcinoma (SCLC. Approximately 80%-85% of cases are NSCLC which includes three main types: adenocarcinoma (40%, squamous cell carcinoma (SCC (20%-30%, and large cell carcinoma (10%. Although therapies that target driver mutations in adenocarcinomas are showing some promise, they are proving ineffective in smoking-related SCC. We need pay more attention to the diagnosis and treatment of SCC. 18F-FDG positron emission tomography (PET/computed tomography (CT has emerged as an accurate staging modality in lung cancer diagnosis. The aim of this study is to investigate the role of maximum standardized uptake value (SUVmax on PET-CT in prognosis and its correlation with clinicopathological characteristics in resectable SCC. Methods One hundred and eighty-two resectable SCC patients who underwent PET/CT imaging between May 2005 and October 2014 were enrolled into this retrospectively study. All the enrolled patients had underwent pulmonary resection with mediastinal lymph node dissection without preoperative chemotherapy or radiotherapy. Survival outcomes were analyzed using the Kaplan-Meier method and multivariate Cox proportional hazards model. Correlation between SUVmax and clinicopathological factors was analysed using Pearson correlation analysis and Spearman rank correlation analysis. Results The patients were divided into two groups on the basis of SUVmax 13.0 as cutoff value, and patients with SUVmax more than 13.0 had shorter median overall survival than patients less than 13.0 in univariate analysis (56 months vs 87 months; P=0.022. There was remarkable correlation between SUVmax and gender, tumor size, tumor-node-metastasis (TNM stage

  17. Lung tattooing combined with immediate video-assisted thoracoscopic resection (IVATR) as a single procedure in a hybrid room: our institutional experience in a pediatric population.

    Science.gov (United States)

    Narayanam, Surendra; Gerstle, Ted; Amaral, Joao; John, Philip; Parra, Dimitri; Temple, Michael; Connolly, Bairbre

    2013-09-01

    Analysis of small pulmonary nodules in children poses an important diagnostic and therapeutic challenge for clinicians. To review our experience of lung tattooing with immediate video-assisted thoracoscopic resection (IVATR) performed as a single procedure in a hybrid room for technical difficulties, complications and diagnostic yield of the procedure. Retrospective analysis of 31 children (16 boys, 15 girls) who underwent lung tattooing of various lesions from January 2001 to July 2011. Data were collected from the Interventional Radiology database, Electronic Patient Chart (EPC) and PACS. A total of 34 lesions were treated in 31 children. Tattooing was performed on lung lesions with median size 3 mm and median depth 2 mm from pleura. Technical success was 91.1% and diagnostic yield was 100%. In seven children, it was combined with other interventional radiologic procedures. The median procedure time for lung tattooing and IVATR was 197 min. Lung tattooing with IVATR as a single procedure in a hybrid room is safe and effective in children with several inherent advantages, including avoiding the need to move the child from the interventional radiology suite to the operating room.

  18. Influence of simultaneous liver and peritoneal resection on postoperative morbi-mortality and survival in patients with colon cancer treated with surgical cytoreduction and intraperitoneal hyperthermic chemotherapy.

    Science.gov (United States)

    Morales Soriano, Rafael; Morón Canis, José Miguel; Molina Romero, Xavier; Pérez Celada, Judit; Tejada Gavela, Silvia; Segura Sampedro, Juan José; Jiménez Morillas, Patricia; Díaz Jover, Paula; García Pérez, José María; Sena Ruiz, Fátima; González Argente, Xavier

    2017-04-01

    Cytoreductive surgery plus intraperitoneal hyperthermic chemotherapy (HIPEC) has recently been established as the treatment of choice for selected patients with peritoneal carcinomatosis of colonic origin. Until recently, the simultaneous presence of peritoneal and hepatic dissemination has been considered a contraindication for surgery. The aim of this paper is to analyze the morbidity, mortality and survival of patients with simultaneous peritoneal and hepatic resection with HIPEC for peritoneal carcinomatosis secondary to colon cancer. Between January 2010 and January 2015, 61 patients were operated on, 16 had simultaneous peritoneal and hepatic dissemination (group RH+), and 45 presented only peritoneal dissemination (group RH-). There were no differences between the groups in terms of demographic data, length of surgery and extension of peritoneal disease. Postoperative grade III-V complications were significantly higher in the RH+ group (56.3 vs. 26.6%; P=.032). For the whole group, mortality rate was 3.2% (two patients in group RH-, and none in group RH+). Patients with liver resection had a longer postoperative stay (14.4 vs. 23.1 days) (P=.027). Median overall survival was 33 months for RH-, and 36 for RH+ group. Median disease-free survival was 16 months for RH-, and 24 months for RH+ group. Simultaneous peritoneal cytoreduction and hepatic resection resulted in a significantly higher Clavien grade III-V morbidity and a longer hospital stay, although the results are similar to other major abdominal interventions. The application of multimodal oncological and surgical treatment may obtain similar long-term survival results in both groups. Copyright © 2017 AEC. Publicado por Elsevier España, S.L.U. All rights reserved.

  19. Acquired lobar emphysema in a case of interstitial chronic lung disease. Surgical implications and review of the literature

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    Sancho Hernández Rogelio

    2014-07-01

    Full Text Available Acquired lobar interstitial emphysema (ALIE, initially described in infants with bronchopulmonary dysplasia is now known to occur in other conditions such as a secondary post-traumatic or inflammatory injury as in patients requiring ventilatory sup- port with chronic lung disease. The ALIE leads to progressive deterioration of lung function with massive distension and com- pression of lung parenchyma with consequent mediastinal shift in the course of chronic interstitial lung disease. This situation requires adequate clinical and radiological interpretation in order to make the proper patient selection i.e., between a candidate for lung biopsy for the benefit of a definitive diagnosis or one who in the course of a superimposed ALIE requires a diagnostic and therapeutic lobectomy. Two cases of this entity and descriptive decision-making diagnostic and surgical about pre-and intraop- erative findings are presented.

  20. Lymph node ratio-based staging system as an alternative to the current TNM staging system to assess outcome in adenocarcinoma of the esophagogastric junction after surgical resection

    Science.gov (United States)

    Chen, Chuangui; Gao, Yongyin; Xiao, Xiangming; Tang, Peng; Duan, Xiaofeng; Yang, Mingjian; Jiang, Hongjing; Yu, Zhentao

    2016-01-01

    This study aimed to assess the prognostic value of the hypothetical tumor-N-ratio (rN)-metastasis (TrNM) staging system in adenocarcinoma of the esophagogastric junction (AEG). The clinical data of 387 AEG patients who received surgical resection were retrospectively reviewed. The optimal cut-off point of rN was calculated by the best cut-off approach using log-rank test. Kaplan-Meier plots and Cox regressions model were applied for univariate and multivariate survival analyses. A TrNM staging system based on rN was proposed. The discriminating ability of each staging was evaluated by using an adjusted hazard ratio