bluuebunny/crossref_metadata_2025 huggingface dataset:
Prolonged survival of stomach cancer patients after extensive surgery and adjuvant treatment: An overview of the japanese experience
Authors: Inokuchi Kiyoshi
Published: February 2007

The 5‐year survival rate of resected stomach cancer patients, which had been nearly 20% or less in the 1950s, has now been increased to more than 60%. Such a remarkable improvement was analyzed from the data of the National Registry or of the nationwide cohort studies. Standardization of the operative method involving extensive lymph node dissection, which has prevailed since the mid‐1960s, was the leading factor in this improvement. Development of improved techniques for early diagnosis increased the rate of detection of early cancer and the rate of early cancer per resected cases amounts to more than 30% in major institutions as of 1981. Adjuvant chemo‐immuno‐therapy administered over a long postoperative period was confirmed to elevate the cure rate substantially. As new anticancer drugs recently developed in Japan, UFT (Uracil/Tegafur mixture) and HCFU (Carmoful) were introduced. Optional use of regional therapy such as arterial infusion chemotherapy or intracavital biological response modifiers (BRM) injection are among the latest treatment possibilities.
Recurrence of early gastric cancer
Authors: Furusawa Motonosuke , Notsuka Takayuki , Tomoda Hirotsugu
Published: February 2007

We investigated the postoperative deaths and recurrence among 673 patients with early gastric cancer who had undergone gastric resection at the National Kyushu Cancer Center Hospital from March 1972 to December 1988. The mode and time of recurrence were assessed with reference to the clinicopathological findings at initial surgery.

Fifteen patients (2.2%) died of cancer recurrence, and 18 patients (2.7%) developed recurrence (3 patients are currently alive after reoperation). A comparison of modes of recurrence revealed that the incidence of hematogenous recurrence was the highest with nine cases, followed by recurrence in the remnant stomach in three cases and by local, lymph node, and peritoneal recurrences in two cases each. Twelve patients developed recurrence within 5 years after operation (early recurrence) and six patients after 5 years (late recurrence). Cases positive for cancer cell invasion into intralesional veins at initial surgery had a significantly higher recurrence rate than negative cases (P <0.001). Thus, venous invasion was the most important factor for the development of recurrence in the patients with early gastric cancer.
Improvement in treatment results of gastric cancer with surgery and chemotherapy: Experience of 9,700 cases in the cancer institute hospital, Tokyo
Authors: Nakajima Toshifusa , Nishi Mitsumasa , Kajitani Tamaki
Published: February 2007

Treatment results of 9,741 cases of gastric cancer treated at the Cancer Institute Hospital, Tokyo during the past 42 years were retrospectively analyzed. Resectability was 89.6% (94.1% for 1960–1988) and operative mortality was 1.9% (1.5% for 1960–1988). Five‐year survival rate was 48.5% (54.9% for 1960–1988) for all cases, 68.8% (73.1% for 1960–1988) for patients with curative surgery, and 4.7% (4.9% for 1960–1988) for those with noncurative surgery. Curative rate was improved twofold among patients with curative gastrectomy. Postoperative adjuvant chemotherapy had a marginal benefit for stage II and III disease. Improvement could be attributed mainly to the relative in crease in early gastric cancer, and partly to the extended surgeries for stage III and IV cases, such as systemic lymphadenectomy and combined resection of involved adjacent organs. Multimodality therapy is expected to control the relapse of peritoneal dissemination (14.2%) and hematogenous metastasis (8.9%).
Survival results depend on the staging system
Authors: Henson Donald Earl , Ries Lynn , Shambaugh Evelyn M.
Published: February 2007

The results of expressing patient outcome are compared using two staging systems: localized, regional, and distant (LRD) and the TNM of the American Joint Committee on Cancer (AJCC). Expressing patient outcome depends on the staging system used. There is overlap between the stage definitions of the LRD and the TNM. A single stage in the LRD may include more than one stage grouping of the TNM and vice versa. For most sites, “localized” provides lower survival rates than stage I of the TNM. The TNM provides more precise information about prognosis because its definitions reflect the latest survival information and diagnostic technology. Time trends can be measured only with the LRD because of its stability over the years. The precision of the TNM has been achieved at the expense of time trend analysis. The LRD is usually not an acceptable end point for the assessment of early cancer detection. © 1992 Wiley‐Liss, Inc.
Staging of colorectal cancer
Authors: Williams Shauna T. , Beart Robert W.
Published: February 2007

A chronological overview of the various staging systems for colorectal cancer is presented in an effort to demonstrate the reason for the current state of confusion. The Dukes 1932 system is considered to be the gold standard because of its simplicity and accuracy and is the system most often referred to in the literature. Number of positive nodes and depth of invasion are two variables that have been found to be predictors of survival. In the future, other prognostic factors such as nuclear morphology, flow cytometric characteristics, histological grade, and vascular or lymphatic invasion may also be entered into the staging equation. Use of the TNM system at this time is recommended since it most completely describes appropriate prognostic factors and allows conversion of other staging systems into a common format. Future modifications could logically evolve from the TNM system. © 1992 Wiley‐Liss, Inc.
Laser and photodynamic therapy of esophageal cancer
Authors: Overholt Bergein F.
Published: February 2007

With proper selection of patients with non‐operative esophageal cancer, palliative therapy with Nd:YAG laser enhances the quality of life by improving the patient's ability to swallow soft or solid food. Also, the use of non‐thermal laser light to initiate the process of photodynamic therapy (PDT) is an additional laser technique that appears effective, not just in palliative treatment, but also in the cure of early esophageal cancer. For PDT, considerable work will be necessary to provide standard techniques in tumor staging, light and drug delivery and in light dosimetry. Ultimately, palliative and curative therapy of esophageal cancer will most likely incorporate multiple modalities, including surgery, radiation, chemotherapy, stents, laser and other thermal modalities, photodynamic therapy, and combinations of these methods.
Current role of laser and photodynamic therapy in gastrointestinal tumors and analysis of a 10‐year experience
Authors: Spinelli Pasquale , Fante Marco Dal , Mancini Andrea
Published: February 2007

Laser energy can be used for a variety of neoplastic diseases including benign tumors, early stage malignancies, and advanced carcinomas, either with curative intent or for palliation. Nd:YAG laser photocoagulation of 168 colorectal adenomas allowed a complete eradication in 70% of cases, after a mean follow‐up of 22 months. Advanced and obstructing tumors were treated with Nd:YAG laser to recanalize the lumen. In the upper gastrointestinal tract the recanalization of the lumen by means of laser photocoagulation improved the quality of life and survival. In fact, in our series of 308 patients treated, 1‐year survival was 23% in recanalized patients and 7% in nonrecanalized patients.

In the lower gastrointestinal tract, 289 cancer patients were treated and an amelioration of symptoms related to the obstruction was obtained in 93%). The current indication for photodynamic therapy is mainly the treatment of flat or ulcerative early stage tumors in the esophagus and stomach of high risk patients. Out of 17 patients treated, 14 were locally cured.
Photodynamic therapy for thoracic malignancies
Authors: Pass Harvey I. , Pogrebniak Helen
Published: February 2007

Photodynamic therapy (PDT) is an experimental form of cancer therapy which employs photoactivation of a sensitizing chemical by light of a given wavelength via the production of toxic oxygen species. PDT causes local destruction of cancer, and relies on a therapeutic index between normal and malignant tissue since the latter seems to selectively retain the sensitizer. PDT has both direct tumoricidal effects as well as indirect effects on tumor vasculature causing an early hemorrhagic necrosis of tissue. The treatment has been used for the treatment of endobronchial obstruction by primary and metastatic tumors. Most recently, trials are being performed to evaluate this therapy as a surgical adjunct in the treatment of pleural malignancies such as mesothelioma.
Biology of metastasis: Clinical implications
Authors: Liu Brian C.‐S. , Weiss Robert E. , Gordon Jeffrey N. , Droller Michael J.
Published: February 2007

Bladder tumor has a spectrum of neoplastic activity. Some behave in a benign fashion, and others are highly aggressive and lead rapidly to metastatic disease and death. The processes of metastasis can be described as a sequence of interrelated steps. The processes involve 1) tumor cell adhesion to basement membranes, 2) the degradation of basement membranes, and 3) the migration of tumor cells through the destroyed stroma into blood and lymphatic vessels. Each of these processes involves the expression of molecular factors unique to tumor cells. With better understanding of the molecular basis of these factors, novel prognostic and potential therapeutic agents can be generated and applied to the clinical arena.
Cutaneous malignant melanoma: Epidemiological considerations
Authors: Franceschi Silvia , Cristofolini Mario
Published: February 2007

Large geographic and ethnic variations in incidence and mortality rates of cutaneous malignant melanoma (CMM) suggest inverse correlations with the degree of skin pigmentation and latitude. Increases in CMM incidence and mortality rates have occurred in virtually all white populations, more markedly in those that permanently (immigrants) or temporarily (tourists/vacationers) reside in very sunny areas outside their primitive living environment. The interpretation of data from case‐control studies is, however, hampered by the difficulties in quantifying retrospectively, but reliably, CMM risk correlates (e.g., host factors, sun exposure, clothing habits, sunburns) in various periods during the life span. There is, thus, a need for large prospective studies on the development of CMM and naevi, ideally in different contexts as concerns host factors, sun exposure, and other life‐style habits within and across different populations.
Surgical management of primary melanoma
Authors: Holmström Hans
Published: February 2007

The outline of the surgical treatment of a primary cutaneous malignant melanoma may be divided into the problems of biopsy, definitive excision and reconstruction of the defect. An excisional, in contrast to an incisional, biopsy provides the full scope of prognostic parameters and should be used whenever possible. General anesthesia is not necessary, and frozen‐section examination is inaccurate. An immediate excision biopsy should therefore be performed under local anesthesia as an outpatient procedure. Whenever possible, a margin of 10 mm should be used, as this would mean an adequate and definitive treatment in melanomas up to 1 mm, and possibly 2 mm, in Breslow thickness. In melanomas more than 1‐2 mm in thickness a 3‐cm free margin instead of a 5‐cm free margin is recommended. Many patients, especially those with trunk lesions with a 3‐cm free margin may not need a complicated repair, such as a skin graft or a flap. The excision in depth is recommended to be carried perpendicular to the skin and inclusion of underlying fascia is optional, as no study has proved it to be beneficial. The defect after the excision should whenever possible be closed directly. If this is not possible the defect is covered with either a skin graft or a flap and the latter is recommended from both a cosmetic and a functional point of view. If a skin graft has been used, the secondary defect may be reconstructed with a skin expansion technique.
Hyperthermic antiblastic perfusion in the treatment of local recurrence or “In‐transit” metastases of limb melanoma
Authors: Cavaliere Renato , Filippo Franco Di , Giannarelli Diana , Carlini Sandro , Anzà Michele , Cavaliere Francesco , Graziano Franco , Perri Pasquale
Published: February 2007

On the basis of personal experience and a review of the literature, the authors have evaluated the results obtained with hyperthermic antiblastic perfusion (HAP) for the treatment of stage II, III and IIIAB limb melanoma.

The evaluation showed that today HAP may be considered a safe and effective treatment, with a major complication rate ranging between 1% and 4%.

In terms of tumor response, locoregional control and survival, this treatment has provided better results than other regional chemotherapeutic modalities and undoubtedly better results than those obtained with conventional, even radical, surgery.

The multiparametric analysis showed that, of the treatment‐related prognostic factors, the minimum tumor temperature influenced the percentage of complete response (CR) to the greatest extent (P< 0.03), with a positive trend also with regard to the dosage of the antiblastic drug employed (P<0.08). In turn, the complete response rate was a determinant as far as locoregional control (75.3%;P< 0.0009) and disease‐free (51.4%;P< 0.009) and overall survival (63.2%);P< 0.009) rates were concerned. Of the tumor‐related prognostic factors, the number of lesions (P< 0.0014), sex (P<0.04), and the number of disease recurrences (P<0.01) appear to influence overall survival.
Surgical management of distant melanoma metastases
Authors: Lejeune Ferdy J. , Liénard Danielle , Sales Francois , Badr‐El‐Din Heiman
Published: February 2007

Disseminated melanoma remains a tumour that is poorly responsive to chemotherapy and radiotherapy. However, this review demonstrates that surgical removal of visceral metastases such as at the, lung or digestive sites, as well as the brain, yields consistent median survivals, often longer than 12 months, and long‐term survivors. Such surgery is followed by little complication cost and low perioperative mortality. Our experience tends to confirm that complete debulking offers longer survivors as compared to partial. Also, one site of metastases, whatever its anatomical location, when operated on, gives a better chance for survival than when there are multiple sites.
Evolving role of surgery after induction chemotherapy and primary site radiation in head and neck cancer
Authors: Norris Charles M. , Busse Paul M. , Clark John R.
Published: February 2007

Chemotherapy, as preliminary treatment before surgery and/or radiation for advanced squamous cell carcinoma of the head and neck, is no longer novel. In prospective trials to date, however, multiple agent induction chemotherapy has yet to demonstrate the initial presumptive promise of improved rates of cure. As an alternate goal, there has emerged a renewed attentiveness toward limiting treatment morbidity, several strategies for which may be considered. Extirpative, often radical, surgery on the primary site of disease usually represents the most significant threat to life quality. Various ways of limiting surgical morbidity will be considered by way of introduction. The trends of head and neck cancer treatment over the decades, leading into the era of induction chemotherapy and refined radiation techniques, will be described. At the combined Dana‐Farber/New England Deaconess Head and Neck Oncology Clinic, an experience with over 300 patients receiving induction chemotherapy for advanced head and neck cancer has been analyzed with an emphasis on the postulate of lessening the extent of surgery in appropriately selected patients. In a comparison between trials initiated in 1980 and 1987, improved complete response rates from 26 to 57% were documented. Survival rates were identical, but the use of planned primary site ablative surgery was decreased from 47 to 14%. While some increase in local failure has been noted in patients treated by primary site radiation alone, surgical salvage appeared to be more effective. The implication of these trends for patterns of failure and surgical salvage and data concerning the need for neck dissection in this group of patients will be briefly summarized. Other trials addressing organ‐preservation strategies will also be referenced and the dichotomy between survival‐based studies and morbidity‐limiting studies illustrated. Independent trends in radiation technique as a potential substitute for traditional surgical practice will be reviewed.
Influence of multimodality therapy on the management of pancreas carcinoma
Authors: Jessup J. Milburn , Posner Marshall , Huberman Mark
Published: February 2007

Carcinoma of the pancreas has an especially grim prognosis. Only 1‐3% of patients survive for 5 years. Radical pancreaticoduodenectomy, especially for minimal disease, is currently the only chance for cure. While radiation therapy does not improve overall survival, it may improve local control following radical resection and decrease pain in locally advanced cancers. Although chemotherapy has led to significant improvements in survival in patients with locally advanced disease, the overall effect is small. When surgery, radiotherapy, and chemotherapy are administered to localized carcinomas in randomized, prospective trials, survival is significantly lengthened. Similar trials in locally advanced, unresectable pancreatic cancer also confirm the concept of synergistic interaction between therapies. Thus, pancreas carcinoma is one neoplasm where multimodality therapy has had a demonstrable, although small effect.
Impact of combined modality therapy on the treatment of adenocarcinoma of the colon
Authors: Posner Marshall R. , Bleday Ronald , Huberman Mark , Jessup John M. , Busse Paul , Steele Glenn
Published: February 2007

An emphasis on careful surgical staging of adenocarcinoma of the colon has improved the predictive value of tumor staging systems. As a result of improved staging and carefully conducted randomized clinical trials, adjuvant therapy of locally advanced colon cancer, based on 5‐fluorouracil chemotherapy, has been proven to substantially reduce recurrence rates and significantly increase overall survival for selected patients. Improved treatments and schedules are currently being studied in randomized trials and may increase the efficacy of this adjuvant therapy. Radiation therapy has not as yet been integrated into the adjuvant treatment of colon carcinoma. The application of a combined approach of surgery and chemotherapy in selected patients with liver metastases may also improve cure rates and long‐term survival. The developing understanding of molecular determinants for the biological behavior of these cancers will increase the opportunities to identify, on the one hand, those patients who will benefit from specific therapies, and, on the other hand, new therapeutic strategies and treatments.
Conservative management of rectal carcinoma: The efficacy of a multimodality approach
Authors: Jessup J. M. , Bleday R. , Busse P. , Steele G.
Published: February 2007

The goals of the conservative management of adenocarcinoma of the distal rectum are to preserve rectal sphincter function and achieve excellent local tumor control. Multimodality therapy for more advanced disease suggests that these goals will be met by conservative surgery combined with radiation therapy and chemotherapy. Over 100 patients with T0‐3 N0‐1 lesions have been treated in prospective single institution trials with either local excision or anterior resection with coloanal anastomosis, usually combined with chemotherapy and radiotherapy. The typical criteria for local excision have been for lesions to be 4.0 cm or less, mobile, and not poorly differentiated or mucinous. Patients with larger or more advanced lesions may undergo anterior resection with coloanal anastomosis. Following resection, radiotherapy is delivered to the pelvis and tumor bed often with concomitant chemotherapy. The overall rate of local failure in the trials in which local excision is performed with postoperative chemoradiotherapy is 3% for TI lesions, 5% for T2 lesions, and 30% for T3 lesions with a median follow‐up of at least 25 months. Local failure in patients with a coloanal anastomosis is 9% overall. Salvage was successful in about half of the patients who failed locally. Importantly, nearly all patients remained continent. These institutional studies show that sphincter preservation can be used in patients who are objectively selected for this procedure. However, before this multimodality approach may be considered standard therapy the rate of local control must be confirmed in a large, Phase II, multicenter, prospective trial such as that now underway in many of the cooperative groups.
Effect of combined modality therapy on the surgical management of locally advanced rectal carcinoma
Authors: Busse Paul M. , Jessup J. Milburn , Cady Blake , Bothe Albert , McDermoll William V. , Stone Michael D. , Steele Glenn
Published: February 2007

The treatment of locally advanced rectal carcinoma is one of the more complicated problems in the management of colorectal carcinoma. More than any other site successful treatment requires a multimodality approach as surgery alone is frequently insufficient to completely eradicate all disease. This review focuses primarily on the management of patients who present without prior treatment and discusses the role of preoperative radiation therapy as well as intraoperative radiation therapy. Although much less gratifying, patients who present after failing previous therapy may also benefit from an aggressive multimodality approach.
Laparoscopy/thoracoscopy for staging: I. Staging endoscopy in surgical oncology
Authors: Forse R. Armour , Babineau Timothy , Bleday Ronald , Steele Glenn
Published: February 2007

The application of laparoscopy to the staging of solid abdominal tumors is reviewed. The current evidence support the use of laparoscopy particularly in hepatic tumors. There is evidence that the hospital length of stay for a patient with a nonresectable hepatic tumor can be reduced from 5.6 ± 0.4 days with a laparotomy to 1.5 ± 0.3 days with a laparoscopy. Where the palliative and bypass issues are not limiting, cases of pancreatic and gastric carcinoma also appear to benefit in having a staging laparoscopy before a formal laparotomy for resection. Current instrumentation does produce limits, but with future prospects of laparoscopic ultrasound, and tumor staining, staging laparoscopy will become an important diagnostic tool in surgical oncology.
Recent developments in the epidemiology of lung cancer
Authors: Kabat Geoffrey C.
Published: February 2007

Lung cancer is currently the leading cause of cancer death in the United States and also the most common tumor worldwide. Changes in the distribution of histologic types over the past two decades in the United States, as well as high rates of lung cancer in certain subpopulations, require explanation. While cigarette smoking and specific occupational exposures are firmly established as important risk factors for lung cancer, recent work provides evidence that other factors may play a role either as independent risk factors or as modifiers of the effect of smoking. This paper reviews the epidemiology of lung cancer, with an emphasis on developments in the past decade.
Choice of procedure for surgical treatment of non‐small cell lung cancer
Authors: Harvey James C. , Pisch Julianna , Rubin Eva , Beattie Edward J.
Published: February 2007

Asymptomatic coin lesions without specific patterns of benign calcifications can and should have a diagnosis established. Surgical diagnosis can be accomplished with very low morbidity. Accurate staging of lung cancer requires tissue confirmation of mediastinal node status either by thorough sampling or by complete node dissection. Complete resection with lobectomy is the preferred treatment providing better results than lesser resections. Segmental or wedge resections and internal radiotherapy are appropriate for patients unable to tolerate lobectomy. Video assisted thoracoscopy may prove useful in wedge excision for patients with poor pulmonary reserve.
Resection for second and third primary lung cancer
Authors: Faber L. Penfield
Published: February 2007

The continued increasing incidence of bronchogenic carcinoma increases the likelihood that a patient may develop a second or third primary tumor. We have carried out a second thoractomy for 114 patients who met our criteria of having a new primary lung cancer. These criteria were a different histologic cell type, a tumor‐free interval of 24 mo, the second primary in the contralateral lung, or the new tumor in a separate and distinct ipsilateral lobe if the tumor was on the same side. There were 18 patients who had a thoracotomy for a third primary lung cancer and they met the same criteria. There were 73 segmental resections in the 132 thoracotomies, and a conservative resection is important to minimize postoperative complications. Operative mortality for the second resection group of patients was 8.8% (10/114). There was one operative death in the 18 patients undergoing a third resection. The cumulative survival rate following a second resection in 114 patients with metachronous tumors was 33% at 5 yr and 20% at 10 yr. Early detection of a second and third primary lung cancer and surgical resection offers the greatest chance for long‐term survival in this group of patients.
Primary tumors of the thoracic skeleton
Authors: Bloom Norman D.
Published: February 2007

From 1975 to 1990, eighty‐nine primary tumors of the thoracic skeleton; ribs, sternum, scapula, clavicle, and thoracic spine, were treated. Forty‐four tumors (49%) were benign lesions. Forty‐five tumors were malignant and were proportionately distributed amongst the five sites. The most common malignancies were Ewing's sarcomas, chondrosarcomas, plasmacytomas, osteogenic sarcomas, and lymphomas.

All patients with Ewing's sarcomas were treated with combination chemotherapy, surgical resection, and radiation therapy for those with residual disease after surgery. Only one patient has died of disease. Patients with primary chondrosarcomas were treated by surgery alone and all are free of disease or have died without disease. Patients with solitary plasmacytomas or primary lymphomas of bone were treated with radiation therapy initially. Half the patients developed systemic disease. The patients with osteogenic sarcomas included several with radiation induced lesions and Paget's osteosarcoma and all but one died of disease.
Superior results with complete resection of Askin's tumor
Authors: Harvey James C. , Bergland Richard , Pisch Julianna , Krishnamachari Venkatesan T. , Reich Herbert , Malamud Stephen , Beattie Edward J.
Published: February 2007

A malignant small round cell tumor of the thoracopulmonary region arising in childhood has been described by Askin and colleagues. Subsequent descriptions have emphasized refinements (or disagreements) regarding pathology and emphasized the usual poor outcome. Complete excision has not been uniformly attempted in previous series. Our purpose is to describe superior results possible in a multidisciplinary setting emphasizing complete surgical excision.
Pleuroperitoneal shunt for malignant pleural effusions: A one‐year experience
Authors: Reich Herbert , Beattie Edward J. , Harvey James C.
Published: February 2007

Malignant pleural effusions are often debilitating conditions for the patient with advanced cancer. Traditionally, treatment has been repeated thoracentesis or tube thoracostomy with installation of sclerosing agents. This, however, required the patient to be hospitalized and subjected to the pain and inconveniences of the chest tubes. The drainage also had to be low enough for sclerotherapy to be effective. In 1982, the pleurovenous shunt was modified and the pleuroperitoneal shunt became a feasible alternative to sclerotherapy. We started using the Denver pleuroperitoneal shunt in July 1991. Seventeen shunts were inserted into 13 patients over a 1‐year period ending June 30, 1992. All patients were relieved of their dyspnea. The average length of patency was 2.5 months, and fewer than 25% of the shunts clotted. Our favorable experience with the shunt has lead us to recommend the Denver pleuroperitoneal shunt for the treatment of recurrent malignant effusions.
Evolution of surgery in the treatment of hepatocellular carcinoma from the 1950s to the 1990s
Authors: Tang Zhao‐You , Yu Ye‐Qin , Zhou Xin‐Da
Published: February 2007

In the 1950s, hepatic lobectomy for huge hepatocellular carcinoma (HCC) has benefited 5–10% of HCC patients; in the 1970s, limited resection for small HCC and reresection for recurrence have benefited another 5–10% HCC patients. Cytoreduction and sequential resection for unresectable HCC might be of benefit to a further 5–10% HCC patients in the 1990s. Analysis of 1,642 patients with pathologically proven HCC in 1959‐1991 demonstrated that the series 5‐year survival has increased from 3.0% (n = 136) in the 1960s, to 12.2% (n = 440) in the 1970s, to 40.2% (n = 1,066) in the 1980s, which was correlated to the increasing number of limited resections for small HCC, re‐resections for subclinical recurrence, and cytoreductions and sequential resections for portions of unresectable HCC. With the advances in early detection, multimodality treatment, and changing concepts in surgical oncology, the role of surgery in the treatment of HCC has increased.
Experience with resection of segment VIII of liver for hepatocellular carcinoma
Authors: Yu Ye‐Qin , Zhou Xin‐Da , Tang Zhao‐You , Xu Dong‐Bo , Feng Xue‐Sheng
Published: February 2007

Hepatic segment VIII is located at the dome of the right liver lobe, next to the intrahepatic inferior vena cava (IVC) and is situated between the right and the middle hepatic veins. Its close relation to the IVC inferior medially makes liver cancer resection in this particular segment extremely difficult and hazardous.

A personal series of 32 cases of segment VIII resection for hepatocellular carcinoma performed during the period January 1970–May 1992 is being presented. Most resections could be performed with occlusion of the porta hepatis only but some cases required total hepatic vascular exclusion.

Since segment VIII is surrounded by major vessels, the extent of resection is limited in this region. Furthermore, tumor cells are easily disseminated along the vascular route. The long‐term results are far from ideal. One‐, 3‐, and 5‐year survival rates were 93.33%, 57.14%, and 28.5%, respectively. However, eight patients in this series have survived 180, 168, 104, 78, 53, 43, 43, and 36 months, respectively, and some of them have returned to work. Therefore, despite the technical difficulties involved in segment VIII resection, it is still worthwhile adopting an aggressive operative approach to this group of patients.
Cryosurgery of liver cancer
Authors: Onik Gary M. , Atkinson Donald , Zemel Reubin , Weaver M. Lance
Published: February 2007

Cryosurgery, the in situ destruction of tissue using subzero temperatures, has been used to treat hepatic metastases. Because it is a focal treatment, cryosurgery can be used in patients with unresectable lesions due to location (next to major blood vessels) or multiplicity. In this study, 57 patients with unresectable hepatic metastases were treated with cryosurgery (with at least a 6‐month follow‐up). The number of lesions treated ranged from 1–16 with a mean of 4.6. Forty‐three patients (73%) had bilobar disease, while 25 patients (42%) were treated with a combination of resection and cryosurgery. The disease‐free survival rate (patients with normal computed tomography [CT] scans and carcinoembryonic antigen [CEA] levels) was 27% with a mean follow‐up of 21 months. This is comparable to other hepatic cryosurgery studies that have found survival rates of 25–37.5%. Although the results are still short‐term, this study indicates that hepatic cryosurgery offers the hope of long‐term survival in patients with unresectable hepatic metastases.
Microwave surgery in the treatment of hepatocellular carcinoma
Authors: Zhou Xin‐Da , Tang Zhao‐You , Yu Ye‐Qin , Ma Zeng‐Chen , Xu Dong‐Bo , Zheng Ya‐Xin , Zhang Bo‐Henc
Published: February 2007

Microwave surgery was employed for the treatment of 50 patients with hepatocellular carcinoma (HCC) and liver cirrhosis, including hepatectomy in 46 patients and in situ coagulation of tumor in 4 patients. In the study, 2,450 MHz microwaves were generated and transmitted to a monopolar needle electrode. For hepatectomy, the needle electrode was inserted into the liver parenchyma to coagulate the liver tissue and this was repeated at 1 cm intervals along the line where incision is anticipated. For unresectable HCC, the needle electrode was directly inserted into HCC to coagulate the cancer in situ. The average amounts of blood loss and blood transfusion for 46 hepatectomies using microwave were 215 ± 189 ml and 274 ± 261ml, respectively. Eighteen patients (39.1%) did not need blood transfusion. A significant lower volume of blood loss and blood transfusion was observed in comparison with 46 matched conventional hepatectomies, 652 ± 1,008 ml and 841 ± 878 mi, respectively, all being P < 0.01. There were no operative mortality and complications, such as delayed bleeding, bile leakage, and abdominal infection. These results indicate that microwave surgery can be utilized safely and effectively in the field of liver surgery.
Evaluation of preoperative transcatheter arterial embolization in the treatment of resectable primary liver cancer
Authors: Nagasue Naofumi , Kohno Hitoshi , Uchida Masaaki
Published: February 2007

The effects of preoperative transcatheter arterial embolization (TAE) and intra‐arterial injection of Lipiodol were retrospectively evaluated in patients with resectable hepatocellular carcinoma experienced during two different periods of time. In the TAE study, there were 31 patients with TAE and 107 patients without TAE. In the Lipiodol study, 60 patients had received Lipiodol injection and 68 patients served as controls. Curative hepatic resection was performed in all cases. As such preceding treatments had been performed at other hospitals, two comparing groups were fairly randomized in both the TAE and the Lipiodol study. Preoperative TAE did not influence the postoperative morbidity and mortality rates, cause of late death, and long‐term survival rate in overall patients, but seemed to produce a better survival in noncirrhotic patients. Antitumor effect by Lipiodol injection was found in that the cancer free survival rate was significantly better in the group with Lipiodol injection. However, the overall 5‐year survival rate was significantly better in the group without Lipiodol (67%) than in the group with Lipiodol (26%). The present study may indicate that preoperative TAE or Lipiodol injection should not be routinely performed. Such treatments may produce a substantial benefit only in selected patients with good hepatic functional reserve.
Role of liver transplantation in the treatment of hepatocellular carcinoma
Authors: Iwatsuki Shunzaburo , Starzl Thomas E.
Published: February 2007

The results obtained by liver transplantation (TX) (n = 105) for hepatocellular carcinoma (HCC) were compared with those achieved by hepatic resection (HX) (n = 76). Overall 1‐ to 5‐year survival rates after TX were 66%, 49%, 39%, 36%, and 36%, and those after HX were 71%, 55%, 47%, 37%, and 33%, respectively. The survival rates after TX and HX correlated well with pTNM stages, and the overall survival rates were similar in each stage between the TX and the HX group. However, when HCC was associated with cirrhosis of the liver, the survival rates after TX were significantly higher than those after HX at each stage of pTNM classification. Tumor recurrence rate was high both after TX (43%) and HX (50%), particularly in stage IV‐A. Tumor recurrence rate was significantly lower after TX than after HX in HCCs of stages II and III. Liver TX has established its definite role in the treatment of HCC, particularly in the presence of hepatic impairment or cirrhosis of the liver.
Comparison of hepatic resection and transplantation in the treatment of liver cancer
Authors: Bismuth Henri , Chiche Laurence
Published: February 2007

One hundred twenty cirrhotic patients underwent hepatic resection (n = 60) or transplantation (n = 60) for hepatocellular carcinoma. Overall 3‐year survival and survival without recurrence were 50% and 23% in the resection group compared to 47% and 44% in the transplantation group. Several characteristics of the tumors have been studied in order to determine prognostic factors in both groups. Thus, results for 3‐year survival without recurrence following transplantation in patients with tumors > 3 cm/one or two nodules (83%) were superior to those following transplantation in patients with tumors larger than 3 cm or three or more nodules (37%) (P < 0.02) and to those following resection (10%). Thus, for patients with small tumors, until now the best candidates for resection, transplantation appears to have significantly better results. Conversely, for larger lesions, with three or more nodules, transplantation, in view of the critical donor situation, is probably not indicated.
Embryologic concepts in the APUD system
Authors: Delcore Romano , Friesen Stanley R.
Published: February 2007

The amalgamation of the neural and endocrine physiologic mechanisms for functional homeostasis as a neuroendocrine system is brought into focus in this chapter on the embryologic concepts in the APUD system. The neuroendocrine system, now regarded as the third division of the nervous system, is a regulatory mechanism that links the functions of the autonomic nerves and the endocrine cells throughout the body. The current realization that both neural and endocrine actions are often involved in the clinical manifestations of many syndromes is clarified by the theories on the embryologic origin of the APUD system described here. Relevant historical developments, as well as cytochemical discoveries, have been gradually integrated into the evolving theories of the embryologic origin of the APUD system. These theories have not been without controversy, but new developments stimulate new concepts and, as new investigative tools have produced a plethora of new information that continues to push investigators, basic and clinical into new horizons, earlier theories have been modified and new theories have been developed. These theories are reviewed in chronological order in this chapter.
Physiology of the APUD system
Authors: Demeure Michael J.
Published: February 2007

The characteristic biochemical pathway of the APUDoma cell, namely amine precursor uptake and decarboxylation, are illustrated by the examples of serotonin and catecholamine metabolism. Increasing understanding of the origins of APUDomas as well as the biochemistry and physiology of the hormones they produce, has led to improved methods of detection, imaging and treatment of afflicted patients.
Screening and surgical intervention in the multiple endocrine neoplasia patient
Authors: Pasleka Janice L.
Published: February 2007

Persons with multiple endocrine neoplasias (MEN) are a unique group of patients that present with various APUDomas. Screening of family members can lead to early detection of these tumors and possible cure of potentially fatal tumors. Screening for the MEN syndromes at present is limited to provocative and biochemical parameters. The gene(s) responsible for these syndromes have not, as of yet, been characterized but in the future will add greatly to the ability to identify these patients early. Early surgical intervention of these APUDomas, has lead to an improved prognosis for these tumors. The screening and the surgical approach to each syndrome are outlined.
Controversies in surgical therapy for APUDomas
Authors: Fraker Douglas L. , Norton Jeffrey A.
Published: February 2007

Location of gastrinomas by means of portal venous sampling is a technique in which venous blood from various sites in the portal system around the pancreas and duodenum is obtained and assayed for gastrin levels. A gradient of 50% or greater compared to systemic gastrin levels from a given location regionally identifies the site of gastrin overproduction, thereby locating the tumor. The only area in which venous sampling may help, in the authors' opinion, is in the small subset of patients who have occult gastrinoma not imaged with any other modality, in the body or tail of the pancreas that cannot be found with intraoperative ultrasound or palpation. It is considered that a secretin angiogram is equally effective and is a simpler procedure. Similarly, in insulinoma regional location of the tumor by means of a calcium angiogram has eliminated the usefulness of portal venous sampling.

Controversial areas of surgical treatment of APUDomas often reflect a balance between the risks and benefits of aggressive surgery, as data to support an aggressive surgical approach to obtain improved survival often do not exist. For example, if patients with occult MTC can undergo cervical reexploration with minimal or no morbidity the potential benefit of removing malignant disease, warrants this approach. Similarly, if patients with MEN‐1 can be explored safely with resection of pancreatic and duodenal tumors, then this position can be defended. On the other hand, if a subgroup of patients with MEN‐2 and pheochomocytomas can be spared bilateral adrenalectomy without compromising their long‐term outcome in terms of disease‐free survival, then this conservative approach is warranted. For all of these controversial areas long‐term follow‐up of these patients with relatively indolent malignancies may support other current therapeutic recommendations.
Metastatic proclivities and patterns among APUD cell neoplasms
Authors: Moffat Frederick L. , Ketcham Alfred S.
Published: February 2007

Neoplasms of APUD cell origin are quite variable in their metastatic behavior. Whereas pituitary and parathyroid tumors almost never metastasize, all oat cell lung cancers, malignant melanomas, trabecular carcinomas of the skin and medullary thyroid cancers are capable of dissemination. The metastatic proclivity of individual carcinoids, pancreatic and extrapancreatic islet cell tumors, and paragangliomas is much less predictable. In particular, there are no reliable histological markers of risk for lymphatic or hematogenous dissemination. The behavior of many carcinoids, islet cell carcinomas and paragangliomas is relatively indolent, even when metastatic disease is already present. However, unresectable distant metastases, especially liver involvement, connote a poor prognosis. Mortality is more often related to uncontrolled tumor growth and metastasis than to associated endocrinopathies. Curative or debulking surgical resection should be aggressively pursued as recent data show that worthwhile clinical disease‐free survival can be realized in at least some patients.
Venous access in pediatric oncology patients
Authors: Albanese Craig T. , Wiener Eugene S.
Published: February 2007

Long‐term central venous access is an integral part of the management of many, but not all children with cancer. The proper selection of those children who require this access and which access device (external vs. totally implanted) is best suited to that child is important to minimize complications and obtain optimal results.

Although most of these devices can be expected to last the duration of the treatment protocol or the patient's life, complications (infection, occlusion, dislodgment) occur with higher than desired frequency, infection being the most common. No measures are clearly beneficial in preventing infection, but most infections can be treated successfully without device removal. Premature removal or dislodgment occurs more frequently with external catheters and may be minimized by techniques used at insertion. Occlusion, detected early, can be successfully managed by clot lysis in most children.
Radical surgery for abdominal neuroblastoma
Authors: Kiely Edward M.
Published: February 2007

Radical operation predominantly for those with stages 111 and IV, i.e., locally advanced and /or metastatic abdominal neuroblastoma, is described. Generally the surgery has been performed when tumour shrinkage has been achieved by means of chemotherapy, and metas‐tases have been ablated. The author compares his results in 46 patients with those of 34 patients undergoing less aggressive surgery performed by a number of surgeons, with similar results. Given the difficulties inherent in performing curative resection for disseminated abdominal neuroblastoma, the surgeon needs to be convinced that hidher efforts are worthwhile. The results reported here do not provide such reassurance.
Current biologic and therapeutic implications in the surgery of neuroblastoma
Authors: Azizkhan Richard G. , Haase Gerald M.
Published: February 2007

Advances in the understanding of neuroblastoma biology have helped distinguish those patients who require maximum therapy from those who do not. However, management of children with advanced disease remains a significant problem. New more intensive multiagent chemotherapy, ablative chemoradiotherapy with bone marrow transplantation, radiolabelled monoclonal antibody technology and a host of biologic response modifiers are currently being intensively studied. Nevertheless, surgery remains crucial for diagnosis, for providing adequate tissue for biological and histopathologic staging, for primary and secondary resections as well as restaging after therapy. Major surgical questions remain to be addressed in cooperative group studies.
On the estimation of survival
Authors: Henson Donald Earl , Ries Lynn A. Gloeckler
Published: February 2007

The advantages and disadvantages of the different methods for calculating survival according to the TNM (Topography, Lymph Node, and Metastasis) are described. Methods include the observed, relative, and conditional survival rates. For large cohorts, relative survival calculated by the life table method is most useful. Conditional survival, which requires long‐term follow‐up, is clinically the most informative. In addition, follow‐up methods employed by tumor registries are considered. © 1994 Wiley‐Liss, Inc.

This article is a U.S. Government work and, as such is in the public domain in the United.
Residual tumor (R) classification and prognosis
Authors: Hermanek Paul , Wittekind Christian
Published: February 2007

The tumor status following treatment is described by the residual tumor (R) classification: R0, no residual tumor; R1, microscopic residual tumor; R2, macroscopic residual tumor. Residual tumor may be found in the area of primary tumor and its regional lymph nodes and/or at distant sites. The R classification reflects the effects of treatment and influences further treatment planning. Furthermore, the R classification is a strong predictor of prognosis. An acceptable long‐term prognosis can be expected only in R0 patients. Although there exist clear correlations between stage and R classification the differences in prognosis of R0 versus R1,2 cannot be explained by differences in stage alone. The prognostic significance of R classification is demonstrated by respective data for non‐small cell lung carcinoma, squamous cell carcinoma of oesophagus, gastric carcinoma, ductal adenocarcinoma of the pancreas, colorectal carcinoma, lung and liver metastases. © 1994 Wiley‐Liss, Inc.