bluuebunny/crossref_metadata_2025_split huggingface dataset:
Survival after resection of gastric cancer and prognostic relevance of systematic lymph node dissection: Twenty years experience in Taiwan
Authors: Lee Wei‐Jei , Lee Wen‐Chung , Houng Shyh‐Jinn , Shun Chia‐Tung , Houng Ren‐Long , Lee Po‐Hung , Chang King‐Jen , Wei Ta‐Cheng , Chen Kai‐Mo 
Published: October 2004

AbstractA retrospective study of 954 resectable gastric cancers in a single institute of Taiwan from 1971 to 1990 was performed to evaluate improvements in gastric cancer surgery. The patients were divided into four time periods representing an overall experience of progressive implementation of aggressive resection and increased extent of systematic lymph node dissection. The clinicopathologic data and survival rates were statistically compared and the significance of the extent of resection on survival analyzed. A significant increase in the proportion of upper one‐third tumors (from 14.8% to 20.4%) and a decrease in the incidence of intestinal type (73.6% to 41.5%) was found within the overall period. The proportion of patients with early gastric cancer increased from 11.5% to 19.4%. Patients who underwent total gastrectomy and combined visceral resection increased from 13.7% to 27.4% and 19.8% to 41.1%, respectively. An increase of both total dissected lymph, node number and the incidence of detected lymph node metastases in early gastric cancer were associated with more extensive lymphadenectomy. An improved 5‐year survival rate following aggressive resection was found for all stages except stage IV and T4 lesions, and the surgical mortality decreased from 5.5% to 2.0%. Patients with earlier stage lesions benefited more from radical resection, especially those with stage II and T2 lesions. Systematic lymph node dissection increased the 5‐year survival of patients by about 10% for stage III or T3 lesions, but not for patients with stage IV or T4 lesions. Multivariate analysis confirmed the significance of the improved technique of lymphadenectomy on the prognosis of gastric cancer following resection in Taiwan. In conclusion, a changing pattern of gastric cancer epidemiology in Taiwan is documented. A decrease in surgical mortality indicates that curative resection with extensive lymph node dissection can be safely performed. Although potential for increasing survival by upstaging remains, radical gastrectomy with extended lymphadenectomy could be adopted for gastric cancer resection with possibly more adequate control of locoregional disease.
Management of intrabiliary rupture of hydatid cyst of the liver
Authors: Ulualp Kenan M. , Aydemir Ismail , Senturk Hakan , Eyuboğlu Erhun , Cebeci Hayrettin , Unal Gurcan , Unal Hilal 
Published: October 2004

AbstractThirty‐six patients with intrabiliary rupture of hepatic echinococcal cysts were managed between 1974 and 1993. Clinical findings, skin tests, serologic tests, and imaging techniques were used to establish the diagnosis. Twenty‐five (69.4%) patients had pain, 24 (66.6%) jaundice 22 (61.1%) fever, 20 (55.5%) chills, 10 (27.7%) malaise, and 7 (19.4%) other symptoms as the major causes of admission. All patients underwent choledochotomy and T‐tube drainage. Treatment directed to the cyst was cystectomy and capittonage, cystectomy and drainage, and partial hepatectomy in 22, 12, and 2 patients, respectively. Omentoplasty was added to the treatment in 10 patients. Seven (19.4%) patients had complications. The period of hospitalization for patients with and without complications was 34.6±18.1 and 15.1±2.7, days, respectively. This study indicates that better results are obtained in patients with cystic lesions of the liver by avoiding percutaneous puncture or biopsy, the early use of ultrasonography and computed tomography, evacuation of the cyst together with its germinative membrane and the involved biliary tract under adequate care to avoid spillage into the peritoneal cavity, treating the remaining cavity according to its location, size, and the presence of infection, and decreasing the pressure in the biliary tract by T‐tube drainage.
Childhood melanoma in Australia
Authors: McWhirter W. R. , Dobson C. 
Published: October 2004

AbstractData from a population‐based registry, the Australian Paediatric Cancer Registry, were used to determine the incidence of malignant melanoma in children under 15 years of age in Australia. Over a 17‐year period, 217 cases were identified. For the period 1977–89 inclusive, the annual age incidence was 0.34 per 100,000. There was some variation in incidence between the different states with Queensland recording the highest incidence at 0.97 per 100,000, the highest reported incidence in the world for childhood melanoma. Most of the cases occurred in children aged 13 or 14 years old with girls affected slightly more often, the sex ratio being 0.92. There was a statistically significant seasonal variation with fewer cases being diagnosed during the winter months. The commonest site was the trunk. Two of the cases were second neoplasms. This series demonstrates the need for increased education of children living in tropical and subtropical regions about the dangers of sun exposure and of methods of reducing exposure. Children who have undergone chemotherapy appear to be at particular risk.
Radiation therapy for nodal disease in malignant melanoma
Authors: Burmeister B. H. , Smithers B. M. , Poulsen M. , McLeod G. R. , Bryant G. , Tripcony L. , Thorpe C. 
Published: October 2004

AbstractRadiation therapy has been widely used for palliative management of inoperable metastatic malignant melanoma. For patients with nodal disease, response rates of approximately 70% have been reported. There are limited data concerning the role of adjuvant irradiation following therapeutic lymph node dissection. In this review, 57 patients with isolated resectable and nonresectable nodal disease have been treated with radiation. The overall response rate is 84% for bulky disease. Large fractions are beneficial. The median disease‐free survivals were 11 months after adjuvant treatment and 7 months for those with inoperable disease. The median overall survivals were 20 months and 18 months, respectively. Local control in long‐term survivors was excellent. Sixty‐five percent of patients developed distant metastases. There is a need for additional studies with the use of adjuvant radiation therapy following lymph node dissection.
Outcome of microscopically nonradical, subtotal pancreaticoduodenectomy (Whipple's resection) for treatment of pancreatic head tumors
Authors: Reinders Marcel E. , Allema Jan H. , van Gulik Thomas M. , Karsten Tom M. , de Wit Laurens Th. , Verbeek Paul C.M. , Rauws Erik J. , Gouma Dirk J. 
Published: October 2004

AbstractFrom 1983 to 1992 a total of 240 patients with a pancreatic head tumor underwent laparotomy to assess the resectability of the tumor. In 44 patients the tumor was not resected because of distant metastases (n=20) or major vascular involvement or local tumor infiltration (n=24) not detected during the preoperative workup. A palliative biliary and gastric bypass was performed in these patients. All other patients underwent a subtotal (Whipple's resection, n=164) or total (n=32) pancreaticoduodenectomy. However, in 56 cases after Whipple's resection, microscopic examination of the specimen showed tumor invasion in the dissection margins. For this reason, these resections were considered palliative. We compared hospital mortality, morbidity, and long‐term survival of patients who had undergone a biliary and gastric bypass for a locally advanced tumor (group A, n=24) with a matched group of patients who had undergone a macroscopically radical Whipple's resection that on microscopic examination proved to be nonradical (group B, n=36). Both groups were comparable with regard to age (mean 61 years in both groups), duration of symptoms (8 weeks in group A and 10 weeks in group B), and tumor size (mean 4.25 cm in group A and 4.30 cm in group B). Median postoperative hospital stay was 18 days in group A and 25 days in group B. Postoperative complications (intraabdominal abscess, gastrointestinal hemorrhage, anastomotic leakage, delayed gastric emptying) occurred in 33% of patients in group A and in 44% of patients in group B. Hospital mortality was 0% and 3% in group A and group B, respectively. Survival in group B was significantly longer than in group A (p<0.03). Survivals after 1 and 2 years were 22% and 2% in group A versus 44% and 24% in group B, respectively. These results support our view that when a macroscopically radical resection seems feasible, a Whipple's resection should be carried out. In case of microscopic, residual tumor, the Whipple procedure offers acceptable palliation.
Simple, effective procedure with few complications for esophageal varices
Authors: Lin Pin‐Wen , Tsai Hong‐Ming , Lin Ching‐Yin , Chiu Nan‐Tsing 
Published: October 2004

AbstractThe surgical morbidity, mortality, and effectiveness of a modified nonshunting operation that includes splenic artery division instead of splenectomy, devascularization, and esophageal transection (SAD group) were evaluated. Eighteen cirrhotic patients with varices who underwent this modified procedure were compared with 54 patients treated with a conventional nonshunting operation (splenectomy group). Results show that immediate effects on portal pressure and preservation of portal perfusion between the two groups were similar. The operative time is shorter (p<0.05), and the bleeding amount is less (p<0.005) in the SAD group than in the splenectomy group. No surgical mortality and no major complications were noted in the SAD group. A surgical mortality of 2.3% and 30% was noted for the elective and emergency operations of the splenectomy group, respectively. There was no encephalopathy in the SAD group but one in the splenectomy group. Recurrent bleeding occurred in three patients of the splenectomy group 1 year after surgery but none in the SAD group. These data indicate that this modified procedure is a simple and effective operation with few complications for esophageal varices.
Long‐term Survival of Patients with Unresectable Colorectal Liver Metastases treated by Percutaneous Interstitial Laser Thermotherapy
Authors: Christophi Christopher , Nikfarjam Mehrdad , Malcontenti‐Wilson Caterina , Muralidharan Vijayaragavan 
Published: October 2004

AbstractIn situ ablation of colorectal cancer (CRC) liver metastases is an accepted form of treatment for selected patients. It is associated with low morbidity and mortality and increases the number of patients who may benefit from therapy compared to resection alone. This study assesses the impact of interstitial laser thermotherapy (ILT) on local tumor control and long‐term survival in patients with unresectable CRC liver metastases. Percutaneous ILT was performed in patients with unresectable CRC liver metastases between January 1992 and December 1999 using a bare‐tip quartz fiber connected to an Nd:YAG laser source. This was prior to the routine use of a diffusing fiber for ablative therapy. Treatment was monitored with real‐time ultrasonography. Tumors were considered unresectable based on their anatomic location or the extent of liver involvement. Patients with extrahepatic disease, more than five liver metastases, or tumors larger than 10 cm in diameter were excluded from this study. Local tumor control was assessed by dynamic computed tomography (CT) 6 months after therapy. Long‐term follow‐up was undertaken, and the impact of various factors on survival was analyzed. Eighty patients with a mean age of 63.8 years were suitable for ILT. In total, 168 liver tumors with a median diameter of 5 cm (range 1–10 cm) were so treated. There were no procedure‐related deaths. The overall complication rate was 16%, with all cases managed conservatively. Bradycardia (n = 5), pneumothorax (n = 3), and persistent pyrexia (n = 3) were the most common complications. Complete tumor ablation was noted in 67% of patients assessed by CT 6 months following the initial therapy. Median follow‐up was 35 months (range 4–96 months), with 10 patients alive at the end of this period. Altogether there were 67 deaths, which were related to hepatic disease in 55 cases and to extrahepatic disease in 9; they were unrelated to malignancy in 3 others. Three patients were excluded from follow‐up after ILT down‐staging of tumors that allowed complete surgical resection. The median disease‐free survival of patients treated by ILT was 24.6 months, with a 5‐year survival of 3.8%. Poor tumor differentiation and the presence of more than two hepatic metastases were associated with lower overall survival (p < 0.01). Fourteen patients treated by ILT for postoperative hepatic recurrences had the best outcome, with a median overall survival of 36.3 months and a 5‐year survival of 17.2%. Percutaneous ILT is a minimally invasive, safe, effective technique that appears to improve overall survival in specific patients with unresectable CRC liver metastases, compared to the natural history of untreated disease reported in the literature.
Effect of Chemoradiotherapy with Gemcitabine and Cisplatin on Locoregional Control in Patients with Primary Inoperable Pancreatic Cancer
Authors: Wilkowski Ralf , Thoma Martin , Schauer Rolf , Wagner Andreas , Heinemann Volker 
Published: October 2004

AbstractGemcitabine sensitizes tumor cells to radiation and cisplatin and thereby enhances the cytotoxic effect of gemcitabine. Here we report the efficacy and toxicity of concurrent chemoradiation with gemcitabine and cisplatin in the treatment of patients with locally advanced, unresectable pancreatic cancer. A total of 47 patients (29 men, 18 women; median age 61 years) with histologically proven advanced pancreatic carcinoma were included in the study. They underwent chemotherapy with gemcitabine 300 mg/m2 and cisplatin 30 mg/m2 on days 1, 8, 22, and 29; concurrent radiation (45—50 Gy) was applied to the tumor and regional lymph nodes (1.8—2.0 Gy/fraction 5 days per week). Subsequent to chemoradiotherapy, treatment was continued with more two cycles of gemcitabine (1000 mg/m2) and cisplatin (50 mg/m2) applied on days 1 and 15 of a 4‐week cycle. After completion of chemoradiotherapy, 9 patients (19.1%) achieved a complete response and 23 patients (48.9%) a partial response, for an overall response rate of 68%. The lesions were considered resectable in 27 patients, and 25 of the 27 patients underwent laparotomy. The other 20 patients underwent a definitive pancreatic resection. Altogether, 13 patients had negative surgical margins. With a median follow‐up of 25.7 months (range 12.7—38.7 months) after completion of chemoradiation, distant metastasis had occurred in 23 patients and local recurrence in only 4 of 44 patients (8.5%). the median progression‐free survival was 7.8 months (range 6.2—9.4 months). The median survival amounted to 10.7 months (range 8.4—13.0 months) for all patients, whereas it was prolonged to 24.2 months (range 6.8—41.7 months) for those undergoing R0 resection. The main toxicities associated with chemoradiation included grade 3/4 leukopenia (68% of patients) and thrombocytopenia (61%). Episodes of cholangitis were observed in 11 patients. We concluded that gemcitabine and cisplatin can safely be combined with external beam radiation. This preoperative treatment approach is highly effective and appears to improve survival in patients whose tumors are rendered completely resectable.
Risk Factors for Postoperative Delirium after Liver Resection for Hepatocellular Carcinoma
Authors: Yoshimura Yasuko , Kubo Shoji , Shirata Kumiko , Hirohashi Kazuhiro , Tanaka Hiromu , Shuto Taichi , Takemura Shigekazu , Kinoshita Hiroaki 
Published: October 2004

AbstractWe investigated risk factors for delirium in 100 patients who underwent liver resection for hepatocellular carcinoma. Postoperative delirium developed in 17 (17%). Univariate analysis revealed that advanced age (especially = 70 years old), a history of smoking, a decreased serum albumin concentration (especially < 3.8 g/dl), advanced cancer stage (II–IV), major hepatectomy, prolonged operating time, and large intraoperative blood loss were possible risk factors for postoperative delirium. When patients’ preoperative condition and laboratory test results were subjected to multivariate analysis, only advanced age [odds ratio (OR) 1.201; confidence interval (CI) 1.063–1.357] and a decreased serum albumin concentration (OR 0.151; CI 0.025–0.900) were independent risk factors for the delirium. The percentages of patients with high aspartate and alanine aminotransferase activities, a high indocyanine green retention rate at 15 minutes, a low platelet count, and advanced cancer stage (II–IV) were higher in patients with a low (< 3.8 g/dl), rather than high (= 3.8 g/dl) serum albumin concentration. These findings indicate that multiple factors, including advanced age, impaired liver function, and advanced cancer stage, affect the development of postoperative delirium after liver resection for hepatocellular carcinoma.
Altered Serum Transforming Growth Factor‐ß1 and Monocyte Chemoattractant Protein‐1 Levels in Obstructive Jaundice
Authors: Sheen‐Chen Shyr‐Ming , Eng Hock‐Liew , Hung Kuo‐Sheng 
Published: October 2004

AbstractImpaired immune function has long been documented in patients with obstructive jaundice, and those with jaundice due to extrahepatic biliary obstruction still experience a high rate of postoperative complications and death. Transforming growth factor‐ß1 (TGFß1) appears to be an important regulator of both normal and pathologic conditions in the liver. Monocyte chemoattractant protein‐1 (MCP‐1) is an important mediator of monocyte recruitment to inflammatory sites. We hypothesize that obstructive jaundice may alter serum TGFß1 and MCP‐1 expressions in the rat and that oral bile acid or glutamine (or both) can restore the altered serum TGFß1 and MCP‐1 expression in rats with obstructive jaundice. Male Sprague‐Dawley rats weighing 250 to 300 g were randomized to four groups (n = 10 in each group). Group 1 underwent a sham operation with oral normal saline administration. Group 2 underwent common bile duct ligation (CBDL) with oral normal saline administration. Group 3 underwent CBDL with oral bile acid replacement. Group 4 underwent CBDL with oral glutamine administration. Animals were sacrificed after 3 days (n = 5) and 7 days (n = 5), and blood samples were collected. Serum was obtained after centrifugation for measurement of TGFß1 and MCP‐1 levels by an enzyme‐linked immunosorbent assay. The serum TGFß1 level was significantly elevated (p = 0.006) 3 days after CBDL. Oral glutamine administration prevented this elevation, but oral bile acid replacement did not. The serum MCP‐1 level showed similar changes. After 3 days of obstructive jaundice, the TGFß1 and MCP‐1 levels were altered in the rat. Oral glutamine administration, not oral bile acid replacement, was able to prevent these alterations.
Decreased Identification Rate of Sentinel Lymph Node after Neoadjuvant Chemotherapy
Authors: Kang Seok Hyung , Kim Seok‐Ki , Kwon Youngmee , Kang Han‐Sung , Kang Jae Hee , Ro Jungsil , Lee Eun Sook 
Published: October 2004

AbstractWe prospectively studied the feasibility of sentinel lymph node biopsy (SLNB) after neoadjuvant chemotherapy by comparing the identification rate and the false‐negative rate (FNR) with the results obtained from the patients without chemotherapy. From October 2001 to March 2003, a total of 284 consecutive patients who underwent SLNB and axillary lymph node dissection (ALND) at the Center for Breast Cancer, National Cancer Center were enrolled. Of the 284 patients, 54 underwent neoadjuvant chemotherapy prior to operation. The sentinel lymph node (SLN) was mapped by radioactive colloid alone or in combination with blue dye. All SLNs were evaluated by 2 mm serial sections after hematoxylin‐eosin staining. The overall SLN identification rate was 91.9% (261/284): 72.2% (39/54) of the patients after chemotherapy and 96.5% (222/230) of the patients without chemotherapy. These results suggest that preoperative chemotherapy significantly affects lymphatic mapping (p< 0.001). Among the patients with chemotherapy, there were 3 false negatives in 39 successfully mapped tumors, yielding an FNR of 11.1% (3/27), a negative prediction value (NPV) of 80.0% (12/15), and an accuracy of 92.3% (36/39). There were 10 false negatives among 222 successfully detected patients without chemotherapy, yielding an FNR of 9.9% (10/101), an NPV of 92.4% (121/131), and an accuracy of 95.5% (212/222). These results were not statistically different when compared (p > 0.05). Although the SLN identification rate significantly decreased after neoadjuvant chemotherapy, SLNB could accurately predict axillary status. Thus SLNB can be an alternative to ALND even after neoadjuvant chemotherapy in cases of successful identification of the SLN.
Patterns and Clinical Outcomes Associated with Routine Intravenous Sodium and Fluid Administration after Colorectal Resection
Authors: Tambyraja Andrew L. , Sengupta Fergus , MacGregor Alasdair B. , Bartolo David C.C. , Fearon Kenneth C.H. 
Published: October 2004

AbstractExcess intravenous water and sodium may be associated with postoperative complications and an adverse outcome. However, the effect of the magnitude of the surgery on such a relation has not been studied. This study assesses current practice in intravenous fluid and sodium administration after colonic and rectal resection and its relation to the postoperative outcome. A series of 100 consecutive patients undergoing elective colonic (n = 44) or rectal resection (n = 56) were included in a retrospective case‐cohort study. The volumes of water and sodium from intravenous fluid and antibiotic administration on the day of surgery and the next 5 days were recorded together with the clinical outcome. The mean ± SEM fluid and sodium administration on the day of operation was greater after rectal than colonic resection (4.6 ± 0.2 vs. 3.6 ± 0.2 liters and 507 ± 34 vs. 389 ± 22 mmol, respectively (p < 0.05). The mean ± SEM rate of daily fluid and sodium administration for the 5 subsequent days was greater following rectal than colonic resection (2.1 ± 0.1 vs. 1.8 ± 0.1 L/day and 155 ± 8.7 vs. 128 ± 8.0 mmol/day; p < 0.05). For all resections, there were no differences in fluid and sodium administration on the day of surgery in patients with or without postoperative complications. During the subsequent 5days, patients with complications after colonic resection had a higher postoperative mean rate of intravenous sodium administration than those who did not (149 ± 12 vs. 115 ± 10 mmol; p < 0.05). A similar pattern was not observed following rectal resection. Current postoperative intravenous fluid prescription delivers approximately 2 liters of fluid and 140 mmol of sodium per day. Complications after colonic, but not rectal, resection are associated with more early postoperative daily intravenous sodium administration. Because colonic resection poses less of a physiologic insult than rectal resection, the overall outcome in the former group may be more sensitive to the interplay between fluid and sodium overload and patient co‐morbidity.