bluuebunny/crossref_metadata_2025_split huggingface dataset:
Multidisciplinary management of cancer of the anus
Authors: Nigro Norman D. 
Published: May 2005

AbstractAnal margin cancers are treated by local excision, with radical surgery reserved only for invasive cancers or those associated with fistula or condylomata. Squamous cell cancers of the anal canal have been treated by abdominoperineal resection regardless of cell type. Radiation therapy alone has been advocated by some, and we initiated a study using a combination of radiation, chemotherapy, and surgery. This study includes 104 patients treated from December, 1971, to July, 1983. Routine abdominoperineal resection was discontinued by us in 1975 because chemoradiation therapy eliminated the primary lesion in 5 of the first 6 patients. In the series, gross tumor disappeared in 97 patients after chemoradiation therapy. Radical operation was done routinely in 24 patients, for residual disease in 7, and for recurrent disease in 7 others. There were 21 deaths of which 13 were due to cancer of the anal canal. Large primary lesions and recurrent local disease account for the majority of deaths due to cancer. The 5‐year survival rate is projected to be 83%, with 65 patients followed for at least 5 years. Under our current regimen only 16 of the 38 patients would have had radical surgery. Chemoradiation therapy is advocated for all patients with squamous cell cancer of the anal canal and for invasive cancers of the anal margin. Patients with large (6–8 cm) primary cancers and those with recurrent disease should have additional chemoradiation therapy and/or abdominoperineal resection of the rectum.
Intraportal chemotherapy in colorectal carcinoma as an adjuvant modality
Authors: Metzger U. , Mermillod B. , Aeberhard P. , Gloor F. , Bissat A. , Egeli R. , Laffer U. , Martinoli S. , Mueller W. , Schroeder R. , Weber W. ,   the Swiss Group for Clinical Cancer Research (SAKK)
Published: May 2005

AbstractLiver metastases of colorectal origin arise from malignant cells entering the portal venous circulation. Four hundred sixty patients from 7 participating institutions have been entered in a prospective randomized trial to assess the value of adjuvant portal venous infusion to prevent liver metastases following curative colorectal cancer surgery. By preoperative randomization, patients were assigned to surgery alone (control arm) or to portal liver infusion with 5‐fluorouracil (5‐FU) (500 mg/m2 daily × 7, continuous infusion during the first 7 postoperative days) and mitomycin C (10 mg/m2, 24 hours postoperatively as a 2‐hour infusion). A portal venous catheter was placed through any side branch of the mesenteric venous system during laparotomy for the primary tumor. Using the transabdominal route, there have been no catheter‐related complications. Despite a large cumulative dose of 5‐FU given during the immediate postoperative period, the systemic side effects were minimal. Overall hospital mortality in this study was 1.85% and was not influenced by the adjuvant treatment. This rate is considerably lower than that reported by previous multicenter trials and by the surgical literature, and it indicates an advance in surgical technique and pre‐/postoperative patient management in this type of elective surgery.Three hundred seventy‐eight patients (187 controls, 191 infusion patients) are completely evaluable for recurrence and survival. After a median follow‐up of 24 months, 43 recurrences have been observed in the control group and 34 in the infusion group (p<0.05). Liver metastases were present in 18 control patients and in 14 infusion patients. Twenty‐five patients in the control group and 18 patients in the infusion group died of recurrent disease. Due to the low number of recurrences in this study, it is too early to draw survival conclusions.Several controlled trials using adjuvant portal infusion are in progress. They also showed the feasibility of this approach and they suggested that adjuvant cytotoxic liver infusion may reduce the incidence of liver metastases without significantly increasing morbidity and mortality. It is too early, however, to recommend adjuvant portal infusion outside a clinical trial setting and such treatment should still be restricted to well‐designed prospective protocols.
Intraoperative radiotherapy in carcinoma of the stomach and pancreas
Authors: Abe Mitsuyuki , Shibamoto Yuta , Takahashi Masaji , Manabe Tadao , Tobe Takayoshi , Inamoto Takashi 
Published: May 2005

AbstractClinical results of intraoperative radiotherapy (IORT) in carcinoma of the stomach and the pancreas are reported. In carcinoma of the stomach, 101 patients were treated by IORT and 110 patients were treated by operation alone. The 5‐year survival rates of patients treated by IORT were 87.2% for Stage I, 83.5% for Stage II, 62.3% for Stage III, and 14.7% for Stage IV. On the other hand, the 5‐year survival rates of patients treated by operation alone were 93.0% for Stage I, 61.8% for Stage II, 36.8% for Stage III, and 0% for Stage IV. It has been demonstrated that IORT has definite effects on locally advanced gastric cancer.In carcinoma of the pancreas, a total of 110 patients with locally advanced disease were entered into the pilot study. Forty‐nine patients were treated by IORT (group 1), 20 patients were treated by IORT followed by external beam radiotherapy (group 2), and 41 patients were treated by operation alone (group 3). The median survivals were 5.5 months for group 1, 12.0 months for group 2, and 5.5 months for group 3. The pilot study suggests that a combined IORT and external beam treatment may provide better survival time than can be achieved by IORT without external beam radiotherapy or by operation alone for locally advanced pancreatic cancer.
The concept of immunochemosurgery in gastric cancer
Authors: Kim Jin ‐Pok 
Published: May 2005

AbstractTo evaluate the effectiveness of adjuvant immunochemotherapy in advanced adenocarcinoma of the stomach, patients who had undergone radical subtotal gastrectomy for stage III gastric carcinoma were randomized to receive immunochemotherapy or not. For immunotherapy,Streptococcus pyogenes preparation (picibanil) was given intramuscularly every week, and for chemotherapy, either MFC (mitomycin C, 5‐fluorouracil, and cytosine arabinoside) regimen or FME (5‐fluorouracil and methyl‐CCNU) regimen was given. Immunotherapy was started at the fourth or fifth postoperative day and chemotherapy was started at the eighth to tenth postoperative day.To evaluate the immune status of patients, various immune parameters such as 1‐chloro‐2, 4‐dinitrobenzene (DNCB) test, T‐lymphocyte count, PHA‐ and concanavalin‐A‐stimulated lymphoblastogenesis, and antibody‐dependent cellular cytotoxicity (ADCC) activity were checked before surgery and 3–4 months postoperatively.One hundred and thirty‐eight patients were chosen for study during a 5‐year period. Seventy‐four patients received postoperative immunochemotherapy and 64 patients received no further anticancer therapy following their operation. All patients had been followed for at least 5 years since they underwent surgery. Survival rate and immune status were compared between the 2 groups. Patient characteristics and preoperative values for the immune status of the 2 groups were similar to each other.The 5‐year survival rate of the postoperative immunochemotherapy group was 44.6%, whereas that of the surgery alone group was 23.4%. The difference is statistically significant (p<0.05). All the postoperative values of immune parameters showed more favorable data in the postoperative immunochemotherapy group.Postoperative immunochemotherapy is no longer adjuvant, but is an essential systemic therapy to prolong patient survival and cure disease. This author proposes to use the termimmunochemosurgery instead of “surgery and adjuvant immunochemotherapy” for gastric cancer.
Adjuvant chemotherapy in gastric cancer
Authors: Schlag Peter 
Published: May 2005

AbstractThe results of adjuvant chemotherapy trials in gastric cancer are less favorable in European and Anglo‐American countries than in Japan. The majority of findings in Western countries leads to the conclusion that the routine application of adjuvant chemotherapy for gastric cancer cannot be recommended. The therapeutic benefit reported in Japanese studies is possibly due to the fact that chemotherapy is started intraoperatively or during the immediate postoperative period in Japan as opposed to the procedure in the majority of Western countries. The effectiveness of adjuvant chemotherapy may be improved by intraperitoneal drug administration because peritoneal seedings and lymph node metastases are the major cause of treatment failure after curative gastric cancer surgery. Since the efficacy of adjuvant chemotherapy is influenced by the responsiveness of cancer cells to cytotoxic agents, preoperative chemotherapy could improve the selection of patients for subsequent postoperative adjuvant treatment trials in the future.
Rationale and indications for limited surgery in breast cancer: Current data
Authors: Veronesi Umberto 
Published: May 2005

AbstractA limited number of clinical trials have been performed in the last 20 years to test the validity of techniques for preserving the breast in patients with a mammary carcinoma. From the trials published, a number of conclusions can be formulated: (a) quadrantectomy, axillary dissection, and radiotherapy for small tumors is a procedure as safe as the Halsted mastectomy in terms of local, regional, and distant recurrences, and long‐term survival (Milan trial, Villejuif trial); (b) limited resection plus axillary dissection without radiotherapy exposes the patients to a high risk of local recurrences (NSABP trial); and (c) large resection without axillary dissection and with inadequate radiotherapy will increase the risk of axillary recurrences (Guy's Hospital trial). Whether the increase of local/regional recurrences will decrease the long‐term survival rates (Guy's Hospital) or will not influence the survival (NSABP) must be clarified.The main problems to be faced by future trials are: the extent of the surgical act (limited excision versus extensive resection, axillary dissection versus no dissection, total axillary dissection versus axillary sampling), the type of radiotherapy (immediate versus delayed, whole breast versus limited direct field, boost versus no boost, regional nodes irradiation versus no nodal irradiation), the comparison with other forms of surgery providing good cosmetic results (conservative treatments versus total mastectomy plus immediate reconstruction), the size of primary tumor to be submitted to conservation procedures, and the pathologic patterns requiring differentiated conservative technique (lobular carcinoma in situ, intraductal noninfiltrating carcinoma, Paget's disease, and minimal carcinoma).
Surgical strategies in locoregional recurrences of gastrointestinal carcinoma
Authors: Herfarth C. , Schlag P. , Hohenberger P. 
Published: May 2005

AbstractIn contrast to the more standardized treatment of primary gastrointestinal cancers, the therapeutic concept in locoregional recurrences requires very individualized approaches. In most patients cure cannot be obtained and those patients who are cured are cured only by combining surgery with adjunctive treatment modalities.In recurrences of colorectal cancer, tumor biological factors limit surgical efforts. In about 50% of the patients, generalized tumor spread is present at the time of diagnosis of a local relapse. More than 75% of the patients present with symptoms thus calling into question the effect of routine follow‐up examinations. The percentage of patients operated on for cure has only slightly increased during the past 25 years. In our series the rate is 26.4%. These patients benefit most, showing a median survival time of 19 months compared to 13 months in nonradical procedures and 6–8 months in palliative interventions. Nodal status of the primary tumor is very important: 27% of the patients with N0 could be re‐resected compared to only 13% with N1 histological findings.In gastric cancer, the chance for cure in locoregional recurrences is minimal since the removal of the draining lymph nodes at the primary operation leads to generalized peritoneal carcinomatosis in almost all patients. Only in recurrences in the gastric stump should secondary resection be radical. Less than 10% of patients undergo resection for gastric cancer recurrence. Since even explorative laparotomy yields a high operative mortality, inoperable situations should be identified preoperatively by imaging procedures.Since encouraging approaches in the treatment of recurrences are lacking, adjuvant pre‐, intra‐, and postoperative chemo‐ and radiotherapy at the time of resection of the primary tumor should be evaluated in controlled trials.
Rationale and indications for perfusion in liver tumors: Current data
Authors: Schwemmte K. , Link K. H. , Rieck B. 
Published: May 2005

AbstractSince Novermber, 1981, 50 patients (predominantly those with metastases of colorectal carcinomas) have been treated in our clinic by an isolated regional chemotherapy on an average of 9 months after the primary operation. The mortality rate was 8%.The cytostatic drugs applied alone or in combination were 5‐fluorouracil (5‐FU) (300–1,250 mg) and mitomycin C (5–50 mg) in 46 patients, and 5‐FU, mitomycin C, and cisplatin (50 mg) in 4 patients. The course of the disease was observed in 41 patients. The median survival was 14 months, 24 months in 11 patients still living, and 12.5 months in those patients who died. An additional treatment with cycles of an intraarterial infusion therapy seeemed to extend the survival time (7.5 months without additional treatment, 18 months with additional treatment). Nine (22%) of 41 patients had a complete remission, and 28 (68%), a partial remission. Lung metastases and/or local tumor recurrences arose in 40% of the patients with secondary liver tumors.We consider the very high cytostatic drug concentrations in the infusion circuit and the additional perfusion of the portal vein to be the advantages of isolated liver perfusion (ILP). Certainly, this therapy can be applied only once, and ILP must be completed by another means of treatment.
The use of ultrasound during spinal cord surgery
Authors: Rubin Jonathan M. , Chandler William F. 
Published: May 2005

AbstractIntraoperative spinal ultrasonography is now considered an indispensable tool in many operations on the spine and spinal cord. Using ultrasonography, surgeons can now easily find and evaluate lesions within the spinal cord, dural sac, and along the ventral margin of the vertebral column during operations. Syrinxes, intra‐ and extramedullary tumors, hematomas, bone fragments, bullet fragements, cysts, and discs can be easily located and treated under ultrasonic guidance. In this article, we described the techniques used in peforming this procedure, normal anatomy, and images of various types of pathologic lesions.
The use of high‐resolution ultrasound to locate parathyroid tumors during reoperations for primary hyperparathyroidism
Authors: Kern Kenneth A. , Shawker Thomas H. , Doppman John L. , Miller Donald L. , Marx Stephen J. , Spiegel Allen M. , Aurbach Gerald D. , Norton Jeffrey A. 
Published: May 2005

AbstractIn a previous report we compared intraoperative ultrasound (IOUS) to preoperative ultrasound (US) in 25 consecutive patients undergoing reoperations for primary hyperparathyroidism. We demonstrated the superior effectiveness of IOUS to image abnormal parathyroid glands compared to US, and a 50% reduction in operative time resulting from this superior imaging capability. The present study extends these comparisons of preoperative imaging techniques to include computed tomography (CT) and technetium/thallium scintigraphy (Tc/Tl) in an updated series of 39 patients undergoing reoperative parathyroid surgery.All 39 patients underwent successful reoperations for either parathyroid adenoma (34 patients), parathyroid hyperplasia (4 patients), or parathyroid carcinoma (1 patient). IOUS was more effective than preoperative US, CT scan, or Tc/Tl scintigraphy in imaging 41 abnormal glands in these 39 patients. IOUS was not dependent on size or anatomic location of an abnormal gland for successful imaging. Abnormal glands in unusual locations, such as intrathyroidal adenomas or undescended adenomas, were imaged accurately with IOUS. Multiglandular disease was detected by IOUS, with correct imaging of 3 hyperplastic glands in a single patient; no other imaging technique was able to identify more than 1 abnormal gland in any patient. No imaging study (including IOUS restricted to the neck alone) was able to identify accurately a mediastinal parathyroid adenoma (1 patient).A clinical decision analysis revealed that IOUS had the highest sensitivity and positive predictive value of any imaging study. IOUS is thus a tool to be used by the surgeon in reoperations for parathyroid disease to facilitate dissection and identification of abnormal glands. When positive, IOUS can help the surgeon proceed quickly and easily to the location of abnormal tissue.
The application of operative ultrasound immediately following carotid endarterectomy
Authors: Lane Rodney J. , Ackroyd Nigel , Appleberg Michael , Graham John 
Published: May 2005

AbstractOne hundred and seventy‐five carotid bifurcations have been scanned using intraoperative ultrasonic imaging. The technique is simple, reproducible, rapid, and reliable. Intimal flaps, clamp stenoses, residual plaques, and platelet accumulations were detected by this method. Most technical defects occurred in the external carotid artery (12%), and it is recommended that significant lesions remaining in this vessel should be removed. Defects in the internal carotid artery and common carotid artery were much less common (7%) and most of these were quite small, not requiring reopening. In fact, only 2% required reopening. In 1% of patients there were defects detected that led to stroke, which would have been removed on present criteria. Although there were other causes of stroke, technical error remains an immediately reversible source of postoperative stroke that can be avoided by the use of operative ultrasonic imaging. Long‐term minor defects, as followed by noninvasive tests, rarely became significant and bore no relationship to the development of restenosis.
The use of two‐dimensional color Doppler sonography during the surgical management of aortic dissection
Authors: Omoto Ryozo , Takamoto Shinichi , Kyo Shunei , Yokote Yuji 
Published: May 2005

AbstractTo examine the clinical significance of two‐dimensional color flow mapping during the surgical management of aortic dissection, we reviewed 18 aortic dissections at Saitama Medical School. In all 18 patients (100%), intraoperative color flow mapping offered total visualization of dissecting aortic aneurysm, confirmation of entry, and flow dynamics in true and false lumina. In 4 patients (22%), the preoperative angiographical diagnoses erred on the extent of the dissection (2 patients) and on the location of entry (2 patients) and were corrected by intraoperative color flow mapping. These color flow results changed the planned operative procedure. The effect of aortic valvuloplasty in the patients with coexisting significant aortic regurgitation was assessed prior to chest closure in 4 patients. Small leakage from the anastomosis line was imaged in 5 patients (28%). Additional sutures were placed in 2 of the patients to stop the leakages. In the other 13 patients (72%), no leakages from the anastomosis line were seen. In some situations when localization of origin of intimal flap is unclear preoperatively, identification of entry by intraoperative color flow mapping is most valuable for precise planning of surgical procedure. The immediate evaluation of repaired valve prior to chest closure may allow the cardiac surgeon to be more aggressive in salvaging native valves. In conclusion, intraoperative color flow mapping can be a valuable new tool to provide information which may significantly improve the surgical management in aortic dissection.
The use of operative ultrasound in surgery of primary liver tumors
Authors: Bismuth Henri , Castaing Denis , Garden O. James 
Published: May 2005

AbstractOperative ultrasound was evaluated in 77 patients submitted for surgery of primary liver tumors over a 3‐year period. Preoperative ultrasonography, computed tomography, and selective hepatic arteriography were performed in all patients before 79 surgical interventions. Peroperative ultrasonography provided additional information to that obtained from preoperative investigations in 26 cases (33%). This information modified the intended surgical procedure in 21 cases and, in 10 patients, subsegmental resection was facilitated by ultrasonically guided cannulation of the portal venous branch.Operative ultrasonography provides more detailed information about liver tumors and their topography than can be obtained by intensive preoperative investigations. This information may avoid unnecessary trial dissection of apparently operable tumors and enables more precise and limited resection of those lesions shown to be resectable by operative ultrasonography.
The use of operative ultrasound as an aid to liver resection in patients with hepatocellular carcinoma
Authors: Makuuchi Masatoshi , Hasegawa Hiroshi , Yamazaki Susumu , Takayasu Kenichi , Moriyama Noriyuki 
Published: May 2005

AbstractIn October, 1979, a new operative probe for liver surgery was developed. Since then, 386 patients who received laparotomy for hepatectomy underwent intraoperative ultrasonography. Of these, 245 patients had hepatocellular carcinoma (HCC), and 152 patients had tumors less than 5 cm in diameter. In these 152 patients, intraoperative sonography detected 198 of a total of 203 small HCC's (sensitivity: 99%), whereas the sensitivity of preoperative ultrasound, angiography, and computed tomography was 89.3%, 84.1%, and 89.6%, respectively. Intraoperative ultrasound had a much higher sensitivity in detecting daughter nodes as well as intraheptic metastasis, but slightly lower specificity in differentiating malignant nodules from benign lesions. Intraoperative sonography revealed 70% of tumor thrombi, while ultrasound and angiography disclosed only 21%. In patients with small HCC associated with liver cirrhosis, 65% had invisible and nonpalpable tumors.Intraoperative ultrasonography led to the development of new liver‐sparing hepatectomy procedures: systematic subsegmentectomy and hepatectomies which preserve the inferior right hepatic vein. Systematic subsegmentectomy was performed on 96 patients. Survival rates after this procedure in 58 patients with small HCC were 53.6±17.7% at 3 years and 47.9±19.1% at 5 years, which was much better than that of patients who received partial hepatectomy.Intraoperative ultrasonography was indispensable in liver surgery, not only for diagnosis of the tumor spread in the liver, but also as a direct guide for hepatectomy.