bluuebunny/crossref_metadata_2025_split huggingface dataset:
Can radical surgery improve survival in colorectal cancer?
Authors: Jeekel J. 
Published: May 2005

AbstractProspective, randomized trials that study the best surgical technique to prevent local and distal metastases in colorectal cancer have not yet been performed. Prevention of local recurrence must be a major effort achieved by radical resection of the tumor area, by minimizing the possibility of suture line recurrence and of tumor remnants in intramesenteric lymph nodes or surrounding tissue, and by avoiding spillage of tumor cells. Extended resections of mesenteric lymph nodes or pelvic lymphadenectomy did not prove to be of significant benefit in most retrospective studies. In the case of adjacent organ involvement, en bloc resection is indicated since long‐term survival can be obtained. This operation can be performed with low operative mortality rates even in the case of pancreas or duodenum involvement as is shown in our series of 34 patients (3% operative mortality). Frozen sections of the resection area have to be included in the operative procedure. For prevention of distant metastases, the no‐touch technique of Turnbull should be performed. In a prospective, randomized trial of 236 patients operated on for colon cancer, liver metastases appeared later and to a lesser degree in patients operated on with the no‐touch isolation technique, particularly in the case of angioinvasive growth of the tumor.
Progress in gastric cancer surgery in Japan and its limits of radicality
Authors: Maruyama Keiichi , Okabayashi Kenzo , Kinoshita Taira 
Published: May 2005

AbstractRadical surgery of gastric cancer has become more widely utilized in Japan. Topics explored in gastric cancer surgery include the extended lymph node dissection guided by the node staining method with India ink, left upper abdominal organs exenteration for advanced cancer of the upper stomach, and pancreaticoduodenectomy for advanced cancer of the lower stomach. Through the progress of surgical treatment as well as that of the early detection system, the treatment results have been improved. Using the data from nationwide registrations (5,706 and 11,845 cases) and those from the National Cancer Center Hospital (3,176 cases), the 5‐year survival rate of total primary resected cases was 44.3% in the first period (1963–1966), 56.3% in the second period (1969–1973), and 61.6% in the third period (1971–1985). Between the first and the third period, the 5‐year survival rate of patients with stage 2 cancer increased from 60.6% to 71.7%, and that of stage 3 increased from 32.7% to 44.3%; however, the limits of radical surgery were also clarified, especially in patients with peritoneal dissemination, liver metastasis, distant lymph node metastasis, and diffusely infiltrating carcinoma (Borrmann type 4). For such patients, chemotherapy, hormonal therapy, immunotherapy, radiotherapy, and hyperthermia should possibly be employed in hopes of improving treatment result.
The value of preoperative radiotherapy in esophageal cancer: Results of a study of the E.O.R.T.C.
Authors: Gignoux Marc , Roussel Alain , Paillot Bernard , Gillet Michel , Schlag Peter , Favre Jean‐Pierre , Dalesio Otilia , Buyse Marc , Duez Nicole 
Published: May 2005

AbstractAttempts to combine radiation therapy and surgery in patients with operable carcinoma of the esophagus began 30 years ago. The first reported surgical series showed a low rate of resectability and a high postoperative mortality. Results of radiation therapy alone were also disappointing in the long run, especially in patients who appeared to be excellent operative risks with small localized tumors. The rationale for a combined approach was that x‐ray therapy could bring about a reduction of tumor activity and bulk, an improvement in nutritional state through the restoration of the ability to swallow, a reduction of transplantability of the tumor, and a curative effect on periesophageal regional disease which is not treated well by surgery. On the other hand, surgery often allowed an extended resection, clearing residual foci or distant esophageal wall extension. The limit of a combined approach is the toxicity of the preoperative radiation which must be mild enough to allow surgery to proceed without excessive delay or increased mortality. Numerous radiotherapy schedules were tried using different fields, doses, and fractionations, most of them in nonrandomized studies. Two prospective randomized trials have been recently reported. The final results of a third prospective trial, run by the E.O.R.T.C., will be presented.
Preoperative chemotherapy in esophageal carcinoma
Authors: Kelsen D. P. 
Published: May 2005

AbstractPreoperative chemotherapy for localized esophageal cancer is an area of increasing interest because neither surgery nor radiation has had a major impact on disease‐free or overall survival. This is probably because, as several autopsy series have demonstrated, esophageal cancer is a systemic disease. Preoperative chemotherapy thus, in theory, allows a simultaneous attack on both the primary and metastatic disease. A number of single‐arm, Phase II, multimodality trials have been completed. Toxicities of chemotherapy, while substantial, have been tolerable. With careful attention to detail, operative morbidity and mortality have not been increased. Although the theory is attractive, large‐scale randomized trials are now needed to evaluate the impact of this technique on disease‐free and overall survival before recommending it for general use.
Adjuvant treatment in colorectal cancer: An update
Authors: Douglass Harold O. 
Published: May 2005

AbstractAnalysis of current and recently completed trials of adjuvant therapy for colorectal cancer permit a few very broad generalizations. Survival of patients initially treated by resection has improved during the past 2 decades, unrelated to adjuvant therapy. While pilot, uncontrolled, and historically controlled studies often suggest a treatment benefit, controlled trials have, to date, failed to show any advantage for adjuvant therapy in colon cancer. For rectal cancer, only those trials including radiation therapy alone or in combination with chemotherapy have provided enhanced patient survival. Superiority of preoperative versus postoperative radiotherapy has not been demonstrated.Of interest is the current United States intergroup trial in colon cancer which is evaluating levamisole in combination with 5‐fluorouracil, based on preliminary experience in a smaller study of the North Central Cancer Treatment Group which suggests that levamisole and 5‐fluorouracil may be a potentially beneficial adjuvant combination. Recent reports of pharmacologic modulation of 5‐fluorouracil resulting in significantly enhanced response rates in advanced metastatic colorectal cancer invite a trial of this pharmacologic concept for surgical adjuvant therapy.
Local procedures in the management of rectal cancer
Authors: Heberer Georg , Denecke Heiko , Demmel Nikolaus , Wirsching Rainer 
Published: May 2005

AbstractOf 1,134 patients treated for rectal cancer from 1973 to 1985, local therapy was used in 310. Forty‐two underwent local excision and the operative morbidity and mortality were lower than after radical operations. The 5‐year survival rate was 84%. This treatment should be reserved for patients who have totally resectable tumors of 3 cm or less in size and of low histologic grade (1 or 2).For local palliation, cryosurgery was applied in 268 patients. By use of this low‐risk treatment, a colostomy could be avoided in 80% of patients (mean observation time 2.3 years). The best results were achieved for “small” carcinomas in high‐risk patients (no evidence of disease in 24 of 31 patients). Local palliation by cryosurgery does not influence the prognosis of survival if distant metastases are present.
Resection of liver metastases—When is it worthwhile?
Authors: Adson Martin A. 
Published: May 2005

AbstractMost of what has been learned about resection of hepatic metastases comes from the study of colorectal cancer because such lesions are so common. One‐fourth or more of patients who have liver metastases from such lesions have hepatic tumors that can be removed, but only about 25% of these patients will live 5 years or more after such tumors have been removed. When resection so often fails to improve survival, there is a need to know when metastatic lesions should be removed. Study of determinants of prognosis, patterns of failure, and the natural history of the disease have shown that surgical failure is determined by the presence of extrahepatic metastases (even when removed) and limited resective margins. The patient's gender and the locoregional stage of the primary resected lesions influence survival, but not so much as to withhold resective treatment from these less favored groups. Studies of size, site, and number of hepatic metastases removed show therapeutic limitations associated with extremes, but these determinants of prognosis after resection must be studied in better ways. Although, at times, palliation is a reasonable goal, this aspect of resective treatment has not been studied well. When there are no good therapeutic alternatives to resection of hepatic metastases and when risk is low, such palliative operations may be justified. Only with further study will absolute contraindications to surgical therapy be well defined. There is an obvious need for biologic control of cancer.
Regional and systemic chemotherapy for colorectal metastases to the liver
Authors: Balch Charles M. , Levin Bernard 
Published: May 2005

AbstractThe fluoropyrimidines 5‐FU and FUDR are antimetabolites that have limited activity in the treatment of patients with colorectal metastases. The availability of implantable or portable drug infusion pumps has caused a renewed interest in continuous infusion therapy using these drugs for patients with colorectal metastases to the liver. While the search for new, more effective agents or combinations continues, it is reasonable to evaluate dose schedules and drug combinations that would maximize the effectiveness of these fluoropyrimidines and lower their toxicity in investigational protocols. In most series both drugs have higher response rates, less myelosuppression, but greater liver toxicity when given by continuous intraarterial infusions compared to bolus injections given intravenously. Nevertheless, there is still insufficient data to conclude that survival rates are sufficiently prolonged in patients for whom an implantable drug infusion pump has been used for regional FUDR chemotherapy. On the other hand, symptomatic patients may have sufficient palliation to constitute an identifiable group for whom this approach is justified. Results of several randomized prospective studies addressing the efficacy of regional versus systemic FUDR chemotherapy infusions will be available in the near future. If these demonstrate improved survival for patients receiving regional FUDR chemotherapy, it will be appropriate to consider this approach in selected patient settings. Until such data are available, routine use of this approach in asymptomatic patients is not warranted.
Isolated regional perfusion in malignant melanoma of the extremities
Authors: Koops Heimen Schraffordt , Oldhoff Jan , Oosterhuis J. Wolter , Beekhuis Henk 
Published: May 2005

AbstractIsolated perfusion for regional chemotherapy is only practical for tumors located on the extremity, because this is the only site where adequate vascular occlusion can be achieved. Indications for perfusion in clinical stage I melanoma patients are determined by microstaging of the tumor. At our institution, patients with Clark's levels III, IV, or V and a Breslow thickness of ≥1.5 mm are eligible. Lower limb perfusions are started through an iliac perfusion. Two perfusions are performed for foot lesions, local recurrences, satellitosis, or intransit metastases.Flow rates for leg perfusion vary from 600 to 1,000 ml/min. During the past few years, higher flows (up to about 1,200 ml/min) have been utilized. Less toxicity developed with better tissue perfusion, and the dosage of cytostatics could be increased. The dosage of cytostatic drugs is calculated by limb volume, as determined by immersion in water. In our opinion, hyperthermia yields superior results for cases of local recurrence or intransit métastases. It is not known if a combination of cytostatic drugs might improve results compared to a single drug.
Pattern of recurrence in liver resection for colorectal secondaries
Authors: Ekberg Henrik , Tranberg Karl ‐Göran , Andersson Roland , Lundstedt Christer , Hägerstrand Inga , Ranstam Jonas , Bengmark Stig 
Published: May 2005

AbstractThe pattern of relapse and factors influencing the site of recurrent disease were studied in 68 patients subjected to liver resection of colorectal metastases. Fifty‐three (78%) patients had recurrence. Liver, lungs, and peritoneal cavity were most frequently involved, and all patients with relapse had recurrence in one or more of these sites. Intraabdominal relapse occurred in 50 (74%) patients (94% of patients with relapse). The liver was involved in 44 (65%) patients and was the only site of recurrence in 19 (28%). Extrahepatic metastases developed in 34 (50%) patients. Four or more liver tumors, a resection margin of less than 10 mm, and extrahepatic disease were the main determinants of hepatic recurrence. Bilateral intrahepatic spread, as compared to unilateral disease, major liver resection, as compared to wedge resection, and percent liver tumor volume were also associated with an increased risk of liver recurrence. The presence of extrahepatic disease before resection was the only factor that could be demonstrated to increase the risk of (further) extrahepatic spread. It is concluded that the number of liver metastases, the resection margin, and the presence or absence of extrahepatic disease helps in predicting the risk of hepatic recurrence after resection for colorectal liver cancer. No variable presently available is of any help, however, in predicting the extrahepatic recurrence affecting about half of the patients having no evidence of extrahepatic disease before liver resection. This finding should urge improved evaluation of candidates for liver resection and should influence adjuvant treatment protocols.
Arterial bullet embolism with radiologic demonstration of vessel entrance site
Authors: Falkmer Lennart , Eriksson Anders , Arnerlöv Conny , Domellöf Lennart 
Published: May 2005

AbstractA case of embolism of a. 22 caliber revolver bullet to the left deep femoral artery after penetrating the abdominal aorta is described. The case is discussed in relation to previous reports with special reference to the surgical intervention. The importance of whole body fluoroscopic search for all bullets not accounted for is emphasized. When the bullet entrance site is in the abdominal aorta, emboli should be expected to locate to the lower extremities.
The application of ultrasound during brain surgery
Authors: Chandler William F. , Rubin Jonathan M. 
Published: May 2005

AbstractThe use of intraoperative, real‐time ultrasound imaging during intracranial neurosurgical procedures is described. This technique has proven to be extremely useful for localization of a wide variety of deep and superficial brain lesions, and for needle biopsy or aspiration of selected lesions. The precise localization provided by ultrasonic imaging shortens the time of surgery and increases the safety for the patient.Every type of primary and metastatic tumor of the brain has imaged well, and low‐grade gliomas are often better defined with ultrasound than by computed tomographic scanning. Abscesses can be imaged and aspirated, and hematomas are easily imaged. A variety of vascular lesions including aneurysms and arteriovenous malformations can be localized and characterized. Structural abnormalities such as hydrocephalus and Arnold‐Chiari malformation can be well delineated.
The use of operative ultrasonography for the localization of renal calculi
Authors: Alken P. , Thüroff J. W. , Hammer C. 
Published: May 2005

AbstractThe ultrasonically guided nephrotomy technique using B‐scanning to identify the localization of stones and Doppler sonography to identify avascular parenchymal areas for nephrotomies allows for transparenchymal stone removal without the need for renal artery clamping and renal cooling. In 175 procedures the average blood loss was 1,350 ml and the rate of residual stones requiring a secondary intervention was 2.8%. Despite the advent of new noninvasive treatment modalities, this technique is still applied in 23% of staghorn stones.
The use of ultrasound during reconstructive arterial surgery of the lower extremities
Authors: Rosenbloom Mark S. , Flanigan D. Preston 
Published: May 2005

AbstractReal‐time, B‐mode ultrasonography is a dependable method of vascular imaging for use during arterial reconstruction. It has been demonstrated in both animal and human studies to detect accurately intimal flaps, arteriotomy stricture, and intraluminal thrombi. Sonographic images are 3‐dimensional and dynamic. Scans can be repeated as often as necessary and in different views to characterize lesions fully. Operative sonography has a sensitivity of 100%, specificity of 94%, and accuracy of 94% compared to 68%, 85%, and 83%, respectively, for operative arteriography. There are limitations to sonography. It can only evaluate vessels in the operative field and is useless for assessment of the arterial run‐off. The high sensitivity of sonography will lead to the discovery of defects that likely pose no threat to the success of the reconstruction. The surgeon will have to decide what lesions are significant and what lesions warrant reexploration. The role of operative ultrasonography in arterial surgery is to complement arteriography. This can be accomplished by assessing areas not readily visualized by arteriography and by providing additional information to assist the surgeon in obtaining a technically successful reconstruction.
Comparison of operative ultrasonography and radiography in screening of the common bile duct for calculi
Authors: Jakimowicz Jack J. , Rutten Harm , Jürgens Philip J. , Carol Erik J. 
Published: May 2005

AbstractWe report a 4‐year experience of operative ultrasonography in 449 patients who underwent cholecystectomy for biliary lithiasis. Intraoperative ultrasonography and intraoperative cholangiography were performed in all of these patients and compared with the operative findings. The diagnostic accuracy of sonography was 97.5% and that of cholangiography was 94.4% in the patient group as a whole. The predictive value of a positive sonogram in this group was 96.4%, while that of a positive cholangiogram was lower at 86.9%. In 148 patients who underwent surgical exploration of the common duct, sonography appeared to have more accurately predicted presence or absence of stones (92.5%) than did cholangiography (79.8%). Use of these intraoperative screening tests together led to a positive common duct exploration in 76.6% of the 148 patients, which is higher than our previous experience in which common duct exploration was performed on the basis of clinical criteria. In 7% of the 301 cholecystectomized patients, unpredicted stones were detected at operative sonography and cholangiography. If the common duct exploration were to be performed based solely on the outcome of the sonogram, the rate of positive exploration could be 97%. Overall morbidity in this series was 9%, and retained stones following duct exploration were encountered in 1 patient. The overall mortality rate of the entire patient group was 0.9%. Operative ultrasonography of the biliary tract as a screening procedure is, in experienced hands, a reliable method and substitute for operative cholangiography.
The prevention of arterial collaterals after repeated temporary blockade of the hepatic artery in pigs
Authors: Persson Bo G. , Jeppsson Bengt , Andersson Lena , Strand Sven‐ Erik , Ekelund Leif , Bengmark Stig 
Published: May 2005

AbstractHepatic dearterialization and permanent hepatic artery ligation can induce tumor necrosis but only of limited duration, partly due to a rapid development of arterial collaterals. The aim of this study was to determine if collateral formation could be reduced or prevented by repeated, transient dearterialization.Three groups of pigs were repeatedly and transiently dearterialized daily for 2 hours (n=5), 4 hours (n=5), and 6 hours (n=4), respectively, over a 4‐week‐period by means of a totally implantable vascular occluder described earlier by us. These pigs were compared with a group having permanent hepatic dearterialization (n=4). An additional group (n=3) served as a control and did not have dearterialization. After 4 weeks of treatment, hepatic angiograms were taken and absolute hepatic arterial blood flow was measured according to the reference sample method with radiolabeled microspheres. There were no demonstrable collaterals in the 2‐hour group, formation of some small collaterals in the 4‐hour group, and a fully developed collateral network in the 6‐hour group, with similar findings in the permanently dearterialized group. Absolute hepatic arterial blood flow was significantly lower in the 4‐hour group with obstructed hepatic artery compared to permanent hepatic dearterialization (p<0.01, Wilcoxon rank sum test) and highly significantly lower in the 2‐hour group (p<0.0001, Wilcoxon rank sum test).Thus, repeated and brief dearterialization seems to prevent the formation of arterial collaterals and makes repeated arterial ischemia of the liver possible which could be of value in the treatment of liver tumors. In addition, a patent artery makes continuous intra‐arterial cytostatic infusion possible.
The indocyanine green test enables prediction of postoperative complications after hepatic resection
Authors: Matsumata Takashi , Kanematsu Takashi , Yoshida Yasuhiro , Furuta Toshiya , Yanaga Katsuhiko , Sugimachi Keizo 
Published: May 2005

AbstractWe evaluated the postoperative course of 50 patients who underwent hepatic resection, using the ratio of indocyanine green (ICG) retention rates measured on the third postoperative day to values estimated immediately after the operation. This ratio was expressed as the remnant liver ICG index. Group A included 22 patients with a remnamt liver ICG index of less than 1.0, which meant that the ICG retention rate at 15 minutes on the third postoperative day showed improvement, compared to events immediately after the operation. In group B, there were 28 patients whose index on the third postoperative day was over 1.0, thereby indicating exacerbation of the ICG clearance rate after hepatic resection. Serious complications including intraabdominal sepsis and hyperbilirubinemia occurred postoperatively in 2 (9.1%) in group A and 16 (57.1%) in group B (p<0.001). One patient (4.5%) in group A died, while 9 patients (32.1%) in group B died during hospitalization (p< 0.02). There were no significant differences with regard to preoperative liver function and clinical parameters. These observations suggest that improvement in the ICG clearance rate on the third postoperative day, compared to that immediately after the operation, is useful to predict the postoperative course of hepatectomized patients.