Average Duration Of Survival Research Articles

Esophagectomy without thoracotomy: A dangerous operation?

Transhiatal esophagectomy without thoracotomy has been performed in 143 patients: 43 with benign disease and 100 with carcinomas at various levels of the esophagus (31 cervicothoracic, five upper third, 33 middle third, and 31 distal third). Esophageal resection and reconstruction were performed in a single stage in 138 patients, and the esophageal substitute was positioned in the posterior mediastinum in the original esophageal bed in 134 patients. Stomach was used to replace the esophagus in 128 patients (93%) and colon in 10 patients. The operative mortality has been 8%, the causes of death being myocardial infarction (three), respiratory insufficiency (three), innominate artery rupture (two), sepsis from mediastinal or retroperitoneal abscess (two), and pulmonary embolus (one). No death was the direct result of the technique of esophagectomy. Complications included intraoperative pneumothorax (51%), transient hoarseness (37%), anastomotic leak (12%), chylothorax (3%), and tracheal laceration (1%). Average intraoperative blood loss for the entire group has been 1,150 ml, 1,800 ml for those requiring concomitant laryngectomy and 900 ml for those undergoing esophagectomy without laryngectomy. Of 63 patients surviving resection of intrathoracic esophageal carcinomas, 86% were discharged, able to swallow, within 3 weeks of operation. Distant lymph node metastases or local tumor invasion precluded a curative resection in 70% of our patients with carcinoma, and the overall average duration of survival has been only 12.5 months. However, of 15 surviving patients with intrathoracic esophageal carcinoma who had “curative” resections, 10 are alive and tumor free from 8 to 60 months (average 31 months) postoperatively. A thoracic incision is seldom required to resect the esophagus for either benign or malignant disease. Transhiatal esophagectomy without thoracotomy is a safe, well-tolerated operation, the “hazards” of which can be minimized by careful technique and experience.

Long-term Survival and Function after Cardiac Transplantation

Cardiac transplantation now permits prolonged survival for some patients with otherwise fatal heart disease. This report summarizes the hemodynamic and clinical characteristics of 25 patients who have survived five or more years after cardiac replacement. The average age of the patients at the time of operation was 40 +/- 10 (SD) years; 23 were men. The average duration of survival is 6.7 years, and ranges from five to 10.5 years. Annual cardiac catheterization and clinical follow-up were performed to assess systolic cardiac function, coronary anatomy, and quality of extended rehabilitation. We found that among these long-term survivors, the left ventricular ejection fraction remained constant (0.59 +/- 0.08 one year postoperatively, 0.57 +/- 0.09 at most recent study, p = ns). Segmental wall motion measured by fluoroscopic examination of midwall intramyocardial markers also remained normal. Four of 21 (19%) patients with complete longitudinal studies developed significant graft coronary artery disease. Clinical evaluation revealed that the long-term survivors required fewer than one unscheduled admission to the hospital per year. Sixteen of 25 patients (64%) were gainfully employed, and 22 of 25 (88%) enjoyed substantial benefit in terms of extended rehabilitation. These 25 long-term survivors represent 27% of 92 patients transplanted between 1968 and 1975. The actuarial survival rate at five years, of patients transplanted since 1975, is 40 +/- 5%. This increase in survival rate reflects improved techniques of early postoperative management. Cardiac transplantation now offers prolonged survival with good quality of life for selected patients with terminal heart disease.

Sacrococcygeal teratomas: a review of 68 cases.

Sixty-eight cases of sacrococcygeal teratoma were reviewed and graded according to the quantity of immature tissue present. Seventy-five percent were benign (grade 0), 11.8% immature (Grades 1-3), and 13.2% malignant. Although the immature component in most tumors was neuroepithelial, in two cases it was exclusively renal. There were no instances of local recurrence or metastasis of immature elements. The malignant lesions were all endodermal sinus tumor, stained positively for alpha-fetoprotein and were uniformly fatal, with an average duration of survival of 8.9 months. Early adequate treatment of sacrococcygeal teratomas results in a favorable prognosis. This experience is different from that reported for immature ovarian teratomas. Immature metanephric tissue in sacrococcygeal teratomas should be interpreted the same way as immature neuroepithelial elements. Immature sacrococcygeal teratomas should be separated from tumors containing malignant elements because of their vastly different prognoses.

Current cancer concepts. Comment: the effect of delay in treatment on prognosis

Common sense and experience would dictate that delay in treatment would worsen the prognosis. Nevertheless, one of the underlying currents in the literature is that treatment has little effect on the ultimate survival in the patients with breast cancer. In fact, statistics can be quoted to support the view that delay in treatment may actually improve prognosis. This contradicts the axiom that early diagnosis and early treatment result in better cure rates. Let us examine the evidence. The first discordant note was sounded in 1932 by Lewis and Reinhoff¹⁹who noted that the average length of survival after operation increased with the delay prior to surgery. This conclusion becomes even more remarkable when one notes that survival rates and the average duration of survival are calculated from the date of surgery rather than from the onset of symptoms (Table 5). For delays of more than three years the survival

Comment: The Effect of Delay in Treatment on Prognosis

Common sense and experience would dictate that delay in treatment would worsen the prognosis. Nevertheless, one of the underlying currents in the literature is that treatment has little effect on the ultimate survival in the patients with breast cancer. In fact, statistics can be quoted to support the view that delay in treatment may actually improve prognosis. This contradicts the axiom that early diagnosis and early treatment result in better cure rates. Let us examine the evidence. The first discordant note was sounded in 1932 by Lewis and Reinhoff¹⁹who noted that the average length of survival after operation increased with the delay prior to surgery. This conclusion becomes even more remarkable when one notes that survival rates and the average duration of survival are calculated from the date of surgery rather than from the onset of symptoms (Table 5). For delays of more than three years the survival

The prognosis of complete left bundle branch block

In a study of 146 patients with complete left bundle branch block the average duration of survival after the conduction disturbance had been diagnosed was 36 months.

Variation in the Duration of Survival of Patients with Acute Leukemia

Abstract Survey of records of 34 Brooklyn hospitals and of selected hospitals elsewhere in New York City revealed records of 623 white residents of Brooklyn diagnosed as having acute leukemia during the period 1943-52. Diagnosis was on the basis of marrow biopsy or autopsy in 79 per cent. Date of death was known for 96 per cent. Almost half of these patients died within one month of diagnosis, and three quarters before the end of the third month. Ten per cent survived for 6 months and 3 per cent for one year. The mean interval between diagnosis and death was 2.4 months. The duration of survival after diagnosis was longer for the group of patients in whom the cell type was diagnosed as lymphocytic, than in those diagnosed as granulocytic. Percentage of patients surviving three months was also significantly higher in the lymphocytic than in the granulocytic group. Average duration of survival was almost twice as long for patients in the first decade as for those in any subsequent age group. Survival was shorter for patients in whom the total white blood cell count taken at diagnosis was high. Duration of survival after diagnosis increased with increasing duration of symptoms prior to diagnosis. This suggests another limitation to the use for prognostic purposes of the interval between onset of symptoms and death. No association of survival with sex, religion or ABO blood group was detected.

Carcinoma of the prostate and the effect of oestrogen therapy.

SUMMARY 1 One hundred and fourteen cases of carcinoma of the prostate have been reviewed. A study has been made of the course of the disease and the salient features have been analysed. 2 The survival of those patients who had no hormonal therapy has been compared with that of those who received aestrogens. The average duration of survival from the time of diagnosis was sixteen months in the first group and thirty-three months in the second. Few of those patients who had no hormonal treatment survived for three years from the time of onset of symptoms, while the majority of the aestrogen-treated group lived for more than three years. 3 Despite the beneficial effects of aestrogens which generally prolonged life and relieved symptoms, in one-third of the cases the course of the disease was not apparently altered.

The effect of transfusions and antibiotics upon the duration of life in children with lymphogenous leucemia

Summary 1.Ninety cases of lymphogenous leucemia in children under 14 years of age were studied, of which 76 were analyzed relative to duration of survival. 2.The average duration of survival of 18 cases of untreated lymphogenous leucemia in children was 5.6 months. 3.A group of 17 children who were treated with irradiation (x-ray or radiophosphorus) plus blood transfusions and antibiotics survived 5.8 months. 4.Twenty-four patients received blood transfusions but no penicillin or sulfonamide therapy and survived an average of 6.0 months. 5.Seventeen patients who received blood transfusions and antibiotics survived an average of 8.9 months, a significantly prolonged survival time in comparison with the first three groups. 6.The necessity of statistical comparison of patients treated experimentally by chemotherapeutic agents with an adequately controlled comparable group is emphasized. Summary 1.Ninety cases of lymphogenous leucemia in children under 14 years of age were studied, of which 76 were analyzed relative to duration of survival. 2.The average duration of survival of 18 cases of untreated lymphogenous leucemia in children was 5.6 months. 3.A group of 17 children who were treated with irradiation (x-ray or radiophosphorus) plus blood transfusions and antibiotics survived 5.8 months. 4.Twenty-four patients received blood transfusions but no penicillin or sulfonamide therapy and survived an average of 6.0 months. 5.Seventeen patients who received blood transfusions and antibiotics survived an average of 8.9 months, a significantly prolonged survival time in comparison with the first three groups. 6.The necessity of statistical comparison of patients treated experimentally by chemotherapeutic agents with an adequately controlled comparable group is emphasized.