Difference In Resection Rate Research Articles

IT-ESD Is Useful Technique for the Elderly Patients with Gastric Cancer

Background: Minimally invasive treatments, such as endoscopic mucosal resection (EMR), are now performed as usual clinical practice in Japan. Moreover, the introduction of various new devices, such as the insulation-tipped electrosurgical knife (IT-Knife), has expanded the indication of EMR for the treatment of early-stage gastric carcinoma, and it is called as endoscopic submucosal dissection using an IT-knife (IT-ESD). IT-ESD makes EMR possible to remove more wide lesion and en bloc resection. However, the safety of this strategy has not validated completely, particularly for elderly patients. In order to assess the availability and safety, especially for the elderly patients with gastric carcinoma, we evaluated efficacy of our expanded criteria compare to the standard criteria, and analyzed our results of IT-ESD retrospectively. Materials & Methods: All patients were undergoing for mucosal gastric carcinoma treated with IT-ESD in our expanded criteria. Our expanded criteria is 1. Mucosal invasive lesion, 2. Adenoma with severe atypia and differentiated carcinoma, 3. No ulceration, 4. Without limitation of tumor size. We retrospectively reviewed the records of 184 patients admitted to St. Marianna University School of Medicine Hospital with our criteria between April 2002 and November 2005. We analyzed our data in several factors, including resection rate, en bloc resection rate, recurrent rage, age, and background characteristics of the patients. We also assessed our expanded criteria compared to the standard one. Results: The number of 154 cases out of 184 (83.7%) were completely removed and 164 cases (87.0%) were en bloc resected with IT-ESD. Two cases were diagnosed to be recurrence by follow up endoscopic biopsy. One case was retried by IT-ESD and another was treated by laparoscopic gastrectomy. Complications, such as post operative bleeding and minimal perforation, occurred in 6%. IT-ESD could remove large lesions (over 20 mm) compare to the traditional EMR apparently. This cohort contained 119 cases (64.7%) of elderly (over 65 years old). There was no significant difference in resection rate and complication between elderly and others. Conclusion: IT-ESD might be safe and useful for treatment of larger tumor than the standard criteria. Moreover, IT-ESD may be useful technique for the elderly patients with gastric cancer.

Evaluation of the Causes for Racial Disparity in Surgical Treatment of Early Stage Lung Cancer

Black patients undergo surgical treatment for early stage lung cancer less often than whites. We wanted to determine the causes for the racial difference in resection rates. We studied a retrospective cohort of patients who presented to our institution with potentially resectable lung cancer (stage I or II) between the years 1995 and 1998, inclusive. A tertiary-referral hospital and clinic with a cancer database of all lung cancer patients seen. A total of 281 patients were included: 97 black patients (35%) and 184 white patients (65%). The surgical rate was significantly lower in blacks than in whites (56 of 97 patients [58%] vs 137 of 184 patients [74%], p = 0.004). We could not find evidence that the rate at which surgical treatment was offered was different between the two racial groups (68 of 97 black patients [70%] and 145 of 184 white patients [79%], p = 0.11). After controlling for preoperative pulmonary function, tumor stage, history of smoking, and significant comorbidities, we were unable to show that race was a predictor of being offered surgical treatment (odds ratio, 0.46; 95% confidence interval, 0.18 to 1.14; p = 0.09). The difference in surgical rates was mainly due to the fact that blacks were found to decline surgical treatment more often than their white counterparts (12 of 68 patients [18%] vs 7 of 145 patients [5%], p = 0.002). Our analysis suggests that the lower surgical rate among black patients with early stage lung cancer is mainly due to low rates of acceptance of surgical treatment.