Median Postoperative Survival Time Research Articles

Predictors of survival after intramedullary nail fixation of completed or impending pathologic femur fractures from metastatic disease

BackgroundSurgical decision-making can be challenging when treating patients with osseous metastases. Numerous factors, including expected duration of survival, must be considered to ensure optimal operative stabilization of the affected bone. However, life expectancy of patients with metastatic carcinoma is often difficult to estimate. The goal of our study was to assess the associations of various clinical and demographic factors with survival time after intramedullary nail fixation of impending or completed pathologic femur fractures. MethodsOne hundred thirty-eight consecutive patients treated with intramedullary nail fixation for impending or completed pathologic femur fractures between 2005 and 2017 were included in this study. Factors related to patient survival were assessed with Cox multivariate survival analysis. For all analyses, p < 0.05 was considered significant. ResultsThe median overall postoperative survival time was 8.4 months. Lower hemoglobin concentration (p = 0.001), lower albumin concentration (p = 0.002), and having a group 2 primary cancer (p = 0.001) were associated with shorter survival on multivariate analysis. When considering the subgroup of 88 prophylactically stabilized patients, lower hemoglobin concentration (p = 0.005), lower albumin concentration (p = 0.015), and having a group 2 primary cancer (p = 0.037) were predictive of shorter survival. ConclusionSeveral factors are associated with shorter survival after intramedullary nail fixation of pathologic femur fractures. These factors should be considered by orthopedic surgeons when educating patients and determining appropriate treatment.

Comparison between minimally invasive spine stabilization with and without posterior decompression for the management of spinal metastases: a retrospective cohort study

BackgroundPosterior decompression and stabilization plays significant roles in palliative surgery for metastatic spinal tumor. However, the indication for addition of posterior decompression have not been examined. The purpose of this study was to investigate a retrospective cohort of outcomes of metastatic spinal tumor treated with minimally invasive spine stabilization (MISt) with or without posterior decompression.MethodsThe subjects were 40 patients who underwent MISt using percutaneous pedicle screws for metastatic spinal tumor, including 20 patients treated with stabilization alone (group A) and 20 patients with added posterior decompression (group B). We analyzed baseline characteristics, postoperative survival time, and perioperative factors such as neurological outcomes, Barthel Index, VAS, and rate of discharge to home.ResultsThe mean ages were 70 and 66 years old (P = 0.06), the mean revised Tokuhashi scores were 7.2 and 5.8 (P = 0.1), the mean spinal instability neoplastic scores (SINS) were 10.5 and 9.0 (P = 0.04), and the mean Barthel Index for ADL were 65.5 and 41.0 (P = 0.06) in groups A and B, respectively. The median postoperative survival time did not differ significantly between groups A and B (12.0 vs. 6.0 months, P = 0.09). Patients in group A had a significantly shorter operation time (166 vs. 232 min, P = 0.004) and lower intraoperative blood loss (120 vs. 478 mL, P < 0.001). Postoperative paralysis (P = 0.1), paralysis improvement rate (P = 0.09), postoperative Barthel Index (P = 0.06), and postoperative VAS (P = 0.6) did not differ significantly between the groups. The modified Frankel classification improved from D1 or D2 before surgery to D3 or E after surgery in 4 of 10 cases (40%) in group A and 8 of 8 patients (100%) in group B (P = 0.01). Significantly more patients were discharged to home in group A (P = 0.02), whereas significantly more patients died in the hospital in group B (P = 0.02).ConclusionsPatients treated without decompression had a shorter operation time, less blood loss, a higher rate of discharge to home, and lower in-hospital mortality, indicating a procedure with lower invasiveness. MISt without decompression is advantageous for patients with D3 or milder paralysis, but decompression is necessary for patients with D2 or severer paralysis.

Clinical results of multidisciplinary therapy including palliative posterior spinal stabilization surgery and postoperative adjuvant therapy for metastatic spinal tumor

BackgroundSurgeries performed for metastatic spinal tumor are mostly palliative and are controversial for patients with short life expectancy. We investigated whether palliative posterior spinal stabilization surgery with postoperative multidisciplinary therapy results in improvement of life prognosis and activities of daily living (ADL) in patients with metastatic spinal tumor.MethodsThe subjects were 55 patients who underwent palliative posterior-only instrumentation surgery for metastatic spinal tumor at our hospital between 2012 and 2015. Postoperative survival, early paralysis improvement, ADL improvement, and rate of discharge to home were examined.ResultsThe patients included 37 males and 18 females, and the mean age at the time of surgery was 66.8 years old. The mean Tokuhashi score was 7.1, the mean spinal instability neoplastic score (SINS) was 9.4, and the epidural spinal cord compression scale (ESCCS) was grade 3 in 20 patients (36.3%). The mean Barthel index for ADL was 48.7. The median postoperative survival time determined using the Kaplan-Meier method was 12.0 months (95% confidence interval 2.4–21.5). Regarding improvement of paralysis, the modified Frankel scale was improved by one grade or more or grade E was maintained in 35 patients (63.6%), whereas paralysis aggravated in 2 (3.6%). In surgery, conventional posterior decompression and fixation were applied in 31 patients (56.3%), and minimally invasive spine stabilization was applied in 24 (43.6%). Postoperative chemotherapy was performed in 31 patients (56.3%), radiotherapy was used in 38 (69.0%), and a bone-modifying agent was administered in 39 (70.2%). Regarding ADL, the mean Barthel index improved from 48.5 before surgery to 74.5 after surgery. Thirty-seven patients (67.2%) were discharged to home.ConclusionsADL improved and allowed discharge to home, and postoperative adjuvant therapy could be administered at a high rate in patients who received palliative posterior spinal stabilization surgery. Survival time extended beyond the preoperative life expectancy in many patients. Patients with a metastatic spinal tumor have short life expectancy and paralysis caused by spinal instability and spinal cord compression. However, multidisciplinary therapy including palliative posterior spinal stabilization surgery with reduced invasiveness and postoperative adjuvant therapy are effective in these patients.

Prognostic analysis of radical resection for intrahepatic cholangiocarcinoma: a retrospective cohort study.

The aim of this study was to investigate the relationship between the clinicopathological characteristics of intrahepatic cholangiocarcinoma (ICC) and both disease-free survival (DFS) and overall survival (OS) in intrahepatic cholangiocarcinoma (ICC) patients who underwent radical resection (R0). We retrospectively analyzed the clinicopathological characteristics of 319 patients who underwent radical resection of ICC between October 1999 and December 2003. The independent adverse prognostic factors that affected DFS after radical resection of ICC were as follows: maximum tumor diameter (HR = 1.330, P = 0.014), complicated bile duct stone (HR = 1.923, P = 0.013), macroscopic tumor thrombus (HR = 1.826, P = 0.009), and lymph node metastasis (Pathology N1) (HR = 2.330, P = 0.005) were independent adverse prognostic factors that affected the DFS after radical resection of ICC. The postoperative median DFS was 6 months. The independent adverse prognostic factors that affected OS after radical resection of ICC were as follows: maximum tumor diameter (HR = 1.326, P = 0.014), complicated bile duct stone (HR = 2.349, P = 0.001), and lymph node metastasis (Pathology N1) (HR = 2.420, P = 0.003). The postoperative median survival time was 22 months, the 3-year survival rate was 33.9%, and the 5-year survival rate was 23.2%. Macroscopic tumor thrombus (OR = 2.991, P = 0.004) was an independent risk factor for death within 1 year after radical resection.

Clinical Results of Minimally Invasive Spine Stabilization for Spinal Metastases.

The goal of the study was to evaluate minimally invasive palliative surgery and the effect of postoperative adjuvant therapy for metastatic spinal tumor with a limited vital prognosis. Of the 70 patients who underwent palliative surgery for metastatic spinal tumor at the authors' hospital between March 2012 and May 2016, thirty-three were treated with minimally invasive spine stabilization (MISt) using percutaneous pedicle screws (PPSs) and included in the current study. Of the 33 patients, 26 were men and 7 were women; mean age at surgery was 68.6 years. Intraoperatively, posterior decompression and fusion was performed in 17 (51.5%) patients and fusion only was performed in 16 (48.5%). Mean operative time was 202.5 minutes, mean intraoperative blood loss was 331.6 mL, and intraoperative blood loss was 1500 mL or greater in 2 (6.1%) patients. Median postoperative survival time determined using the Kaplan-Meier method was 11.0 months (95% confidence interval, 7.3-14.6). Regarding improvement of paralysis, neurological deficit was improved by at least 1 Frankel grade for 15 (45.5%) patients, and the number of ambulatory patients increased from 22 (66.7%) to 25 (75.8%). Postoperative adjuvant therapy included chemotherapy in 17 (51.5%) patients, radiotherapy in 21 (63.6%), and bone-modifying agent treatment in 25 (75.8%). The mean Barthel Index for activities of daily living improved from 53.5 preoperatively to 71.5 postoperatively. Discharge to home was possible for 23 (69.7%) patients. Activities of daily living for patients with metastatic spinal tumor were improved by minimally invasive palliative surgery with MISt using PPSs and postoperative adjuvant therapy. [Orthopedics. 2017; 40(4):e693-e698.].

Conversion surgery for unresectable gastric cancer following complete response of distant metastasis by systemic chemotherapy.

152 Background: In case of gastric cancer (GC), conversion surgery (CS) can be defined as resection of the primary cancer by gastrectomy which had not been originally planned but was indicated after confirming complete response (CR) in the distant metastasis (DM) by chemotherapy. In the present study, we looked at prognostic significance of CS, which is intended to cure originally unresectable GC. Methods: From 2004 to Feb in 2016, 24 GC patients who were treated by chemotherapy and achieved CR in DM underwent CS among 909 patients with gastrectomy in our department. 10 out of 24 patients who had peritoneal metastases (P) as a single non-curative factor underwent intraperitoneal chemotherapy (IP) in addition to systemic chemotherapy. CR was confirmed by CT and/or laparoscopic examination. Results: 15 patients had P, 13 had distant lymph node metastases (LYM), 2 had liver metastases, and 2 had lung metastases. Chemotherapeutic regimens consisted of systemic chemotherapy plus IP of taxane in 10 patients, S-1/CDDP in 7, capecitabine/CDDP/trastsuzumab in 3, and others in 4. Median duration of chemotherapy before surgery was 7.3 months (2.3-17.5). Total gastrectomy was performed in 18 patients and distal gastrectomy in 6, achieving R0 resection in 21 patients and R1 in 3. 10 patients with P who underwent IP relapsed within 12 months postoperatively except for 2 and had significantly shorter overall survival time than those with other DM except for P (median: 20 vs. 42 months, P = 0.004). Among 14 patients who had DM other than P as target lesions, 9 are disease-free with postoperative median follow up time of 35 months (6.8-82), and 5 patients had recurrence (LYM in 4 and P in 1) with postoperative median survival time of 25 months (4.8-45). DM of the patients without recurrence had achieved CR within shorter period (median: 3.6 vs. 6.7 months) and had higher pathological response rate of the primary lesion (89% vs. 40%) compared to patients with recurrence. Conclusions: Outcome of GC patients who underwent CS after achieving CR in DM was promising, especially in those without P. Further issues such as appropriate chemotherapeutic period, and prognostic factors to decide on the indication for CS need to be solved.

Preoperative palsy score has no significant association with survival in non-small-cell lung cancer patients with spinal metastases who undergo spinal surgery.

BackgroundSurvival is a key factor physicians consider when selecting a treatment modality for the treatment of spinal metastases. Various assessment systems can predict length of survival and facilitate selection of the most appropriate treatment. Spinal palsy is a prognostic parameter in the Tokuhashi scoring system but not in the Tomita scoring system. A limitation of these scoring systems is that studies of them have included different tumor types. The aim of this study was to evaluate the usefulness of preoperative neurological status as a prognostic factor in non-small-cell lung cancer patients with spinal metastases who underwent surgical treatment.MethodsFrom November 2000 to March 2010, 50 patients with symptomatic metastatic spinal cord compression secondary to non-small-cell lung cancer underwent palliative surgery. Data collected included patient age and sex, tumor histology, date of surgery, death or last follow-up, preoperative and postoperative ambulatory status according to the Frankel grading system, body mass index (BMI), number of vertebra involved, number of other bone metastasis, visceral metastasis, and preoperative Karnofsky performance status. Log-rank test and multivariate Cox proportional hazard regressions were used to evaluate possible prognostic factors.ResultsThe mean patient age was 61.6 years (range, 20–87 years), and 34 were male and 16 were female. The median postoperative survival time was 7.5 months. The median survival was 2.5 months (95 % confidence interval (CI): 1.22–16.3 months) in the Frankel A + B group and 8.0 months (95 % CI: 5.52–9.89 months) in the Frankel C + D group (p = 0.87). Multivariate Cox proportional hazard regressions showed that preoperative performance status was significantly associated with survival. Preoperative palsy score had no statistically significant association with survival.ConclusionsPreoperative palsy score had no statistically significant association with survival in non-small-cell lung cancer patients with spinal metastases who underwent spinal surgery in this study.

A clinical series of 80 patients with adenosquamous carcinoma of pancreas

To raise the awareness of adenosquamous carcinoma of pancreas and discuss the treatment of it. Clinical data of 80 cases of pancreas adenosquamous carcinoma patients in the Department of Pancreas Surgery of Changhai Hospital of Second Military Medical University from December 2003 to October 2011 were analyzed. The diagnose and treatment methods were discussed. There were 61 male cases and 19 female cases who aged from 28 to 81 years, with an average age of 60 years. The primary symptoms included 46 cases (57.5%) of abdominal malaise, 6 cases (7.5%) of low back pain, 4 cases (5.0%) of abdominal swelling pain with low back pain, 15 cases (18.8%) of abdominal swelling pain with jaundice, 5 cases (6.3%) of painless jaundice, 3 cases (3.8%) of significantly decreased body-weight and 1 case (1.3%) of no symptom. All the patients had been identified as pancreas tumor suffers by ultrasound, enhanced CT scan or MRI. Totally there were 43 cases of head/unciform process tumors, 15 cases of pancreas body tumors and 22 pancreas tail cases.Health situation of all cases were follow-up observed in the outpatient department or telephoned every 3 months till 24 months after the surgery. Among the 80 patients, 19 patients underwent pancreaticoduodenectomy (PD) , 19 patients received pylorus-preserving PD, with 4 cases of palliative resection and 1 case of total pancreatectomy. The volume of bleeding during the surgery varied from 50 to 3 500 ml with a blood transfusion volume varied from 0 to 4 000 ml. Consumed time for PD procedures was 90 to 260 min with 60 to 150 min for body and (or) tail resection with or without lienectomy. The mean diameter of tumor was (4.9 ± 2.2) cm. Pathological tests showed 35 cases of positive lymph nodes, adjacent organ invasion happened in 35 patients, however, nerve invasion were found in 68 cases.Eighteen cases occurred postoperative complications, including bleeding, pancreatic fistula, gastric emptying, incision fat liquefaction and infection, pleural effusion, ascites and nervous diarrhea. There were only 48 effective follow-up patients, with a loss ratio of follow-up by 40.0%, reasons for the loss includes change of contact information, refuse or unable to provide useful information by the relatives of the patients.Sixteen patients received chemotherapy, and 8 patients received radiotherapy after operation. All patients were dead in the effective follow-ups. The postoperative median survival time was 6 months (0.1 to 23.0 months). Adenosquamous carcinoma of pancreas is a rare kind of malignant tumor, nerve invasion can be found in almost all the cases. Patients with adenosquamous carcinoma of pancreas have an unfavorable prognosis. The principle treatments are surgery, radiotherapy and chemotherapy.

Surgery for ampullary tumors: a study of 238 patients

Objective To compare the various surgical procedures commonly used to treat ampullary neoplasms.Methods The clinical data of 238 patients with ampullary tumor who were admitted to the Peking Union Hospital from January 1995 to June 2012 were retrospectively analyzed.There were 51 patients with benign ampullary adenomas (34 patients treated with local tumor resection,17 patients treated with pancreaticoduodenectomy) and 187 patients with ampullary cancer (25 patients treated with ampulla local excision,162 patients treated with pancreaticoduodenectomy).Results For both ampullary cancer and benign tumor,the group of patients who received local excision was superior to the group of patients who received pancreaticoduodenectomy in operative time,blood loss,hospital stay,and incidence of postoperative complications (all P＜0.05).For benign ampullary adenomas,there were no significant differences in postoperative median survival time between local resection and pancreaticoduodenectomy (P=0.071,x2 =2.003).For stage T1 or T2 ampullary cancer,there was also no significant difference in the postoperative median survival time (P=0.054,x2=3.163).However,the postoperative median survival time of the pancreaticoduodenectomy group was significantly longer than that of the local resection group for patients with stage T3 or T4 ampullary cancer (P=0.041,x2 =6.309).Conclusions Ampullary tumors are characterized by relatively good response to treatment.The results suggested that for patients with benign ampullary adenomas and stage T1 or T2 of ampullary cancer,local resection is a good surgical procedure.For patients with ampullary cancer at more advanced stages (T3 or T4),pancreaticoduodenectomy is the first choice of therapy. Key words: Neoplasms; Ampulla of vater; Pancreaticoduodenectomy

Expression of DNA methyltransferases in hilar cholangiocarcinoma and its clinical significance

Objective To investigate the expression of DNA methyltransferases ( DNMTs) in hilar cholangiocarcinoma and its clinical significance.Methods A total of 150 samples of cholangetic tissues were collected from 111 patients with hilar cholangiocarcinoma ( cholangiocarcinoma group) and 39 patients with choledochocele ( control group) at the First Affiliated Hospital of Sun Yat-Sen University from April 1997 to March 2007.A tissue chip containing the samples of hilar cholangiocarcinoma and choledochocele was prepared.Expressions of DNMT1,DNMT3a and DNMT3b were detected by the immunohistochemical staining. Differences in the protein expressions of DNMTs in the cholangiocarcinoma group and the control group were compared,and the correlation between DNMTs protein expressions and clinicopathological features was analyzed.All data were analyzed by using the chi-square test or Fisher exact probability.The survival curve was drawn by using the Kaplan-Meier method and the survival rate was compared by using the Log-rank test.Results The rates of high protein expressions of DNMT1 and DNMT3b were 54.1％ (60/111) and 47.7％ (53/111) in the cholangiocarcinoma group, which were significantly higher than 28.2％ ( 11/39) and 23.1％ ( 9/39) in the control group ( x2 =7.740,7.240,P ＜0.05). The high protein expression of DNMT1 was correlated with-the Bismuth-Corlette classification and T staging of the tumor ( x2 =12.200, 17.800,P ＜0.05) ; there was no significant difference in the high protein expressions of DNMT3a in the cholangiocarcinoma group and the control group ( x2 =3.370.P ＞0.05 ) ; while the high protein expressions of DNMT3b was correlated with the Bismuth-Corlette classification (x2 =8.300,P ＜ 0.05 ),but not with the T staging. Sixty-six patients received hilar cholangiocarcinoma resection,and 42 of them were followed up.The median postoperative survival time of patients with low protein expression of DNMT1 was 23.9 months,which was significantly longer than 11.8 months of patients with high protein expression of DNMT1 (x2 =3.980,P ＜ 0.05).Conclusions DNMT1 and DNMT3b with high protein expression might play important roles in the carcinogenesis and development of hilar cholangiocarcinoma.There is an obvious relationship between the expression of DNMT1 and postoperative survival time of patients with hilar cholangiocarcinoma,and DNMT1 might be a valuable prognostic factor for hilar cholangiocarcinoma. Key words: Cholangiocarcinoma, hilar; DNA methyltransferases; Bismuth-Corlette classification

Influence of co-stimulatory molecules B7-H4 expression on the prognosis of patients with gastric cancer treated with cytokine-induced killer cells adoptive immunotherapy

To investigate the influence of co-stimulatory molecules B7-H4 expression on prognosis of gastric cancer patients treated by cytokine-induced killer cells (CIK cells) adoptive immunotherapy. Clinical data of 156 cases of gastric cancer patients were retrospectively analyzed. Patients were divided into chemotherapy group(n=81) and chemotherapy combined with CIK cell therapy group(n=75). B7-H4 expression was detected in the surgical specimens of gastric cancer patients by immunohistochemistry assay. Disease-free survival was compared between the chemotherapy group and the CIK group at different expression levels of B7-H4. The difference was not statistically significant in all clinical and pathological data between the chemotherapy group and the CIK treatment group (P>0.05). The postoperative median tumor-free survival in two groups was 18.0 and 45.0 months, respectively, and the difference was statistically significant (chi(2)=11.631, P=0.001). The postoperative median survival time was 27.0 and 49.0 months, respectively, and the difference was statistically significant (chi(2)=10.907, P=0.001). In 86 patients with low B7-H4 expression, the median tumor-free survival time was 32.0 and 62.0 months, respectively, and the difference was statistically significant (chi(2)=4.663,P=0.03). In 70 patients with high B7-H4 expression, the median tumor-free survival time was 11.0 and 18.0 months, respectively, and the difference was statistically significant (chi(2)=11.971, P=0.001). The median tumor-free survival time of patients with gastric cancer may be further improved by chemotherapy combined with CIK cell therapy, regardless of the level of B7-H4 expression.

Factors influencing survival of patients with cancer of the pancreatic head after resection

The aim of this cohort study was to investigate the clinical outcome and prognostic factors in patients after resection for ductal adenocarcinoma of the pancreatic head. patients with pancreatic head cancer undergoing curative resection (R0) between 1997 and 2002 were included in this study. Univariate and multivariate analyses were performed to examine factors affecting clinical outcome and recurrence of the cancer. Surgical procedures consisted of 58 (43.3%) extended pancreaticoduodenectomies (EPD), 47 (35.1%) pancreaticoduodenectomies (PD) and 29 (21.6%) pylorus-preserving pancreaticoduodenectomies (PPPD). The results showed that 81.3% (109/134) of patients had a recurrence during the study period, mainly retroperitoneal combined with distant metastasis (53.7%). The median postoperative survival time was 24.7 months. The 1-, 3- and 5-year overall survival rates for the study population were 67.1%, 38.5% and 17.6%, respectively. Univariate analysis showed that preoperative abdominal and/or back pain, tumor size > 2 cm, lymph node involvement and vascular invasion, and CA19-9 level were all significant predictors for poor survival. Multivariate analysis also showed that preoperative abdominal and/or back pain, tumor size > 2 cm, lymph node involvement and vascular invasion were all significant predictors for poor survival. Our results suggest that preoperative abdominal and/or back pain, tumor size > 2 cm, lymph node involvement and vascular invasion are significant predictors for poor survival in patients with pancreatic head cancer.

Dose distribution and clinical response of glioblastoma treated with boron neutron capture therapy

The dose distribution and failure pattern after treatment with the external beam boron neutron capture therapy (BNCT) protocol were retrospectively analyzed. BSH (5 g/body) and BPA (250 mg/kg) based BNCT was performed in eight patients with newly diagnosed glioblastoma. The gross tumor volume (GTV) and clinical target volume (CTV)-1 were defined as the residual gadolinium-enhancing volume. CTV-2 and CTV-3 were defined as GTV plus a margin of 2 and 3 cm, respectively. As additional photon irradiation, a total X-ray dose of 30 Gy was given to the T2 high intensity area on MRI. Five of the eight patients were alive at analysis for a mean follow-up time of 20.3 months. The post-operative median survival time of the eight patients was 27.9 months (95% CI=21.0–34.8). The minimum tumor dose of GTV, CTV-2, and CTV-3 averaged 29.8±9.9, 15.1±5.4, and 12.4±2.9 Gy, respectively. The minimum tumor non-boron dose of GTV, CTV-2, and CTV-3 averaged 2.0±0.5, 1.3±0.3, and 1.1±0.2 Gy, respectively. The maximum normal brain dose, skin dose, and average brain dose were 11.4±1.5, 9.6±1.4, and 3.1±0.4 Gy, respectively. The mean minimum dose at the failure site in cases of in-field recurrence (IR) and out-field recurrence (OR) was 26.3±16.7 and 14.9 GyEq, respectively. The calculated doses at the failure site were at least equal to the tumor control doses which were previously reported. We speculate that the failure pattern was related to an inadequate distribution of boron-10. Further improvement of the microdistribution of boron compounds is expected, and may improve the tumor control by BNCT.

Liver resection for spontaneous rupture of primary hepatocellular carcinoma

目的 探讨肝切除治疗原发性肝癌自发性破裂(简称肝癌破裂)的作用.方法分析两所医院1970年以来采用肝切除术治疗肝癌破裂21例的临床资料.结果本组男17例,女4例.平均年龄42(22～65)岁.19例为急症肝切除,2例为2期切除,包括左外叶切除8例,左内叶切除2例,左半肝切除2例,右肝部分切除5例,肿瘤切除4例.本组中Child-Paugh肝功能分级A级的15例,B级6例,B级中1例术后死于肝衰,手术死亡率4.8%.20例生存者18例获得随访,中位生存时间16个月,1,3,5年生存率分别为64.7%,11.8%,5.9%.其中1例已无瘤生存25年9个月.结论肝切除是治疗肝癌破裂的最好方法,当有可能时应争取施行.肝切除治疗肝癌破裂可能使病人获得长时间生存。

The use of cardiopulmonary bypass during extended resection of non-small cell lung cancer

We undertook a retrospective study in order to assess the risks and benefits of the use of cardiopulmonary bypass (CPB) during operative resection of non-small cell lung cancer (NSCLC). Eleven patients (nine male and two female with a median age of 62 years, range 28-76 years) underwent extended resection of locally advanced NSCLC using CPB. The indication for the use of CPB was resection of the left atrium (n=4), the aorta (n=3), the pulmonary artery (n=3), or for respiratory support (n=1). No deaths occurred during the first 30 days postoperatively. With exception of one hospital death due to MRSA mediastinitis and local recurrence, all the patients were discharged and returned to their social activities. Two patients are alive with recurrent disease at follow-up 37 and 41 months post-surgery, respectively. Eight patients died due to recurrence and the median postoperative survival time was 269 days (range: 112-1132 days). One patient who had no evidence of recurrence died of aspiration pneumonia 10 months after surgery. CPB is a safe and effective tool for use during extended resection of locally advanced NSCLC. However, careful consideration for the risk/benefit ratio should be required when assessing the indication for surgical intervention.

Operative results of non-small cell lung cancer clinically presenting mediastinal lymph adenopathy.

Selection of treatment for operable N2 non-small cell lung cancer (NSCLC) is still controversial. If considered resectable, we have actively performed surgery even for clinical stage IIIA-N2 disease. In this retrospective study, surgical results in NSCLC with clinically presenting mediastinal lymph adenopathy examined to investigate its indication. Consecutive 202 patients who were preoperatively diagnosed or suspected of mediastinal lymph adenopathy and underwent operation were investigated for such as pathological judgement of nodal metastasis, completeness of operation and prognosis. Perioperative chemotherapy and/or radiotherapy was performed in 56 patients. Pathological diagnosis of nodal status was N0 in 64 patients, N1 in 27, N2 in 104 and N3 in 7. Complete resection was performed in 109 patients (54%). In 111 patients with pathologically proven N2 (pN2), only 40 (36%) were completely resected. The reason of incomplete resection included extranodal extension of mediastinal nodal metastasis in 31 patients, pleural dissemination in 18, extension of primary tumor to mediastinum in 11. Median post-operative survival time was 553 days, and survival rates at 2- and 5-years were 43% and 22%, respectively. In all pN2, survival rates at 2- and 5-years were 33% and 11%, respectively. In 40 patients of completely resected pN2, survival rates at 2- and 5-years were 42% and 22%, respectively, whereas those were 17% and 5% in 64 patients with incompletely resected pN2. The positive effect of perioperative treatment on survival was not apparent. If resectable, surgical approach to N2 might be approved, however, extensive examination is required prior to therapy to avoid incomplete resection.

Multimodality therapy including surgical resection for limited small cell lung cancer

From 1975 through 1990, 199 patients with limited small cell lung cancer (LSCLC) were subjected to multimodality treatment including surgical resection combined with chemotherapy or chemoradiotherapy in our department. The median postoperative survival time of the 199 patients was 39 months, and the 5-year survival rate was 26%, which was decreased with increase of tumor-stage. In comparison of the survival time of patients in Stage I and those in Stage IIIa, there was a significant difference (P < 0.01). There were no significant differences in survival rate of 3 and 5 years between the patients receiving chemotherapy prior to or after surgical resection. The improvement in survival was documented by surgical resection combined with chemotherapy or chemoradiotherapy for LSCLC. The effect of multimodality treatment is correlated with tumor P-TNM staging, the involvement of lymph node, especially that of the mediastinal lymph node, is a negative factor influencing the prognosis. Surgical resection is an initial management, followed by chemotherapy or chemoradiotherapy may be indicated in LSCLC patients of Stage I, Stage II and some Stage IIIa as the cancer can be resected completely.

Operative management of epidural tumors of the spine

Seventy-two patients with neoplastic involvement of the vertebral column were operated on between 1986 and 1991. In the course of 79 operations anterior decompression and stabilization alone were performed in 3 cases, while ventrodorsal spondylodesis was carried out in 10 individuals. The remainder of the patients underwent exclusively dorsal decompression and stabilization, mainly with the Cotrel-Dubousset instrumentation (CDI). No external spinal support was required following posterior fixation by CDI alone or in combination with ventral spondylodesis. Forty patients suffered from neurological deficits preoperatively, 20 of them being unable to walk, in most cases owing to severe vertebral collapse. Neurologic symptoms improved in 18 patients postoperatively. Median postoperative survival time averaged 11.5 months. In palliative surgery of the spine, posterior decompression and fixation using CDI permit most patients to retain ambulation without requiring external orthotics. The rate of postoperative complications is reduced by the introduction of CDI.

Insulin‐secreting tumours of the canine pancreas: Clinical and pathological features of 11 cases

ABSTRACTThis paper describes the clinical and pathological features of 11 dogs with insulin‐secreting tumours of the pancreas. All the dogs showed episodic weakness or collapse. The diagnosis was made on fasting plasma glucose and serum insulin concentrations, the insulimglucose ratio, and the results of an intravenous glucose tolerance test. Ten of the dogs had exploratory laparotomy, and partial pancreatectomy was performed in nine of the cases. One case was euthanased at surgery because of widespread metastases. The tumours were graded histologically and the results compared with the time to recurrence of clinical signs and postoperative survival time. Postoperative survival time for dogs which died or were euthanased as a direct result of tumour recurrence, and time to recurrence of clinical signs were calculated from actuarial survival curves. The median time to recurrence of clinical signs after surgery was 12 months (range from four to 16 months; mean time to recurrence of clinical signs 12 months). Two cases died of unrelated disease, without recurrence of hypoglycaemic signs. The median postoperative survival time was 14 months (range 10 to 33 months; mean survival time 15 months). There is a suggestion that tumours with a high mitotic count carried a worse prognosis.

Oligodendroglioma: incidence and biological behavior in a defined population.

The cases of 208 patients with histologically confirmed oligodendrogliomas were studied. The incidence represents 4.2% of all primary brain tumors diagnosed in the Norwegian population over a 25-year period. All of these tumors were cerebral and the majority affected the frontal lobe. The patients' median age at diagnosis was 47 years, with a range from 3 to 76 years; 6% of the oligodendrogliomas occurred in children. The median duration of symptoms before diagnosis was 20.5 months (mean 43 months). Plain skull x-ray films showed calcified deposits in 28% of the tumors. At operation, most of the tumors were poorly defined, without cyst formation, hematoma necrosis, or calcification. The median duration of disease from onset of symptoms until death was 14 months in nine untreated cases. In surgically treated oligodendroglioma patients the median survival time from onset of symptoms was 74 months. The median postoperative survival time was 35 months (mean 52 months). Tumor calcification, as seen on plain skull x-ray films, was associated with a significantly longer survival period. The surgical findings of gross necrosis, gross hypervascularity, and soft tumor consistency were all related to a shorter total duration of disease. Grossly well demarcated lesions were associated with a significantly longer postoperative survival. The length of postoperative survival correlated with the preoperative clinical status. The cumulative proportion of patients surviving 5 years was 0.342. The patient's age and sex did not have a statistically significant influence on survival time. The extent of surgical excision only seemed to play a role when the neurosurgeon considered that he had removed the whole lesion: these patients had a median postoperative survival period 14 months longer than the other oligodendroglioma patients. The ABO blood group of the oligodendroglioma patient was of prognostic value. In particular, patients with blood group A had a distinctly poorer prognosis than patients with O or B blood. The survival data from this unselected series indicate that cerebral oligodendrogliomas have a less favorable prognosis than has generally been believed.