Presence Of Hepatic Metastases Research Articles

Prognostic factors for noncurative gastric cancer: univariate and multivariate analyses.

We performed univariate and multivariate analyses of possible prognostic factors related to postoperative clinical course of patients with advanced gastric cancer. Noncurative resection was done for 119 patients with hepatic metastasis, peritoneal seeding, extensive lymph node metastasis, or direct invasion to adjacent organs, either alone or in various combinations. In the univariate analysis, 6 of 17 items such as peritoneal seeding, lymphatic invasion, vascular invasion, mode of invasion, extent of lymphadenectomy, and width of serosal invasion significantly correlated to the prognosis. The multivariate analysis indicated that three inherent pathologic factors, mode of invasion, lymph node metastasis, and hepatic metastasis, and one treatment factor, extent of lymphadenectomy, were significant variables predictive of the prognosis and that the prognosis was expected to be very poor in cases of infiltrative type, nodal involvement to tertiary nodes, presence of hepatic metastasis, and lymphadenectomy less than R3. Prognosis in terms of the extent of lymphadenectomy shows that extensive lymphadenectomy (R3) proved to be significantly effective in prolonging survival time, even after noncurative gastrectomy. We recommend extensive lymphadenectomy to prolong survival time for such patients.

Benefit of resection of metastatic gastrinoma in multiple endocrine neoplasia type I

Although gastrinoma resection is generally advocated for patients with the sporadic form of nonmetastatic Zollinger-Ellison syndrome, there is controversy regarding the surgical management of the gastrinoma among patients with multiple endocrine neoplasia type I (MEN-I). Using strict criteria, to date no biochemical cures of the Zollinger-Ellison syndrome lasting 5 months have been achieved by gastrinoma resection among patients with MEN-I. Whereas resections of hepatic metastases have been performed in patients with sporadic gastrinoma, none have been reported among patients with MEN-I. The current report describes a patient with MEN-I, closely followed up for 30 years, in whom enlargement of pancreatic gastrinoma and development of hepatic gastrinoma was observed to occur over 3 years. After preoperative localization, an 80% pancreatectomy and a left lateral segmentectomy of the liver were performed. Sixteen months after the operation, secretin and calcium provocative testing showed that the patient's fasting gastrin and stimulated plasma gastrin concentrations were normal; also, results of computerized tomographic angiography, selective abdominal angiography, and hepatic venous sampling for gastrin after intra-arterial secretin injection were negative for gastrinoma. By achieving a 16-month cure of gastrinoma, this case shows that an aggressive surgical approach can benefit certain patients with gastrinoma who have MEN-I even in the presence of hepatic metastases.

The effects on resting energy expenditure of different tumor types

The presence of a malignant tumor is said to influence the resting energy expenditure (REE) of the host. This study assesses the hypothesis that different tumor types exert differing effects on REE. REE was measured using indirect calorimetry in 84 cancer patients. Fifty-one patients had colorectal cancer, 22 had gastric cancer, and 11 had non-small cell bronchial cancer. For each tumor type, REE correlated significantly with body weight and lean body mass (LBM). The slope of the regression line for the bronchial cancer patients was significantly different from the colorectal (P less than 0.02) and gastric (P less than 0.02) cancer patients when REE was related to LBM. When related to body weight, the slope of the line of the bronchial cancer patients was significantly different from that of the gastric cancer patients only (P less than 0.05). The bronchial cancer patients had a significantly higher REE than the colorectal (P less than 0.005) and gastric (P less than 0.02) cancer patients when REE was expressed in terms of body weight. However, when corrected for LBM, no significant differences in REE were found between the groups. The presence of hepatic metastases did not influence REE in any of the tumor groups. Differing relationships between REE and indices of body size have been detected in differing tumor types. Consequently, the use of heterogeneous cancer groups may be inappropriate in studies of REE and cancer.

Lactic Acidosis and Death Owing to Cancer

The relationship between the presence of a malignancy and the death of a patient is often obscure. Sometimes the clinician, more frequently the pathologist, can point to a single mechanism of death. One can mention hypercalcemia, acute cerebral edema surrounding a brain metastasis, or bilateral ureteral obstruction with uremia. However, it appears that death is most frequently due to a remote mechanism, such as infection, hemorrhage, or infarction.1 Even more subtle mechanisms are now being discovered. For example, the presence of hepatic metastases was of interest to the clinician only as a poor prognostic factor or a contraindication to surgery. Massive replacement of liver parenchyma by metastasis is not usually considered crucial to patient survival but only as a source of discomfort. Recently, hepatic involvement has been recognized as an infrequent cause of death. Eras et al described hepatic coma in 7.2% of all patients with metastatic liver disease,

The accuracy of liver scanning in the detection of metastatic disease.

Isotopic scanning of the liver to detect hepatic metastases is a commonly used clinical tool in assessing the extent of malignant disease and the proper mode of therapy. Opinions vary widely as to the efficacy of this test. To determine the accuracy of our scanning technique the clinical and laboratory data on 429 patients who had hepatic scans (technetium sulfur colloid) between February 1971 and May 1973 was reviewed. Of these patients, 125 had a confirmatory procedure (needle biopsy - 15, abdominal exploration - 69, autopsy - 41) done within 6 weeks of their scan. Nineteen patients who had negative scans were proven to have hepatic metastases. Fourteen patients had positive scans which could not be substantiated by one or more of the above confirming examinations. Thus the frequency of error was 25%. Regarding other tests - alkaline phosphatase and bilirubin - no better correlation could be made with respect to the presence or absence of metastases. From the data available on this small group of patients the liver scan is sufficiently inaccurate to preclude relying upon it for the selection of therapy in cancer patients. When the presence of hepatic metastases changes the type of therapy a confirmatory laparotomy or biopsy should be considered.

The fibrinolytic enzyme system in hepatic cirrhosis and malignant metastases.

Components of the blood fibrinolytic system were measured in 18 patients with hepatic cirrhosis, in two patients with acute hepatic necrosis, and in 10 patients with hepatic metastases. The frequency of an elevation of plasminogen activator and a reduction in plasminogen in hepatic cirrhosis has been confirmed. Patients with compensated cirrhosis had low levels of the serum inhibitor of plasminogen activation while those with severe hepatic insufficiency or coma due to cirrhosis or hepatic necrosis had elevated levels. The presence of hepatic metastases was associated with reduced plasminogen activator levels and an increase in the fibrinogen concentration.

A RE-EVALUATION OF NEEDLE BIOPSY IN THE DIAGNOSIS OF METASTATIC CANCER OF THE LIVER.

Article1 July 1963A Re-evaluation of Needle Biopsy in the Diagnosis of Metastatic Cancer of the LiverHAROLD O. CONN, M.D., RAYMOND YESNER, M.D.HAROLD O. CONN, M.D.Search for more papers by this author, RAYMOND YESNER, M.D.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-59-1-53 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptPercutaneous liver biopsy has been demonstrated to be a valuable tool in the diagnosis of metastatic cancer of the liver (1-7). The frequency with which a single liver biopsy demonstrates metastatic cancer in patients proved to have hepatic metastases has been reported to range from 66 (3) to 91 per cent (2) and averages 71 per cent (Table 1). These studies, in which most of the patients have shown obvious signs of metastatic disease of the liver, may have exaggerated its true value. It has been widely stated that the presence of hepatic metastases can be detected by a single...

Manifestations of metastatic tumors of the liver: A study of eighty-one patients subjected to needle biopsy

The clinical manifestations and needle biopsy findings in eighty-one patients with proved metastatic tumor of the liver have been reviewed. Attention is drawn to a number of insufficiently emphasized features of the disease that may be misleading. These include a characteristic type of hepatic pain, fever, signs of portal hypertension, fluid retention and the presence of a friction rub over the liver. Evidence is presented to show that once signs or symptoms of hepatic metastases appear, the disease is in an advanced stage of development, and that this accounts for the remarkable frequency with which the presence of tumor can be demonstrated by random sampling of the liver with a small biopsy needle. The results of the present study confirm previous reports indicating the great diagnostic value of needle biopsy in metastatic disease of the liver, and support the view that the presence of hepatic metastases does not enhance the hazards of the procedure.

Diagnostic Accuracy of Hepatic Metastases at Laparotomy IU

One of the most important steps in the procedures of the surgeon on opening the abdomen of a patient with cancer is to inspect the liver with care, in order to determine possibly the presence or absence of metastatic cancer. The determination is one which may change completely the nature and degree of the contemplated operation. For example, some surgeons rigidly refuse to proceed with a gastrectomy, pancreatectomy, or rectal resection in the presence of hepatic metastases, regardless of their small size or small number, whereas other surgeons with different points of view would proceed with the resection and, even under favorable circumstances, practice metastasectomy. Moreover, an operation applied for obvious palliation is often of more limited scope than the radical procedures designed with hope for cure. We thought it to be of interest to determine the accuracy of our diagnosis of freedom or noninvolvement of the liver by metastatic