RESUMEN
The standard procedure for cervical oesophageal carcinoma consists of partial pharyngectomy, laryngectomy with tracheostomy, resection of one thyroid lobe and complete oesophagectomy. For intrathoracic and abdominal carcinoma of the oesophagus, subtotal resection leaving a small cervical portion is sufficient. If the carcinoma has not exceeded the organ boundaries or is located below the tracheal bifurcation, the choice of resection either by transthoracic, transmediastinal or endoscopic methods is not critical with respect to the radical nature of the resection. In carcinoma located at or above the tracheal bifurcation a transthoracic approach is mandatory, but due to a significant hospital mortality and a low 5-year survival the question regarding valid indications for surgery remains open in most patients. With reference to the rules of radical surgery a "three-field" lymphadenectomy, which includes the resection of cervical, mediastinal and upper gastric lymph nodes, seems to be indispensable in all oesophageal carcinomas. Only some Japanese groups perform this procedure routinely or in selected cases. They report a positive correlation between the extent of lymph node dissection and the long-term survival. Since none of their studies is prospectively randomized, a certain bias could exist resulting in better results for extended lymphadenectomy. According to European experience, radical surgery of oesophageal carcinoma is more fiction than fact.
Asunto(s)
Neoplasias Esofágicas/cirugía , Toracoscopía/métodos , Anastomosis Quirúrgica/métodos , Neoplasias Esofágicas/mortalidad , Neoplasias Esofágicas/patología , Estudios de Seguimiento , Mortalidad Hospitalaria , Humanos , Escisión del Ganglio Linfático/instrumentación , Estadificación de Neoplasias , Complicaciones Posoperatorias/mortalidad , Tasa de SupervivenciaRESUMEN
The results and the costs of a routine follow-up program for patients with curatively resected colo-rectal carcinoma were evaluated in a retrospective matched pair study. Patients, who never had participated in such a program, were used as controls. In addition 58 patients were questioned prospectively regarding their opinion about the value of the follow-up program for their present and future life. Significantly more local recurrences and distant metastases were diagnosed at an average of 1.5 years earlier in the follow-up group as compared with the control group. Neither the hereby resulting higher number of curatively resected local recurrences or distal metastases nor a more aggressive oncological approach in unresectable cases resulted in a substantial improvement of survival time in the follow-up group. Considering the relatively high costs of the program, only the diagnosis of several other illnesses which one was able to treat, and the high appreciation by the patients speak in favor of the follow-up program. 86.2% of the patients believed that routine follow-up would be of essential value for their future life.
Asunto(s)
Cuidados Posteriores/economía , Neoplasias Colorrectales/cirugía , Recurrencia Local de Neoplasia/cirugía , Complicaciones Posoperatorias/cirugía , Anciano , Neoplasias Colorrectales/diagnóstico , Neoplasias Colorrectales/economía , Neoplasias Colorrectales/mortalidad , Análisis Costo-Beneficio , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Recurrencia Local de Neoplasia/diagnóstico , Recurrencia Local de Neoplasia/economía , Recurrencia Local de Neoplasia/mortalidad , Cuidados Paliativos/economía , Satisfacción del Paciente , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/economía , Complicaciones Posoperatorias/mortalidad , Estudios Prospectivos , Estudios Retrospectivos , Tasa de SupervivenciaRESUMEN
From January 1, 1981 to January 1, 1992 a total of 30 liver abscesses were treated in the University Clinic for Surgery in Cologne. 23 patients underwent an primary operative treatment and seven patients received a controlled guided percutaneous drainage. During the observation period four patients (13.3%) died by the effect of the liver abscess. 20 patients (66.7%) were subjected to clinical, laboratorical and computertomographical post examinations. The primary rate of operation success amounted to 47.8%, that of controlled guided percutaneous drainage of 42.8% (NS). The secondary success rate (that means after successful operative reintervention) amounted to 86.9% by the operative and to 85.7% by the percutaneous drainaged cases. During the post examination no relapse was determinated. Larger or chambered liver abscesses as well as extrahepatic spreading required operative drainage and, in cases of multifocal spreading, a resection with concomitant antibiotics. In case of solitary abscesses the controlled guided percutaneous drainage is the least harmful and low-prices method.
Asunto(s)
Absceso Hepático/cirugía , Causas de Muerte , Drenaje , Femenino , Estudios de Seguimiento , Hepatectomía , Humanos , Absceso Hepático/mortalidad , Masculino , Persona de Mediana Edad , Insuficiencia Multiorgánica/mortalidad , Complicaciones Posoperatorias/mortalidad , Complicaciones Posoperatorias/cirugía , Reoperación , Tasa de SupervivenciaAsunto(s)
Carcinoma de Células Escamosas/cirugía , Neoplasias Esofágicas/cirugía , Instituciones Oncológicas , Carcinoma de Células Escamosas/tratamiento farmacológico , Carcinoma de Células Escamosas/patología , Carcinoma de Células Escamosas/radioterapia , Quimioterapia Adyuvante , Terapia Combinada , Neoplasias Esofágicas/tratamiento farmacológico , Neoplasias Esofágicas/patología , Neoplasias Esofágicas/radioterapia , Estudios de Seguimiento , Alemania , Humanos , Escisión del Ganglio Linfático , Estadificación de Neoplasias , Complicaciones Posoperatorias/mortalidad , Tasa de SupervivenciaRESUMEN
Retrospective analysis of 155 liver angiographies and the literature data was carried out to appraise the current relevance of liver angiography in digital subtraction technique (i.a. DSA) for diagnosis of focal liver changes. A focal liver lesion was detected by angiography in 58 out of the 80 patients (72.5%) we investigated with a confirmed hepatic space occupation; an angiography correlate of the tumour type diagnosed was shown in 41 out of 69 (59.4%) of malignancies confirmed by surgery or biopsy histology; in the benign lesions, the angiographic diagnosis was consistent with the histological result in five out of six cases. DSA is thus usually clearly inferior to the tomographic sonography, CT and MRI in detection and qualification of the tumour type. However, it is still indispensable for planning operations or chemoembolization and for exact imaging of the portal perfusion conditions because of the frequent vascular anomalies in the anatomy of the liver.
Asunto(s)
Adenoma de los Conductos Biliares/diagnóstico por imagen , Angiografía de Substracción Digital , Carcinoma Hepatocelular/diagnóstico por imagen , Hemangioma/diagnóstico por imagen , Neoplasias Hepáticas/diagnóstico por imagen , Adenoma de los Conductos Biliares/epidemiología , Adulto , Anciano , Carcinoma Hepatocelular/epidemiología , Femenino , Alemania/epidemiología , Hemangioma/epidemiología , Humanos , Neoplasias Hepáticas/epidemiología , Neoplasias Hepáticas/secundario , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Tomografía Computarizada por Rayos X , UltrasonografíaRESUMEN
During the past 10 years, postoperative mortality associated with resection of oesophageal carcinoma has been reduced from 30% to 11%. However, all efforts to improve longterm survival with extensive excisional procedures and adjuvant chemotherapy and radiotherapy have failed. Fifty-three of 100 patients presenting to the surgeon with an oesophageal carcinoma have resectable disease. Six of them will die from postoperative complications and 47 patients will be discharged from the hospital after an average of 3 weeks. Of these patients, 30 will survive the first, 17 th second, and 7 the fifth year. Although in may be possible to further reduce postoperative complications and mortality, the chances of improving the long-term prognosis of patients with oesophageal carcinoma seem small.
Asunto(s)
Neoplasias Esofágicas/cirugía , Complicaciones Posoperatorias/mortalidad , Neoplasias Esofágicas/mortalidad , Neoplasias Esofágicas/patología , Europa (Continente)/epidemiología , Estudios de Seguimiento , Humanos , Estadificación de Neoplasias , Sistema de Registros/estadística & datos numéricos , Tasa de SupervivenciaRESUMEN
At the department of surgery of the university of Cologne-Lindenthal, 184 patients (142 with squamous cell carcinoma of the esophagus, 42 with adenocarcinoma of the gastroesophageal junction) underwent blunt dissection of esophageal cancer between 1983 and 1991. Tumor expansion classified by the pathologist was stage I in 13.6%, stage II in 31.0%, stage III in 41.8%, and stage IV in 13.6% of all cases. Histological tumor differentiation was graded well in 4.3%, moderate in 71.7%, and poor in 19.6%. Principally a gastric tube was used for esophageal replacement (96.3%), while interposition of the large bowel was performed in 5 cases. All the patients were prospectively monitored for perioperative complications. 64.7% fared without any complications intraoperatively. The most frequent intraoperative complications were damage of the pleura parietalis (16.3%), rupture of the tumor during dissection (13.0%), and lesion of the spleen (11.4%). 29.9% of the patients had a postoperative course without any complications. Pleural effusion (38.6%) and insufficiency of the cervical anastomosis (22.8%) were the most frequent complications seen postoperatively. Hospital mortality amounted to 6.0%. Six months after the operation most patients deemed their quality of life satisfying or excellent, respectively. The cumulative survival rate (without hospital mortality) was 78.3% after the first year, 24.7% after the third year and 20.6% after the fifth year.
Asunto(s)
Adenocarcinoma/cirugía , Carcinoma de Células Escamosas/cirugía , Neoplasias Esofágicas/cirugía , Esófago/cirugía , Adenocarcinoma/mortalidad , Adenocarcinoma/patología , Adulto , Anciano , Anciano de 80 o más Años , Anastomosis Quirúrgica/métodos , Carcinoma de Células Escamosas/mortalidad , Carcinoma de Células Escamosas/patología , Cardias/patología , Cardias/cirugía , Neoplasias Esofágicas/mortalidad , Neoplasias Esofágicas/patología , Esófago/patología , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/mortalidad , Estudios Prospectivos , Neoplasias Gástricas/patología , Neoplasias Gástricas/cirugía , Tasa de Supervivencia , Técnicas de SuturaRESUMEN
Palliative surgery, including cleaning resection, colon or stomach bypass, intubation or fistula is all one can offer to the majority of patients suffering from oesophageal carcinoma due to an usually advanced tumor stage at the time of diagnosis. The primary goal is to prevent or resolve dysphagia. A prolongation of survival time can - with the exception of cleaning resection - not be expected by these procedures. The average survival time was 9.4 months after cleaning resection and 4.7 months after other palliative procedures in our series. If a cleaning resection is not possible, the endoscopic implantation of an endotube is the treatment of choice because of its low mortality and morbidity.
Asunto(s)
Adenocarcinoma/cirugía , Carcinoma de Células Escamosas/cirugía , Carcinoma/cirugía , Neoplasias Esofágicas/cirugía , Cuidados Paliativos , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana EdadRESUMEN
During the past 10 years, postoperative mortality associated with surgical treatment of oesophageal carcinoma has been reduced by one-half. However, it appears that all efforts to improve long-term survival with extensive excisional procedures and adjuvant chemotherapy and radiotherapy have failed. Fifty-six of 100 patients presenting to the surgeon with an oesophageal carcinoma have resectable disease. Recent studies suggest that seven of them will die from postoperative complications and 49 patients will be discharged from the hospital after an average of 3 weeks. Of these patients, 27 will survive the first, 12 the second, and ten the fifth year. Although it may be possible to further reduce postoperative complications and mortality, the chances of improving the long-term prognosis of patients with oesophageal carcinoma seem small.
Asunto(s)
Neoplasias Esofágicas/cirugía , Esófago/cirugía , Terapia Combinada , Neoplasias Esofágicas/mortalidad , Neoplasias Esofágicas/radioterapia , Humanos , Complicaciones Posoperatorias/etiologíaRESUMEN
Improvements in operative technique and perioperative management have lowered hospital mortality of esophageal resection at our department from 31% to 8% during the past decade. Cumulative 5-year-survival rate depending on the tumor stage only remained unchanged at 21%. Neither extended resection nor perioperative chemo- or radio-therapy show any advantage compared to conventional resection or blunt dissection regarding long-term survival.
Asunto(s)
Adenocarcinoma/cirugía , Carcinoma de Células Escamosas/cirugía , Neoplasias Esofágicas/cirugía , Esófago/cirugía , Estómago/cirugía , Adenocarcinoma/mortalidad , Carcinoma de Células Escamosas/mortalidad , Terapia Combinada , Neoplasias Esofágicas/mortalidad , Femenino , Humanos , Masculino , Tasa de Supervivencia , Factores de TiempoRESUMEN
In case of clear indication, the locking nail system brings about good results in the treatment of problematic long bone fractures. The indication for primary static locking should be defined in a wide manner. Early loading is possible and is applied by us more and more in not adipose patients with static locking, too. From our point of view, the following factors are some of the drawbacks of the system: bolt loosening due to different causes, the impractical aiming device for distal locking, problems with the lavage of the medullary cavity in case of infection, pains in the knee joint after transcondylar implantation of a Steinmann nail. In case of long bones with narrow medullary cavities (young women) for which the thinnest nail has to be used, slotted nails bear the risk of distortion.