RESUMO
Pulmonary resection of metastatic lesions from colorectal cancer was performed in 62 patients, and their cumulative 5-year and 10-year survival rates were 42% and 22%, respectively. The overall median survival was 24 months. The survival curve decrease even after 5 years after pulmonary resection; four of 13 patients who survived more than 5 years subsequently died of metastatic disease and only two patients survived more than 10 years. The number and size of the pulmonary metastases were significantly correlated with postthoracotomy survival. Solitary metastases less than 3.0 cm in diameter were good indicators of favorable postthoracotomy survival. There were no significant differences in survival based on Dukes' classification or location of the primary lesion. Sex, age, disease-free interval between the primary tumor and appearance of metastasis, and extent of pulmonary resection had no influence on survival. It is impossible to say from our experience that surgical resection of pulmonary metastases increased the cure rate. Presumably a good 5-year survival rate after thoracotomy would be a reflection of a length bias caused by the biologic behavior of the metastatic pulmonary lesions.
Assuntos
Neoplasias do Colo , Neoplasias Pulmonares/secundário , Neoplasias Retais , Neoplasias do Colo/mortalidade , Neoplasias do Colo/cirurgia , Seguimentos , Humanos , Japão , Neoplasias Pulmonares/mortalidade , Neoplasias Pulmonares/cirurgia , Metástase Linfática/cirurgia , Neoplasias do Mediastino/cirurgia , Neoplasias Retais/mortalidade , Neoplasias Retais/cirurgiaRESUMO
This retrospective study compared elective neck dissection with elective neck radiotherapy for the control of subclinical nodal metastases. Four hundred ninety-eight patients with head and neck primary cancers and no clinically apparent neck metastases on initial presentation comprised the study population. Each patient was followed up for at least 5 years to detect failure to control neck metastases and control of the primary tumor at the time of neck recurrence. Analysis of neck recurrences occurring in patients with control of the primary tumor showed that there was no statistically significant difference between elective radiation therapy to the neck and elective neck dissection for oral cavity, oropharyngeal, and laryngeal cancers. The only statistically significant difference was noted for hypopharyngeal cancers, with radiation therapy being more effective than surgery.
Assuntos
Carcinoma de Células Escamosas/secundário , Irradiação Linfática , Metástase Linfática/prevenção & controle , Esvaziamento Cervical , Carcinoma de Células Escamosas/radioterapia , Carcinoma de Células Escamosas/cirurgia , Seguimentos , Glote , Humanos , Neoplasias Hipofaríngeas , Neoplasias Laríngeas , Metástase Linfática/radioterapia , Metástase Linfática/cirurgia , Neoplasias Bucais , Pescoço , Recidiva Local de Neoplasia , Neoplasias Orofaríngeas , Dosagem Radioterapêutica , Estudos RetrospectivosRESUMO
The management of two groups of patients with papillary carcinoma of the thyroid gland (n = 165) was evaluated retrospectively. Total thyroidectomy was the standard procedure in both groups, but the peroperative diagnosis and treatment of metastases to the regional lymph nodes differed. In group 1 (n = 84), only clinically positive lymph nodes were resected, and if residual postoperative 131I uptake was found, an ablation dose of 131I was given. In group 2 (n = 81), all of the tissue in the tracheoesophageal groove was removed routinely at total thyroidectomy and frozen section was done of the lymph nodes lying along the internal jugular vein. If metastases were found, a modified radical dissection of the neck was performed on the affected side. The two patient groups were comparable with regard to risk factors--local tumor stage, age and sex. Almost twice as many patients were found to have metastases to the lymph nodes in group 2. There was no significant difference in the ten year over-all or recurrence free survival time between the two groups. In group 1, there were more recurrences on the explored side of the neck but fewer distant metastases; however, both findings were not significant. In group 2, significantly more instances of hypoparathyroidism and palsy of the accessory nerve were found (p less than 0.05). Thus, when a more extensive search was carried out, more metastases to the lymph node were discovered and treated, but this did not prevent recurrences in the neck nor did it improve survival time. This approach resulted in more postoperative morbidity. There seems to be no justification for prophylactic removal of regional lymph nodes in instances of papillary carcinoma of the thyroid gland, but modified radical neck dissection may be beneficial if clinically suspect regional lymph nodes are present in the lateral part of the neck.
Assuntos
Adenocarcinoma/patologia , Carcinoma Papilar/patologia , Metástase Linfática , Neoplasias da Glândula Tireoide/patologia , Adenocarcinoma/mortalidade , Adenocarcinoma/cirurgia , Adulto , Animais , Carcinoma Papilar/mortalidade , Carcinoma Papilar/cirurgia , Feminino , Seguimentos , Humanos , Hipotireoidismo/etiologia , Radioisótopos do Iodo/uso terapêutico , Metástase Linfática/diagnóstico , Metástase Linfática/cirurgia , Masculino , Camundongos , Pessoa de Meia-Idade , Pescoço , Esvaziamento Cervical/efeitos adversos , Recidiva Local de Neoplasia/mortalidade , Recidiva Local de Neoplasia/cirurgia , Estudos Retrospectivos , Fatores de Risco , Neoplasias da Glândula Tireoide/mortalidade , Neoplasias da Glândula Tireoide/cirurgia , TireoidectomiaRESUMO
In connection with the mammary tumor of a 41-year-old woman the authors draw attention to the rare occurrence of malignant fibrous histiocytoma in the mamma. The histology of the mammary malignant fibrous histiocytoma, role of immunohistochemical reactions in the diagnosis are described. The literature dealing with the malignant fibrous histiocytoma in the mamma is reviewed. This is the 11th case reported in the literature. The authors discuss the possibilities of the therapy of the malignant fibrous histiocytoma in the mamma.
Assuntos
Neoplasias da Mama/cirurgia , Carcinoma Intraductal não Infiltrante/cirurgia , Histiocitoma Fibroso Benigno/cirurgia , Neoplasias Primárias Múltiplas/cirurgia , Adulto , Neoplasias da Mama/patologia , Carcinoma Intraductal não Infiltrante/patologia , Histiocitoma Fibroso Benigno/patologia , Humanos , Excisão de Linfonodo , Metástase Linfática/cirurgia , Masculino , Mastectomia , Neoplasias Primárias Múltiplas/patologiaRESUMO
To determine the extent of lymphadenectomy necessary to cure early gastric cancer, the relationship between the frequency of nodal involvements and the extent of the primary invasion was examined in 274 patients with primary cancer of the stomach. We also evaluated the relationship between the number of metastatic lymph nodes, the pattern of metastases to the nodes, and the histologic type of the primary tumor. In early gastric cancer, lymph node metastasis was more frequent in protruded-type cancer with invasion into the submucosa more than 3 cm in diameter and located in the lower third of the stomach, but was limited to the group 1 lymph nodes, which were defined as being anatomically located nearest to the cancer. In cancer invading into the muscularis propria, metastasis to the group 2 or 3 lymph nodes, which were defined as being anatomically located farther from the cancer than group 1, was found. The number of lymph nodes involved and extent of cancer metastasis in these lymph nodes metastasis, differentiated early gastric cancer had more lymph node involvement and wider extent of metastases than undifferentiated cancers. The cancer cells sometimes replaced most of the node and invaded the perinodal fatty tissue, even in early gastric cancer. In addition, it is occasionally difficult to distinguish macroscopically early gastric cancer with submucosal invasion from cancer invaded into the muscle layer. In conclusion, group 1 and 2 lymph nodes, including perinodal fatty tissue, should be removed completely, even in early gastric cancer, except for carcinoma in situ, particularly when the cancer is of the differentiated type.
Assuntos
Adenocarcinoma Papilar/cirurgia , Adenocarcinoma/cirurgia , Excisão de Linfonodo/métodos , Metástase Linfática/cirurgia , Neoplasias Gástricas/cirurgia , Adenocarcinoma/patologia , Adenocarcinoma Papilar/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Avaliação como Assunto , Feminino , Gastrectomia , Humanos , Masculino , Pessoa de Meia-Idade , Invasividade Neoplásica , Inoculação de Neoplasia , Estadiamento de Neoplasias , Neoplasias Gástricas/patologiaRESUMO
Since the majority of colorectal cancers are well differentiated adenocarcinomas and grow rather slowly and well limited, surgery is the most available and favored treatment. The cancer-related 5-year survival rates of patients having undergone an extended operation versus those undergoing the conventional operation in our hospital (1969-1983) were 86% and 70% for Dukes B stage, and 60% and 38% for Dukes C stage. The survival superiority of the extended operation was confirmed as statistically significant (p less than 0.05). However, this survival advantage not true for patients with lateral lymphnode metastasis. A more extended operation with lateral dissection cutting the iliac internal vessels was performed for patients suspected of having lateral metastasis. Reduction of the incidence of local recurrence is really observed by this procedure. Urine-voiding and sexual dysfunction were observed more frequently in patients with the extended operation than the conventional one. By selectively preserving only 4th pelvic nerve, it becomes possible to preserve the urine voiding function without losing the benefits of the extended operation. In cases of far advanced cancer invading to adjacent organs, value of combined resection was also confirmed. Metastatic lesions to the liver or the lung should be removed by enucleation or partial resection of these organs, unless a multiple case. The 5-year survival of patients were 35% for liver metastasis and 40% for pulmonary metastasis.
Assuntos
Neoplasias Colorretais/cirurgia , Humanos , Neoplasias Hepáticas/secundário , Neoplasias Hepáticas/cirurgia , Neoplasias Pulmonares/secundário , Neoplasias Pulmonares/cirurgia , Metástase Linfática/cirurgia , Complicações Pós-Operatórias , PrognósticoRESUMO
The extent of lymph node dissection necessary to optimize survival and minimize local recurrence in patients with melanoma of the trunk or lower extremity is not well defined. We reviewed the records of 420 patients undergoing superficial or combined superficial and deep groin dissection for melanoma. Prognosis depended on the extent of lymph node involvement rather than the extent of surgery performed. Node-positive patients undergoing elective lymph node dissection had an improved survival over those undergoing therapeutic lymph node dissection. In no subgroup of patients was more extensive lymphadenectomy associated with significant improvement in survival or alteration in pattern of recurrence. Dissection of the deep pelvic nodes in patients with melanoma appears to be of more prognostic than therapeutic value.
Assuntos
Extremidades , Excisão de Linfonodo , Melanoma/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Virilha , Humanos , Excisão de Linfonodo/métodos , Metástase Linfática/patologia , Metástase Linfática/cirurgia , Masculino , Melanoma/mortalidade , Melanoma/patologia , Pessoa de Meia-Idade , Recidiva Local de Neoplasia , Cuidados PaliativosAssuntos
Adenocarcinoma/cirurgia , Carcinoma de Células Escamosas/cirurgia , Neoplasias Pulmonares/cirurgia , Excisão de Linfonodo/métodos , Metástase Linfática/cirurgia , Adenocarcinoma/patologia , Carcinoma de Células Escamosas/patologia , Humanos , Neoplasias Pulmonares/patologia , Mediastino , Estadiamento de NeoplasiasRESUMO
The aim of this study was to evaluate the independent influence of clinical and pathological variables on survival of patients with gastric carcinoma using the Cox regression proportional hazard model. Of 156 patients operated on for gastric carcinoma, 46 (29.5%) underwent palliative operation, 24 (15.5%) had a palliative resection, and 86 (55%) had a curative resection. The overall 5-year survival rate was 25 +/- 4%. After curative resection, the 5-year survival rate was 44 +/- 6%. Univariate analysis applied to these patients showed that poor survival was related (p less than 0.01) to: age (over 80 years), absence of epigastric pain, vomiting and dysphagia, total gastrectomy, tumor size (more than 4 cm), lymph node involvement (LNI), invasion through the muscularis propria, absence of intestinal metaplasia near the tumor, and linitis plastica. In multivariate analysis, lymph node involvement was found to be the only independent prognostic factor. The 5-year survival rate was 75.5 +/- 8% without LNI, 28 +/- 10% with proximal LNI, and 7 +/- 6% with distal LNI. Our results suggest that classification into 3 LNI groups is the best staging system for curative resection in gastric carcinoma.
Assuntos
Adenocarcinoma/cirurgia , Carcinoma/cirurgia , Metástase Linfática/cirurgia , Neoplasias Gástricas/cirurgia , Adenocarcinoma/mortalidade , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma/mortalidade , Feminino , Humanos , Metástase Linfática/mortalidade , Masculino , Pessoa de Meia-Idade , Cuidados Paliativos , Prognóstico , Estatística como Assunto , Neoplasias Gástricas/mortalidadeRESUMO
Axillary lymph node status remains the single most useful prognostic parameter in breast cancer patients. As clinical examination, imaging techniques, and lymph node sampling methods cannot accurately assess the axillary node involvement, a complete axillary dissection should always be performed. Moreover, this technique provides an excellent treatment modality for regional disease, abolishing the need for radiotherapy to the axilla. The status of the internal mammary lymph nodes is of less importance in the management of the breast cancer patient.
Assuntos
Neoplasias da Mama/diagnóstico , Metástase Linfática/diagnóstico , Axila , Diagnóstico por Imagem , Feminino , Humanos , Excisão de Linfonodo , Linfonodos/análise , Linfonodos/patologia , Linfonodos/cirurgia , Metástase Linfática/patologia , Metástase Linfática/cirurgia , Prognóstico , Receptores de Estrogênio/análiseRESUMO
Completeness of regional lymph node dissection was controlled in 23 patients with melanoma malignum. For that purpose 3--6 weeks after block-dissection lymph node scintigraphy was performed, by administration of intercostal and interdigital radiopharmacutical. Blockdissection was considered as complete, when neither after intercostal, nor after interdigital administration, any lymph nodes were delineated. On the basis of investigations until now, postoperative lymph node scintigraphy proves to be suitable, held to be a non-invasive method for controlling completeness of blockdissection.
Assuntos
Metástase Linfática/cirurgia , Melanoma/cirurgia , Adulto , Idoso , Feminino , Seguimentos , Humanos , Excisão de Linfonodo , Linfonodos/diagnóstico por imagem , Linfonodos/patologia , Metástase Linfática/diagnóstico por imagem , Metástase Linfática/patologia , Masculino , Melanoma/patologia , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Cuidados Pós-Operatórios , CintilografiaAssuntos
Adenocarcinoma/cirurgia , Carcinoma Papilar/cirurgia , Excisão de Linfonodo , Esvaziamento Cervical/métodos , Neoplasias da Glândula Tireoide/cirurgia , Adenocarcinoma/patologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma Papilar/patologia , Criança , Feminino , Humanos , Metástase Linfática/cirurgia , Masculino , Pessoa de Meia-Idade , Neoplasias da Glândula Tireoide/patologiaRESUMO
The management of differentiated thyroid cancer in childhood is controversial. In particular, the role of aggressive surgical treatment has been questioned. This study was performed to identify those factors that are predictive of recurrence and morbidity following treatment through use of a multivariate model. The records of all patients 17 years of age or less admitted in the last 35 years with histologically confirmed differentiated thyroid carcinoma were reviewed. Data were sufficient for multivariate analysis in 93. The mean age at diagnosis was 13.3 years, and the median period of follow-up was 20 years. Seventy-one percent of the patients had nodal metastases. There were no deaths from thyroid carcinoma in this series, and the overall recurrence rate after initial treatment was 34%. Multivariate analysis demonstrated that only age (p less than or equal to 0.07) and histologic subtype (p less than or equal to 0.01) were predictive of time to recurrence. Major morbidity was a function of age (p less than or equal to 0.007) and extent of thyroid surgery (p less than or equal to 0.01). Probability of minor complications was predicted by use of radical neck dissection (p less than or equal to 0.02). Use of total or subtotal thyroidectomy or of radical neck dissection in children does not prevent recurrence and is associated with an increased risk of complications. We conclude that these procedures should be avoided in pediatric patients.
Assuntos
Carcinoma/cirurgia , Neoplasias da Glândula Tireoide/cirurgia , Adolescente , Carcinoma/mortalidade , Criança , Feminino , Humanos , Metástase Linfática/cirurgia , Masculino , Modelos Teóricos , Recidiva Local de Neoplasia , Complicações Pós-Operatórias , Estudos Retrospectivos , Estatística como Assunto , Glândula Tireoide/cirurgia , Neoplasias da Glândula Tireoide/mortalidade , TireoidectomiaAssuntos
Neoplasias da Mama , Metástase Linfática/cirurgia , Idoso , Axila , Neoplasias da Mama/mortalidade , Feminino , Humanos , Pessoa de Meia-Idade , PrognósticoRESUMO
The controversy surrounding the management of patients with invasive carcinoma of the penis and clinically negative nodes is discussed. The rationale, technique and preliminary results of a modified inguinal lymphadenectomy in which the lateral and caudal extents of nodal excision are reduced, and the saphenous veins are preserved also are presented. This modified lymphadenectomy has been performed in 6 patients with invasive carcinoma of the penis or distal urethra without major or troublesome complications.
Assuntos
Carcinoma de Células Escamosas/cirurgia , Excisão de Linfonodo/métodos , Neoplasias Penianas/cirurgia , Neoplasias Uretrais/cirurgia , Carcinoma de Células Escamosas/secundário , Feminino , Humanos , Excisão de Linfonodo/efeitos adversos , Metástase Linfática/cirurgia , MasculinoRESUMO
Fifteen patients with esophageal carcinoma received the photosensitizing dye Eosin Yellow (10 mg/kg) intravenously prior to surgery, and their para-esophageal lymph nodes were then examined for fluorescence using a laser beam at the time of operation. When the time interval between the injection of Eosin Yellow and the operation was 48 hours, 21 out of 22 (95.4 per cent) metastatic lymph nodes exhibited fluorescence and 25 out of 26 (96.2 per cent) non-metastatic lymph nodes did not exhibit fluorescence. This method proved to be invaluable for detecting metastatic lymph nodes macroscopically at the time of surgery for esophageal carcinoma.
Assuntos
Amarelo de Eosina-(YS) , Neoplasias Esofágicas/cirurgia , Fluorescência , Lasers , Metástase Linfática/diagnóstico , Idoso , Carcinoma de Células Escamosas/diagnóstico , Carcinoma de Células Escamosas/cirurgia , Amarelo de Eosina-(YS)/administração & dosagem , Feminino , Humanos , Injeções Intravenosas , Excisão de Linfonodo , Metástase Linfática/cirurgia , Masculino , Pessoa de Meia-IdadeRESUMO
Extended-field irradiation was administered after radical surgery to 76 patients with nodal metastases from cervical carcinoma Stages IB (37 patients), IIA (six patients), IIB (29 patients), and IIIB (four patients). The first recurrent sites of disease were distant organs via hematogenous routes of 12 patients and in the pelvic fields of eight patients. The 5-year disease-free survival rates were 95% for 27 patients with one positive node, 64% for 37 patients with multiple positive nodes, and 44% for 12 patients with unresectable nodes; 72% in total. Poor disease-free survival rates were associated with Stage IIB (60%), more than 30 mm invasion depths (44%), small cell cancer (0%), adenocarcinoma (57%), adenosquamous carcinoma (50%), and premenopause (60%). In 52 patients with nonkeratinizing large cell carcinoma, the disease-free survival rates were significantly different between Stage IB and IIB (87% versus 47%, P less than 0.05). This dissimilarity was caused by significant differences between Stage IB and IIB patients with less than 30 mm invasion depths (90% versus 53%, P less than 0.05), with parametrial extension (100% versus 39%, P less than 0.005), and with unresectable nodes (100% versus 0%, P less than 0.05). These results indicate that postoperative extended-field irradiation can control distant spread via lymphatic routes with significant improvement of patient survival, and that the number of positive nodes, tumor cell types, depth of tumor invasion, and clinical stages are important prognostic factors subsequent to this combined therapy.
Assuntos
Metástase Linfática/radioterapia , Radioterapia de Alta Energia , Neoplasias do Colo do Útero/patologia , Adulto , Idoso , Terapia Combinada , Estudos de Avaliação como Assunto , Feminino , Humanos , Histerectomia , Excisão de Linfonodo , Metástase Linfática/cirurgia , Pessoa de Meia-Idade , Recidiva Local de Neoplasia , Prognóstico , Neoplasias do Colo do Útero/radioterapia , Neoplasias do Colo do Útero/cirurgiaRESUMO
Computed tomography (CT) and mediastinoscopy were compared in 151 patients with bronchogenic carcinoma. In all patients in whom findings at mediastinoscopy were negative, all accessible nodes were either removed or sampled at thoracotomy. Several size criteria for identifying nodes as enlarged on CT scans were compared. The long axis greater than or equal to 15 mm and short axis greater than 10 mm had very low sensitivity (61%), and the long axis greater than 5 mm had a low specificity (23%). CT (long axis greater than 10 mm) allowed sensitivity equal to that of mediastinoscopy (79%) in the detection of mediastinal metastases, but the specificity with CT was lower (65% vs. 100%). In seven of 44 patients with nodes greater than 10 mm on CT scans and with positive findings at mediastinoscopy, tumor was present not in the enlarged nodes but rather in normal-sized nodes in a different nodal station. The sensitivity of CT for actual nodal stations involved with tumor was only 66%. Eighty-three percent of patients with false-negative findings at mediastinoscopy but only 33% of patients with false-negative findings at CT had surgically resectable stage IIIa disease.
Assuntos
Carcinoma Broncogênico/diagnóstico por imagem , Neoplasias Pulmonares , Metástase Linfática/diagnóstico por imagem , Mediastinoscopia , Mediastino , Tomografia Computadorizada por Raios X , Carcinoma Broncogênico/patologia , Carcinoma Broncogênico/secundário , Carcinoma Broncogênico/cirurgia , Reações Falso-Negativas , Humanos , Metástase Linfática/patologia , Metástase Linfática/cirurgia , Mediastino/diagnóstico por imagem , Estadiamento de NeoplasiasRESUMO
From 1978 through August 1986, 32 patients with lymph node metastases of the neck and unknown primary tumor were treated at the Radiotherapeutic Hospital of the University Erlangen-Nürnberg. Most of the cases were large metastases from squamous cell carcinomas or anaplastic carcinomas. The patients were treated by surgery and postsurgical radiotherapy or radiotherapy alone. In nearly all patients the target volume comprised both sides of the neck including the median structures as well as the base of the tongue and the nasopharynx. A dose of at least 50 Gy was aimed at, which was given within five weeks by individual doses of 2 Gy each. The survival at three years is 70% and at five years 52%. Out of twenty patients irradiated with more than 50 Gy following lymph node extirpation or radical excision of the lymph nodes of the neck, sixteen are tumor-free. The five year survival of this group is 80%. The results of radiotherapy alone are unsatisfactory, because only two out of nine patients are alive with follow-up periods of less than one year. Two primary tumors were found after the end of treatment. Both were situated within the ORL areas beyond the ancient irradiation fields, and both were developed by patients who at first had only been treated by local irradiation. Half of the patients with lymph node metastases of the neck and unknown primary tumors can be cured by complete tumor excision and postsurgical irradiation. The target volume of radiotherapy comprises both sides of the lymph drainage area of the neck as well as the mucous membranes of the ORL region including nasopharynx and base of the tongue. The dose is at least 50 Gy which is given after surgery with conventional fractionation.