241 research outputs found
Perioperative PET/CT lymphoscintigraphy and fluorescent real-time imaging for sentinel lymph node mapping in early staged colon cancer
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Losses of chromosomes 1p and 3q are early genetic events in the development of sporadic pheochromocytomas
Despite several loss of heterozygosity studies, a comprehensive genomic
survey of pheochromocytomas is still lacking. To identify DNA copy number
changes which might be important in tumor development and progression and
which may have diagnostic utility, we evaluated genetic aberrations in 29
sporadic adrenal and extra-adrenal pheochromocytomas (19 clinically benign
tumors and 10 malignant lesions). Comparative genomic hybridization was
performed using directly fluorochrome-conjugated DNA extracted from frozen
(16) and paraffin-embedded (13) tumor tissues. The most frequently
observed changes were losses of chromosomes 1p11-p32 (86%), 3q (52%), 6q
(34%), 3p, 17p (31% each), 11q (28%), and gains of chromosomes 9q (38%)
and 17q (31%). No amplification was identified and no difference between
adrenal and extra-adrenal tumors was detected. Progression to malignant
tumors was strongly associated with deletions of chromosome 6q (60% versus
21% in clinically benign lesions, P = 0.0368) and 17p (50% versus 21%).
Fluorescence in situ hybridization confirmed the comparative genomic
hybridization data of chromosomes 1p, 3q, and 6q, and revealed aneuploidy
in some tumors. Our results suggest that the development of
pheochromocytomas is associated with specific genomic aberrations, such as
losses of 1p, 3q, and 6q and gains of 9q and 17q. In particular, tumor
suppressor genes on chromosomes 1p and 3q may be involved in early
tumorigenesis, and deletions of chromosomes 6q and 17p in progression to
malignancy
The relevance of reducing Veress needle overshooting
Safe insertion of the Veress needle during laparoscopy relies on the surgeons’ technical skills in order
to stop needle insertion just in time to prevent overshooting in the underlying organs. To reduce this
risk, a wide variety of Veress needle systems were developed with safety mechanisms that limit the
insertion speed, insertion depth or decouple the driving force generated by the surgeon’s hand on
the needle. The aim of this study is to evaluate current surgeons’ perceptions related to the use of
Veress needles and to investigate the relevance of preventing overshooting of Veress needles among
members of the European Association of Endoscopic Surgery (EAES). An online survey was distributed
by the EAES Executive Office to all active members. The survey consisted of demographic data and
14 questions regarding the use of the Veress needle, the training conducted prior to usage, and the
need for any improvement. A total of 365 members residing in 58 different countries responded the
survey. Of the responding surgeons, 36% prefer the open method for patients with normal body mass
index (BMI), and 22% for patients with high BMI. Of the surgeons using Veress needle, 68% indicated
that the reduction of overshoot is beneficial in normal BMI patients, whereas 78% indicated that this
is beneficial in high BMI patients. On average, the members using the Veress needle had used it for
1448 (SD 3031) times and felt comfortable on using it after 22,9 (SD 78,9) times. The average years
of experience was 17,6 (SD 11,1) and the surgeons think that a maximum overshoot of 9.4 (SD 5.5)
mm is acceptable before they can safely use the Veress needle. This survey indicates that despite the
risks, Veress needles are still being used by the majority of the laparoscopic surgeons who responded.
In addition, the surgeons responded that they were interested in using a Veress needle with an extra
safety mechanism if it limits the risk of overshooting into the underlying structures.peer-reviewe
The surgical stress response and postoperative immune function after laparoscopic or conventional total mesorectal excision in rectal cancer: a randomized trial
Ten-year outcomes of a randomised trial of laparoscopic versus open surgery for colon cancer
Background: Laparoscopic surgery for colon cancer is associated with improved recovery and similar cancer outcomes at 3 and 5 years in comparison with open surgery. However, long-term survival rates have rarely been reported. Here, we present survival and recurrence rates of the Dutch patients included in the COlon cancer Laparoscopic or Open Resection (COLOR) trial at 10-year follow-up.
Methods: Between March 1997 and March 2003, patients with non-metastatic colon cancer were recruited by 29 hospitals in eight countries and randomised to either laparoscopic or open surgery. Main inclusion criterion for the COLOR trial was solitary adenocarcinoma of the left or right colon. The primary outcome was disease-free survival at 3 years, and secondary outcomes included overall survival and recurrence. The 10-year follow-up data of all Dutch patients were collected. Analysis was by intention-to-treat. The trial was registered at ClinicalTrials.gov (NCT00387842).
Results: In total, 1248 patients were randomised, of which 329 were Dutch. Fifty-eight Dutch patients were excluded and 15 were lost to follow-up, leaving 256 patients for 10-year analysis. Median follow-up was 112 months. Disease-free survival rates were 45.2 % in the laparoscopic group and 43.2 % in the open group (difference 2.0 %; 95 % confidence interval (CI) −10.3 to 14.3; p = 0.96). Overall survival rates were 48.4 and 46.7 %, respectively (difference 1.7 %; 95 % CI −10.6 to 14.0; p = 0.83). Stage-specific analysis revealed similar survival rates for both groups. Sixty-two patients were diagnosed with recurrent disease, accounting for 29.4 % in the laparoscopic group and 28.2 % in the open group (difference 1.2 %; 95 % CI −11.1 to 13.5; p = 0.73). Seven patients had port- or wound-site recurrences (laparoscopic n
Laparoscopic versus open left lateral segmentectomy
<p>Abstract</p> <p>Background</p> <p>Laparoscopic liver surgery is becoming increasingly common. This cohort study was designed to directly compare perioperative outcomes of the left lateral segmentectomy via laparoscopic and open approach.</p> <p>Methods</p> <p>Between 2002 and 2006 43 left lateral segmentectomies were performed at King's College Hospital. Those excluded from analysis included previous liver resections, polycystic liver disease, liver cirrhosis and synchronous operations. Of 20 patients analysed, laparoscopic (n = 10) were compared with open left lateral segmentectomy (n = 10). Both groups had similar patient characteristics.</p> <p>Results</p> <p>Morbidity rates were similar with no wound or chest infection in either group. The conversion rate was 10% (1/10). There was no difference in operating time between the groups (median time 220 minutes versus 179 minutes, p = 0.315). Surgical margins for all lesions were clear. Less postoperative opiate analgesics were required in the laparoscopic group (median 2 days versus 5 days, p = 0.005). The median postoperative in-hospital stay was less in the laparoscopic group (6 days vs 9 days, p = 0.005). There was no mortality.</p> <p>Conclusion</p> <p>Laparoscopic left lateral segmentectomy is safe and feasible. Laparoscopic patients may benefit from requiring less postoperative opiate analgesia and a shorter post-operative in-hospital stay.</p
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