PET probe-guided surgery: applications and clinical protocol

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Locoregional recurrence (non hepatic abdominal recurrence) of rectal cancer.

Thirty percent of deaths are related to locoreional recurrence. All patients with nonhepatic abdominal recurrence (NHAR) were considered as having locoregional failure. The aims of this study are firstly to retrospectively evaluate the results of potentially curative resection and palliative treatment modalities for a group of 25 patients with NHAR from rectal cancer. The second aim is to determine the effectiveness of R1 resection in these patients in terms of survival. In this study we have followed 25 patients with NHAR of which 10 were able to undergo potentially curative salvage resection, whilst the remaining 15 had either a palliative (R2) or no resection. The goals of treatment for recurrent rectal cancer are palliation of symptoms, a good quality of life, and if possible, cure with a low rate of treatment--related complications. Indications for salvage surgery depend on several factors including the extent of disease, the presence of concomitant illness and the surgeons experience. Systemic disease, systemic disease with peritoneal implants, multiple hepatic metastases, or extensive pelvic involvement preclude surgical treatment for cure. Curative and noncurative surgical procedures were performed width acceptable complications in the series presented hereThe mean survival for the group undergoing R0 resection was 50 months versus 55 months for the group undergoing R1 resection (not significant). Mean survival were 7,3 and 6 months in the groups undergoing R2, NR and NS respectively. The 5-year survival for the 10 patients who had potentially curative resection was 30 per cent versus 0 per cent for 15 patients who had non-curative procedures (p = 0.001). There was 1 post-operative 30 day mortality in the series of 19 patients who underwent surgery. Five patients (6 per cent) developed one or more post-operative complications. Two of them required reoperation

Does the administration route of leucovorin have any influence on the impairment of colonic healing caused by intraperitoneal 5-fluorouracil treatment?

Intraperitoneal chemotherapy with li-fluorouracil (5-FU) is a new, promising alternative in adjuvant treatment of advanced colorectal cancer. Leucovorin (LV), a biomodulator of 5-FU, potentiates the antineoplastic effect of 5-FU. The aim of this study was to determine whether the administration routes of LV had any influence on the impairment of colonic healing caused by intraperitoneal 5-FU treatment. 48 male Wistar rats were subjected to left colonic resection and anastomosis, and randomized to 1 of 4 groups: control group (receiving intraperitoneal NaCl, intravenous NaCl); ipFU group (receiving intraperitoneal 5-FU, intravenous NaCl); ipFU+ivLV group (receiving intraperitoneal 5-FU, intravenous LV), and ipFU+LV group (receiving intraperitoneal 5-FU+LV, intravenous NaCl). Treatment was started after surgery and continued for 5 days with daily injections. The animals were sacrificed on the 7th day postoperatively. Anastomotic complications were more common in the ipFU, ipFU+ivLV, and ipFU+LV groups (p < 0.05) compared to the control group. The anastomotic breaking strength was significantly reduced in the ipFU, ipFU+ivLV, ipFU+LV groups (p < 0.05) than in the control group, but it did not differ between the ipFU, ipFU+ivLV, and ipFU+LV groups. The hydroxyproline content of the anastomotic segment was also significantly reduced in the ipFU, ipFU+ivLV and ipFU+LV groups (p < 0.05) compared to the control group. However, there was no difference between the anastomotic hydroxyproline content of the ipFU, ipFU+ivLV, and ipFU+LV groups. In this experiment, colonic healing was impaired after intraperitoneal 5-FU administration as judged by the higher rates of anastomotic complications, reductions in anastomotic breaking strength and hydroxyproline content; but LV administration either intravenously or intraperitoneally did not cause further deterioration in colonic healing. Copyright (C) 2001 S. Karger AG, Baser

Early reoperations in rectal cancer

Retrospective review of 76 rectal cancer operations performed in our Colorectal Unit during an 8-year period revealed that ten (13%) patients required relaporotomy because of postoperative early complications at the same hospitilization. There was no mortality due to reoperations. The indications of reoperations were anastomotic leak in three cases, hemorrhage in three cases, intestinal adhesions in three cases and abdominal wound dehiscence in one case. Out often reoperated cases, only three had preoperative radiotherapy. There were no significant difference between the irradiated and non-irradiated groups in terms of the incidence of early reoperation. This study revealed that preoperative radiotherapy did not cause an important increase in morbidity or mortality in rectal cancer

Cytoreductive approach to peritoneal carcinomatosis

Purpose: To present our clinical experience on the combined (surgicochemotherapeutic) treatment of peritoneal carcinomatosis. Patients and methods: Thirteen patients (six men and 7 women) with a mean age of 53 years (range 23-75) with peritoneal carcinomatosis (11 colorectal carcinoma, 1 ovarian carcinoma, and 1 malignant peritoneal mesothelioma) were treated with a cytoreductive approach (CRA) that consisted of cytoreductive surgery (CRS), early postoperative intraperitoneal chemotherapy (IPCT), and late systemic chemotherapy. CRS aimed at removing all visible disease. Patients with colorectal and ovarian cancer received IPCT with mitomycin-C 10 mg/m2 (postop. day 1). On postop, days 2-5, 5-fluorouracil (5-FU) 15 mg/kg/day was administered. The patient with mesothelioma received IPCT with adriamycin 0.1 mg/kg/day on postop, days 1-5. Late systemic chemotherapy with 5-FU 450 mg/m2/day and leucovorin 20 mg/m2/day for 5 consecutive days every 3 weeks and for a total of 6 cycles, was administered to all patients. Results: No major complications were encountered in 9 (69%) patients. In 10 (77%) patients complete removal of all visible disease was achieved. The mean survival of all patients was 17 months. Four patients are still alive with no evidence of disease for a mean survival time of 27+ months. Conclusion: The results in our small series indicate that the CRA seems to have some noticeable beneficial effects for patients with peritoneal carcinomatosis

PRINCIPAL CAUSES OF MECHANICAL BOWEL OBSTRUCTION IN SURGICALLY TREATED ADULTS IN WESTERN TURKEY

A retrospective study of the principal causes of mechanical bowel obstruction occurring in Western Turkey between 1979 and 1989 was undertaken. The records of 14777 operations performed in the general surgery departments of two hospitals were reviewed. Mechanical bowel obstruction occurred in 582 patients. Among the causes of mechanical bowel obstruction, adhesions were most common (44.0 per cent), followed by strangulated hernia (23.9 per cent), volvuli (12.7 per cent) and colonic carcinomas (10.1 per cent). A previous appendicectomy appeared to be the most important cause of adhesions causing mechanical bowel obstruction

Potentially curative resection for locoregional recurrence of colorectal cancer

Purpose. Local recurrence after curative surgery for colorectal cancer may be treated by potentially curative surgery, defined as resection of all macroscopic disease. We conducted this retrospective study to show the effectiveness of potentially curative resection for patients with locoregional recurrence (LRR)

An unusual mesenteric paraganglioma producing human chorionic gonadotropin

Adrenal and extra-adrenal paragangliomas are uncommon neoplasms arising from the parenchymal cells of paraganglia. The presenting symptoms are mostly due to excess catecholamine secretion. Extra-adrenal paragangliomas are mostly localized in the superior para-aortic region of the abdomen. Mesenteric paragangliomas are very rare. We report an unusual case of mesenteric paraganglioma producing human chorionic gonadotropin (hCG). To the best of our knowledge, this is the first case report describing hCG secretion in an extra-adrenal paraganglioma

Does early postoperative intraperitoneal chemotherapy increase the operative morbidity in colon cancer surgery?

The combination chemotherapy (CT) of immediate postoperative intraperitoneal (IP) administration of 5-fluorouracil (5FU) plus systemic 5FU and levamisole as a means to prevent locoregional recurrences following surgery is a logical adjuvant treatment of patients with curatively resectable colonic cancers. Although it has been reported that this combined locoregional and systemic treatment schedule was well tolerated, there is relatively little available experience demostrating the operative morbidity with IPCT in treatment of colon cancer. The authors presented their clinical experience about operative complications in the small patient population for whom IPCT should be considered appropriate. Intestinal obstruction due to adhesions and low-grade peritonitis were common in these cases and resulted with apparent increase in the operative morbidity when compared to non-IPCT-treated colon cancer patients