Abstract:
BACKGROUND:Hepatectomy for colorectal liver metastases (CRLM) may offer good long-term survival. The impact of the tumor-free surgical margin on long-term results remains controversial, and we have assessed this component in 185 patients. METHODS:Between 1992 and 2005, 185 patients underwent primary hepatectomy with curative intent for CRLM (which originated from colon/rectum 133/52, synchronous/metachronous 66/119, and single/multiple 100/85). In this study, 105 major and 80 minor hepatectomies were evaluated; 133 hepatectomies had pedicle clamping. RESULTS:Operative mortality was 1.1%, morbidity was 25.7%, and blood transfusion requirement was 27.6%. Stratification of tumor-free margin in the patients with R0 liver resection was greater than or equal to 10 mm (63.0% of patients), 6-9 mm (11.4% of patients), 3-5 mm (16.5% of patients), and less than or equal to 2 mm (9.1% of patients), with infiltrated margin in the remainder (R1 liver resection 4.9% of the total number of patients). The 3-year, 5-year, and 10-year survival rates were 54.9%, 37.9%, and 22.9%, respectively. Global and surgical margin recurrence rates increased as the tumor-free margin decreased (P = .01 and P < .001, respectively). At univariate analysis, the width of surgical margin (P < .001), transfusion requirement, major hepatectomy, R1 resection, number of metastases, high preoperative CEA, and increasing tumor size (P value from .001 to .03) were associated with lesser rates of long-term survival. A similar association was found with disease-free survival. At multivariate analysis, width of surgical margin was the only independent predictor of both overall (P = .003) and disease-free (P < .001) survival. Although smaller margins were associated with synchronicity, increasing number of, and with bilobar distribution of, metastases which contributed to explain recurrences away from the margin), the width of surgical margin maintained the prominent impact on outcome. CONCLUSIONS:In our patients, the width of the surgical margin was a powerful prognostic factor after hepatectomy for CRLM. A resection margin less than or equal to 5 mm was associated with a greater risk of recurrence on the surgical margin, with a lesser rate of overall and disease-free survival.
journal_name
Surgeryjournal_title
Surgeryauthors
Nuzzo G,Giuliante F,Ardito F,Vellone M,Giovannini I,Federico B,Vecchio FMdoi
10.1016/j.surg.2007.09.038subject
Has Abstractpub_date
2008-03-01 00:00:00pages
384-93issue
3eissn
0039-6060issn
1532-7361pii
S0039-6060(07)00635-6journal_volume
143pub_type
杂志文章相关文献
SURGERY文献大全abstract::During the 24-year period from 1956 to 1980, 148 patients with aneurysms confined to the thoracic aortic segment, bounded above by the left subclavian artery and below the diaphragm, were treated with replacement therapy. From 1956 to 1967, 36 patients were treated by use of temporary bypass or shunts which carried a ...
journal_title:Surgery
pub_type: 杂志文章
doi:
更新日期:1981-01-01 00:00:00
abstract::Intracellular pH provides an important measure of the adequacy of local tissue perfusion. The purpose of this study was to measure regional intracellular myocardial pH (impH) in the ischemic zone in vivo during experimental canine coronary occlusion, with and without coronary reperfusion. Twenty adult dogs were studie...
journal_title:Surgery
pub_type: 杂志文章
doi:
更新日期:1987-08-01 00:00:00
abstract::A patient's condition was initially diagnosed as constrictive pericarditis, but an echocardiogram revealed the presence of an intracardiac tumor. The tumor was a slow-growing leiomyosarcoma that originated in the left internal iliac vein, extended into the inferior vena cava, and reached the right ventricle. This tumo...
journal_title:Surgery
pub_type: 杂志文章
doi:
更新日期:1981-05-01 00:00:00
abstract:BACKGROUND:Microvascular invasion is the strongest prognostic factor of survival in patients with hepatocellular carcinoma. We therefore developed a predictive model for microvascular invasion of hepatocellular carcinoma to help guide treatment strategies in patients scheduled for either hepatic resection or liver tran...
journal_title:Surgery
pub_type: 杂志文章
doi:10.1016/j.surg.2019.01.012
更新日期:2019-06-01 00:00:00
abstract::Active-specific immunotherapy with concanavalin A or with neuraminidase-modified syngeneic tumor cells has been studied in an experimental model of colon cancer. Systemic immunotherapy with concanavalin A-modified tumor cells or with neuraminidase-modified tumor cells has resulted in up to 70 percent cure of rats rece...
journal_title:Surgery
pub_type: 杂志文章
doi:
更新日期:1976-08-01 00:00:00
abstract:BACKGROUND:Long-term follow-up of heart, liver, and lung transplantation has led to an increased recognition of secondary end-stage renal failure (ESRF) in transplant recipients. This study examines our center's experience with renal transplantation following previous solid organ transplantation. METHODS:From January ...
journal_title:Surgery
pub_type: 杂志文章
doi:10.1067/msy.2001.115834
更新日期:2001-09-01 00:00:00
abstract:BACKGROUND:Operative therapy for Crohn's disease (CD) recurrence is supposed to be more complex and demanding than primary resection. The purpose of this study was to assess a postoperative course after reoperation for the recurrence of CD. METHODS:From 1998 to 2008, 61 patients underwent reoperation for the recurrenc...
journal_title:Surgery
pub_type: 杂志文章
doi:10.1016/j.surg.2010.02.001
更新日期:2010-11-01 00:00:00
abstract:BACKGROUND:It is well recognized that hypoxia/reoxygenation and exposure to inflammatory mediators such as cytokines and neutrophils alter the barrier function of the vascular endothelium. The experiments we conducted tested whether hypoxia alone could produce changes in permeability and whether a prolonged period of h...
journal_title:Surgery
pub_type: 杂志文章
doi:
更新日期:1998-09-01 00:00:00
abstract:BACKGROUND:New surgeons are faced with inadequate mentoring when first entering practice. Our study examined challenges faced by young surgeons during their transition in practice and their mentoring experience when entering practice. METHODS:An article-based survey was mailed in August 2019 to general, colorectal, va...
journal_title:Surgery
pub_type: 杂志文章
doi:10.1016/j.surg.2020.11.044
更新日期:2020-12-28 00:00:00
abstract:BACKGROUND:The long-term outcome of bilateral adrenalectomy in the management of patients with Cushing's syndrome has not been previously well studied. METHODS:We reviewed our long-term results in 34 patients treated with bilateral adrenalectomy between 1983 and the present. Fourteen presented with occult or metastati...
journal_title:Surgery
pub_type: 杂志文章
doi:
更新日期:1993-12-01 00:00:00
abstract::Until recently, it was unclear whether calcium is more than a bystander in the development of acute pancreatitis. Now important evidence has been accumulated supporting a pivotal role of intracellular levels of calcium in the early pathogenesis of the disease. A sustained increase of cytosolic calcium concentrations, ...
journal_title:Surgery
pub_type: 杂志文章,评审
doi:10.1016/j.surg.2012.05.013
更新日期:2012-09-01 00:00:00
abstract::Direct measurement of the femoral artery pressure before operation has been used to predict the postoperative change in ankle and toe pressure in 102 limbs (83 patients) that underwent aortoiliac surgery for the treatment of atherosclerotic occlusion or stenosis affecting both the aortoiliac and femoral artery segment...
journal_title:Surgery
pub_type: 杂志文章
doi:
更新日期:1982-07-01 00:00:00
abstract::A randomized trial involving 50 patients has demonstrated that a new type of debriding agent, cross-linked dextran beads with the trade name Debrisan (dextranomer, Pharmacia, Inc.), will produce rapid healing of cutaneous ulcers which have been resistant to conventional therapy over the long-term. Evaluation in terms ...
journal_title:Surgery
pub_type: 临床试验,杂志文章,随机对照试验
doi:
更新日期:1979-02-01 00:00:00
abstract:BACKGROUND:Although there is a large body of published data demonstrating improved outcomes for complex operations when performed by high-volume surgeons at high-volume hospitals, the literature is mixed regarding whether this same relationship applies in less complex and more common surgeries such as laparoscopic chol...
journal_title:Surgery
pub_type: 杂志文章
doi:10.1016/j.surg.2016.08.027
更新日期:2017-03-01 00:00:00
abstract::In this study we describe the investigation and treatment of 14 patients with primary hepatocellular carcinoma. Patients were treated with intra-arterial infusion of iodized oil and doxorubicin hydrochloride. Five of these patients were alive after 1 year. Twelve patients showed a fall in alpha-fetoprotein, and in sev...
journal_title:Surgery
pub_type: 杂志文章
doi:
更新日期:1991-06-01 00:00:00
abstract:BACKGROUND:Hypoxia is a common tumor condition correlated with therapeutic resistance. Ribonucleotide reductase (RR) is a rate-limiting enzyme for viral replication. We hypothesize that hypoxia-driven transcription of UL39, the gene encoding the large subunit of RR, would enhance herpes oncolytic viral therapy in breas...
journal_title:Surgery
pub_type: 杂志文章
doi:10.1016/j.surg.2004.04.016
更新日期:2004-08-01 00:00:00
abstract:INTRODUCTION:Posthepatectomy liver failure (PHLF) is a severe complication after hepatectomy for colorectal liver metastases. This study evaluated its actual incidence and its effects on short- and long-term overall survival (OS) in a specialized center. MATERIALS AND METHODS:Between 2006 and 2008, 193 patients who un...
journal_title:Surgery
pub_type: 杂志文章
doi:10.1016/j.surg.2013.05.039
更新日期:2014-01-01 00:00:00
abstract:BACKGROUND:Despite the recommendations of the Advanced Trauma Life Support course of the American College of Surgeons, patients undergo computed tomography (CT) in local hospitals before transfer to a trauma center. The problem of repeat CTs caused by technical and protocol issues is ongoing. The objective is to measur...
journal_title:Surgery
pub_type: 杂志文章
doi:10.1016/j.surg.2018.07.007
更新日期:2018-10-01 00:00:00
abstract:BACKGROUND:The prognosis of neuroblastoma patients remains unsatisfactory. Therefore, developing an effective treatment strategy is important. Resveratrol, a natural polyphenol, possesses chemopreventive and antitumor effects. We investigated the effects of resveratrol on the proliferation, apoptosis, and cell cycle al...
journal_title:Surgery
pub_type: 杂志文章
doi:10.1016/j.surg.2004.01.017
更新日期:2004-07-01 00:00:00
abstract::The effect of a new extracorporeal system combining direct hemoperfusion (DHP) with venovenous bypass was evaluated in the elimination of anticancer drugs in hepatic artery infusion. Adriamycin (3 mg/kg) and mitomycin C (1 mg/kg) were given to mongrel dogs through the hepatic artery with three different durations of 1...
journal_title:Surgery
pub_type: 杂志文章
doi:
更新日期:1990-03-01 00:00:00
abstract::The Consortium of American College of Surgeons-Accredited Education Institutes was created to explore new opportunities in simulation-based surgical education and training beyond the scope of individual accredited institutes. During the Third Annual Meeting of the Consortium of American College of Surgeons-Accredited ...
journal_title:Surgery
pub_type:
doi:10.1016/j.surg.2010.11.010
更新日期:2011-06-01 00:00:00
abstract::The acquired failure of host immunocompetence that may result from significant protein and caloric malnutrition has been associated with an increased incidence of septic complications in patients undergoing operation. Wound infection in patients undergoing vascular surgical procedures may lead to exposure or contamina...
journal_title:Surgery
pub_type: 杂志文章
doi:
更新日期:1983-06-01 00:00:00
abstract:BACKGROUND:Glucagon-like peptide-2 induces small intestine mucosal epithelial cell proliferation and may have benefit for patients who suffer from short bowel syndrome. However, glucagon-like peptide-2 is inactivated rapidly in vivo by dipeptidyl peptidase IV. Therefore, we hypothesized that selectively inhibiting dipe...
journal_title:Surgery
pub_type: 杂志文章
doi:10.1016/j.surg.2011.05.013
更新日期:2011-08-01 00:00:00
abstract::The quantitative effects of cytomegalovirus (CMV) infection on morbidity and mortality rates were examined in 320 renal transplant cases. With the use of virus cultures and CMV antibody measurements, all patients were studied, regardless of symptoms, from a time before transplantation to at least 1 year, 11 months aft...
journal_title:Surgery
pub_type: 杂志文章
doi:
更新日期:1981-06-01 00:00:00
abstract:BACKGROUND:The purpose of this study was to determine whether intraoperative parathyroid hormone (IOPTH) assay improved results of reoperations. METHODS:One hundred two patients with persistent/recurrent sporadic primary hyperparathyroidism underwent 108 reoperations (1996-2002). IOPTH was not used (n=58) from 1996-19...
journal_title:Surgery
pub_type: 杂志文章
doi:10.1016/j.surg.2003.08.007
更新日期:2003-12-01 00:00:00
abstract:BACKGROUND:Reoperative neck exploration for hyperparathyroidism is often difficult even for experienced surgeons. Recent advances in preoperative and intraoperative localization techniques have improved successful resection rates. This prospective study evaluates the accuracy and clinical utility of intraoperative tech...
journal_title:Surgery
pub_type: 临床试验,杂志文章
doi:10.1067/msy.2000.109533
更新日期:2000-10-01 00:00:00
abstract::Sixty patients with recurrent ulcers after vagotomy were treated by partial gastrectomy without revagotomy. One patient died after surgery. Seven others died of unrelated causes and one patient was lost to follow-up before 5 years, without rerecurrence having been diagnosed. Of the remaining 51 patients, one underwent...
journal_title:Surgery
pub_type: 杂志文章
doi:
更新日期:1986-05-01 00:00:00
abstract::Two cases are reviewed here that highlight the utility of minimally invasive surgery (MIS) techniques in major surgery procedures involving the liver. They also demonstrate specific operative procedures once thought beyond the scope of the MIS surgeon, but they are now standard in expert hands. Improved methods for at...
journal_title:Surgery
pub_type: 杂志文章
doi:10.1016/j.surg.2007.08.008
更新日期:2007-10-01 00:00:00
abstract:BACKGROUND:Understanding predictors of mortality in bariatric surgery enables surgeons to use these factors for analysis of risk-adjusted mortality and aids in the surgical decision making and informed consent process. OBJECTIVES:To evaluate the effect of patient characteristics (age, gender, race, and payer type), pr...
journal_title:Surgery
pub_type: 杂志文章
doi:10.1016/j.surg.2011.05.020
更新日期:2011-08-01 00:00:00
abstract::In this study, we have compared a bioassay procedure with high-pressure liquid chromatography (HPLC) for the determination of metronidazole levels in serum and urine. Plasma and urine of volunteers with normal or impaired renal function were obtained at various intervals after a single intravenous dose of 500 mg metro...
journal_title:Surgery
pub_type: 杂志文章
doi:
更新日期:1983-01-01 00:00:00