Abstract:
:Twelve prognostic features of melanoma were examined in a series of 185 patients with nodal metastases (Stage II), who underwent surgical treatment at our institution during the past 20 years. Forty-four per cent of the patients presented with synchronous nodal metastases (substage IIA), 44% of the patients had delayed nodal metastases (substage IIB), and 12% of the patients had nodal metastases from an unknown primary site (substage IIC). The patients with IIB (delayed) metastases had a better overall survival rate than patients with IIA (synchronous) metastases, when calculated from the time of diagnosis. These differences could be explained on the basis of tumor burden at the time of initial diagnosis (microscopic for IIB patients versus macroscopic for IIA patients). Once nodal metastases became evident in IIB patients, their survival rates were the same as for substage IIA patients, when calculated from the onset of nodal metastases. The survival rates for both subgroups was 28% at five years and 15% for ten years. Substage IIC patients (unknown 1 degrees site) had better five-year survival rates (39%), but the sample size was small and the differences were not statistically significant. A multifactorial analysis was used to identify the dominant prognostic variables from among 12 clinical and pathologic parameters. Only two factors were found to independently influence survival rates: 1) the number of metastatic nodes (p = 0.005), and the presence or absence of ulceration (p = 0.0019). Additional factors considered that had either indirect or no influence on survival rates (p > 0.10) were: anatomic location, age, sex, remission duration, substage of disease, tumor thickness, level of invasion, pigmentation, and lymphocyte infiltration. All combinations of nodal metastases were analyzed from survival differences. The combination that showed the greatest differences was one versus two to four versus more than four nodes. Their five-year survival rates were 58%, 27% and 10%, respectively (p < 0.001). Ulceration of the primary cutaneous melanoma was associated with a <15% five-year survival rate, while nonulcerative melanomas had a 30% five-year survival rate (p < 0.001). The combination of ulceration and multiple metastatic nodes had a profound adverse effect on survival rates. While tumor thickness was the most important factor in predicting the risk of nodal metastases in Stage I patients (p < 10(-8)), it had no predictive value on the patient's clinical course once nodal metastases had occurred (p = 0.507). The number of metastatic nodes and the presence of ulceration are important factors to account for when comparing surgical results, and when analyzing the efficacy of adjunctive systemic treatments.
journal_name
Ann Surgjournal_title
Annals of surgeryauthors
Balch CM,Soong SJ,Murad TM,Ingalls AL,Maddox WAdoi
10.1097/00000658-198103000-00023subject
Has Abstractpub_date
1981-03-01 00:00:00pages
377-88issue
3eissn
0003-4932issn
1528-1140journal_volume
193pub_type
杂志文章abstract:OBJECTIVE:To investigate the workup/treatment provided to pregnant motor vehicle accident (MVA) casualties in a mature trauma system. Adherence to recommendations was used to measure quality of care. BACKGROUND:MVAs affect approximately 3% of pregnant women. Trauma casualty outcome improves after implementation of gui...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0b013e31822638d4
更新日期:2011-08-01 00:00:00
abstract:OBJECTIVE:To investigate the safety of radical resection for retroperitoneal sarcoma (RPS). BACKGROUND:The surgical management of RPS frequently involves complex multivisceral resection. Improved oncologic outcomes have been demonstrated with this approach compared to marginal excision, but the safety of radical resec...
journal_title:Annals of surgery
pub_type: 杂志文章,多中心研究
doi:10.1097/SLA.0000000000002250
更新日期:2018-05-01 00:00:00
abstract:OBJECTIVE:To discuss the difficulties in dealing with infected or exposed ventral hernia mesh, and to illustrate one solution using an autogenous abdominal wall reconstruction technique. SUMMARY BACKGROUND DATA:The definitive treatment for any infected prosthetic material in the body is removal and substitution. When ...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/01.SLA.0000055278.80458.D0
更新日期:2003-03-01 00:00:00
abstract:OBJECTIVE:Venous thromboembolic events (VTE) are potentially preventable causes of morbidity and mortality after injury. We hypothesized that the current clinical incidence of VTE is relatively low and that VTE risk factors could be identified. METHODS:We queried the ACS National Trauma Data Bank for episodes of deep ...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/01.sla.0000137138.40116.6c
更新日期:2004-09-01 00:00:00
abstract::Measurement of cytochrome a(+a(3)) contents in liver mitochondria was made on 52 biopsy specimens of patients with liver tumor. Patients having higher cytochrome a(+a(3)) contents in mitochondria from remaining liver than those of normal human liver mitochondria could survive well major liver resections whether or not...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-197412000-00013
更新日期:1974-12-01 00:00:00
abstract:OBJECTIVE:To evaluate the effect of inhalation of aerosolized opsonized dead Escherichia coli on inflammatory pulmonary neutrophil (PMN) apoptosis, lung injury, and survival in a PMN-mediated lung injury model in vivo. SUMMARY BACKGROUND DATA:Neutrophils that have transmigrated into an inflammatory focus display incre...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-200202000-00018
更新日期:2002-02-01 00:00:00
abstract::Tissue reaction to sutures was studied in 666 specimens obtained from patients from one day to 23 years after operation. Reaction to catgut depends on the stage of absorption and is mainly histocytic in type. Nonabsorbable sutures are encapsulated by a rim of connective tissue, while near the suture histocytes, giant ...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-197502000-00003
更新日期:1975-02-01 00:00:00
abstract::A case of acquired aneurysm of the sinus of Valsalva, associated with severe coronary atherosclerosis and successfully treated surgically, is reported. The unusual features of the case are the presenting symptom (angina pectoris) and the cause of the aneurysm (severe coronary atherosclerosis). ...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-197903000-00008
更新日期:1979-03-01 00:00:00
abstract::Descriptions of the fasciae of the lower half of the face and of the adjacent cervical fasciae have long been puzzling and descriptively much too complex. For this reason, medical students, young medical and dental practitioners, and at times even senior surgeons frequently do not understand the anatomy of the cervico...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-198612000-00015
更新日期:1986-12-01 00:00:00
abstract:OBJECTIVE:To investigate the use of coffee, caffeinated drinks, and caffeine tablets for pharmacological cognitive enhancement (CE) among surgeons. BACKGROUND:Surgeons have demanding workloads, and the resulting fatigue and concentration deficits can lead to medical errors. Some surgeons use substances that promote wa...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0000000000000830
更新日期:2015-06-01 00:00:00
abstract:OBJECTIVE:The aim of the study is to evaluate whether intra-operative induction with anti-lymphocytic serum (ALS) is superior to no induction in adult liver transplantation (LT). BACKGROUND:The efficacy of ALS induction remains inconclusive in LT, because of poorly designed trials. METHODS:A randomized controlled tri...
journal_title:Annals of surgery
pub_type: 杂志文章,随机对照试验
doi:10.1097/SLA.0000000000002943
更新日期:2018-11-01 00:00:00
abstract:OBJECTIVE:This study aims to describe recent experience with rectal carcinoids in European and North American centers. BACKGROUND:While considered indolent, the propensity of carcinoids to metastasize can be significant. METHODS:Rectal carcinoid patients were identified from prospective databases maintained at 9 inst...
journal_title:Annals of surgery
pub_type: 杂志文章,多中心研究
doi:10.1097/SLA.0b013e3181fb8df6
更新日期:2010-11-01 00:00:00
abstract:OBJECTIVE:Influence of sacral nerve modulation (SNM) on cerebral somatosensory evoked potentials (SEP) was determined in patients with incontinence and constipation. BACKGROUND:Selection of patients with incontinence and constipation for SNM could be improved. METHODS:The latency (ms) of SEP induced by pudendal nerve...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0b013e3182196ff4
更新日期:2011-07-01 00:00:00
abstract::Total hemolytic complement (CH50), conversion of C3 by inulin and cobra venom factor (CoVF), and immunochemical levels of Clq, C4, C2, C3, C5, factor B, properdin, C3b inactivator (KAF), and immunoglobulins (Igs) G, A, and M were measured in the sera of ten patients with abdominal trauma and ten medical patients with ...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-197807000-00017
更新日期:1978-07-01 00:00:00
abstract::Reconstitution of the mesenteric vascular circulation, in our experience, is advisable when advanced occlusive disease is noted on the preoperative arteriogram of patients selected for aortoiliofemoral, renal artery, or aortic aneurysm surgery. A lateral aortogram is mandatory, and the presence of an anastomotic meand...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-197910000-00011
更新日期:1979-10-01 00:00:00
abstract::During a 10-year period, 94 surgical resections for adenocarcinoma of the cardia (75 "curative" and 19 palliative) were performed using three primary approaches: Group I (46 curative, 14 palliative), esophagogastrectomy performed through a left thoracotomy or left thoraco-abdominal incision; Group II (17 curative, 4 p...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-198202000-00004
更新日期:1982-02-01 00:00:00
abstract:OBJECTIVE:Using a prospective randomized study to assess postoperative morbidity and pancreatic function after pancreaticoduodenectomy with pancreaticojejunostomy and duct occlusion without pancreaticojejunostomy. SUMMARY BACKGROUND DATA:Postoperative complications after pancreaticoduodenectomy are largely due to leak...
journal_title:Annals of surgery
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1097/00000658-200210000-00004
更新日期:2002-10-01 00:00:00
abstract::Fifteen mini-pigs were bled to a mean aortic blood pressure of 40 mm Hg and maintained at that level for three hours. The control group consisted of eight animals with shock for three hours, while the test group was comprised of seven animals with a similar shock period but which had undergone splanchnicectomy 14 days...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-197712000-00019
更新日期:1977-12-01 00:00:00
abstract:OBJECTIVE:To quantitate disease-specific hospital-based medical costs in 34 patients with chronic pancreatitis before and after treatment by either duodenal-preserving pancreatic head resection (DPPHR) or pylorus-preserving pancreaticoduodenectomy (PPPD). SUMMARY BACKGROUND DATA:Pancreatic head resection in selected p...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-200111000-00012
更新日期:2001-11-01 00:00:00
abstract:OBJECTIVE:To assess the efficacy of cultured epidermal autografts (CEA) for closure of burn wounds in pediatric burn patients with full-thickness burns of more than 90% total body surface area. SUMMARY BACKGROUND DATA:Paucity of donor sites in massive burns makes the use of expanded skin of paramount importance. CEA t...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-200006000-00011
更新日期:2000-06-01 00:00:00
abstract:BACKGROUND:Despite antiviral treatment has been shown to reduce hepatocellular carcinoma (HCC) recurrence after curative treatment for hepatitis B virus (HBV)-related HCC in patients with high preoperative HBV-DNA levels, it is still unclear whether antiviral therapy is useful in reducing recurrence in patients with lo...
journal_title:Annals of surgery
pub_type: 杂志文章,随机对照试验
doi:10.1097/SLA.0000000000002727
更新日期:2018-12-01 00:00:00
abstract:OBJECTIVE:To compare the systemic cytokine response in patients after laparoscopic-assisted resection with those after open resection of rectosigmoid carcinoma. SUMMARY BACKGROUND DATA:Laparoscopic resection of colorectal carcinoma is technically feasible, but objective evidence of its benefit is scarce. Systemic cyto...
journal_title:Annals of surgery
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1097/00000658-200004000-00008
更新日期:2000-04-01 00:00:00
abstract:BACKGROUND:Some, but not all, studies using registry data have suggested a small but significant long-term survival advantage following a curative surgical resection of gastric cancer at hospitals where the volume of such surgeries is high. However, because such data may be significantly influenced by the impact of pos...
journal_title:Annals of surgery
pub_type: 杂志文章,随机对照试验
doi:10.1097/01.sla.0000245469.35088.42
更新日期:2007-03-01 00:00:00
abstract:OBJECTIVE:To determine the optimal method of wound closure for dirty abdominal wounds. SUMMARY BACKGROUND DATA:The rate of wound infection for dirty abdominal wounds is approximately 40%, but the optimal method of wound closure remains controversial. Three randomized studies comparing delayed primary closure (DPC) wit...
journal_title:Annals of surgery
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1097/00000658-200103000-00016
更新日期:2001-03-01 00:00:00
abstract:OBJECTIVE:The purpose of the study was to test the hypothesis that cardiac mucosa, carditis, and specialized intestinal metaplasia at an endoscopically normal-appearing cardia are manifestations of gastroesophageal reflux disease. SUMMARY BACKGROUND DATA:In the absence of esophageal mucosal injury, the diagnosis of ga...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-199710000-00013
更新日期:1997-10-01 00:00:00
abstract::A biochemical assay of renal viability previously described for rabbits is validated in a canine model using anoxia, hypothermia, and hypothermic perfusion. The assay correlated well with the decree of anoxic injury and protective effect of hypothermia. It was found to be unable to document significant injury when pul...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-197412000-00008
更新日期:1974-12-01 00:00:00
abstract:OBJECTIVE:The aim of this study was to evaluate the association between metformin and survival of gastric cancer (GC) patients. BACKGROUND:Metformin has recently received attention as a potential anticancer treatment. However, no study has shown the survival benefit of metformin for GC patients. METHODS:A total of 19...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0000000000001086
更新日期:2016-01-01 00:00:00
abstract:OBJECTIVE:This study compared the results of video-assisted thoracic surgery (VATS) with thoracoscopic surgery (TS) for diseases of the lung and pleura. SUMMARY BACKGROUND DATA:No studies exist that compare the capabilities of VATS with advanced video systems and instrumentation to that of TS which has been done for 8...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-199305010-00018
更新日期:1993-05-01 00:00:00
abstract:OBJECTIVES:Although weight loss following Roux-en-Y gastric bypass is acceptable in patients with preoperative body mass index (BMI) between 35 and 50 kg/m, results from several series demonstrate that failure rates approach 40% when BMI is > or =50 kg/m. Here we report the first large single institution series directl...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/01.sla.0000239086.30518.2a
更新日期:2006-10-01 00:00:00
abstract::Adenocarcinoma involving the distal esophagus usually is far advanced when the patient is first seen. Adenocarcinoma differs from squamous carcinoma of the esophagus since it is relatively unresponsive to radiation therapy or chemotherapy. Adenocarcinoma of the esophagus resembles gastric cancer in its tendency to for...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-198705000-00015
更新日期:1987-05-01 00:00:00