Abstract:
OBJECTIVE:The objective of the study was to achieve limb salvage in patients with locally advanced soft tissue sarcomas that can only be treated by amputation or functionally mutilating surgery by performing an isolated limb perfusion (ILP) with tumor necrosis factor (TNF) + melphalan (M) as induction biochemotherapy to obtain local control and make limb-sparing surgery possible. SUMMARY BACKGROUND DATA:To increase the number of limb-sparing resections in the treatment of locally advanced extremity soft tissue sarcoma, preoperative radiation therapy or chemotherapy or a combination of the two often are applied. The ILP with cytostatic agents alone is another option but rarely is used because of rather poor results. The efficacy of the application of TNF in ILP markedly has changed this situation. METHODS:In 8 cancer centers, 186 patients were treated over a period of almost 4.5 years. There were 107 (57%) primary and 79 (43%) recurrent sarcomas, mostly high grade (110 grade III; 51 grade II; and 25 very large, recurrent, or multiple grade I sarcomas). The composition of this series of patients is unusual: 42 patients (23%) had multifocal primary or multiple recurrent tumors; median tumor size was very large (16 cm); 25 patients (13%) had known systemic metastases at the time of the ILP. Patients underwent a 90-minute ILP at 39 to 40 C with TNF + melphalan. The first 55 patients also received interferon-tau. A delayed marginal resection of the tumor remnant was done 2 to 4 months after ILP. RESULTS:A major tumor response was seen in 82% of the patients rendering these large sarcomas resectable in most cases. Clinical response rates were: 33 complete response (CR) (18%), 106 partial response (PR) (57%), 42 no change (NC) (22%), and 5 progressive disease (PD) (3%). Final outcome was defined by clinical and pathologic response: 54 CR (29%), 99 PR (53%), 29 NC (16%), and 4 PD (2%). At a median follow-up of almost 2 years (22 months; range, 6-58 months), limb salvage was achieved in 82%. Regional toxicity was limited and systemic toxicity minimal to moderate, easily managed, with no toxic deaths. CONCLUSIONS:In the setting of isolated limb perfusion, TNF is an active anticancer drug in patients. The ILP with TNF + melphalan can be performed safely in many centers and is an effective induction treatment with a high response rate that can achieve limb salvage in patients with locally advanced extremity soft tissue sarcoma.
journal_name
Ann Surgjournal_title
Annals of surgeryauthors
Eggermont AM,Schraffordt Koops H,Klausner JM,Kroon BB,Schlag PM,Liénard D,van Geel AN,Hoekstra HJ,Meller I,Nieweg OE,Kettelhack C,Ben-Ari G,Pector JC,Lejeune FJdoi
10.1097/00000658-199612000-00011subject
Has Abstractpub_date
1996-12-01 00:00:00pages
756-64; discussion 764-5issue
6eissn
0003-4932issn
1528-1140journal_volume
224pub_type
临床试验,杂志文章,多中心研究abstract::The etiology and mechanisms by which severe trauma or sepsis induce hepatic failure are unknown. Previously we showed that Kupffer cells (KC), the fixed macrophages of the liver, induce a profound decrease in hepatocyte (HC) total-protein synthesis when exposed to endotoxin. Furthermore we demonstrated that endotoxin-...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-199010000-00009
更新日期:1990-10-01 00:00:00
abstract:OBJECTIVE:Results of the first prospective randomized clinical trial comparing partial and total portacaval shunt for variceal hemorrhage are reported. SUMMARY BACKGROUND DATA:Total portacaval shunts produce subnormal portal pressures, completely diverting hepatic portal flow. Partial shunts maintain higher pressures ...
journal_title:Annals of surgery
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1097/00000658-199404000-00005
更新日期:1994-04-01 00:00:00
abstract:OBJECTIVE:To assess development of mucosal damage in the esophageal remnant in regard to the level of the esophagogastrostomy reconstruction either in a right chest or in a left neck position. SUMMARY BACKGROUND DATA:Esophagectomy with gastric interposition creates an in vivo human model of pathologic esophageal reflu...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0b013e31818eec06
更新日期:2009-02-01 00:00:00
abstract:OBJECTIVE:To determine the optimum excision margin and nodal management for patients with primary cutaneous melanomas 2.01- to 4.00-mm thick (T3 melanomas). BACKGROUND:Currently available evidence does not reliably define the minimum safe excision margin and best nodal management for patients with primary cutaneous T3...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0000000000000792
更新日期:2014-12-01 00:00:00
abstract:OBJECTIVE:To compare safety and healthcare utilization after sleeve gastrectomy versus Roux-en-Y gastric bypass in a national Medicare cohort. SUMMARY BACKGROUND DATA:Though bariatric surgery is increasing among Medicare beneficiaries, no long-term, national studies examining comparative effectiveness between procedur...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0000000000004526
更新日期:2020-11-17 00:00:00
abstract::The combined Cambridge/King's College Hospital series of 64 orthotopic liver grafts' experience dates back to 1968. Many patients were referred for liver grafting late in the course of their diseases and were operated on when they were too ill or died before suitable livers could be found. Complications of biliary dra...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-197709000-00006
更新日期:1977-09-01 00:00:00
abstract::The enterococcus has been relegated to a position of unimportance in the pathogenesis of surgical infections. However the increasing prevalence and virulence of these bacteria prompt reconsideration of this view, particularly because the surgical patient has become increasingly vulnerable to infectious morbidity due t...
journal_title:Annals of surgery
pub_type: 杂志文章,评审
doi:10.1097/00000658-199008000-00007
更新日期:1990-08-01 00:00:00
abstract:BACKGROUND:Fine-needle aspiration (FNA) is currently the primary diagnostic procedure in diagnosing thyroid malignancy and guides surgeons on patient selection for thyroidectomy for thyroid nodules. Diagnostic sensitivity is reported to be approximately 80%; however, patients with negative FNA results do not necessaril...
journal_title:Annals of surgery
pub_type: 杂志文章,评审
doi:10.1097/SLA.0b013e3180f61adc
更新日期:2007-11-01 00:00:00
abstract:OBJECTIVE:To evaluate the relation between delay in surgery because of preoperative biliary drainage (PBD) and survival in patients scheduled for surgery for pancreatic head cancer. BACKGROUND:Patients with obstructive jaundice due to pancreatic head cancer can undergo PBD. The associated delay of surgery can lead to ...
journal_title:Annals of surgery
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1097/SLA.0b013e3181fd36a2
更新日期:2010-11-01 00:00:00
abstract:OBJECTIVE:To examine the extent to which multiple, sequential complications impacts variation in institutional postoperative mortality rates. BACKGROUND:Failure to rescue (FTR) has been proposed as an underlying factor in hospital variation in surgical mortality. However, little is currently known about hospital varia...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0000000000001917
更新日期:2017-07-01 00:00:00
abstract:BACKGROUND:Over the past 2 decades, there has been an increase in opioid use and subsequently, opioid deaths. The amount of opioid prescribed to surgical patients has also increased. The aim of this systematic review was to determine postdischarge opioid consumption in surgical patients compared with the amount of opio...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0000000000002591
更新日期:2018-06-01 00:00:00
abstract:OBJECTIVE:To determine overall survival and disease-free survival in selected patients with nonresectable liver-only colorectal cancer receiving liver transplantation. BACKGROUND:Patients with nonresectable colorectal cancer receiving palliative chemotherapy has a 5-year overall survival of about 10%. Liver transplant...
journal_title:Annals of surgery
pub_type: 临床试验,杂志文章
doi:10.1097/SLA.0000000000003404
更新日期:2020-02-01 00:00:00
abstract:OBJECTIVE:To analyze the challenges encountered during surgical quality improvement interventions, and explain the relative success of different intervention strategies. SUMMARY BACKGROUND DATA:Understanding why and how interventions work is vital for developing improvement science. The S3 Program of studies tested wh...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0000000000001583
更新日期:2016-12-01 00:00:00
abstract:OBJECTIVE:To define and test "Textbook Outcome" (TO)-a composite measure for healthcare quality-among Medicare patients undergoing hepatopancreatic resections. Hospital variation in TO and Medicare payments were analyzed. BACKGROUND:Composite measures of quality may be superior to individual measures for the analysis ...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0000000000003105
更新日期:2020-06-01 00:00:00
abstract:OBJECTIVE:To determine the role of the microvascular endothelium in the regulation of regenerating liver mass after partial hepatectomy. SUMMARY BACKGROUND DATA:Angiogenesis is critical for both pathologic and physiologic processes. The ability of certain tissues, such as the liver, kidney, and spleen, to regenerate a...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/01.SLA.0000059986.96051.EA
更新日期:2003-04-01 00:00:00
abstract:INTRODUCTION:Intraductal papillary mucinous neoplasms (IPMNs) are being increasingly recognized, and often harbor cancer. Lymph node metastases are an important prognostic factor for patients with invasive intraductal papillary carcinoma (I-IPMC), but the role of lymph node ratio (LNR) in predicting survival after surg...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0b013e3181cf9155
更新日期:2010-03-01 00:00:00
abstract:OBJECTIVE:To develop a model for the identification of individuals at risk for carotid stenosis (CS) that could be useful in a clinical setting when trying to decide whether screening is worthwhile. BACKGROUND:Evidence that aggressive medical therapy and life style changes reduce the risk of stroke in individuals with...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0b013e31827b9761
更新日期:2013-06-01 00:00:00
abstract::One hundred and forty patients with an intractable ascites complicating a chronic liver disease received a peritoneovenous shunt (PVS) using the LeVeen valve. Operative mortality was ten per cent but was 25% in patients with severe liver failure. Intraoperative drainage of ascites sharply decreased postoperative compl...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-198504000-00014
更新日期:1985-04-01 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: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:OBJECTIVE:To explore challenges and opportunities for surgery departments' academic missions as they become increasingly affiliated with expanding health systems. SUMMARY BACKGROUND DATA:Academic medicine is in the midst of unprecedented change. In addition to facing intense competition, narrower margins, and decrease...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0000000000004462
更新日期:2020-11-12 00:00:00
abstract::The University of Rochester, Department of Surgery, in response to an experimental community-wide limit on hospital budgets, studied high-cost general surgical patients as a potential source of leverage for containment of hospital costs. It was found that a small number of patients impact significantly on hospital cos...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-198309000-00005
更新日期:1983-09-01 00:00:00
abstract:OBJECTIVE:The aim of this study was to determine characteristics of the most cited publications in the history of the American Surgical Association (ASA). SUMMARY BACKGROUND DATA:The Annals of Surgery has served as the journal of record for the ASA since 1928, with a special issue each year dedicated to papers present...
journal_title:Annals of surgery
pub_type: 历史文章,杂志文章
doi:10.1097/SLA.0000000000003633
更新日期:2020-04-01 00:00:00
abstract::From 1979 to 1983, 1726 carotid endarterectomies were performed at the Cleveland Clinic. During this period, 39 men (mean age, 60 years) and 22 women (mean age, 63 years) required 65 reoperations (3.8%) for correction of recurrent carotid stenosis occurring 3 to 194 months (mean, 42 months) after previous endarterecto...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-198507000-00004
更新日期:1985-07-01 00:00:00
abstract:OBJECTIVE:To examine preoperative dietary influences on gut-associated lymphoid tissue (GALT) cell number in the context of postoperative infectious complications. BACKGROUND:There is little clinical evidence regarding whether nutritional routes affect GALT size and/or phenotype. The influence of GALT atrophy on clini...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0b013e31827a0e05
更新日期:2013-12-01 00:00:00
abstract::Celiotomy in cirrhotic patients is reported to bear a high risk of operative morbidity and mortality. We reviewed 100 consecutive, cirrhotic patients who underwent nonshunt celiotomy. Thirty patients died and major complications occurred in another 30 patients. Hospital mortality rate was 21% in 39 biliary operations,...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-198406000-00003
更新日期:1984-06-01 00:00:00
abstract::The obturator bypass graft operation can be performed in a moderately simplified manner by a technique that allows extension of indications for the procedure beyond situations in which sepsis is present in the groin. Long-term analysis of the results of the cases available for study indicates that the procedure may ve...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-198303000-00015
更新日期:1983-03-01 00:00:00
abstract:OBJECTIVE:Posterior retroperitoneoscopic adrenalectomy (PRA) is a minimally invasive approach to removal of the adrenal gland. This anatomically direct approach, popularized by Walz, minimizes dissection and affords early access to the adrenal vein. We report the largest experience to date of PRA in the United States. ...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0b013e31818a1d2a
更新日期:2008-10-01 00:00:00
abstract:OBJECTIVE:To characterize factors predictive of improved survival following gastrectomy with additional organ resection for the treatment of gastric cancer. SUMMARY BACKGROUND DATA:Recent large series have reported significant survival disadvantages to patients who have undergone gastrectomy with splenectomy or pancre...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-200208000-00003
更新日期:2002-08-01 00:00:00
abstract:INTRODUCTION:For patients with hepatocellular carcinoma (HCC) in particular, living donor liver transplant (LDLT) improves access to transplant. We report our results in 36 patients with HCC who underwent LDLT with a median follow-up >1 year. METHODS Underlying diagnoses included: hepatitis C (24), hepatitis B (9), cry...
journal_title:Annals of surgery
pub_type: 评论,杂志文章
doi:10.1097/01.sla.0000109022.32391.eb
更新日期:2004-02-01 00:00:00