Seminars in surgical oncology最新文献

{"title":"Adjuvant therapy for resectable rectal adenocarcinoma.","authors":"K. Hu, L. Harrison","doi":"10.1002/SSU.4","DOIUrl":"https://doi.org/10.1002/SSU.4","url":null,"abstract":"The mainstay of treatment for rectal cancer over the past 100 years has been surgical resection. However, for the majority of rectal cancers treated conventionally by resection alone, locoregional recurrence is the major mode of failure. Over the past several decades, significant progress has been made in developing effective adjuvant regimens. In the United States, postoperative chemoradiation is standard treatment for T3 or node-positive patients. However, preoperative radiation with or without chemotherapy decreases local recurrence, increases sphincter preservation, and may improve survival. The purpose of this article is to review the role of adjuvant therapy in resectable rectal cancers and to update the status of ongoing randomized trials.","PeriodicalId":77390,"journal":{"name":"Seminars in surgical oncology","volume":"73 1","pages":"336-49"},"PeriodicalIF":0.0,"publicationDate":"2000-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90594654","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Role of endorectal ultrasound in the conservative management of rectal cancers.","authors":"Hong-Jin Kim, W. Wong","doi":"10.1002/SSU.6","DOIUrl":"https://doi.org/10.1002/SSU.6","url":null,"abstract":"Endorectal ultrasonography (ERUS) extends the ability of the clinician to define the clinical features assessed on routine physical examination, and remains the best modality for accurately staging depth of penetration and presumptive nodal status in rectal cancers. The success of conservative management of rectal cancers is predicated on proper patient selection. The preoperative selection of the ideal patient for local therapies can be difficult, and the decision-making process takes into account many critical factors. Careful assessment of the T and N stages is critical in determining the success of conservative therapies, and directing treatment algorithms. Local resections with curative intent are limited to patients with T1N0 rectal cancers, and select patients with T2N0 tumors with favorable pathological criteria. Conservative management may also be extended to patients identified with significant underlying comorbid conditions staged preoperatively with unfavorable T2/T3 lesions, often combined with adjuvant therapies in a palliative setting. In addition, ERUS may have a role in the selection of those patients with more advanced lesions to neoadjuvant chemoradiation, followed by radical resection. Though not clearly defined, ERUS is evolving in its role in the postoperative follow-up of patients treated conservatively for rectal cancers, and can lead to the early detection of local recurrences. The widespread use of ERUS remains limited due to high operator variability and errors in interpretation; however, the role of ERUS in the postoperative management of rectal cancers is evolving and requires further evaluation.","PeriodicalId":77390,"journal":{"name":"Seminars in surgical oncology","volume":"42 1","pages":"358-66"},"PeriodicalIF":0.0,"publicationDate":"2000-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86558382","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Current status of total mesorectal excision and autonomic nerve preservation in rectal cancer.","authors":"M. Murty, W. Enker, J. Martz","doi":"10.1002/SSU.2","DOIUrl":"https://doi.org/10.1002/SSU.2","url":null,"abstract":"Two decades have passed since the late 1970s, which witnessed the introduction of total mesorectal excision (TME)-based operations for rectal cancers on both sides of the Atlantic. Since the introduction of TME, clinical experience has been reported widely in the form of single- and multisurgeon reports from wide geographic regions with multiple participants, and from specialty services with narrow focus and high levels of expertise. All of these published results conclude that in comparison with conventionally practiced blunt surgery for rectal cancer, TME-based (i.e., anatomically correct, sharply performed) operations are associated with significantly lower rates of pelvic (local) recurrences, a significantly higher rate of survival, and significantly lower long-term morbidity. The latter is accomplished through dramatically higher rates of sphincter preservation, and the preservation of both sexual and urinary functions. Overall, there is a remarkable similarity in the clinical results that have been reported from diverse centers. TME now forms the basis of large randomized clinical trials in which the role of adjuvant therapy is being reexamined. The current status of TME is reviewed, and the authors' clinical results of a consecutive series of 544 TME-based operations performed through 1998 are updated.","PeriodicalId":77390,"journal":{"name":"Seminars in surgical oncology","volume":"32 1","pages":"321-8"},"PeriodicalIF":0.0,"publicationDate":"2000-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81204658","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"New directions in rectal surgery: Conservative surgery for rectal cancer","authors":"W. Enker","doi":"10.1002/SSU.1","DOIUrl":"https://doi.org/10.1002/SSU.1","url":null,"abstract":"","PeriodicalId":77390,"journal":{"name":"Seminars in surgical oncology","volume":"24 1","pages":"319-320"},"PeriodicalIF":0.0,"publicationDate":"2000-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87426293","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Role of the surgeon as a variable in the treatment of rectal cancer.","authors":"P. Hermanek, P. Hermanek","doi":"10.1002/SSU.3","DOIUrl":"https://doi.org/10.1002/SSU.3","url":null,"abstract":"Increasingly, data are being accumulated on the influence of intersurgeon variability on outcome after curative surgical treatment of rectal carcinoma. Thus, today the individual surgeon has to be considered as an independent factor influencing locoregional recurrence, as well as survival rates. In general, higher local control and survival can be expected for specialized colorectal surgeons. There are no clear correlations between surgical volume and outcome. Interinstitutional variability in treatment results reflects intersurgeon variability, but analysis is generally more difficult because of a lack of homogeneity with respect to different confounding factors. There are several factors in surgical technique that are important for long-term outcome. Of greatest apparent importance is the adequacy of mesorectal excision (for carcinomas of the middle and lower third, total mesorectal excision; for carcinomas of the upper third, mesorectal excision down to a mesorectal plane 5 cm distal to the gross tumor margin detected by the surgeon in situ). Furthermore, intraoperative local tumor spillage (tumor perforation during mobilization, incision into the tumor), en bloc resection technique, skill, and the extent of regional lymphadenectomy may influence outcome. For quality assurance, detailed operative reports are required, as well as histopathology examinations concerning indicators of surgical oncologic quality discernable from the resection specimens. In future clinical trials of multimodal treatment of rectal cancer, quality assurance of surgery and pathology is necessary for consideration of the surgeon and surgical technique prognostic factors.","PeriodicalId":77390,"journal":{"name":"Seminars in surgical oncology","volume":"9 1","pages":"329-35"},"PeriodicalIF":0.0,"publicationDate":"2000-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74392320","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lateral ligament: its anatomy and clinical importance.","authors":"T. Takahashi, M. Ueno, K. Azekura, H. Ohta","doi":"10.1002/SSU.9","DOIUrl":"https://doi.org/10.1002/SSU.9","url":null,"abstract":"Since Miles proposed abdominoperineal excision as a radical surgery for rectal cancer in 1908, surgeons have recognized the lateral ligament in the pararectal space of their patients and attached clinical importance to it, although anatomists did not describe any such configuration in cadavers. By analyzing an experience of 421 lower rectal cancer cases at the Cancer Institute Hospital in Tokyo, discussion of the lateral ligament was focused on its relationship to the fascial arrangements in the pelvis, the pelvic autonomic nervous system, and the lymphatic drainage of the rectum. The lateral ligament is not an anatomical term, but a clinical or surgical one. It exists in a living pelvis as a condensation of connective tissue around the middle rectal artery and is divided into two segments by the inferior hypogastric nerve plexus inside it and the visceral endopelvic fascia around it. The lateral ligament is a pathway of blood vessels and nerve fibers toward the rectum and lymphatic vessels from the lower rectum toward the iliac lymph nodes. Therefore, the lateral ligament plays a critical role in surgery for lower rectal cancer in two respects: the anatomic extent of resection for curing rectal cancer, and the preservation of sexual function.","PeriodicalId":77390,"journal":{"name":"Seminars in surgical oncology","volume":"71 1","pages":"386-95"},"PeriodicalIF":0.0,"publicationDate":"2000-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74047506","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Laparoscopic total mesorectal excision with autonomic nerve preservation.","authors":"M. Weiser, J. Milsom","doi":"10.1002/SSU.10","DOIUrl":"https://doi.org/10.1002/SSU.10","url":null,"abstract":"Laparoscopy has greatly influenced abdominal surgery. We hypothesize that the benefits of minimally invasive surgery are applicable to rectal cancer. A cadaver model of laparoscopic rectal resection with total mesorectal excision (TME) and autonomic nerve preservation was utilized to explore this hypothesis. The principles of TME were followed, including high vascular ligation, sharp mesorectal dissection, and identification and preservation of the autonomic pelvic nerves. After proving feasibility in the cadaver model, a clinical study was performed on patients with mid to low rectal cancers. We observed acceptable morbidity with this minimally invasive technique of rectal resection and TME. We conclude that there is growing evidence that laparoscopic methods can be applied to patients with rectal cancer.","PeriodicalId":77390,"journal":{"name":"Seminars in surgical oncology","volume":"8 1","pages":"396-403"},"PeriodicalIF":0.0,"publicationDate":"2000-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87690419","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"European trials with total mesorectal excision.","authors":"E. Kapiteijn, C. V. D. Velde","doi":"10.1002/SSU.5","DOIUrl":"https://doi.org/10.1002/SSU.5","url":null,"abstract":"The outcome after surgery for rectal cancer differs markedly between patient series regarding local recurrence rates and survival. A high incidence of local recurrence is associated with conventional, nonstandardized procedures. To improve results of surgery, various additional treatments, such as radiotherapy, chemotherapy, and immunotherapy, have been tested. The Swedish Rectal Cancer Trial (SRCT) was the first trial to show that better local control achieved with preoperative radiotherapy resulted in improved survival. In recent years local control and survival have been further improved by the introduction of standardized total mesorectal excision (TME) surgery. A major problem of published studies on adjuvant therapy is that surgery was not standardized in these studies. Furthermore, quality control of the surgical technique by standardized pathological examination of the specimen is absent in most studies. In Europe, TME has become the preferred standard of operative management for rectal cancer. Adjuvant therapy studies should now be reexamined based on a platform of standardized, optimal surgery and pathology. We studied the European trials in which TME surgery is intentionally performed. Most of these trials are still in progress, with follow-up too short for definitive results, apart from interim analyses. However, the Dutch TME trial has already shown that performing a large, multicenter trial with quality control of both surgery and pathology is feasible.","PeriodicalId":77390,"journal":{"name":"Seminars in surgical oncology","volume":"7 1","pages":"350-7"},"PeriodicalIF":0.0,"publicationDate":"2000-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84890723","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adipose tissue engineering: the future of breast and soft tissue reconstruction following tumor resection.","authors":"C W Patrick","doi":"10.1002/1098-2388(200010/11)19:3<302::aid-ssu12>3.0.co;2-s","DOIUrl":"https://doi.org/10.1002/1098-2388(200010/11)19:3<302::aid-ssu12>3.0.co;2-s","url":null,"abstract":"<p><p>Reconstructive surgeons have always been at the forefront of medical technology. The history of reconstructive surgery began with ablative surgery, which was followed by tissue and organ transplantation, leading to contemporary tissue reconstruction. The field of reconstructive surgery is poised at the next stage of its evolution, namely tissue regeneration. The field of tissue engineering has largely defined this evolutionary leap. One active area of investigation is the development of tissue engineering strategies for adipose tissue. Bioengineers, life scientists, and reconstructive surgeons are synergistically coupling expertise in areas such as cell culture technology, tissue transfer, cell differentiation, angiogenesis, computer modeling, and polymer chemistry to regenerate adipose tissue de novo for breast replacement and soft-tissue augmentation following tumor resection. This work presents the current state of the art in adipose tissue engineering, as well the clinically translatable strategies currently under development. Semin. Surg. Oncol. 19:302-311, 2000.</p>","PeriodicalId":77390,"journal":{"name":"Seminars in surgical oncology","volume":"19 3","pages":"302-11"},"PeriodicalIF":0.0,"publicationDate":"2000-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1002/1098-2388(200010/11)19:3<302::aid-ssu12>3.0.co;2-s","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21957547","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Microvascular reconstruction of the breast.","authors":"J M Serletti,&nbsp;S L Moran","doi":"10.1002/1098-2388(200010/11)19:3<264::aid-ssu8>3.0.co;2-d","DOIUrl":"https://doi.org/10.1002/1098-2388(200010/11)19:3<264::aid-ssu8>3.0.co;2-d","url":null,"abstract":"<p><p>The growth of microsurgical procedures has led to significant technological, scientific, and clinical advances that have made these procedures safe, reliable, reproducible, and routine in most major medical centers. In many instances, free flap reconstruction has become the primary reconstructive method for many major defects, including breast reconstruction. The advantages of free flap breast reconstruction include better flap vascularity, broader patient selection, easier insetting of the flap, and decreased donor site morbidity. Free flap breast reconstruction can occur either at the time that the mastectomy is performed or as a delayed reconstruction following a previous mastectomy. Immediate reconstructions have the advantage of avoiding scar contracture and fibrosis within the mastectomy flaps and at the recipient vessel site. The most common recipient vessel sites are the thoracodorsal vessels and the internal mammary vessels. The thoracodorsal vessels are most frequently used in immediate reconstruction because they are partially exposed during the mastectomy procedure. The internal mammary vessels are used more frequently in delayed reconstructions, to avoid repeat surgery in the axilla. This recipient site also allows more medial placement of the reconstruction. Flap selections for free autogenous breast reconstruction include the transverse rectus abdominis myocutaneous (TRAM) flap, the superior gluteal myocutaneous flap, the inferior gluteal myocutaneous flap, the lateral thigh flap, and the deep circumflex iliac soft tissue flap (Rubens). The TRAM flap is most commonly used in free flap breast reconstruction. For patients with inadequate abdominal tissue or prior abdominal surgery, the superior gluteal flap is typically used. Both the TRAM flap and the superior gluteal flap can be designed as perforator flaps, preserving all of the involved muscle and, in the TRAM perforator, all the rectus fascia. These flaps are more technically demanding, with minimal impact on donor site function. The other flaps are less frequently used and limited to special patient circumstances. Free flap autogenous breast reconstruction provides a natural, long-lasting result with a high degree of patient satisfaction. Semin. Surg. Oncol. 19:264-271, 2000.</p>","PeriodicalId":77390,"journal":{"name":"Seminars in surgical oncology","volume":"19 3","pages":"264-71"},"PeriodicalIF":0.0,"publicationDate":"2000-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1002/1098-2388(200010/11)19:3<264::aid-ssu8>3.0.co;2-d","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21958797","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}