Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract
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J. Gastrointest. Surg. · Jan 2002
Comparative StudyShould suspected early gallbladder cancer be treated laparoscopically?
Early gallbladder cancer (EGC), defined as T1 and T2 disease, is frequently curable when completely excised without bile spillage. The objective of the present study was to determine what effect initial laparoscopic cholecystectomy has on outcome in patients with EGC. Of 89 patients referred to our institution with gallbladder cancer over an 11-year period, 26 had undergone initial laparoscopic cholecystectomy. ⋯ One-year Kaplan-Meier survival (T1 = 89%, T2 = 71%) and 3-year Kaplan-Meier survival (T1 = 47%, T2 = 40%) of these patients is worse than prior reports for open cholecystectomy. An initial laparoscopic cholecystectomy with its potential for bile spillage can convert potentially curable EGC to incurable disease. Patients with preoperative findings suspicious for gallbladder cancer should undergo open exploration with intent to perform a radical cancer operation as a primary procedure if the diagnosis is confirmed intraoperatively.
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J. Gastrointest. Surg. · Jul 2001
Selective role of vagal and nonvagal innervation in initiation and coordination of gastric and small bowel patterns of interdigestive and postprandial motility.
Our previous studies suggested that extrinsic innervation modulates upper gut motility but is not requisite for cyclic interdigestive and postprandial motility of the stomach. However, the specific role of vagal and nonvagal extrinsic innervation in the initiation, coordination, and pattern of gastric motility in dogs after denervation of the entire upper gastrointestinal tract remains unclear. The aim of this study was to determine the role of vagal and nonvagal extrinsic innervation in control of gastric motility patterns. ⋯ However, although a cyclic phase III activity persisted in the stomach after vagotomy, the number of contractions and the motility index during phase III were decreased, and the duration between groupings of contractions was increased. No differences were noted in the duration of postprandial inhibition after feeding meals before and after vagotomy. These observations support our hypothesis that the vagal nerves are not necessary for the initiation or temporal coordination of global fasting or postprandial gastroduodenal motility patterns but are involved in modulating the pattern of contractions during gastric phase III.
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J. Gastrointest. Surg. · May 2001
Randomized Controlled Trial Multicenter Study Comparative Study Clinical TrialToxicity and effects of adjuvant therapy in colon cancer: results of the German prospective, controlled randomized multicenter trial FOGT-1.
In this adjuvant three-arm multicenter trial, we studied whether modulating the standard 5-fluorouracil (5-FU) treatment with either folinic acid (FA) or interferon-alpha-2a (IFN-alpha) was superior to the recommended standard of adjuvant treatment in R0 resected colon cancer, 5-FU plus levamisole (LEV) for 12 months, in terms of toxicity and outcome. From July 1992 to October 1999, a total of 813 patients with resected colon cancer in stage II (T4N0M0; n = 63) or stage III (TxN1-3M0; n = 750) were randomized into three treatment groups and stratified according to N stage and participating centers (64 hospitals). The patients received a postoperative loading dose of 5-FU (450 mg/m2 on days 1 to 5 [arms A and C]) or 5-FU (450 mg/m2) plus FA (Rescuvolin, Medac, Hamburg, Germany, 200 mg/m2 on days 1 to 5 [arm B]). ⋯ The 4-year survival rate in arm B was significantly higher compared to arm A (P <0.02, log-rank test) with arm A being equal to arm C. Adjuvant therapy with 5-FU plus FA plus LEV for 12 months is superior to the recommended standard (5-FU + LEV for 12 months). IFN-alpha modulation of 5-FU (plus LEV) adds to the toxicity with no therapeutic benefit.
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J. Gastrointest. Surg. · May 2001
Selective internal radiation therapy with 90yttrium microspheres for extensive colorectal liver metastases.
Increasing attention has been given to treatments for colorectal liver metastases ever since hepatic resection was established as being worthwhile. Given the high proportion of patients who die of colorectal cancer with liver-only disease, it seems appropriate to be developing and investigating methods of local liver tumor ablation. Selective internal radiation therapy (SIRT) is a relatively new, not widely used, modality suitable for use even in patients with extensive liver involvement. ⋯ Tumor marker data suggest that substantial destruction of liver tumors can be achieved in more than 90% of patients by a single treatment. Survival times, particularly for those who do not develop extrahepatic metastases for some time, appear to be extended. SIRT warrants further use and investigation in patients with advanced colorectal liver metastases.