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  • 1
    Electronic Resource
    Electronic Resource
    Advances in Perioperative Nutrition: Cancer (2000)
    Springer
    World journal of surgery 24 (2000), S. 1477-1485 
    Details
    ISSN: 1432-2323
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The role of perioperative nutritional support in the management of cancer patients remains controversial. The benefit of supplemental calories is not the only current issue: in fact, the route of delivery, composition of basic nutrients (carbohydrate, protein, fat), and the role of supplemental additives (arginine, glutamine, omega-3 fatty acids, nucleotides) in improving immune status and ultimate outcome have been the focus of much discussion. Emerging data suggest that the use of supplemental agents is associated with improvement in immune status in these patients, although there is little clear evidence that this improves outcome. Ongoing studies are aimed at defining the group of patients who would most benefit from nutritional interventions during the perioperative period.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s002680010265
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  • 2
    Electronic Resource
    Electronic Resource
    Effect of perioperative blood transfusion on recurrence and survival in 232 primary high-grade extremity sarcoma patients (1994)
    Springer
    Annals of surgical oncology 1 (1994), S. 189-197 
    Details
    ISSN: 1534-4681
    Keywords: Blood ; Transfusion ; Recurrence ; Sarcoma
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Background: Allogeneic blood transfusion (BT) has been implicated as an unfavorable factor influencing cancer recurrence and overall survival. Methods: To investigate this, 232 consecutive localized, high-grade extremity soft tissue sarcoma (STS) patients admitted between January 1, 1983, and December 31, 1989, were analyzed from our prospective database by univariable and Cox multivariable statistical methods. Results: Twenty-eight patients developed a local recurrence (LR). Factors found significantly unfavorable for the rate of developing an LR by uni- and multivariable tests were age 〉60 years and positive microscopic margin. Eighty-nine patients developed a distant metastasis (DM) and 72 patients died of their tumor. Median follow-up of survivors was 48 months. Unfavorable factors for DM and tumor mortality (TM) by univariable analysis included large size, deep tumor (that involved or was below the superficial fascia), positive microscopic margin, invasion of a vital structure, operative blood loss, duration of operation, and perioperative BT (whole blood or packed cells -24 to +48 h of curative operation). Multivariable analysis found large size, deep tumor, and positive margin significant independent unfavorable factors for DM and TM. The effect of BT was not a significant independent prognosticator for LR, DM, or TM by multivariable analysis (p=0.26, 0.56, 0.08, respectively), The only factor that was found to be significant in a multivariable analysis of factors contributing to postmetastasis survival was time 〈6 months until metastasis (p=0.008). BT had no significant impact on postmetastasis survival (p=0.42). There was a significant association between BT and deep, large tumors. As the size of deep tumors increased from 〈5, ≥5〈10, ≥10〈15, or≥15 cm, the amount transfused was 15, 16, 49, and 68% (p〈0.00001). Also, BT was significantly (p〈0.005) associated with low hematocrit at initial diagnosis, blood loss during surgery, and the length of the surgical procedure. Conclusions: These data emphasize the importance of size, depth, and margin on distant recurrence and death for localized high-grade extremity STS. In the absence of a randomized trial, the impact of allogeneic blood transfusion would appear to be due to its strong association with large size and deep tumor invasion. This study also highlights the importance of a multivariable analysis and long-term follow-up to better define this controversial question.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02303523
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  • 3
    Electronic Resource
    Electronic Resource
    Core needle biopsy for diagnosis of extremity soft tissue sarcoma (1997)
    Springer
    Annals of surgical oncology 4 (1997), S. 425-431 
    Details
    ISSN: 1534-4681
    Keywords: Sarcoma ; Biopsy ; Core needle
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Background: Classic teaching has advocated the use of open biopsy to diagnose and grade extremity soft-tissue sarcoma. Reported advantages of core needle biopsy include the minimal morbidity, cost, and time. The perceived disadvantage has been diagnostic inaccuracy. The objective of this study was to compare the diagnostic accuracy of core needle biopsy to incisional or frozen section biopsy for primary extremity masses suspicious for soft-tissue sarcoma. Methods: Patients presenting with extremity masses were identified from our prospective soft-tissue sarcoma database (malignant) and from the clinical information center (benign) between January 1, 1990, and December 31, 1995. Biopsy and subsequent resection data were collected from the pathologic records. Results: During this time, 164 primary extremity soft-tissue masses were evaluated before any biopsy. As the initial diagnostic approach, there were 60 core needle, 44 incisional, 36 frozen section, and 26 excisional biopsies. Two patients underwent two biopsy procedures. Ninety-three percent of the specimens obtained at core needle biopsy were adequate to make a diagnosis. Of the adequate core needle biopsy specimens, 95%, 88% and 75% correlated with the final resection diagnosis for malignancy, grade, and histologic subtype, respectively. Of the frozen section biopsy specimens, 94% were adequate, and accurate diagnostic results of malignancy were obtained with 88%. However, only 62% and 47% were correct for grade and histologic subtype, respectively, which was significantly different than the results obtained with incisional biopsy. The false-negative and false-positive rates for core needle biopsy were 5% and 0% for malignancy. Two core needle biopsy specimens graded low were found to be high, and one core needle biopsy specimen graded high was subsequently found to be low on final resection. Conclusions: When read by an experienced pathologist, the results of core needle biopsy provide accurate diagnostic information for malignancy and grade. Adequate core needle biopsy obviates the need for open biopsy and can be used for rational treatment planning. In the absence of adequate tissue, open biopsy is required.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02305557
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  • 4
    Electronic Resource
    Electronic Resource
    Surgical Oncology Fellowship: Viable Pathway to Academic Surgery? (1999)
    Springer
    Annals of surgical oncology 6 (1999), S. 542-545 
    Details
    ISSN: 1534-4681
    Keywords: Surgical oncology fellowship ; Academic ; Residency ; Training
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Background: Data that document academic status after surgical oncology fellowship are sparse. This study was done to report the academic status and clinical practice of graduates of a major surgical oncology program. Methods: During the 10 years that ended in 1994, 68 fellows graduated. Each was surveyed about current academic status, number of jobs, job satisfaction, hours worked per week, and clinical practice. During 1995 and 1996, 11 fellows graduated. From this group, data were available on clinical practice while in fellowship (n = 6) and from the most recent year (ending July 1997) in a new position (n = 8). Results: Sixty-seven of the 68 (99%) who were fellows from 1985 to 1994 returned surveys. Most (69%) are in “academic full-time” positions. Of those who listed an academic rank, 51% and 27% are assistant or associate professors, respectively. Job satisfaction was reported at a mean of 4.2, median of 5, on a scale from 1 to 5, with 5 being the best. Seventy-one percent remain at their first job, whereas 26% have had one previous position. The median number of hours worked per week was 70 (range, 45–100). Time allocation was patient care—60%; research—20%; education—10%; and administration—10%. Conclusions: Surgical oncology fellowship results in the majority placed in academic surgery, satisfied with their positions. Graduates are prepared for current practice patterns, and surgical oncology fellowship training should be suggested to residents interested in academic medicine.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s10434-999-0542-1
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  • 5
    Electronic Resource
    Electronic Resource
    Neovascularity and clinical outcome in high-grade extremity soft tissue sarcomas (1998)
    Springer
    Annals of surgical oncology 5 (1998), S. 48-53 
    Details
    ISSN: 1534-4681
    Keywords: Angiogenesis ; Factor VIII ; Extremity sarcoma
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Background: Increased tumor neovascularity has been shown to correlate with poor prognosis in solid tumors. Methods: Microvessels were identified by factor VIII immunohistochemical staining. Analysis of microvessel counts, tumor characteristics, and resection details was performed on 119 primary, high-grade extremity soft tissue sarcomas (STS) and correlated with clinical outcome. Results: Tumor characteristics and resection details were analyzed and patient outcome was examined with respect to local recurrence, distant metastasis, and disease-specific survival. Factors found to be significant on univariate analysis for all outcome variables were positive microscopic margin and tumor size. A positive microscopic margin was found to be a significant risk factor for local recurrence (P=.03), distant metastasis (P=.006), and disease-specific survival (P=.004). A primary tumor greater than 10 cm in diameter was a poor prognostic factor for distant metastasis (P=.03) and disease-specific survival (P=.006) when compared to tumors smaller than 10 cm. Microvessel count did not correlate with survival nor did it predict distant metastasis or local recurrence. Histologic subtypes of STS that have a prominent vascular pattern as a diagnostic criterion (i.e., angiosarcoma, liposarcoma, hemangiopericytoma) form a subgroup of all STS. Neovascularity in these subtypes showed no relationship to clinical outcome. Conclusions: These data confirm the prognostic importance of microscopic margin and tumor size in high-grade extremity STS. Neovascularity measured by factor VIII staining had no prognostic significance in these mesenchymal tumors, in contradistinction to carcinomas. Alternatively, microvessel counts may not accurately represent the angiogenic capacity of STS. Therefore, patients with STS who are eligible for anti-angiogenesis clinical trials cannot be identified solely by microvessel count.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02303764
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  • 6
    Electronic Resource
    Electronic Resource
    Superficial extremity soft tissue sarcoma: An analysis of prognostic factors (1998)
    Springer
    Annals of surgical oncology 5 (1998), S. 41-47 
    Details
    ISSN: 1534-4681
    Keywords: Soft tissue sarcoma ; Prognosis ; Superficial sarcoma ; Extremity sarcoma ; Staging
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Background: Experience with soft tissue sarcoma has suggested that superficial tumors have a favorable prognosis. We evaluated the prognostic features of this subset of sarcoma. Methods: Prospective data on 215 patients presenting to Memorial Sloan-Kettering Cancer Center with primary extremity superficial soft tissue sarcomas between July 1, 1982 and July 1, 1996 were analyzed. Superficial sarcomas were defined as subcutaneous tumors not invading the investing fascia of the muscle. Analysis was by univariate and multivariate tests for local recurrence, metastasis, and tumor mortality. Results: Ninety (42%) patients were over 50 years of age, 115 (53%) had high-grade tumors, 53 (25%) had tumors ⩾5 cm, and 18 (8%) had positive margins following definitive resection. Median follow-up was 45 months (range 2 days to 151 months), 31 (14%) patients had local recurrences, 20 (9%) had distant metastases, and 15 (7%) died of disease. Five- and 10-year actuarial disease-specific survivals were 91% and 85%, respectively. On multivariate analysis, age 〉50 years predicted local recurrence (RR 5.7; 95% CI, 2.4–13.3;p〈0.0001). High grade (RR 4.2; 95% CI, 1.4–12.7;p〈0.006), and size ⩾5 cm (RR 4.4; 95% CI, 1.8–11;p〈0.002) predicted distant metastases. High grade (RR 7; 95% CI, 1.5–31.4;p〈0.003), size ⩾5 cm (RR 6.9; 95% CI, 2.3–20.8;p〈0.0006), and positive margins (RR 3.8; 95% CI, 1.2–12.4;p〈0.006) predicted tumor mortality. Conclusion: Primary superficial extremity soft tissue sarcomas have a favorable prognosis. Size and grade of superficial tumors are the strongest factors in predicting survival.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02303763
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  • 7
    Electronic Resource
    Electronic Resource
    The effect of blood transfusion on tumor growth in sarcoma-bearing rats (1996)
    Springer
    Annals of surgical oncology 3 (1996), S. 74-79 
    Details
    ISSN: 1534-4681
    Keywords: Blood transfusion ; Tumor growth ; Methylcholanthrene-induced sarcoma
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Background: The effect of blood transfusion on tumor growth is controversial. Under experimental conditions, even similar animal models can give varied results. This study was undertaken to characterize the nature of the effect of blood transfusion on tumor growth. Methods: Sixty-five Fischer 344 rats subcutaneously implanted with a methylcholanthrene-induced sarcoma were studied with additive blood transfusion at 1% tumor burden in two separate experiments. In experiment 1, the effects of syngeneic fresh whole blood transfusion (5, 10, and 15 ml/kg) and allogeneic (5 ml/kg) were tested. To determine if stored blood influenced the results, experiment 2 was performed with syngeneic blood transfusion (15 ml/kg) and allogeneic blood transfusion at 5 ml/kg. Tumor dimensions were determined daily by external measurement, and tumor weight and growth rate were calculated. Results: No significant differences in final tumor weights or tumor growth rates were found in transfused rats compared with controls. This held true for syngeneic blood transfusion regardless of dose, allogeneic blood transfusion, and regardless of whether the blood was fresh or stored. Conclusions: Additive blood transfusion does not affect tumor growth in this animal model. This finding, together with the general inconclusiveness in the reported literature on this topic, speaks against a dominant role for the effect of blood transfusion on tumor behavior.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02409055
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  • 8
    Electronic Resource
    Electronic Resource
    Extended Lymph Node Dissection in Gastric Cancer: If a Benefit Exists, Can It Ever Be Proven? (2000)
    Springer
    Annals of surgical oncology 7 (2000), S. 715-716 
    Details
    ISSN: 1534-4681
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s10434-000-0715-4
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  • 9
    Electronic Resource
    Electronic Resource
    Clinicopathological Characteristics of Gastric Carcinoma in Young and Elderly Patients: A Comparative Study (2000)
    Springer
    Annals of surgical oncology 7 (2000), S. 515-519 
    Details
    ISSN: 1534-4681
    Keywords: Gastric cancer ; Younger patients ; Elderly patients ; Comparative study ; Prognosis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Background: Gastric cancer is one of the most common gastrointestinal malignancies worldwide. Some studies have suggested that it has a worse prognosis in young than in elderly patients. Methods: All young and elderly patients treated for gastric adenocarcinoma during the period 1988 to 1994 in a tertiary referral center in Mexico City were included. Demographic, clinical, and pathologic features of young patients (less than 40 years of age) with gastric cancer were compared with those of elderly patients (70 years of age or older) with the same diagnosis. Overall survival was the main outcome measure. Results: There were 38 patients in each group. The mean age of the young and elderly groups was 33 and 77 years, respectively. Family history of gastric cancer was reported by 6 patients of the younger group and by 1 patient in the older group (P 〈 .05). Most patients in both groups were symptomatic and had an advanced stage of the disease. With a mean follow-up of 17 months, the overall median survival for all patients was 12 months. By group, the median survival was 13 and 12 months for the young and elderly patients, respectively (P = .38). Variables with significant impact on survival were the stage of the disease, possibility of surgical resection, location of the tumor, and a family history of gastric cancer. Conclusions: Young patients represent a significant proportion of patients with gastric cancer in Hispanic populations. There were no significant differences in clinicopathological characteristics and outcome of gastric adenocarcinoma between young and elderly patients. Survival was determined by the stage of the tumor and the possibility of complete surgical resection.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s10434-000-0515-x
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