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  • 1
    Electronic Resource
    Electronic Resource
    J. G. Geraghty, J. M. Sackier, H. L. Young (eds), Minimal access surgery in oncology (1998)
    Springer
    Annals of oncology 9 (1998), S. 1150-1150 
    Details
    ISSN: 1569-8041
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1023/A:1008438100839
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  • 2
    Electronic Resource
    Electronic Resource
    Quality of life as subjective experience: Reframing of perception in patients with colon cancer undergoing radical resection with or without adjuvant chemotherapy (1999)
    Springer
    Annals of oncology 10 (1999), S. 775-782 
    Details
    ISSN: 1569-8041
    Keywords: adjuvant therapy ; colon cancer ; quality of life ; randomized trial ; reframing ; response-shift
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Purpose and background: We examined whether patients with colon cancer undergoing surgery with or without adjuvant chemotherapy change the internal standards on which they base their quality-of-life (QL) estimation, and, if they do so, whether this reframing alters interpretation of QL findings. These questions were addressed within a randomized clinical trial of the Swiss Group for Clinical Cancer Research (SAKK 40/93). Patients and methods: After radical resection of adenocarcinoma of the colon (pT1–4pN〉0M0 and pT3–4pN0M0) and perioperative chemotherapy, patients were randomized to three treatment arms: observation only (A), 5-FU 450 mg/m2 plus Levamisol (B), or 5-FU 600 mg/m2 (C). QL was measured by linear analogue self-assessment indicators. Patients estimated their pre-surgery QL both before surgery and retrospectively thereafter, and their pre-adjuvant QL both at the beginning of randomly assigned chemotherapy or observation and retrospectively about two months later. Thereafter, current QL was assessed. Paired t-tests were used to test the hypotheses of no change. Results: Overall, 187 patients with at least one pair of corresponding questionnaires were analyzed. Patients estimated their pre-surgery QL after surgery significantly lower than before and their pre-adjuvant QL under treatment or observation also lower than at the beginning. In the adjuvant phase, in contradiction to our hypothesis, chemotherapy had almost no impact on these changes attributed to reframing. Conventionally assessed changes indicated an improvement in QL. Patients with treatment C reported less improvement in functional performance than those with B or those under observation (P = 0.04). Patients with treatment B indicated a greater worsening in nausea/vomiting than those with C, whereas patients with observation only showed an improvement (P = 0.0009). After adjustment of current QL scores under treatment or observation to patients' retrospective estimation, the treatment effects were diluted but the overall improvement was substantially amplified in most QL indicators. Conclusions: Patients with colon cancer substantially reframe their perception in estimating QL both under radical resection and under adjuvant chemotherapy or observation. This effect is an integral part of patients' adaptation to disease and treatment. An understanding of this phenomenon is of particular relevance for patient care. Its role in evaluating QL endpoints in clinical trials needs further investigation.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1023/A:1008311918967
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  • 3
    Electronic Resource
    Electronic Resource
    Intraportal chemotherapy in colorectal carcinoma as an adjuvant modality (1987)
    Springer
    World journal of surgery 11 (1987), S. 452-458 
    Details
    ISSN: 1432-2323
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Résumé Les métastases hépatiques des cancers colo-rectaux trouvent leur origine dans les cellules malignes qui pénètrent dans la circulation portale. Quatre cent soixante malades provenant de 7 institutions ont constitué la base d'un essai prospectif randomisé destiné à évaluer la valeur d'une perfusion portale à l'aide d'un agent chimique dont le but est de prévenir les métastases après chirurgie curative du cancer colo-rectal. En préopératoire, les malades ont été choisis au hasard pour constituer 2 groupes: (a) malades traités par la chirurgie (groupe de contrôle), (b) opérés recevant une perfusion portale de 5-FU (500 mg/m2/jour × 7) infusée continuement les 7 premiers jours post-opératoires et de mitomycine C (10 mg/m2/24 heures après l'intervention) pendant 2 heures. Le cathéter veineux portal fut placé dans une collatérale quelconque du système veineux mésentérique au cours de l'opération. Il n'y eut aucune complication dûe au cathéter intra-abdominal. Malgré une dose importante de 5-FU administrée dans la période post-opératoire immédiate, les effets secondaires systémiques furent minimes. La mortalité globale au cours de l'hospitalisation fut de 1.85% et sans relation avec la chimiothérapie. Ce taux est remarquablement inférieur à ceux rapportés par de multiples centres ou dans la littérature. Il est l'expression d'un progrès dans la technique chirurgicale et les soins pré- et postopératoires. 378 malades (groupe de contrôle: 187, perfusés: 191) ont permis une évaluation exacte de la récidive et de la survie. Après un suivi moyen de 24 mois, il a été observé 43 récidives dans le groupe de contrôle et 34 dans le groupe traité (p〈0.05). Des métastases hépatiques furent découvertes 18 fois dans le premier groupe et 14 fois dans le second. Les malades moururent de récidive 25 fois dans le groupe de contrôle et 18 fois dans le groupe traité par perfusion. En raison du faible nombre des récidives dans cette étude il est trop tôt pour tirer des conclusions sur la durée de la survie. Plusieurs essais contrôlés de traitement par perfusion portale sont en cours. Ils montrent également que la méthode peut être pratiquée et ils suggèrent que la perfusion hépatique par un agent cytotoxique peut réduire le nombre des métastases sans augmenter significativement la morbidité et la mortalité. Il est trop tôt cependant pour recommander la pratique courante de cette méthode. Elle reste sous essai clinique contrôlé et doit s'appliquer seulement à partir de protocoles prospectifs bien définis.
    Abstract: Resumen Las metástasis hepáticas de origen colorrectal se originan en células malignas que ingresan a la circulación venosa portal. Cuatro cientos sesenta pacientes de 7 instituciones participantes han sido introducidos a un ensayo clínico prospectivo y aleatorizado para determinar el valor de la terapia adyuvante con perfusión venosa portal en la prevención de las metástasis hepáticas después de cirugía colorrectal curativa. Mediante aleatorización preoperatoria, los pacientes fueron asignados a un grupo manejado con cirugía solamente (grupo control) o al grupo de infusión portal del hígado con 5-fluoruracilo (500 mg/m2 diarios × 7 en infusión continua por los 7 primeros días postoperatorios) y mitomicina-C (10 mg/m2 por 24 horas postoperatorias como infusión de 2 horas). El catéter venoso portal fue colocado a través de cualquier rama del sistema venoso mesentérico en el curso de la laparotomía para el tumor primario. Con el uso del abordaje transabdominal no se han presentado complicaciones relacionadas con el catéter. A pesar de la elevada dosis acumulativa de 5-FU administrada en el periodo postoperatorio inmediato, los efectos sistémicos han sido mínimos. La tasa global de mortalidad hospitalaria en este estudio es de 1.85% y no aparece afectada por la terapia adjuvante. Esta tasa es considerablemente menor que la informada en ensayos multicéntricos y en la literatura quirúrgica y es indicativa de un avance en la técnica operatoria y en el manejo pre-/postoperatorio de los pacientes en este tipo de cirugía electiva. Tres cientos setenta y ocho pacientes (187 del grupo control, 191 del grupo de infusión) son susceptibles de valoración total en cuanto a recurrencia y supervivencia. Después de un seguimiento promedio de 24 meses, se han presentado 43 recurrencias en el grupo control y 34 en el grupo de infusión (p 〈0.05). Se presentaron metástasis hepáticas en 18 pacientes del grupo control y en 14 del grupo de infusión. Veinte y cinco pacientes en el grupo control y 18 en el grupo de infusión murieron como consecuencia de enfermedad recurrente. Debido al bajo número de recurrencias observado en el estudio, es todavía demasiado temprano para derivar conclusiones en cuanto a supervivencia. Varios ensayos clínicos controlados utilizando infusión portal adyuvante están siendo realizados; también han demostrado la factibilidad de este enfoque y sugieren que la infusión hepática con agentes citotóxicos puede reducir la incidencia de metástasis hepáticas sin que haya un aumento significativo en la morbilidad o mortalidad. Sin embargo, es todavía muy pronto para poder recomendar la terapia adyuvante con infusión portal por fuera del marco de los ensayos clínicos y tal forma de tratamiento debe permanecer restringida a protocolos prospectivos debidamente diseñados.
    Notes: Abstract Liver metastases of colorectal origin arise from malignant cells entering the portal venous circulation. Four hundred sixty patients from 7 participating institutions have been entered in a prospective randomized trial to assess the value of adjuvant portal venous infusion to prevent liver metastases following curative colorectal cancer surgery. By preoperative randomization, patients were assigned to surgery alone (control arm) or to portal liver infusion with 5-fluorouracil (5-FU) (500 mg/m2 daily × 7, continuous infusion during the first 7 postoperative days) and mitomycin C (10 mg/m2, 24 hours postoperatively as a 2-hour infusion). A portal venous catheter was placed through any side branch of the mesenteric venous system during laparotomy for the primary tumor. Using the transabdominal route, there have been no catheter-related complications. Despite a large cumulative dose of 5-FU given during the immediate postoperative period, the systemic side effects were minimal. Overall hospital mortality in this study was 1.85% and was not influenced by the adjuvant treatment. This rate is considerably lower than that reported by previous multicenter trials and by the surgical literature, and it indicates an advance in surgical technique and pre-/postoperative patient management in this type of elective surgery. Three hundred seventy-eight patients (187 controls, 191 infusion patients) are completely evaluable for recurrence and survival. After a median follow-up of 24 months, 43 recurrences have been observed in the control group and 34 in the infusion group (p〈0.05). Liver metastases were present in 18 control patients and in 14 infusion patients. Twenty-five patients in the control group and 18 patients in the infusion group died of recurrent disease. Due to the low number of recurrences in this study, it is too early to draw survival conclusions. Several controlled trials using adjuvant portal infusion are in progress. They also showed the feasibility of this approach and they suggested that adjuvant cytotoxic liver infusion may reduce the incidence of liver metastases without significantly increasing morbidity and mortality. It is too early, however, to recommend adjuvant portal infusion outside a clinical trial setting and such treatment should still be restricted to well-designed prospective protocols.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01655809
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  • 4
    Electronic Resource
    Electronic Resource
    Prevention of deep vein thrombosis in patients with hip fractures: Low molecular weight heparin versus dextran (1992)
    Springer
    World journal of surgery 16 (1992), S. 980-984 
    Details
    ISSN: 1432-2323
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Résumé Par un essai thérapeutique ouvert et randomisé, on a comparé l'efficacité antithrombotique de l'héparine à bas poids moléculaire (LMWH: Sandoparin) à celle de Dextran 70 chez des patients opérés d'une fracture du col de fémur. Cent treize patients ont reçu une dose unique de 36 mg de LMWH en sous-cutanée alors que 103 patients ont reçu 1500 ml de Dextran 70 par voie IV en trois injections. L'éventualité d'une thrombose profonde (TP) postopératoire a été évaluée par un algorythme diagnostique utilisantile fibrinogène marqué (à l'iode 125) comme examen de dépistage et l'examen échographie/Doppler ou la phlébographie ascendante pour confirmer le diagnostic. La fréquence de TP a été significativement plus basse chez les patients recevant la LMWH par rapport à ceux qui recevaient le Dextran (15.5% vs 32.6%, respectivement,p〈0.005). La TP proximale a été rare dans les deux groupes (2% vs 1%, respectivement). Il n'y a eu qu'un seul cas fatal d'embolie graisseuse pulmonaire, observé dans le groupe recevant le Dextran. Il y a eu trois cas d'embolie pulmonaire plus tardifs: un cas mortel dans le groupe Dextran, 14 jours après l'opération et deux cas (un mortel et un non mortel) dans le groupe LMWH, respectivement 14 et 17 jours après. Il n'y a eu aucune complication hémorragique majeure dans les deux groupes. Nous concluous que la LMWH est sûre, bien tolérée et est plus efficace pour prévenir la TP que la Dextran.
    Abstract: Resumen Se emprendió un ensayo clínico randomizado con el propósito de comparar la eficacia antitrombótica de una heparina de bajo peso molecular (HBPM; Sandoparina) con la del dextrán 70 en pacientes sometidos a cirugía por fractura de cadera. 113 pacientes recibieron HBPM una vez al día por vía subcutánea a una dosis fija, y 103 pacientes recibieron dextrán 70 por vía intravenosa. La presencia de trombosis venosa profunda postoperatoria (TVP) fue determinada mediante un algorritmo utilizando la capacitación fibrinogeno125I como prueba de tamizaje y ultrasonografía duplex Doppler y/o venografía ascendente como prueba de comprobación en los casos de sospecha de TVP. La fecuencia de TVP fue significativamente más baja en el grupo de HBPM que en el grupo de dextrán (15.5% versus 32.6%,p〈0.005). La TVP proximal fue infrecuente en los dos grupos (HBPM: 2%, Dextrán: 1%). Sólo se observó un caso de embolismo pulmonar fatal en el curso de profiliaxis de 10 días en un paciente que recibió dextrán. Hubo tres casos tardíos de embolismo pulmonar: uno de carácter fatal en el grupo de dextrán en el día 14, y dos casos en el grupo de HBP (uno fatal y uno no fatal) en los días 14 y 17, respectivamente. No se presentaron complicaciones de sangrado en los dos grupos. Nuestra conclusión es que la HBPM que utilizamos es un agente seguro, que fue bien tolerado y que exhibió una acción tromboprofiláctica significativamente superior que el dextrán 70.
    Notes: Abstract A randomized open trial was undertaken to compare the antithrombotic efficacy of a low molecular weight heparin (LMWH; Sandoparin®) with that of dextran 70 in patients undergoing surgery for hip fracture. One hundred thirteen patients received LMWH once daily subcutaneously at a fixed dosage while 103 patients received intravenous dextran 70. Postoperative deep vein thrombosis (DVT) was assessed by a diagnostic algorithm using the125Iodine fibrinogen uptake test as screening and Duplex ultrasonography and/or ascending venography as confirming techniques for suspected DVT. The frequency of DVT was significantly lower in the LMWH group than in the dextran group (15.5 versus 32.6%,p〈0.005). Proximal DVT was rare in both groups (LMWH: 2%, Dextran: 1%). Only one case of fatal fat pulmonary embolism was observed during the 10 day prophylaxis period in a patient receiving Dextran. Three cases of pulmonary embolism occurred later; one fatal event in the dextran group on day 14, and two cases in the LMWH group (one fatal and one non-fatal event) on day 14 and 17, respectively. There was no major bleeding complication in either group. We conclude that the LMWH we used is safe, was well tolerated, and has a significantly better thromboprophylactic effect than dextran 70.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02067011
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  • 5
    Electronic Resource
    Electronic Resource
    102. Stellenwert der subtotalen Magenresektion beim Magencarcinom (1987)
    Springer
    Langenbeck's archives of surgery 372 (1987), S. 583-586 
    Details
    ISSN: 1435-2451
    Keywords: Gastric cancer ; Resection ; Gastrectomy ; Magencarcinom ; Resektion ; Gastrektomie
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung In der jahrzehntealten Kontroverse um das Resektionsausmass bei Magencarcinom nähern sich in neuerer Zeit die Standpunkte der „Konservativen” und der „Radikalen” etwas. Dies, obwohl Daten kontrollierter Studien noch ausstehen. Eine vorsichtige Erweiterung der Indikation zur Gastrektomie ist deshalb gegeben, weil diese in den vergangenen Jahren allgemein sicherer geworden ist. Beim Antrumcarcinom des intestinalen Typs ohne offensichtlichen Befall tumorferner Lymphknoten und bei gesundem Absetzungsrand am Magen, bei gewissen fortgeschrittenen Tumorstadien und bei ausgesprochenen, vor allem kardiopulmonalen Risikopatienten hat die subtotale Resektion weiterhin ihren Platz.
    Notes: Summary The controversy about the extent of resection of gastric cancer has been lasting for decennies. The extreme viewpoints may have become less divergent recently although controlled data are still lacking. As gastrectomy has generally become safer, a somewhat broader indication for it is justified. Subtotal resection is still justified for cancer of the antrum of the intestinal type (Laurén-classification) without evidently involved distant nodes and as long as a clear margin can be expected, furthermore in some advanced disease situations and finally in high risk patients, especially with severe cardiopulmonary handicaps.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01297886
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  • 6
    Electronic Resource
    Electronic Resource
    Ist die adjuvante Chemotherapie von Kolonkarzinomen (Dukes C; TxN +) heute als Standard anzusehen? (1993)
    Springer
    Langenbeck's archives of surgery 378 (1993), S. 370-374 
    Details
    ISSN: 1435-2451
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01876441
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  • 7
    Electronic Resource
    Electronic Resource
    Technik der brusterhaltenden Behandlung (1986)
    Springer
    Langenbeck's archives of surgery 368 (1986), S. 255-266 
    Details
    ISSN: 1435-2451
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01263215
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  • 8
    Electronic Resource
    Electronic Resource
    263. Adjuvante portale Chemotherapie bei colorectalen Carcinomen, eine multizenterstudie der schweizerischen arbeitsgemeinschaft für klinische krebsforschung (SAKK) (1987)
    Springer
    Langenbeck's archives of surgery 372 (1987), S. 889-889 
    Details
    ISSN: 1435-2451
    Keywords: Adenocarcinoma of the colon and rectum ; Adjuvant perioperative liver infusion ; Liver metastases ; Colorectales Carcinom ; Adjuvante, perioperative Chemotherapie ; Lebermetastasen
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung Untersucht wird beim colorectalen Carcinom die Wirkung einer perioperativen portalen Leberperfusion mit 5-Fluorouracil und Mitomycin C. Zur Zeit sind 409 Patienten auswertbar, 202 im Kontroll- und 207 im Behandlungsarm. Die bisherigen Resultate (März 87), bei einer Beobachtungszeit von 35 Monaten, zeigen im Behandlungsarm eine deutlich geringere Tendenz für Lebermetastasen (10,4% vs 6,3%), besonders auch in den Untergruppen (Colon 11,5% vs 6,8% und Dukes' C: 22,2% vs 6,9%). Entsprechend ist auch der Carcinom-Tod seltener (14,4% vs 12,1%; 15,8% vs 8,5% und 25,4% vs 15,5%). Die Beobachtungszeit ist für eine statistische Analyse noch zu kurz.
    Notes: Summary The efficacy of adjuvant, perioperative portal liver infusion with 5-fluorouracil and mitomycin C was investigated (409 patients, 202 control subjects, 207 treated). Liver metastases were detected in 10.4% of the untreated vs 6.3% of the treated patients. The median follow-up was 35 months. For the colon subgroups (excluding the rectum) and Dukes' C tumors alone, the corresponding results were as follows: 11.5% vs 6.8% and 22.2% vs 6.9%, respectively. Death from progressive cancer disease occurred in 14.4% vs 12.1% of all patients: 15.8% vs 8.5% (colon) and 25.4% vs 15.5% (Dukes' C), respectively. The follow-up time is too short for statistical analysis, however.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01298047
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  • 9
    Electronic Resource
    Electronic Resource
    87. Beeinflussen pathologisch-anatomische Parameter die Rezidivhäufigkeit nach konservativer Mamma-Chirurgie und Strahlentherapie? (1986)
    Springer
    Langenbeck's archives of surgery 369 (1986), S. 437-439 
    Details
    ISSN: 1435-2451
    Keywords: Conservative breast surgery ; Treatment failure ; Pathologic predictors ; Konservative Mamma-Chirurgie ; Therapieversager ; Pathologischanatomische Parameter
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung 201 Patientinnen mit Mamma-Ca (pT1–2, pN0–1) wurden mit konservativer Brustchirurgie und postoperativer Strahlentherapie prospektiv behandelt. Nach einer mittleren Beobachtungszeit von 47 Monaten fanden sich insgesamt 28 (13,9%) Therapieversager, — 13 (6,5 %) Lokalrezidive, 4 ( 2,0%) axilläre Rezidive und 11 (5,5%) Fernmetastasen. Als statistisch signifikante Risikogruppen fanden wir die pT2-Tumoren (20,6% vs 10,5%) und tumorbefallene Lymphknoten (28,1 % vs 6,8%). Keine signifikanten Unterschiede wurden bezüglich Morphologie und Differenzierungsgrad entdeckt.
    Notes: Summary 201 breast cancer patients (pT1–2, pN0–1) were treated with conservative breast surgery and radiation therapy. 28 (13.9%) treatment failures, — 13 (6.5%) local recurrences, 4 (2.0%) axillary — and 11 (5.5%) distant metastases —, were found overall after a mean follow-up of 47 months. The differences between pT2 and pT1-tumors (20.6% vs 10.5%) and nodal positive versus nodal negative patients (28.1% vs 6.8%) are statisticallv sienificant. No differences were seen regarding histnlnuical features.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01274404
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  • 10
    Electronic Resource
    Electronic Resource
    Long-term antimicrobial treatment of severe infections using a fully implantable catheter system (1993)
    Springer
    European journal of clinical microbiology & infectious diseases 12 (1993), S. 300-301 
    Details
    ISSN: 1435-4373
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01967264
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