ABSTRACT
There is a controversy as to whether the optimal surgery for gastric cancer in the distal half of the stomach is subtotal or total gastrectomy. The aim of this prospective study was to compare postoperative morbidity and mortality, nutritional status, and long-term survival between the two groups. A total of 32 patients with cancer in the distal half of the stomach were randomized to total gastrectomy [TG] [n=15] or subtotal gastrectomy [SG] [n=l7] provided there was at least 6 cm from the proximal edge of the tumour to the cardia. Both surgical treatments included a second-level lymphadenectomy. Operative data as well as the length of hospital stay were recorded. Postoperative complications were divided into non-fatal and fatal complications. Nutritional profile was evaluated preoperatively at admission and postoperatively at one and six months, respectively. The 5-year survival probability was estimated with regard to type of surgical treatment/tumour characteristics by univariate and multivariate analysis. The duration of the surgical procedure, the amount of operative blood loss, the amount of blood transfused, and the length of hospital stay were statistically significant in favour of the SG group [P<0.01]. Postoperative morbidity rate was 29.4% in the SG group and 66.7% in the TG group [P=0.03].The nutritional profile of patients with SG improved significantly at 6 months compared to the values observed in the TG group [P<0.05]. Median follow-up was 36 months after SG [range 9 to 60] and 28 months after TG [range 6 to 60]. Five-year survival probability was 56.2% for SG and 38.5% for TG [P=0.34]. Analysis using a multivariate Cox regression model showed a statistically significant impact on survival for age, extent of resection to the spleen and/or neighboring organs, tumour spread within the gastric wall, lymph node involvement, and tumour stage. In conclusion, there are several advantages in performing a more conservative operation [SG] in patients with cancer of the lower half of the stomach. This study showed that long-term survival is similar after SG or TG. However, the better postoperative outcome and quality of life of patients with SG suggested that this procedure should be the treatment of choice when a cancer free proximal resection margin can be guaranteed
ABSTRACT
Pelvic and aortic nodes are common sites of metastasis from gynaecologic malignancies, and there is no question that evaluation of lymph node status provides an important prognostic infomation. The aim of the study was to assess the patterns of lymphatic spread of gynaecologic malignancies, the number of nodes which can be excised from each pelvic and aortic group, and the impact of this surgical procedure on the perioperative complications and survival. Between January 1998 and December 2002, 50 patients with previously untreated and biopsy-proven gynaecologic malignancies: cervix [n=15], ovary [n=17], and endometrium [n=18] Were operated upon in the Departments of General Surgery, and Gynaecology and Obstetrics, Minoufnya University Hospital. The surgical procedure consisted of total abdominal hysterectomy, bilateral salpingo-oophorectomy and/or omentectomy, in addition to systematic pelvic and Para-aortic Iymphadenectomy. The median number of nodes removed was 21 pelvic [range 11-38] and 8 aortic [range 5-18]. Positive nodes were found in 22 patients [44%], 12 having pelvic, 4 aortic, and 6 both pelvic and aortic metastasis. The median number of positive nodes was 5 pelvic [range 1-12] and one aortic [range 1-6] nodes. The most frequently involved node groups were the obturator group with both cervical and ovarian carcinomas, and the external iliac group with endometrial carcinoma. The higher prevalence of aortic metastasis was observed in ovarian carcinoma. Lymphocele was the most frequent postoperative complication in 20% of patients. No postoperative mortality occurred in this series. The 5-year survival rate of patients with lymph node metastasis was significantly worse than that of patients without node metastasis [31% versus 84% P=<0.001]. These data may be useful for tailoring lymphadenectomy in relation to the preferred sites of retroperitoneal lymph node metastasis and the median number of nodes resected from each group, and confirms that systematic pelvic and aortic lymphadenectomy is a feasible procedure and can be performed with acceptable morbidity and no mortality. However, to provide solid evidence that this procedure has a therapeutic benefit, randomized controlled studies are needed
ABSTRACT
To evaluate the outcome of concomitant radiocemotherapy [RCT] in terms of treatment response, tolerability, possibility of subsequent surgical resection and survival in locally advanced pancreatic carcinoma. Twenty patients with locally advanced pancreatic carcinoma had been included in a prospective study. Patients had attended to Kas El Aini Center of Clinical Oncology and to the Menoufiya University Hospital and Liver institute, between September 1998 and December 2000. All patients were treated by RCT compirising 5400 cGy daily fractions of180 cGy 5 days a week, 5-Floruracil [5-FU] : 600mg/m2 by continuous intravenous infusion day 1-day 5 and Mitomycin-C': 10mg/m[2], i.v.-bolus day 2. Chemotherapy was repeated on day 29. patients were re-evaluated for the treatment outcome and the possibility of surgical resection 4 weeks after RCT Treatment response, toxicity and overall survival were the study end point. Twelve patients [60%] had decreased primary tumor size. Five cases appeared potentially respectable by CT and exp1plorative laparotomies were done but only four could be respected. The median survival of the study group was 10 months [range 4-21]. Themedian survival of patients who had undergone surgery was 19 ms [1421] response but appeared irresistible by the CT scan. The mediam survival of patients with stationary or progressive tumors was 6.5 ms [4-10]. The treatment applied in the study is feasible and have o significant acute toxicity. The respectability was improved but with no improvement of survival. Additional neoadjuvanl chemotherapy trials with new regimens may support the potential benefits of this line of treatmen