A cura em oncologia: uma ambição improvável / Cure in cancer: an improbable ambition / La guérison en cancérologie: une improbable ambition

Résumé Cet article propose une réflexion sur la notion de guérison et sur ses usages en cancérologie. Un premier point ausculte sa mise en œuvre en tant qu'ambition à la fois médicale et politique suprême de la mission fondatrice de la cancérologie française. Un deuxième axe pointe ses divers accommodements sociaux, en observant les différentes figures et mésaventures du concept confronté à l'épreuve de l'incurabilité d'un certain nombre de cancers. Enfin, une troisième partie de l'article s'intéresse aux effets de l'incertitude chronique inhérente à l'oncologie. Fondée sur des recherches empiriques inspirées par la grounded theory, par l'interactionnisme et sous l'influence revendiquée d'Anselm Strauss, cette réflexion peut être vue comme un abrégé des travaux de l'auteure, réalisés de la fin des années 1990 à nos jours, sur la cancérologie française. L'incertitude médicale et sa gestion, individuelle et collective, sont au cœur de ce travail.

Abstract This article proposes a reflection about the notion of cure and its uses in oncology. A first point examines its implementation as the utmost medical and political ambition of the founding mission of French oncology. A second axis points to its various social accommodations, observing the different figures and misadventures of the concept confronted with the test of the incurability of numerous cancers. Finally, a third part of the article focuses on the effects of the chronic uncertainty inherent in oncology. Based on empirical research made from the late 1900s to our days, inspired by grounded theory, interactionism and under the influence of Anselm Strauss, this reflection can be seen as an abstract of the author's work on French oncology. Medical uncertainty and its individual and collective management are at the core of this work.

Resumo Este artigo propõe uma reflexão sobre a noção de cura e seus usos em oncologia. Um primeiro ponto examina sua implementação como uma ambição suprema tanto médica quanto política da missão fundadora da oncologia francesa. Um segundo eixo aponta suas diversas acomodações sociais, observando as diferentes figuras e desventuras do conceito confrontado com o teste de incurabilidade de um certo número de cânceres. Finalmente, a terceira parte do artigo se centra sobre os efeitos da incerteza crônica inerente à oncologia. Com base em pesquisas empíricas inspiradas pela grounded theory, pelo interacionismo e sob a influência reivindicada de Anselm Strauss, esta reflexão pode ser vista como um resumo da obra do autor, feitas desde o final de 1900 até atualmente, sobre oncologia francesa. A incerteza médica e sua gestão, individual e coletiva, estão no centro deste trabalho.

The Clinical Significance and Management of Noncurative Endoscopic Resection in Early Gastric Cancer

Nowadays, endoscopic mucosal resection or endoscopic submucosal dissection has shown effectiveness equivalent to that of gastrectomy and has emerged as a popular technique for curative treatment of gastric cancer. However, noncurative resection or resection beyond the indication may lead to lymphatic and extended organ metastasis resulting in loss of the opportunity for full recovery. Therefore, it is an important issue to decide the range of curative resection in the endoscopic resection field. Furthermore, management of noncurative endoscopic resection in early gastric cancer is also important. The most favorable treatment after noncurative resection would be surgery. However, other noninvasive treatments such as argon plasma coagulation, additional endoscopic resection and close observation for recurrence are thought to be the optional treatments after the noncurative resection. In the future, prospective research studies and observations are expected to verify the effectiveness of noninvasive treatments.

Different Clinical Outcomes of Stage IV Gastric Cancer according to the Curability of Surgery

PURPOSE: This study was conducted to evaluate the survival differences between curative stage IV and non-curative stage IV gastric cancers after gastrectomy. METHODS: Stage IV gastric cancer patients who received gastrectomy were selected from our surgical data-base from 1995 to 2004. These patients were separated into two groups according to the curability by surgery. We analyzed the survival differences between curative stage IV patients and non-curative stage IV patients. Survival analysis was performed by Kaplan-Meier survival analysis. RESULTS: During a 10-year period, gastrectomy was performed in 2,214 patients. 224 patients were diagnosed as stage IV. 144 patients were male and 80 patients were female. 97 patients received total gastrectomy. 127 patients received subtotal gastrectomy. 173 patients were diagnosed with curative stage IV and 51 patients were non-curative stage IV. Overall 3-year and 5-year survival rates of stage IV gastric cancer patients in this study were 31.5% and 18.4%. 3-YSR of curative and non-curative stage IV were 36.0% and 16.7% respectively (P-value=0.0204). 5-YSR of curative and non-curative stage IV was 21.9% and 4.2% (P-value=0.0169). CONCLUSION: Significant survival differences were found between curative and non-curative stage IV. Although direct tumor extension or distant metastasis exists, gastrectomy with combined resection was important to improve prognosis if it is possible to resect. When it comes to the matter of survival rate, the subclassification of stage IV gastric cancer should be considered for further management.

Total en bloc spondylectomy——a new surgical technique for primary malignant vertebral tumors / 中国矫形外科杂志

[Objective]To report a new surgical technique of total en bloc spondylectomy for complete resection of primary spinal malignancy and for oncologic curability.The conventional approach for primary spinal malignancy is via intralesional piecemeal resection,and very few reports have described en bloc extralesional resectioning with histopathologically wide or marginal surgical margins.[Method]Total en bloc spondylectomy,consisting of en bloc laminectomy and en bloc corpectomy followed by anterior instrumentation with spacer grafting and posterior spinal instrumentation,was performed in five patients with primary malignant tumors and two patients with giant cell tumors.Patients were observed for 2 years to 6.5 years,except for one patient who died 7 months after surgery because of mediastinal metastasis.[Result]All patients attained significant clinical improvement after surgery with no major complications except one.Histologically,the margins were wide or marginal except for the pedicles,and occasionally the spinal canal and the posterior,where they were accepted to be intralesional.One patient died of metastasis that was not directly related to surgery itself.There was no local recurrence.[Conclusion]The advantages of total en bloc spondylectomy include resection of the involved vertebra(e)in two major blocs,rather than in a piecemeal pattern,and completion of the procedure during one surgical session posteriorly.The"total en bloc spondylectomy"offers one of the most aggressive modes of therapy for primary spinal malignancy.