Chinese thoracic surgery experts consensus on postoperative follow-up plans for non-small cell lung cancer patients / 中国胸心血管外科临床杂志

@#Resection is crucial for treating non-small cell lung cancer. Routine follow-up after surgery is an effective method for early detection and treatment of tumor recurrence and metastasis or the second primary tumor, which can improve the quality of life of patients and their prognosis. This consensus aims to provide a reference for colleagues responsible for postoperative follow-up of non-small cell lung cancer patients in China, and further improve the standardization of lung cancer diagnosis and treatment.

Exploration of clinicopathologic factors associated with postoperative pulmonary metastasis in elderly patients.with rectal cancer / 中华老年医学杂志

Objective To investigate the incidence rate,timing and risk factors of metachronous pulmonary metastasis after curative resection in patients with rectal cancer.Methods A total of 198 patients with rectal cancer undergoing curative resection in gastroenterology surgery department of Beijing Hospital from 2007 to 2012 were enrolled in this retrospective study.The metachronous metastasis and recurrence were observed.Clinicopathologic factors which might be associated with postoperative pulmonary metastasis were analyzed by the univariate and multivariate analysis.Results The 5-year disease-free survival was 76.8％ in a total of 198 patients cohort.The most frequent metastatic sites were the lung(incidence of 11.6 ％)followed by liver(7.6 ％).Median interval from rectal surgery to diagnosis of pulmonary metastasis was much longer than that of hepatic metastasis(19 vs.11 months,P =0.002).Tumor location,current tumor-node-metastasis (TNM)stage,and a positive circumferential resection margin(CRM)were identified as the independent risk factors for pulmonary metastasis.The most common metachronous metastasis site for rectal cancer after curative surgery was the lung in elderly patients.Conclusions The lung is the most common metachronous metastatic site after curative surgery of rectal cancer in elderly patients.For patients with unfavorable risk profiles,a more intensive surveillance program is needed for the early detection of metachronous metastasis and recurrence.

Surgical treatment of aorta coarctation / 医学研究生学报

Congenital coarctation of the aorta is a complex and common congenital heart disease, which can be combined with other heart defects. The clinical symptoms vary from the severity of the disease. In 1944, Crafoord successfully performed surgical repair of coarctation of the aorta, along with the progress of surgical Methods and the advent of interventional techniques, the treatment effect is improved, But no matter what kind of treatment it is, restenosis, aortic aneurysm, hypertension and other complications cannot be avoided. From long-term analysis of the followup Results , the overall effect of surgical treatment is still better than interventional treatment. This article reviews the surgical treatment of coarctation of the aorta.

Conocimientos vigentes acerca del cáncer de colon recurrente / Currently used knowledge about the recurrent colon cancer

Aproximadamente hasta 30 % de todos los pacientes con cáncer de colon, intervenidos con intención curativa, presentarán enfermedad recurrente, la cual puede provocar la muerte o motivar nuevos tratamientos con alto grado de morbilidad, sin que se haya logrado definir un modelo efectivo sobre la conducta a seguir, habida cuenta que aún no existen criterios uniformes con respecto a su prevención, tratamiento y seguimiento posoperatorio luego de la cirugía inicial, por cuanto se desconocen las posibilidades reales de supervivencia y las causas asociadas a la mortalidad. Sobre la base de tales reflexiones, se revisó la bibliografía pertinente sobre algunas cuestiones elementales al respect.

Approximately up to a 30% of patients with colon cancer, surgically treated with healing aims, will have a recurrent disease, which can cause death or motivate new treatments with high morbidity degree, without achieving yet a definite and effective model on the behaviour to be followed, taking into account that there are no uniform approaches with regard to its prevention, treatment and postoperative follow-up after the initial surgery, so that the real possibilities of survival and the causes associated with mortality are ignored. On the basis of such conclusions, the pertinent literature was reviewed on some elementary questions in this respect.

Algunas especificidades sobre el diagnóstico del cáncer de colon recurrente / Some specificities on the diagnosis of the recurrent colon cancer

Se realizó un estudio descriptivo y observacional de 37 pacientes operados de cáncer de colon, con intención curativa, y que presentaron recurrencia tumoral, atendidos en el Hospital Clinicoquirúrgico Docente "Saturnino Lora Torres", de Santiago de Cuba, durante el período 2006-2012, con vistas a identificar algunos aspectos relevantes relacionados con el diagnóstico del cáncer de colon recurrente. Predominaron las mujeres mayores de 65 años, el tumor primario en el colon ascendente, con estadificación posoperatoria III y II, la recurrencia locorregional, así como el tumor palpable como forma de presentación. El método clínico, la ecografía y la radiografía por enema fueron determinantes para el diagnóstico. Se concluye que durante los primeros 2 años del seguimiento posoperatorio deben agotarse todos los medios para el diagnóstico precoz de dicha recurrencia, independientemente de su localización.

A descriptive and observational study of 37 operated patients due to colon cancer, with healing purposes, and who presented tumorous recurrences, assisted in "Saturnino Lora Torres" Teaching Clinical Surgical Hospital, in Santiago de Cuba was carried out during the period 2006-2012, with the objective of identifying some outstanding aspects related to the diagnosis of recurrent colon cancer. Women older than 65 years, the primary tumour in the ascending colon, with postoperative staging III and II, the locorregional recurrence, as well as the palpable tumour as presentation form prevailed. The clinical method, the echography and the x-ray for enema were decisive for the diagnosis. It is concluded that during the first 2 years of the postoperative follow-up all means should be used for the early diagnosis of this recurrence, independently from its localization.

Cirugía de Nikaidoh modificada: experiencia inicial y resultados a corto y a mediano plazos / The Modified Nikaidoh Procedure: Initial Experience and Short and Mid-term Outcomes

Introducción: El tratamiento convencional de los pacientes con transposición de los grandes vasos con comunicación interventricular y estenosis pulmonar es la cirugía de Rastelli. Sin embargo, sus resultados son subóptimos, razón por la cual se han propuesto otras alternativas quirúrgicas. El procedimiento de Nikaidoh es una técnica reciente que surge como una opción terapéutica atractiva. Objetivo: Analizar nuestra experiencia inicial con la cirugía de Nikaidoh modificada: translocación aórtica y reconstrucción de ambos tractos de salida ventriculares. Material y métodos: Se analizaron 11 pacientes consecutivos operados con técnica de Nikaidoh modificada en nuestra institución en el período 2005-2014, con edad mediana de 3 años (intervalo intercuartil 25-75%: 1-5,5 años) y peso medio de 13,8 ± 5,4 kg, 9 de ellos con transposición de los grandes vasos con comunicación interventricular y estenosis pulmonar y 2 con doble salida del ventrículo derecho con estenosis pulmonar y fisiología de transposición. Todos tenían comunicación interventricular no relacionada con la aorta y un paciente tenía además ventrículo derecho hipoplásico. Resultados: En el posquirúrgico inmediato no hubo mortalidad, un paciente desarrolló endocarditis infecciosa y requirió reoperación. Seis pacientes tuvieron disfunción ventricular transitoria; solo uno necesitó asistencia ventricular. No se registró obstrucción a los tractos de salida ventriculares ni insuficiencia aórtica mayor que leve. En el seguimiento a mediano plazo, con una media de seguimiento de 5,5 ± 2,1 años (rango: 2-8,6 años), no hubo mortalidad ni reoperaciones. Se efectuó un cateterismo intervencionista para dilatación del conducto ventrículo derecho-arteria pulmonar. Todos los pacientes permanecían en clase funcional I, con buena función biventricular, sin arritmias, sin obstrucción al tracto de salida ventricular izquierdo y sin insuficiencia aórtica significativa. Conclusiones: La cirugía de Nikaidoh y sus modificaciones constituyen una buena opción quirúrgica para los pacientes con transposición de los grandes vasos con comunicación interventricular y estenosis pulmonar, que por su morfología son malos candidatos para cirugía de Rastelli. En esta serie no hubo mortalidad y todos los pacientes se encuentran en clase funcional I. En el seguimiento a mediano plazo, el tracto de salida del ventrículo izquierdo permaneció sin obstrucción y no se registró insuficiencia aórtica significativa.

Background: The Rastelli operation is the conventional procedure for transposition of the great vessels with ventricular septal defect and pulmonary stenosis. Its results, however, are suboptimal and other surgical alternatives have been postulated. A recent surgical technique, the Nikaidoh procedure, appears as a new therapeutic option. Objective: The aim of this study was to review our initial experience using the modified Nikaidoh procedure consisting in aortic translocation and biventricular outflow tract reconstruction. Methods: The study analyzed 11 consecutive patients operated on with the modified Nikaidoh procedure at our institution between 2005 and 2014. Median age was 3 years (25-75% interquartile range: 1-5.5 years) and mean weight was 13.8 ± 5.4 kg. Nine patients had transposition of the great vessels with ventricular septal defect and pulmonary stenosis and 2 had double outlet right ventricle with pulmonary stenosis and transposition physiology. All patients had a ventricular septal defect unrelated to the aorta and one patient also had a hypoplastic right ventricle. Results: There were no deaths in the immediate postoperative period. One patient developed infective endocarditis needing reoperation. Six patients had some degree of transient left ventricular dysfunction, and one patient only needed ventricular assistance. There was no involved right or left ventricular outflow tract obstruction and only mild aortic regurgitation. At mid-term follow-up (mean of 5.5 ± 2.1 years, range: 2-8.6 years) there were no deaths or reoperations. An interventional cardiac catheterization to dilate the right ventricle to pulmonary artery conduit was performed in one patient. All patients remained in functional class I, with good biventricular function, free from arrhythmias, no left ventricular outflow tract obstruction and no significant aortic regurgitation. Conclusions: The Nikaidoh operation and its variants are a satisfactory surgical option for patients presenting transposition of the great vessels with ventricular septal defect and pulmonary stenosis, who due to their morphology are inadequate candidates for a Rastelli procedure. In the mid-term follow-up, the left ventricular outflow tract remained without obstruction and there was no significant aortic valve regurgitation.

Intervalo libre de enfermedad en pacientes con cáncer de colon recurrente / Interval free of disease in patients with recurrent colon cancer

Se realizó un estudio descriptivo de 37 pacientes operados de cáncer de colon con intención curativa y que presentaron recurrencia tumoral, atendidos en el Hospital Provincial Docente Clinicoquirúrgico "Saturnino Lora Torres", de Santiago de Cuba, durante el período 2006-2012, con vistas a identificar los factores asociados al intervalo libre de enfermedad luego de la cirugía inicial. En la casuística predominaron los afectados mayores de 65 años, del sexo femenino; el tumor primario localizado en el colon derecho con estadificación posoperatoria III y II, la recurrencia locorregional como la de mayor frecuencia y el tumor palpable como el más común. El método clínico, la ecografía y la radiografía de colon por enema fueron determinantes para el diagnóstico. El tratamiento exerético del cáncer de colon asociado a la quimioterapia adyuvante garantizó un intervalo libre de enfermedad más prolongado, si bien el diagnóstico de la recurrencia se correspondió con la detección temprana durante el período posoperatorio, la cirugía fue esencialmente paliativa.

A descriptive study of 37 operated patients of colon cancer with healing intention and who presented tumoral recurrence, assisted in "Saturnino Lora Torres" Teaching Clinical Surgical Provincial Hospital, in Santiago de Cuba was carried out during the period 2006-2012, aimed at identifying the factors associated with the interval free of disease after the initial surgery. The affected patients older than 65 years, female sex; a primary tumour located in the right colon with postoperative stage III and II, local-regional recurrence as that of greater frequency and a palpable tumour as the most common, prevailed in the case material. The clinical method, echography and colon x-ray for enema were decisive for the diagnosis. The exeresis of the colon cancer associated with the adjuvant chemotherapy guaranteed a longer interval free of disease, although the diagnosis of recurrence was in correspondence with the early detection during the postoperative period, the surgery was essentially palliative.

Factores asociados a la supervivencia de pacientes con cáncer de colon recurrente / Factors associated with the survival of patients with recurrent colon cancer

Se efectuó un estudio observacional, descriptivo y longitudinal de 37 pacientes operados de cáncer de colon, con intención curativa, en el Hospital Clinicoquirúrgico Docente "Saturnino Lora Torres" de Santiago de Cuba, durante el período 2006-2012, quienes presentaron recurrencia tumoral diagnosticada en consulta externa mediante un esquema de seguimiento posoperatorio durante un quinquenio o más, con vistas a identificar algunos factores asociados a la supervivencia. Entre los principales resultados de la serie, se obtuvo que la recurrencia tumoral loco-regional fuese predominante y la nueva intervención quirúrgica junto a la quimioterapia adyuvante devino mayor supervivencia en comparación con la alcanzada al emplear solo agentes químicos. Por otro lado, la mayoría de los afectados alcanzaron una supervivencia no mayor de un año, tomando en cuenta el intervalo desde el diagnóstico hasta el deceso, y al finalizar el estudio existía una mortalidad de 62,2 %, cuya causa más frecuente fue la propia recurrencia tumoral. Pudo concluirse que las intervenciones fueron en esencia paliativas, si bien el diagnóstico se correspondió con la detección temprana durante el período de seguimiento posoperatorio.

An observational, descriptive and longitudinal study of 37 patients operated from colon cancer was made, with healing intention, in "Saturnino Lora Torres" Teaching Clinical Surgical Hospital in Santiago de Cuba, during the period 2006-2012 who presented tumorous recurrence diagnosed in the out-patient department, by means of an outline of postoperative follow up during a five year period or more, with the aim of identifying some factors associated to the survival. Among the main results of the series, it was obtained that the local-regional tumorous recurrence was predominant and the new surgery together with the adjuvant chemotherapy caused a greater survival in comparison to the one reached when using just chemical agents. On the other hand, most of the affected patients reached a survival no longer than one year, taking into account the interval from the diagnosis to death, and when concluding the study there was a mortality of 62.2%, whose most frequent cause was the tumorous recurrence itself. It could be concluded that surgeries were essentially palliative, although the diagnosis was in correspondence to the early detection during the period of postoperative follow up.

The Minimal Postoperative Follow-Up Period to Determine Secondary Surgery in Patients with Intermittent Exotropia

PURPOSE: We investigated the recommended minimum postoperative follow-up period for the determination of secondary corrective surgery for the consecutive esotropia (ET) and recurrent exotropia (XT) after the first intermittent XT surgery. METHODS: The medical records of 728 patients who underwent surgical treatment for intermittent XT between 2004 and 2009 with a minimum postoperative follow-up of 1 year were retrospectively reviewed. Each patient underwent a detailed sensory and motor examination, including measurements of near and distance stereoacuity, alternating-cover test, and extraocular muscle function testing. Consecutive ET was defined as esodeviation over 15 prism diopter (PD) at distance persisting for more than 6 months after surgery despite medical treatment. Recurrent XT was defined as exodeviation over 15 PD at distance after surgery despite medical treatment. RESULTS: The mean age of the 728 patients at first surgery was 7.5 years (range, 22 months - 30 years). When only the motor outcome was considered, 663 patients (91.1%) had an orthrotropia at the final follow-up and 44 patients (6.0%) among consecutive ET patients and 21 patients (2.9%) who had a recurrent XT underwent secondary surgical correction. Binocularity decreased postoperatively in patients with consecutive ET (p < 0.001), whereas the other patients demonstrated improved stereopsis postoperatively (p = 0.041, 0.021). Patients with consecutive ET showed esodeviation over 10 PD when compared with orthotropia after 2 months postoperatively (p = 0.005). At 6 months postoperatively, 17 (81.0%) of 21 patients with recurrent XT showed orthotropia with an exodeviation over 11 PD after 18 months postoperatively. CONCLUSIONS: The success rate of surgical correction for intermittent XT showed a favorable outcome. However, careful concern for consecutive ET and recurrent XT are required in postoperative follow-up periods. Over-corrected or consecutive ETs need early surgical correction because no further improvement of ocular alignment will occur after 2 months postoperatively and delayed correction can result in poor sensory binocularity. Under-corrected or recurrent XT should be observed for an extended period because of the exotropic drift after surgery, thus requiring periodic long term follow-up for secondary surgery at least for 18 months postoperatively.

The Minimal Postoperative Follow-Up Period to Determine Secondary Surgery in Patients with Intermittent Exotropia

PURPOSE: We investigated the recommended minimum postoperative follow-up period for the determination of secondary corrective surgery for the consecutive esotropia (ET) and recurrent exotropia (XT) after the first intermittent XT surgery. METHODS: The medical records of 728 patients who underwent surgical treatment for intermittent XT between 2004 and 2009 with a minimum postoperative follow-up of 1 year were retrospectively reviewed. Each patient underwent a detailed sensory and motor examination, including measurements of near and distance stereoacuity, alternating-cover test, and extraocular muscle function testing. Consecutive ET was defined as esodeviation over 15 prism diopter (PD) at distance persisting for more than 6 months after surgery despite medical treatment. Recurrent XT was defined as exodeviation over 15 PD at distance after surgery despite medical treatment. RESULTS: The mean age of the 728 patients at first surgery was 7.5 years (range, 22 months - 30 years). When only the motor outcome was considered, 663 patients (91.1%) had an orthrotropia at the final follow-up and 44 patients (6.0%) among consecutive ET patients and 21 patients (2.9%) who had a recurrent XT underwent secondary surgical correction. Binocularity decreased postoperatively in patients with consecutive ET (p < 0.001), whereas the other patients demonstrated improved stereopsis postoperatively (p = 0.041, 0.021). Patients with consecutive ET showed esodeviation over 10 PD when compared with orthotropia after 2 months postoperatively (p = 0.005). At 6 months postoperatively, 17 (81.0%) of 21 patients with recurrent XT showed orthotropia with an exodeviation over 11 PD after 18 months postoperatively. CONCLUSIONS: The success rate of surgical correction for intermittent XT showed a favorable outcome. However, careful concern for consecutive ET and recurrent XT are required in postoperative follow-up periods. Over-corrected or consecutive ETs need early surgical correction because no further improvement of ocular alignment will occur after 2 months postoperatively and delayed correction can result in poor sensory binocularity. Under-corrected or recurrent XT should be observed for an extended period because of the exotropic drift after surgery, thus requiring periodic long term follow-up for secondary surgery at least for 18 months postoperatively.

Bypass total del ventrículo pulmonar: complicaciones y sobrevida en el seguimiento alejado / Total Right Heart Bypass: Long-Term Complications and Survival

Introducción La cirugía de bypass total del ventrículo pulmonar (BPTVP) es un procedimiento paliativo con una incidencia elevada de complicaciones. El reconocimiento e individualización precoz de estas complicaciones es esencial para definir estrategias terapéuticas adecuadas. Objetivo Evaluar los eventos alejados del BPTVP, analizar la mortalidad alejada y comparar la técnica auriculopulmonar (AP) con el conducto extracardíaco (CE). Material y métodos Entre 1987 y 2010 se analizaron 191 pacientes sometidos a BPTVP con un tiempo medio de seguimiento posquirúrgico (X) de 6,5 ± 5 años (1-20 años). Los pacientes se dividieron, de acuerdo con la variante quirúrgica, en grupo I: A P, 39 pacientes, X = 14 años y grupo II: CE, 152 pacientes, X = 4 años. Resultados El 57% de los pacientes (n = 116) presentaron las siguientes complicaciones: La mortalidad global alejada fue del 4,6% (n = 9). En el análisis univariado, la mortalidad estuvo asociada con disfunción ventricular (p = 0,0000), enteropatía perdedora de proteínas (p = 0,0000), aleteo auricular (p = 0,0012), reoperaciones (p = 0,0006), estenosis subaórtica (p = 0,0024), trombos (p = 0,01) y la técnica quirúrgica AP (p = 0,0004). En el estudio multivariado, la mortalidad estuvo relacionada con disfunción ventricular [OR 27,7 (4,64-165,24); p = 0,0003], técnica AP [OR 2,5 (16,2-105,9); p = 0,0036] y enteropatía perdedora de proteínas [OR 9,31 (1,53-56,66); p = 0,01]. Conclusiones - El BPTVP presentó eventos adversos en el 57% de los pacientes durante el seguimiento alejado. - La mortalidad alejada estuvo asociada con disfunción ventricular, aleteo auricular, enteropatía perdedora de proteínas, estenosis subaórtica, reoperaciones, trombos y técnica quirúrgica auriculopulmonar. - Los predictores de mortalidad fueron la disfunción ventricular, la enteropatía perdedora de proteínas y la técnica auriculopulmonar.

Introduction Total right heart bypass (RHB) is a palliative procedure with high incidence of complications. Early recognition and individualization of these complications is crucial to define adequate therapeutic strategies. Objective To evaluate the incidence of events and mortality of total RHB during long-term follow-up and compare the atriopulmonary (AP) technique with the extracardiac conduit (EC). Methods Between 1987 and 2010, 191 patients undergoing total RHB with a mean follow-up (X) of 6.5 ± 5 years (1-20 years) after surgery were analyzed. The patients were divided, according to the surgical approach, in group I: A P, 39 patients, X=14 years and group II: EC, 152 patients, X=4 years. Results The following complications were present in 57% (n = 116) of the patients: Global long-term mortality was 4.6% (n = 9). At univariate analysis, mortality was associated with ventricular dysfunction (p=0.0000), protein-losing enteropathy (p=0.0000), atrial flutter (p=0.0012), reoperations (p=0.0006), sub-aortic stenosis (p=0.0024), thrombosis (p =0.01) and AP technique (p=0.0004). Multivariate analysis revealed that mortality was associated with ventricular dysfunction [OR 27.7 (4.64-165.24); p = 0.0003], AP technique [OR 2.5 (16.2-105.9); p = 0.0036] and protein-losing enteropathy [OR 9.31 (1.53-56.66); p = 0.01]. Conclusions - Adverse events were present in 57% of patients undergoing total RHB during long-term follow-up. - Long-term mortality was associated with ventricular dysfunction, atrial flutter, protein-losing enteropathy, sub-aortic stenosis, reoperations, thrombosis and atriopulmonary technique. - Ventricular dysfunction, protein-losing enteropathy and atriopulmonary technique were predictors of mortality.

Seguimiento posterior a la cirugía curativa para el cáncer colorrectal: impacto de la tomografía por emisión de positrones - tomografía computarizada (PET/TC) / Follow-up after curative surgery for colorectal cancer: impact of positron emission tomography - computed tomography (PET/CT)

El seguimiento postoperatorio tiene un rol importante para la sobrevida del paciente después de la resección curativa del cáncer colorrectal. OBJETIVOS: Describir las características del seguimiento con tomografía por emisión de positrones (PET) integrado a tomografía axial computarizada (CT) (PET/CT) y su impacto en los sobrevivientes de cáncer colorrectal (CCR) posterior a la resección con intención curativa en un hospital universitario en la prefectura de Tochigi, Japón. MATERIAL Y MÉTODOS: Revisión consecutiva de las historias clínicas de 209 pacientes sometidos a estadificación prequirúrgica con PET/CT para la resección curativa de cáncer colorrectal entre abril de 2005 y marzo de 2008. La información de la evaluación postoperatoria se revisó hasta setiembre de 2008. RESULTADOS: De 209 pacientes que fueron estadificados preoperatoriamente por CCR, 207 (varones/mujeres = 125/82; edad promedio = 65,2 ± 11,4 años) fueron operados con intención curativa e incluidos en el presente estudio. La tasa de cumplimiento con los lineamientos de seguimiento de la Sociedad Japonesa para el Cáncer de Colon y Recto (JSCCR) fue del 53%. La sobrevida acumulada total al final del intervalo de estudio fue de 96.4%. La prueba más utilizada en el seguimiento postoperatorio del CCR fue el antígeno carcinoembrionario (CEA). La PET/CT fue la prueba que detectó más pacientes con lesiones recurrentes (n = 11; valor predictivo positivo = 23.4), entre ellos un paciente con lesión asintomática curable (metástasis a nódulo linfático inguinal), siendo la prueba con mayor efectividad (2.1%). No obstante, su elevado costo convierte a la PET/ CT en el procedimiento menos costo-efectivo. CONCLUSIONES: La utilización de PET/CT en el seguimiento posoperatorio tras resección curativa en CCR ha demostrado ser una alternativa individualizada y efectiva en el hallazgo de enfermedad asintomática curable. El estudio sistemático con CEA y CT como primera línea de despistaje y PET...

Postoperative surveillance has an important role in patient survival after curative resection of colorectal cancer. OBJECTIVES: To describe the characteristics of the follow-up with positron emission tomography(PET) / computed tomography (CT)(PET/CT) and its impact in colorectal cancer (CRC) survivors after curative resection in a university hospital in Tochigi Prefecture, Japan. MATERIALS AND METHODS: Consecutive review of patients hospital charts who underwent presurgical staging with PET/CT for curative resection of colorectal cancer between April 2005 and March 2008. The follow-up data of these patients was reviewed until September 2008. RESULTS: Of 209 patients presurgically staged for CRC, 207 (male/female = 125/82; mean age = 65.3 ± 11.3 years) underwent curative resection and were included in the present study. The compliance rate with the Japanese Society for Cancer of the Colon and Rectum (JSCCR) follow-up guidelines was 53%. The cumulative survival at the end of study interval was 96.4%. The test most commonly used in postoperative follow-up of CRC was the carcinoembryonic antigen (CEA). PET/CT was the test that detected more patients with recurrent lesions (n = 11, positive predictive value = 23.4), including one patient with an asymptomatic curable recurrence (inguinal lymph node metastasis), also being the most effective test (2.1%). However, its high cost makes it the less cost-effective. CONCLUSIONS: The use of PET/CT in the postoperative follow-up after curative resection in CRC has proven to be an individualized and effective alternative in the finding of asymptomatic disease curable. Systematic CEA tests with contrast-enhanced CT as a first line of screening and PET/CT as a second line may be an alternative follow up approach after curative resection for CRC.

Application of Positron Emission Tomography (PET) in Postoperative Follow-Up of the Breast Cancer

PURPOSE: Positron Emission Tomography (PET) is an imaging method that can diagnose diseases by detecting physiologic and biochemical changes of the body. In this study, we attempted to evaluate the value of PET in the postoperative follow-up of breast cancer. METHODS: From September, 1994 to December, 2001, postoperative PET was performed 67 times at Samsung Medical Center on 66 patients who underwent curative operation for breast cancer. Clinical outcomes were confirmed by clinicoradiologic courses, fine needle aspiration cytology, biopsy and operation. We reviewed the medical records and PET reports of these patients. RESULTS: The time interval between operation and PET ranged from 1 to 88 months with a median of 26.5 months. The PET results were abnormal physical examination (23 cases, 34.3%), equivocal result of bone scan (22 cases, 2.8%), other radiologic abnormalities (9 cases, 13.4%), abnormal laboratory findings (4 cases, 6.0%), and symptoms of patients (4 cases, 6.0%). Among the 67 PET studies, 48 were confirmed as having metastasis or recurrence, while 19 did not have metastasis or recurrence. Forty-five of the studies produced true positive results, 16 true negative, 3 false positive and 3 false negative. Therefore, in the detection of postoperative metastasis or recurrence of breast cancer the parameters for the use of PET were 93.8% sensitivity, 84.3% specificity, 93.8% positive predictive value, 84.3% negative predictive value and 91.0% accuracy. On the basis of the lesion site, the accuracy of PET in the detection of bone (98.5%), lung (100%) and liver (98.5%) metastases was superior to that of local recurrence (85.1%) or lymph node metastasis (86.6%). CONCLUSION: PET may be diagnostically helpful in a select subgroup of patients for whom findings remain inconclusive after performning conventional postoperative follow-up methods for breast cancer, especially in the detection of bone, lung and liver metastases.

Follow-up report of one case one year after orthotopic heart transplantation / 中华器官移植杂志

Orthotopic heart transplantation was successfully performed on one patients with endstage dilated cardiomyopathy.The patient has been survived for more than 1 year until today and is now living well.The immunosuppressive therapy and the acute rejective surveillance for 1 year after operation were detailedly introduced and discussed in this paper.In the second week and sixteenth week after operation,two episodes of acute cardiac rejection occurred and were promptly treated well with methylprednisolone.