ABSTRACT
Reports have focused on the perceived benefit of a new method of managing pancreatic necrosis and sepsis: leaving the abdomen packed open after debridement, the "marsupialization" technique. We have continued to treat infected pancreatic necrosis with aggressive pancreatic debridement and drainage, closure of the abdomen, and prompt reoperation as often as necessary if further sepsis is identified. We report 52 consecutive patients with infected pancreatic necrosis operated upon between July, 1972 and March, 1990. Postoperative organ failure and APACHE II scoring correlated with survival. Patients with APACHE II scores less than 15 had an operative mortality rate of 4 per cent, whereas patients with scores greater than 15 had a 44 per cent mortality rate. We recognize that no two retrospective series are truly comparable, but in comparison to published reports on the open technique, fascial closure after pancreatic debridement appeared to produce fewer wound complications (only one dehiscence and one incisional hernia) and fewer trips to the operating room.
Subject(s)
Abdomen/surgery , Bacterial Infections/surgery , Fasciotomy , Pancreatitis/microbiology , Pancreatitis/surgery , Bacteremia/microbiology , Cardiac Output, Low/complications , Cause of Death , Debridement , Drainage , Female , Gastrointestinal Hemorrhage/complications , Humans , Liver Failure/complications , Male , Necrosis , Pancreatitis/complications , Pancreatitis/pathology , Renal Insufficiency/complications , Respiratory Insufficiency/complications , Severity of Illness Index , Survival RateABSTRACT
The treatment of potentially curable carcinoma of the breast has changed from one operation, radical mastectomy, to a flexible approach. At the Cleveland Clinic, we use four types of treatment for primary potentially curable carcinoma of the breast (Stages 0, I and II)--modified radical mastectomy, simple mastectomy, partial mastectomy with postoperative adjuvant radiation therapy and partial mastectomy without radiation therapy. The latter treatment (partial mastectomy without adjuvant radiation) is controversial. We recommend this procedure for patients with T(is) and T1 carcinomas that appear to be localized, without lymph node metastases, Stages 0 and I disease. The overall and disease-free survival rates are similar to those of patients having modified radical or partial mastectomy with radiation. Local recurrence is slightly higher at five years (11.0 percent) as compared with the other procedures, but at ten years, is only 16.1 percent, a figure comparable with patients having partial mastectomy with radiation (14.4 percent). For patients with Stages 0 and I carcinoma of the breast, the addition of postoperative radiation therapy after partial mastectomy seems to be unnecessary.
Subject(s)
Breast Neoplasms/surgery , Carcinoma/surgery , Mastectomy, Segmental , Breast Neoplasms/mortality , Breast Neoplasms/pathology , Carcinoma/mortality , Carcinoma/pathology , Carcinoma, Intraductal, Noninfiltrating/mortality , Carcinoma, Intraductal, Noninfiltrating/pathology , Carcinoma, Intraductal, Noninfiltrating/surgery , Combined Modality Therapy , Female , Follow-Up Studies , Humans , Incidence , Mastectomy, Simple , Neoplasm Recurrence, Local/etiology , Neoplasm Staging , Survival RateABSTRACT
Twenty-seven women with disseminated estrogen receptor-negative breast cancer received an aggressive chemotherapy program of prednisone, methotrexate, 5-FU, doxorubicin, and cyclophosphamide. Responses were achieved in 21 of 26 (81%) evaluable patients, eight (31%) of whom had complete responses. The median survival was 17 months. Despite the favorable overall response and a significant number of complete responses, all patients eventually relapsed. Although most patients relapsed systematically, two relapsed initially in the CNS.
