ABSTRACT
BACKGROUND: The prognosis for patients with locally advanced carcinoma of the breast remains poor. This study examines the pathologic evidence of response of the mammary tumor and axillary nodes after preoperative chemotherapy. We sought to determine if there was a relationship between the histologic response and clinical outcome. STUDY DESIGN: Between 1987 and 1992, 36 patients with locally advanced carcinoma of the breast received three cycles of chemotherapy after incisional biopsy. Modified radical mastectomy was then performed. The breast and axillary nodes were examined pathologically for therapeutic effect and a grading scale was assigned. Postoperatively, patients received completion chemotherapy with the same agents used preoperatively followed by radiation therapy to the chest wall. RESULTS: Fourteen tumors (39 percent) showed near total therapeutic effect, five (14 percent) showed greater than 50 percent but less than total effect, 12 (33 percent) showed less than 50 percent effect, and five (14 percent) showed no effect. Nodal positivity was seen in 61 percent of the patients. Overall clinical response to induction chemotherapy was seen in 86 percent of the patients. There was poor correlation between clinical and pathologic response. Only 50 percent of the patients with complete clinical response were pathologically free of disease. Patients with excellent pathologic therapeutic response had a 79 percent overall five-year survival rate compared with 34 percent for tumors with a lesser response. This was irrespective of nodal status. While pathologic response was critical in determining outcome, clinical response was not. CONCLUSIONS: These results indicate that patients whose tumors have the best pathologic response to induction chemotherapy experience the best outcome.
Subject(s)
Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Breast Neoplasms/drug therapy , Breast Neoplasms/pathology , Carcinoma/drug therapy , Carcinoma/pathology , Adult , Aged , Breast Neoplasms/radiotherapy , Breast Neoplasms/surgery , Carcinoma/radiotherapy , Carcinoma/surgery , Combined Modality Therapy , Cyclophosphamide/administration & dosage , Doxorubicin/administration & dosage , Female , Fluorouracil/administration & dosage , Follow-Up Studies , Humans , Lymph Nodes/drug effects , Lymph Nodes/pathology , Mastectomy, Modified Radical , Methotrexate/administration & dosage , Middle Aged , Neoplasm Recurrence, Local , Neoplasm Staging , Preoperative Care , Prognosis , Remission Induction , Retrospective Studies , Survival Rate , Treatment OutcomeABSTRACT
The elderly population in the United States has been subjected to a massive experiment in mandatory outpatient surgery. Fortunately, this experiment has proven successful. Outpatient surgery of the elderly is feasible and routinely safe if common sense is used and appropriate precautions are undertaken.
Subject(s)
Ambulatory Surgical Procedures , Geriatrics , Aged , Ambulatory Surgical Procedures/economics , Ambulatory Surgical Procedures/methods , Ambulatory Surgical Procedures/psychology , Humans , PrognosisABSTRACT
Gastric-restrictive operations for the treatment of morbid obesity are well established. Postoperative stricture is one complication of this procedure. In a large obesity practice, 40 patients presented with this complication. The authors reviewed retrospectively the management of these strictures, using endoscopic dilatation. All patients were morbidly obese, defined as greater than 100 pounds more than ideal weight. The original gastric-restrictive procedure included vertical-banded gastroplasty (35 patients); revision vertical-banded gastroplasty (2 patients); and revision of gastric bypass to vertical-banded gastroplasty (3 patients). Three methods were used: dilatation with endoscope, balloon dilatation, and Savary-Guilliard dilatation. Twenty-seven patients became asymptomatic after dilatation (68%). Occasionally, multiple dilatations were necessary. In 13 patients (32%), dilatation was unsuccessful and revision surgery was needed. In early postoperative (6 to 12 weeks) stricture, dilatation with the endoscope was often successful. When strictures were associated with an angulated channel, dilatation was almost uniformly unsuccessful. In summary, endoscopic dilatation for postgastroplasty strictures is a useful and effective technique, obviating the need for operative revision in the majority of patients; however, when the stenosis is associated with channel angulation, dilatation is almost uniformly unsuccessful. Such patients should not be subjected to repeated dilatation but rather proceed promptly to revision surgery.
Subject(s)
Catheterization/methods , Obesity, Morbid/surgery , Postoperative Complications/therapy , Constriction, Pathologic/etiology , Constriction, Pathologic/therapy , Female , Follow-Up Studies , Gastroplasty/adverse effects , Gastroscopy , Humans , Postoperative Complications/diagnostic imaging , Radiography , Surgical Staplers/adverse effectsABSTRACT
Morbid obesity is a significant health problem in the United States today. This has resulted in an intensive investigation into temporary interventions for weight control. Dental splinting does not result in long-term weight loss because patients rapidly regain weight following release of jaw fixation. The Garren-Edwards intragastric bubble was equally ineffective in achieving weight loss and was fraught with numerous complications.
