ABSTRACT
The surgical resection of metastases is nowadays feasible in selected patients with multifocal metastatic disease due to the implementation of interdisciplinary multimodal therapeutic options. Anatomical limitations do not seem to represent obstacles which cannot be overcome because of the development of new surgical techniques. The cornerstone of the selection of patients is the correct staging diagnosis achieved through modern diagnostic tools; however, surgery alone does not always offer acceptable survival and recurrence-free rates. Furthermore, in every complex surgical procedure there is the risk of morbidity and mortality; therefore, parameters such as alternative therapeutic modalities, the individual situation of the patient and tumor biology have to be considered in order to make the correct selection of patients. This is one of the major future challenges and should never be driven by unfounded hopes and expectations of the patients. The same principle also applies for brain metastases, which represent the most common brain tumors. Approximately 70 % of patients with brain metastases have 1-3 lesions (oligometastases). Treatment is now individualized and the goal of therapy has shifted towards long-term survival (≥ 24 months) and improved quality of life. Under this aspect surgery is one of the important treatment options, particularly in patients with a single metastasis or oligometastases. Furthermore, approximately 20 % of patients who have recurrent brain metastases, successfully undergo a complete resection of tumors and with a Karnofsky performance status (KPS) score > 70 show a long-term survival of ≥ 24 months.
Subject(s)
Ethics, Medical , Interdisciplinary Communication , Intersectoral Collaboration , Metastasectomy/ethics , Metastasectomy/methods , Neoplasm Metastasis/pathology , Neoplasm Metastasis/therapy , Brain Neoplasms/pathology , Brain Neoplasms/secondary , Brain Neoplasms/surgery , Chemotherapy, Adjuvant/ethics , Combined Modality Therapy/ethics , Humans , Karnofsky Performance Status , Neoplasm Staging/ethics , Patient Selection/ethics , Prognosis , Reoperation/ethicsSubject(s)
Neoplasms/pathology , Neoplasms/surgery , Anastomosis, Roux-en-Y/ethics , Chemotherapy, Adjuvant/ethics , Combined Modality Therapy/ethics , Disease Progression , Disease-Free Survival , Ethics, Medical , Follow-Up Studies , Gastrectomy/ethics , Germany , Humans , Lymph Node Excision/ethics , Male , Medical Futility/ethics , Middle Aged , Neoplasm Staging/ethics , Patient Participation , Pelvic Exenteration/ethics , Quality of Life , Reoperation/ethics , Stomach Neoplasms/pathology , Stomach Neoplasms/surgeryABSTRACT
El diagnóstico y tratamiento del cáncer de mama es una fase temprana mejora las perspectivas para una supervivencia a largo plazo. Por lo tanto, los tiempos de demora relacionados constituyen factores pronósticos de primer orden. Se realizó un estudio descriptivo sobre el tiempo que tardan las mujeres que son remitidas desde la Diputaicón General de Aragón (DGA), mediante el programa de screening de Cáncer de Mama, en ser visitadas en el Hospital Clínico Universitario Lozano Blesa (HCU) de Zaragoza. También se estudiaron las demoras entre el momento del diagnóstico y la confirmación anatomopatológica y el momento del inicio del tratamiento. Para ello se diseñó un análisis de las tendencias de las principales demoras entre los años 2002 y 2006. Se observa una tendencia descendente en casi todos los tiempos de espera, excepto en dos: el tiempo que se tarda en remitir a las mujeres desde el programa de screening de la DGA y ser visitadas en la Unidad de Mama del HCU y la demora entre la realización de la biopsia y el diagnóstico anatomopatológico
The diagnosis and treatment of the cancer of breast in an early phase improbé the perspective for a survival in the long term. Therefore, the related times of delay constitute factors prognoses of first order. A descriptive study was made on the time that takes the women who are sent from the General Delegation of Aragón (DGA), by means of the program of screening of Cancer of Breast, in being visited in the Clinical Hospital University Lozano Blesa (HCU) of Zaragoza. Also the delays between the moment of the diagnosis and the pathological confirmation and the moment of the beginning of the treatment studied. For it an analysis of the tendencies of the main delays between years 2002 and 2006 was designed. A descendent tendency in almost all the times of delay is observed, except in two: the time that takes in sending to the women from the program os screening of the DGA and being visited in the Unit of Breast of the HCU and the delay between the accomplishment of the biopsy and the pathological diagnosis
