Surgical treatment of chronic pancreatitis and its complications. Comparative analysis of results in 91 patients.

There is a large variety of proposed conservative, invasive, endoscopic and surgical methods for treatment of chronic pancreatitis and its complications. This study presents a comparative analysis of the results from each group of patients subjected to drainage, resection, denervation and other operative techniques for a total of 91 patients with chronic pancreatitis and its complications. Drainage and resection operative techniques yield comparable results in terms of postoperative pain control 93.1% and 100%, perioperative mortality--3.17% and 5.8%, perioperative morbidity--7.9% and 11.7%, respectively. There is a significant increase in the instances of diabetes in the resection group. Right-side semilunar ganglionectomy is a good method for pain control as an accompanying procedure in the course of another main operative technique.

[Lymph nodes metastases in differentiated thyroid cancer--prognostic value and syrgical results with 430 patients for 30 years period (1980-2010)].

In this we review 430 differentiated thyroid cancer patients underwent surgery for 30 years period since 1980 to December 2009. The stage of disease was T1-3.Na-b.Mo(TNM). Papillary thyroid cancer patients were 77.2% and folicular thyroid cancer--22.8%. The regional lymph nodes metastases distribution were analyzed according to the age, sex, of the patients and tumor histology. Preoperatively,clinically involved were neck nodes in 35 patients 8.3%--26 patients with PTC and in 9 patients with FTC. Surgical procedures for low-risk group of patients were variable from lobectomy and istmusectomy to near total thyroidectomy and modified radical lymph node dissections of the neck and patients in high risk group underwent total thyroidectomy and radiojodine therapy. The level of regional recurrences was 1.7 folds higher in patients treated by total thyroidectomy and radiotherapy J131.

Lymph nodes metastases in differentiated thyroid cancer--prognostic value and surgical results with 430 patients for 30 years period (1980-2010).

The papillary cancer and the follicular cancer are the most common forms of thyroid malignitet. Based on 30-year follow up of 430 patients, who underwent differentiated thyroid cancer surgery, the incidence of the lymph nodes metastases and the rate of postoperative recurrence of the disease was studied and the performance criteria of modified radical lymph node dissection of the neck were specified. Papillary cancer patients were 77.2% (332 people) and follicular cancer patients were 22.8% (98%). At the time of the diagnosis 8.2% (35 people) of the patients had palpable lymph nodes metastases. All patients with lymph nodes metastases, which developed after the surgery, underwent successful treatment with a modified lymph node dissection of the neck. In none of the cases the lymph node metastases led to a fatal outcome.

Therapeutic strategies and long-term results in differentiated thyroid cancer.

Differentiated thyroid carcinoma (DTC) is usually an indolent tumor associated with a low mortality. However, DTC, particularly papillary thyroid carcinoma, happens to be a multicentric tumor and tends to spread to the regional lymph nodes in the early stage of the disease; some patients with DTC do die from metastatic or recurrent disease. Despite the small number of these patients, therapeutic strategies designed to prevent such outcomes should be pursued. In this review, we attempt to evaluate the impact of different therapeutic strategies on survival and recurrence. Consequently, we conclude that the surgical approach to DIC should be individualized on the basis of the biologic behavior of the tumor, rather than on the extent of cancer involvement in the thyroid and regional lymph nodes. It is mandatory to expand our efforts to identify high-risk patients more accurately, thereby facilitating more rational approaches to treatment.

Clinical and histologic determinations of adequate breast resection in breast-conserving surgery. A review.

Patient selection is an important consideration in breast-conserving therapy (BCT), and is dependent on the clinical and histologic determination of disease extent. In order to provide adequate local control without compromising cosmetic outcome, the amount of breast tissue that must be excised in BCT needs to be individualized. Nuclear magnetic resonance (NMR) imaging can provide better information than mammography or ultrasonography for assessing multifocal and multicentric disease in the breast. However, they will play a limited role in breast cancer staging until NMR imaging-directed sterotaxic biopsy becomes available. On the other hand, the histologic status of the surgical margins as well as certain features of the tumor including the presence of intraductal components is predictive of the extent of breast cancer. It is reasonable to evaluate and obtain clear margins when performing BCT. However, further investigation of new preoperative imaging and intraoperative staging modalities for assessing multifocal and multicentric disease is necessary.

Controversies in the surgical management of differentiated thyroid carcinoma.

We reviewed the literature related to the surgical management of differentiated thyroid carcinoma (DTC), and examined ongoing controversies regarding treatment. DTC has a relatively indolent biologic behavior, but it tends to spread to the thyroid and/or regional lymph nodes even in the early stages of the disease. On the other hand, surgical resection is the most effective treatment for DTC, but the extent of surgical resection has been controversial. The impact of surgery has been considered to be only minor in the prognosis of the majority of patients, unless grossly malignant residue is left behind. Nevertheless, in some patients the disease follows an aggressive course culminating in death. For such high-risk patients, a more extensive operation should be performed. Therefore, it may be concluded that the extent of surgical resection should depend on the basis of the biologic behavior of the DTC rather than the extent of cancer involvement in the thyroid and regional lymph nodes.

Diagnosis of axillary lymph node metastases in patients with breast cancer.

The diagnosis of axillary (AX) metastases remains a challenge in the management of breast cancer and is a subject of controversy. Clinical node staging clearly is limited in the assessment of AX lymph nodes. AX mammography, ultrasonography, and computed tomography (CT) do not provide histologic information. Although nuclear magnetic resonance imaging may have considerable value in the diagnosis of AX metastases, it does not detect micrometastases. The use of biologic markers in the assessment of AX metastases remains a subject of investigation. On the other hand, biopsy of selected AX nodes or tissue with examination of histology or cytology generally would not identify a significant percentage of patients with AX node involvement. Sentinel lymph node biopsy, however, might be potentially useful for assessing AX metastases, although it remains investigational. In order to simplify diagnosis and reduce morbidity and mortality, alternatives to AX dissection must be sought and imaging and staging modalities refined. We present a review of the literature pertaining to the diagnosis of AX metastases in patients with breast cancer and a discussion of some current areas of controversy.