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Yuman Fong - One of the best experts on this subject based on the ideXlab platform.
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anatomic Segmental hepatic Resection is superior to wedge Resection as an oncologic operation for colorectal liver metastases
Journal of Gastrointestinal Surgery, 2000Co-Authors: Ronald P Dematteo, Caron Palese, William R Jarnagin, Ruth L Sun, Leslie H Blumgart, Yuman FongAbstract:Hepatic wedge Resection tor colorectal liver metastasis has been reported to have a high incidence of positive surgical margins. Anatomic Segmental Resection is now widely practiced, although there are few data comparing Segmental and wedge Resection in terms of tumor clearance or long-term outcome. There were 267 patients who underwent liver Resection for metastatic colorectal cancer between July 1985 and October 1998 at our institution who had either a wedge (n = 119) or Segmental (n = 148) Resection. Patient, tumor, and treatment data were compared, actuarial survival was determined, and prognostic factors were analyzed. Anatomic Segmental Resection was associated with similar blood loss, operative time, and complications as wedge Resection. Segmental Resection had a signilicantly lower rate of positive margins (2% vs. 16%) compared to wedge hepatcctomy (P <0.001). On univariatc analysis, segnicntcctoiuy resulted in longer survival with a median of 53 months vs. 38 months for wedge hepatectomy (P = 0.015). Preoperative carcinoembryomc antigen level, positive margin of Resection, and the presence of extra-hepatic disease independently predicted survival on multivjriate analysis. Anatomic Segmental Resection is a safe procedure and is superior to wedge Resection as an oncologic operation for colorectal liver metastasis because it results in better tumor clearance and improved survival.
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anatomic Segmental hepatic Resection is superior to wedge Resection as an oncologic operation for colorectal liver metastases
Journal of Gastrointestinal Surgery, 2000Co-Authors: Ronald P Dematteo, Caron Palese, William R Jarnagin, Ruth L Sun, Leslie H Blumgart, Yuman FongAbstract:Hepatic wedge Resection for colorectal liver metastasis has been reported to have a high incidence of positive surgical margins. Anatomic Segmental Resection is now widely practiced, although there are few data comparing Segmental and wedge Resection in terms of tumor clearance or long-term outcome. There were 267 patients who underwent liver Resection for metastatic colorectal cancer between July 1985 and October 1998 at our institution who had either a wedge (n = 119) or Segmental (n = 148) Resection. Patient, tumor, and treatment data were compared, actuarial survival was determined, and prognostic factors were analyzed. Anatomic Segmental Resection was associated with similar blood loss, operative time, and complications as wedge Resection. Segmental Resection had a significantly lower rate of positive margins (2% vs. 16%) compared to wedge hepatectomy (P <0.001). On univariate analysis, segmentectomy resulted in longer survival with a median of 53 months vs. 38 months for wedge hepatectomy (P = 0.015). Preoperative carcinoembryonic antigen level, positive margin of Resection, and the presence of extrahepatic disease independently predicted survival on multivariate analysis. Anatomic Segmental Resection is a safe procedure and is superior to wedge Resection as an oncologic operation for colorectal liver metastasis because it results in better tumor clearance and improved survival.
Ronald P Dematteo - One of the best experts on this subject based on the ideXlab platform.
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anatomic Segmental hepatic Resection is superior to wedge Resection as an oncologic operation for colorectal liver metastases
Journal of Gastrointestinal Surgery, 2000Co-Authors: Ronald P Dematteo, Caron Palese, William R Jarnagin, Ruth L Sun, Leslie H Blumgart, Yuman FongAbstract:Hepatic wedge Resection tor colorectal liver metastasis has been reported to have a high incidence of positive surgical margins. Anatomic Segmental Resection is now widely practiced, although there are few data comparing Segmental and wedge Resection in terms of tumor clearance or long-term outcome. There were 267 patients who underwent liver Resection for metastatic colorectal cancer between July 1985 and October 1998 at our institution who had either a wedge (n = 119) or Segmental (n = 148) Resection. Patient, tumor, and treatment data were compared, actuarial survival was determined, and prognostic factors were analyzed. Anatomic Segmental Resection was associated with similar blood loss, operative time, and complications as wedge Resection. Segmental Resection had a signilicantly lower rate of positive margins (2% vs. 16%) compared to wedge hepatcctomy (P <0.001). On univariatc analysis, segnicntcctoiuy resulted in longer survival with a median of 53 months vs. 38 months for wedge hepatectomy (P = 0.015). Preoperative carcinoembryomc antigen level, positive margin of Resection, and the presence of extra-hepatic disease independently predicted survival on multivjriate analysis. Anatomic Segmental Resection is a safe procedure and is superior to wedge Resection as an oncologic operation for colorectal liver metastasis because it results in better tumor clearance and improved survival.
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anatomic Segmental hepatic Resection is superior to wedge Resection as an oncologic operation for colorectal liver metastases
Journal of Gastrointestinal Surgery, 2000Co-Authors: Ronald P Dematteo, Caron Palese, William R Jarnagin, Ruth L Sun, Leslie H Blumgart, Yuman FongAbstract:Hepatic wedge Resection for colorectal liver metastasis has been reported to have a high incidence of positive surgical margins. Anatomic Segmental Resection is now widely practiced, although there are few data comparing Segmental and wedge Resection in terms of tumor clearance or long-term outcome. There were 267 patients who underwent liver Resection for metastatic colorectal cancer between July 1985 and October 1998 at our institution who had either a wedge (n = 119) or Segmental (n = 148) Resection. Patient, tumor, and treatment data were compared, actuarial survival was determined, and prognostic factors were analyzed. Anatomic Segmental Resection was associated with similar blood loss, operative time, and complications as wedge Resection. Segmental Resection had a significantly lower rate of positive margins (2% vs. 16%) compared to wedge hepatectomy (P <0.001). On univariate analysis, segmentectomy resulted in longer survival with a median of 53 months vs. 38 months for wedge hepatectomy (P = 0.015). Preoperative carcinoembryonic antigen level, positive margin of Resection, and the presence of extrahepatic disease independently predicted survival on multivariate analysis. Anatomic Segmental Resection is a safe procedure and is superior to wedge Resection as an oncologic operation for colorectal liver metastasis because it results in better tumor clearance and improved survival.
Byung Mo Kang - One of the best experts on this subject based on the ideXlab platform.
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lymph node metastasis patterns in right sided colon cancers is Segmental Resection of these tumors oncologically safe
Annals of Surgical Oncology, 2009Co-Authors: In Ja Park, Gyuseog Choi, Byung Mo Kang, Kyoung Hoon Lim, Soo Han JunAbstract:The type of surgery and the extent of lymphadenectomy depend on the tumor location and should be based on the extent of lymphatic spread and the oncologic outcome. The aim was to analyze patterns of lymph node metastasis in patients with right-sided colon cancer. Between 1996 and 2007, a total of 419 patients underwent curative Resection for right-sided colon cancer. Lymph nodes were grouped immediately after surgery on the basis of the location of the tumor. There were 75, 208, 78, and 58 tumors in the cecum, ascending colon, at the hepatic flexure, and in the transverse colon, respectively. Of the 58 patients with transverse colon tumors, 43, 11, 3, and 1 underwent right hemicolectomies, transverse colectomies, left hemicolectomies, and a subtotal colectomy, respectively. Patients with cecal and ascending colon cancers most frequently had metastases in the ileocolic lymph nodes. Metastasis to the lymph nodes along the right branch of the middle colic artery occurred in 6.1% of patients with cecal cancer. In patients with hepatic flexure cancers, the epicolic lymph nodes along the right and middle colic arteries were most commonly metastatic lymph nodes. In transverse colon cancer, the middle colic node was the most commonly involved lymph node. Approximately 10% of patients had metastases to the right colic nodes. Metastasis to lymph nodes along the right colic artery occurred in approximately 10% of the patients with transverse cancer, indicating the need for great care in deciding the extent of Segmental Resection for these patients.
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lymph node metastasis patterns in right sided colon cancers is Segmental Resection of these tumors oncologically safe
Annals of Surgical Oncology, 2009Co-Authors: In Ja Park, Gyuseog Choi, Byung Mo KangAbstract:PURPOSE: The type of surgery and the extent of lymphadenectomy depend on the tumor location and should be based on the extent of lymphatic spread and the oncologic outcome. The aim was to analyze patterns of lymph node metastasis in patients with right-sided colon cancer. METHODS: Between 1996 and 2007, a total of 419 patients underwent curative Resection for right-sided colon cancer. Lymph nodes were grouped immediately after surgery on the basis of the location of the tumor. RESULTS: There were 75, 208, 78, and 58 tumors in the cecum, ascending colon, at the hepatic flexure, and in the transverse colon, respectively. Of the 58 patients with transverse colon tumors, 43, 11, 3, and 1 underwent right hemicolectomies, transverse colectomies, left hemicolectomies, and a subtotal colectomy, respectively. Patients with cecal and ascending colon cancers most frequently had metastases in the ileocolic lymph nodes. Metastasis to the lymph nodes along the right branch of the middle colic artery occurred in 6.1% of patients with cecal cancer. In patients with hepatic flexure cancers, the epicolic lymph nodes along the right and middle colic arteries were most commonly metastatic lymph nodes. In transverse colon cancer, the middle colic node was the most commonly involved lymph node. Approximately 10% of patients had metastases to the right colic nodes. CONCLUSIONS: Metastasis to lymph nodes along the right colic artery occurred in approximately 10% of the patients with transverse cancer, indicating the need for great care in deciding the extent of Segmental Resection for these patients.
Michael J Solomon - One of the best experts on this subject based on the ideXlab platform.
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deeply infiltrating endometriosis of the rectum shave disc or Segmental excision
Surgical Endoscopy and Other Interventional Techniques, 2013Co-Authors: Cherry E Koh, Michael Cooper, Michael J SolomonAbstract:Dear Editor, The article by Ruffo et al. [1] describes a single-center series of 750 Segmental Resections of the mid or low rectum for deeply infiltrating endometriosis. Although the authors’ relatively low complication rate is impressive, we are concerned about the large number of low or very low anastomoses being performed in otherwise well and young (median age, 33 years) women without accompanying report of bowel function. Anterior Resection syndrome is well documented, particularly after low rectal anastomoses, the management of which can be difficult [2–4]. Considering that endometriosis surgery is in many ways a quality-of-life operation to alleviate symptoms, we are interested in the authors’ comments. In our experience as well as that of others, most rectal endometriosis can be managed with shave or disc excisions without recourse to Segmental Resection [5, 6]. Although Ruffo et al. describe pathological confirmation of endometriosis, it will be important to determine the extent of disease on pathology. In our opinion, Segmental Resection should be reserved for patients with multicentric involvement or where a less invasive procedure is deemed inadequate. The authors did not make any comments on discs or shave excisions; if all patients were managed with Segmental Resection, then we consider this approach overly aggressive. We recently published our experience with rectal endometriosis and reported that the majority of patients (71 %) can be spared the morbidity of Segmental Resection by undergoing a disc excision of the anterior rectal wall because most will have focal rectal wall involvement [5]. This avoids the morbidity of full rectal mobilization, which risks rectal denervation and preserves the native rectal reservoir, which in turn reduces the likelihood of bowel dysfunction. Routine mobilization of the splenic flexure, as highlighted by Ruffo et al., necessarily implies a generous Segmental Resection. We are concerned about the appropriateness of this aggressive approach. We do not contest the safety and feasibility of laparoscopic management of rectal endometriosis, and recent publications testify that rectal Resection can indeed be performed with low complication rates. Other than cyclical bleeding in 20 % and a preoperative median dyschezia score of 6.7, it was difficult to grasp the severity of patients’ symptoms in the series of Ruffo et al. to justify such aggressive surgical management. One could argue that even a 3 % anastomotic leak rate, 2 % rectovaginal fistula rate, 0.7 % risk of ureteric injury, and 14.5 % temporary ileostomy rate is excessive if the rectal Resection was unwarranted in the first place. As we discuss in our recent article, the literature seems divergent in that there seems to be a lack of consensus as to whether bowel Resection is warranted [6]. In the absence of definitive evidence to support one approach or the other, and in an era of patient-centered care, we urge all authors to move away from only reporting on short-term surgical outcomes and instead focus on functional outcomes with regard to symptom control, fertility, and bowel function outcomes. C. E. Koh (&) M. J. Solomon Surgical Outcomes Research Center, Royal Prince Alfred Hospital, Camperdown, NSW, Australia e-mail: cherry_koh@hotmail.com
Ellen M Van Cann - One of the best experts on this subject based on the ideXlab platform.
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locoregional recurrence rate and disease specific survival following marginal vs Segmental Resection for oral squamous cell carcinoma with mandibular bone invasion
Journal of Surgical Oncology, 2020Co-Authors: Celine C Stoop, Ellen M Van Cann, Remco De Bree, Antoine J W P Rosenberg, Jan T M Van Gemert, Tim ForouzanfarAbstract:BACKGROUND AND OBJECTIVES To determine locoregional recurrence rate (LRR) and disease-specific survival (DSS) following marginal vs Segmental mandibulectomy. METHODS Included were 210 patients, who had marginal or Segmental mandibulectomy between 2000 and 2017. Marginal Resection was performed when complete removal of the tumor was deemed feasible on the condition that at least 1 cm bone height of the inferior border of the mandible could be preserved. Segmental Resection was performed in case less than 1 cm bone height of the mandible would remain. Clinical and histopathological data were collected from medical records. LRR and DSS were computed using Kaplan-Meier analysis. Cox-regression analysis was used to identify risk factors for LRR and DSS. RESULTS A total of 59 marginal and 151 Segmental Resections had been performed. There was no significant difference in 3- and 5-year LRR (P = .904) and no significant difference in 3- and 5-year DSS (P = .362) between the marginal and Segmental Resection group. Cox-regression analysis showed a trend for surgical margin less than equal to 1 mm, to affect LRR (P = .05) and surgical margin less than equal 1 mm, perineural invasion and lymph node metastasis to affect DSS (P < .05). CONCLUSIONS There was no difference in outcome between the two types of mandibulectomy.
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health related quality of life after Segmental Resection of the lateral mandible free fibula flap versus plate reconstruction
Journal of Cranio-maxillofacial Surgery, 2015Co-Authors: Johannes T M Van Gemert, Irene Holtslag, Andries Van Der Bilt, Matthias A W Merkx, Ron Koole, Ellen M Van CannAbstract:Abstract Objectives Segmental Resection of the mandible causes functional, aesthetic and social problems affecting health-related quality of life (HRQoL). It is often assumed that reconstruction with composite free flaps guarantees better function and aesthetics than bridging the defect with reconstruction plates. Methods Using the European Organization for Research and Treatment of Cancer questionnaires (EORTC QLQ-C30 version 3.0 and EORTC QLQ-H&N35), we compared HRQoL in patients who received free fibula flaps versus reconstruction plates after Segmental Resection of the lateral mandible. Results Thirty-seven completed questionnaires (18 fibula reconstructions and 19 patients with reconstruction plates) were available. Reconstruction with a free fibula flap did not provide clear additional benefit to bridging the defect with a reconstruction plate after Segmental Resection of the lateral mandible. In particular aspects known to have the most impact on HRQoL like swallowing, speech and chewing were not influenced by the type of reconstruction. Conclusions Reconstruction of Segmental defects of the lateral mandible with free fibula flap and reconstruction plate resulted in comparable HRQoL. If dental rehabilitation by means of dental implants is not anticipated in the fibula, then plate reconstruction with adequate soft tissue remains a suitable technique for the reconstruction of Segmental defects of the lateral mandible.