Gastric stump cancer was initially defined as a carcinoma of the stomach occurring more than 5 years after surgery for gastric or duodenal benign disease. In recent years, as the number of total gastrectomy for benign disease has gradually decreased and the gastric cancer detection and operation rate have annually increased, residual recurrence of primary gastric cancer more than 10 years after gastric cancer surgery has also been considered as gastric stump cancer. The incidence of gastric stump cancer is increasing annually. The epidemiological characteristics of this form of cancer are also developing, and they show a higher incidence in males compared to females. The incidence has been affected following digestive tract reconstruction, and the risk increases in patients who undergo Billroth II( reconstruction. The interval of onset is related to the benign and malignant condition of primary disease, and the incidence increases after 10 years of early gastric cancer surgery. Lymph node metastasis pattern in gastric stump cancer is different from that in primary gastric cancer as the primary operation may destroy normal lymph flow. Many factors are known to cause gastric stump cancer, mainly duodenal gastric reflux, Helicobacter pylori infection, and gastric mucosal barrier dysfunction; however, the mechanism is not clear. It is expected to reduce the incidence of gastric stump cancer by taking precautionary measures against different inducements, which also has some guiding significance for the treatment and prognosis of gastric cancer.
Female ; Gastrectomy ; Gastric Stump ; pathology ; surgery ; Gastroenterostomy ; Humans ; Incidence ; Male ; Neoplasm Recurrence, Local ; Risk Factors ; Stomach Neoplasms ; epidemiology ; etiology ; surgery

OBJECTIVETo investigate the regular pattern and prognostic evaluation of patients with recurrent rectal cancer after resection.

METHODSThree hundred and fourteen cases with recurrent rectal cancer after resection treated between May 1979 and November 2006 were classified into three groups according to the recurrence intervals (<3 years, 3-5 years, >5 years). The survival rates and prognosis in the three groups were analyzed and compared retrospectively.

RESULTSOf the 314 patients, the cancer relapsed in 247 cases (78.7%) in less than 3 years, and the recurrence occurred predominantly within 2 years (207 cases, 65.9%) after the operation. The neoplasm in 41 cases (13.3%) recurred in 3-5 years after the operation, and 26 cases (8. 3%) in more than 5 years after the resection. Disease-free interval, Dukes stage, neoplasm gross type, histological type, T stage, lymphatic and distant metastasis were associated with the prognosis on univariate analysis. And disease-free interval and tumor Dukes stage were independent prognostic factors for survival rate on multivariate analysis. Disease-free interval and progression-free survival were related positively with survival time.

CONCLUSIONSThe rectal cancer patients should be followed-up intensively for 2 years after the operation and moderately from then on. Disease-free interval and progression-free survival could be taken as the best predictors of long-term cure and prognosis.

Humans ; Multivariate Analysis ; Neoplasm Recurrence, Local ; epidemiology ; Postoperative Period ; Prognosis ; Rectal Neoplasms ; pathology ; surgery ; Retrospective Studies ; Survival Analysis

To determine whether radical hysterectomy is necessary in the treatment of endometrial cancer patients with cervical involvement, we reviewed the medical records of women who underwent primary surgical treatment for endometrial carcinoma and selected patients with pathologically proven cervical invasion. Among 133 patients, 62 patients underwent extrafascial hysterectomy (EH) and 71 radical or modified radical hysterectomy (RH). The decision regarding EH or RH was made at the discretion of the attending surgeon. The sensitivity of pre-operative magnetic resonance imaging for cervical invasion was 44.7% (38/85). In RH patients, 10/71 (14.1%) patients had frankly histologic parametrial involvement (PMI). All were stage III or over. Eight of 10 patients had pelvic/paraaortic node metastasis and two showed extrauterine spread. In 74 patients with stage II cancer, RH was performed in 41 and PMI was not seen. Sixty-six (89.2%) patients had adjuvant radiation therapy and there were 3 patients who had developed recurrent disease in the RH group and none in the EH group (Mean follow-up: 51 months). Although these findings cannot conclusively refute or support the necessity of radical hysterectomy in patients with cervical extension, it is noteworthy that the risk of PMI seems to be minimal in patients with a tumor confined to the uterus without evidence of extrauterine spread.
Adult ; Aged ; Databases, Factual ; Endometrial Neoplasms/epidemiology/*pathology/*surgery ; Female ; Humans ; *Hysterectomy/methods ; Korea/epidemiology ; Middle Aged ; Neoplasm Metastasis ; Neoplasm Recurrence, Local/pathology ; Neoplasm Staging ; Radiotherapy, Adjuvant ; Retrospective Studies ; Treatment Outcome ; Uterine Cervical Neoplasms/epidemiology/*pathology/*surgery

OBJECTIVETo discuss clinical effects of surgical treatment for desmoplastic fibroma of bone.

METHODSBetween June 2000 and June 2010, 15 cases of desmoplastic fibroma were treated by surgical operation including 4 males and 7 females with an average age of 39 years old (ranged from 18 to 64 years old). The site of tumor was proximal femur in 4 cases, distal femur in 3, distal tibia in 2, proximal humerus in 1, distal humerus in 1, scapula in 1, pelvic in 2, manubrium of sternum in 1. The simple intralesional curettage was performed in 1 case. The other 14 cases were divided into two groups, 7 cases had an aggressive curettage with inactivation and the last 7 cases had a wide resection. Recurrence condition were observed after operation. The function was valuated in two groups after the operation according to Enneking's standard.

RESULTSThe mean duration of follow-up was 56 months (ranged, 18 to 132 months). Two cases recurred, but no metastasis. The patient with simple intralesional curettage recurreed, 1 of the 7 patients with a wide resection recurred. The recurrence rate was 13.3% (2/15). There was no recurrence in the group with an aggressive curettage with inactivation. According to Enneking's standard, Enneking scoring was 21.6 +/- 3.8 in the group with a wide resection and 28.3 +/- 1.3 in another group, The results were excellent in 2 cases and good in 5 in the group with a wide resection, excellent in 7 in the other group.

CONCLUSIONThe aggressive curettage with inactivation has better functional recovery than the wide resection,and it should be chosen when the lesion is small or located in an area where reconstruction is difficult.

Adolescent ; Adult ; Bone Neoplasms ; pathology ; surgery ; Female ; Fibroma, Desmoplastic ; pathology ; surgery ; Humans ; Male ; Middle Aged ; Neoplasm Recurrence, Local ; epidemiology ; Young Adult

The aim of this study was to compare the rate of incomplete resection and treatment outcome of the second-pass technique with those of single-pass technique in loop electrosurgical excisional procedure (LEEP). From 1997 to 2002, 683 women were diagnosed as squamous dysplasia via LEEP in our institution. Age, parity, LEEP technique, grade of lesion, glandular extension, margin status, residual tumor and recurrence were obtained by reviewing medical records. Positive margin was defined as mild dysplasia or higher grade lesions at resection margin of the LEEP specimen. In women who underwent hysterectomy, residual tumor was defined as mild dysplasia or higher grade lesions in hysterectomy specimen. In women who did not underwent hysterectomy, Pap smear more than atypical squamous cells of undetermined significance or biopsy result more than mild dysplasia within two years after LEEP were regarded as cytologic or histologic recurrences, respectively. Treatment failure of LEEP was defined as residual tumor or histologic recurrence. The second-pass technique significantly reduced the endocervical margin positivity (odds ratio [OR], 0.36; 95% confidence interval [CI], 0.21-0.63). However, the second-pass technique did not reduce the treatment failure (OR, 0.62; 95% CI, 0.29-1.32). In conclusion, the second-pass technique markedly reduced the endocervical margin positivity, but did not reduce the treatment failure rate of LEEP.
Adult ; Cervical Intraepithelial Neoplasia/pathology/*surgery ; Electrosurgery/*methods ; Female ; Humans ; Hysterectomy ; Medical Records ; Middle Aged ; Neoplasm Recurrence, Local/diagnosis/epidemiology ; Neoplasm, Residual/diagnosis/epidemiology ; Odds Ratio ; Recurrence ; Retrospective Studies ; Risk Factors ; Severity of Illness Index ; Uterine Cervical Neoplasms/pathology/*surgery

OBJECTIVE: To evaluate the recurrence rates and patterns of failure in patients with stage I endometrial carcinoma after surgical staging without adjuvant therapy. METHODS: Medical records of 229 patients with stage I endometrial carcinoma, treated with surgery alone between 2002 and 2010 at Siriraj Hospital were retrospectively reviewed. The primary objective of this study was recurrence rates. The secondary objectives were patterns of failure, disease-free survival, overall survival, and prognostic factors related to outcomes. RESULTS: During median follow-up time of 53.3 months, 11 recurrences (4.8%) occurred with a median time to recurrence of 21.2 months (range, 7.7 to 77.8 months). Vaginal recurrence was the most common pattern of failure (8/11 patients, 72.7%). Other recurrences were pelvic, abdominal and multiple metastases. Factors that appeared to be prognostic factors on univariate analyses were age and having high intermediate risk (HIR) (Gynecologic Oncology Group [GOG] 99 criteria), none of which showed significance in multivariate analysis. The recurrence rates were higher in the patients with HIR criteria (22.2% vs. 4.1%, p=0.013) or patients with stage IB, grade 2 endometrioid carcinoma (9.4% vs. 4.3%, p=0.199). Five-year disease-free survival and 5-year overall survival were 93.9% (95% CI, 89.9 to 5.86) and 99.5% (95% CI, 97.0 to 99.9), respectively. CONCLUSION: The patients with low risk stage I endometrial carcinoma had excellent outcomes with surgery alone. Our study showed that no single factor was demonstrated to be an independent predictor for recurrence.
Adult ; Aged ; Aged, 80 and over ; Endometrial Neoplasms/mortality/pathology/*surgery ; Female ; Humans ; Middle Aged ; Neoplasm Recurrence, Local/epidemiology ; Neoplasm Staging ; Treatment Outcome

OBJECTIVETo investigate the effect of total mesorectal excision(TME) and preoperative therapy on local recurrence in rectal cancer.

METHODSRectal cancer patients who received TME in School of Oncology, Peking University, from January 2000 to August 2004 were enrolled in the study group. Patients who received surgical resection for rectal cancer from January 1996 to December 1999,before the introduction of TME,were chosen as controls. Postoperative complications and local recurrence were compared. Clinicopathological and follow- up data were analyzed.

RESULTSThere were 161 patients in the TME group and 173 as controls. The intra- operative blood loss was significant less,hospital stay shorter,and lymph nodes harvested more in TME group than those in the control group,there was no difference in complication rate between the two groups. Local recurrence (LR) rate was 2.5% in TME and 8.0% in the control group, respectively (chi2=5.144; P=0.023). In TME group,the local recurrence rate was 1.8% in the 77 patients with preoperative therapy,and 2.9% in the other patients without preoperative therapy (P=0.182). Logistic regression analysis revealed that TME and vessel cancerous emboli were major risk factors for local recurrence of rectal cancer.

CONCLUSIONTME and vessel cancerous emboli are major risk factors for local recurrence of rectal cancer.

Aged ; Chemotherapy, Adjuvant ; Female ; Follow-Up Studies ; Humans ; Male ; Mesentery ; surgery ; Middle Aged ; Neoplasm Recurrence, Local ; epidemiology ; Prognosis ; Radiotherapy, Adjuvant ; Rectal Neoplasms ; pathology ; surgery ; therapy

OBJECTIVETo study the relation of the sex, age, location and chemotherapy with recurrence of the tumor.

METHODSFrom January 2000 to August 2010, 47 patients with giant cell tumor of tendon sheath in upper extremity were retrospectively analyzed. Statistical analysis of sex, age at presentation, lesion location, chemical inactivation, surgical complications, tumor recurrence and pathological findings were explored. There were 28 females and 19 males, ranging in age from 17 to 78 years, with an average of 38.15 years. All the patients underwent surgical excision. Fourteen patients received intraoperative chemically inactive treatment. All the patients had routine follow-up to observe the wound healing, pathological findings,tumor recurrence, and received necessary imaging examinations.

RESULTSAll the patients were followed up, and the duration ranged from 22 to 129 months, with a mean time of 53.89 months. Four patients who received intraoperative alcohol inactivation appeared wound complications such as wound swelling, discharge of necrotic tissue, delayed wound healing. Fifteen patients had active growth of tumor tissue, 1 patient had low-grade malignant giant cell tumor of tendon sheath. The recurrence rate was significantly higher in the group which preoperative X-ray was found to have bone destruction (P = 0.003); patients receiving chemically inactivation had lower risk of recurrence after surgery than patients not receiving chemically inactivation (P = 0.042).

CONCLUSIONThe recurrence rate of giant cell tumor of tendon sheath in upper limb was closely related to tumor growth site, bone destruction and chemical inactivation. Local excision of giant cell tumor of tendon sheath was the effective treatment. How to identify the patients at high risk of recurrence, how to reduce the recurrence rate and the functional restoration after wide resection are the priorities and difficulties of future researches.

Adult ; Female ; Giant Cell Tumors ; pathology ; surgery ; Humans ; Male ; Middle Aged ; Neoplasm Recurrence, Local ; epidemiology ; Postoperative Complications ; epidemiology ; Retrospective Studies ; Soft Tissue Neoplasms ; pathology ; surgery ; Tendons ; pathology ; Upper Extremity

PURPOSE: The role of local excision in treating rectal cancer patients continues to be controversial. The aim of this study was to evaluate the long-term oncological results of local excision for early rectal adenocarcinomas and review the outcomes of salvage therapy on rectal cancer patients. MATERIALS AND METHODS: Between March 1992 and September 2005, 35 consecutive patients with early-stage primary rectal adenocarcinomas were treated by local excision with curative intent. The mean tumor distance from the anal verge was 5 cm (range, 1-10 cm). RESULTS: The median follow-up was 66 months (range, 17-161 months). Pathological examination revealed 23 cases of T1 and 12 cases of T2. Recurrence had developed in 10 patients (6 local recurrences, 4 systemic recurrences). Purely extrapelvic recurrence was observed in only two (5.7%) patients. Of the eight recurrent patients with surgical salvage, five survived with no evidence of disease at the time of this analysis. The 5-year local recurrence-free and disease-free survival rates were 79.6% and 67.9%, respectively. CONCLUSION: Local excision alone of early-staged rectal adenocarcinomas, even in the ideal candidate, is followed by a relatively higher local recurrence rate than previously reported and may not be a valid modality. Either the use of adjuvant therapy with local excision, even in patients with T1 lesions or the use of preoperative therapy followed by local excision has good promise.
Adenocarcinoma/*pathology/surgery ; Adult ; Aged ; Aged, 80 and over ; Female ; Humans ; Male ; Middle Aged ; Neoplasm Recurrence, Local/epidemiology/*pathology/surgery ; Rectal Neoplasms/*pathology/surgery ; Retrospective Studies ; Risk Factors ; Salvage Therapy ; Time Factors ; Treatment Outcome

PURPOSE: After esophagectomy and gastric reconstruction for esophageal cancer, patients suffer from various symptoms that can detract from quality of life. Endoscopy is a useful diagnostic tool for evaluating patients after esophagectomy. This observational study was performed to investigate the correlation between symptoms and endoscopic findings one year after esophageal surgery and to assess the clinical usefulness of one-year endoscopic follow-up. MATERIALS AND METHODS: From 2001 to 2008, 162 patients who underwent esophagectomy with gastric reconstruction were endoscopically examined one year after operation. RESULTS: Patients suffered from the following symptoms: nocturnal cough (n=10), regurgitation (n=7), cervical heartburn (n=3), lump sensation (n=2), dysphagia (n=20) and odynophagia (n=22). Eighty-five (52.5%) patients had abnormal findings on endoscopic examination. Twelve (7.4%) patients had reflux esophagitis, and 37 (22.8%) patients had an anastomotic stricture. Only stricture-related symptoms were correlated with the finding of anastomotic strictures (p<0.001). Two patients had recurrences at the anastomotic sites, and four patients had regional lymph node recurrences with gastric conduit invasion visualized by endoscopy. Newly-developed malignancies in the esophageal remnant or hypopharynx that were not detected by clinical symptoms and imaging studies were reported in two patients. CONCLUSION: One year after esophagectomy, endoscopic findings were not correlated with clinical symptoms, except those related to stricture. Routine endoscopic follow-up is a useful tool for identifying latent functional and oncological lesions.
Anastomosis, Surgical ; Carcinoma, Squamous Cell/pathology/*surgery ; Esophageal Neoplasms/pathology/*surgery ; Esophagectomy/*adverse effects ; Follow-Up Studies ; Humans ; Neoplasm Recurrence, Local/diagnosis/epidemiology ; Postoperative Complications/*diagnosis/epidemiology ; Reconstructive Surgical Procedures ; Retrospective Studies