European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology
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Post-operative difficulties apart, venous thrombosis, extravasation and dislocation, obstruction, catheter leakage and local and systemic infections are the typical complications associated with venous port systems. Such complications considerably reduce the benefits otherwise accruing from a reliable access to the venous system of patients with malignant tumours. ⋯ In may cases it will be possible, with the help of a specific diagnostic investigation, to identify and correct a fault and this ensure that the system installed continues to function. Typical and frequent complications observed (with specific examples) in connection with port systems are described together with preventative measures, diagnosis and therapy.
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Randomized Controlled Trial Clinical Trial
Preservation versus section of intercostal-brachial nerve (IBN) in axillary dissection for breast cancer--a prospective randomized trial.
Preservation of the intercostal-brachial nerve is advocated to reduce side effects of axillary dissection for breast cancer. We conducted a prospective randomized trail to compare functional results: sensory deficit and/or shoulder pain in preserved (group I) vs sacrificed (group II) intercostal-brachial nerve (IBN). ⋯ Conservation of the IBN, while anatomically preferable, is not functionally necessary during axillary dissection for breast cancer.
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To describe a new technique of axillary dissection and evaluate the results. ⋯ Axillary lymphadenectomy prepared by fat and lymph node suction is a reliable and effective procedure. However, it does not appear to be better than standard dissection as regards post-operative complications, except for arm oedema, but this must be confirmed by further studies.
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Multicenter Study
Extended lymph node dissection for gastric cancer: results of a prospective, multi-centre analysis of morbidity and mortality in 118 consecutive cases.
This study reports interim data on post-operative morbidity, hospital mortality and duration of hospital stay of Italian patients undergoing extended lymph-node dissection combined with a pancreas-preserving technique for gastric cancer. Of the 218 patients admitted to one of eight general and/or university hospitals in North Italy, 118 were enrolled in the trial. Eligible patients presented with proven primary adenocarcinoma of the stomach without clinical evidence of distant, peritoneal and/or liver metastasis, or metastasis in para-aortic and retropancreatic nodes at intraoperative biopsy. ⋯ Only one patient died from an anastomotic leak. The rate of leakages was higher after total than after distal gastrectomy (15.9 vs 5.4%); the association of splenectomy and pancreatectomy worsened the morbidity rate. D2 lymphadenectomy with pancreas-preserving technique, when performed at experienced centres, seems a feasible and safe technique for the radical treatment of gastric cancer in selected Western patients.
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A retrospective study of patients with cancer diagnoses treated at a Swedish county hospital was carried out in order to analyse medical care utilization by incurable cancer patients. All 208 patients customarily treated at the Department of General Surgery in Ostersund Hospital for cancer diagnoses during 1 year were included in the study. The main outcome measures were: number of institutional days; admissions; duration of terminal hospitalization. ⋯ The duration of the terminal hospitalization seemed to be unrelated to various diagnoses and demographic variables. Patients with cancer of the breast utilized most institutional days/patient (median 80 institutional days) during the disease course. Married patients and patients living within a 40 km radius of the hospital spent significantly more days at the Department of General Surgery during the last 6 months of life than did the unmarried and those living further afield.