Search

Colorectal surgery is a commonly used treatment for various benign and malignant colorectal diseases, such as inflammatory bowel disease (IBD), diverticulitis, intestinal polyposis, and colorectal cancer. The surgical technique is chosen according to the severity of disease and to the extent of the involved bowel segment. Recent surgical techniques include segmental resection, sphincter-preserving surgery, and radical resection.

Tumors involving the main carina pose a considerable challenge to thoracic surgeons. On one hand, radical resection needs to be pursued; on the other, tension-free anastomoses are of great importance to ensure primary healing. Compromised healing of anastomoses is the predominant cause of morbidity and mortality. Various techniques for resection and reconstruction have been described; however, only a few institutions report a sufficient number of cases to provide reliable data concerning morbidity and mortality. The first publications with high case numbers go back to Grillo (1982) and Dartevelle et al. (1988). The mortality for tracheobronchoplastic surgery for lung cancer was reported to range from 10 % to almost 30 %.

It has been reported that hydatid disease involving the vertebral body and paraspinal muscles is rare, even in rural areas where echinococcosis is endemic. The treatment of choice for spinal hydatidosis is surgical resection of the affected vertebrae combined with stabilization, followed by postoperative adjuvant chemotherapy. Nevertheless, the recurrence rate is extremely high, and radical resection is often impossible to achieve in cases of extradural lesions involving the spine due to rupture of the hydatid cyst during surgery.

We report on 15 patients with mucinous and 19 patients with serous cystadenoma of the pancreas. Cystadenomas were more common in female patients (22/12), and CT was the most sensitive diagnostic tool. There was no mortality in the short or the long term (median 6 years); however, mucinous cystadenomas tend to recur when not treated by radical resection.

The carotid body tumors are semimalignant tumors. According to our results, the best diagnostic procedure is a combination of Doppler color flow imaging ultrasound, computed tomography and selective angiography. In our opinion, the treatment of choice is radical resection of the tumor with the carotid bifurcation, especially to reduce recurrence of the tumor. Considering the problems in recurrent tumors, consequent monitoring of the patients is necessary.

Radical resection of the breast, pectoral muscles, and regional lymph nodes for breast cancer was popularized by William S. Halsted late in the nineteenth Century, and became the mainstay for treat-ment. The lack of benefit from this Operation for some patients was first appreciated by Haagensen who, in classic publications with Stout in 1942 and 1943, described clinical features that were predictors of a shortened life expectancy after radical mastectomy (Haagensen and Stout 1942, 1943). Based on a series of 640 patients treated by radical mastectomy, they defined what they called “specific criteria of clinical inoperability” in patients who were considered technically resectable at the time of initial clinical presentation but who experienced early recurrence after surgery. Haagensen and Stout concluded from their thoughtful analysis that other treatment strategies for the management of these patients with locally more advanced breast cancer had to be found.

Currently, patients with soft-tissue sarcomas are managed by a multimodality approach. For small low-grade lesions in fleshy parts, treatment will be less than radical resection alone. For other lesions the treatment will be the combination of less than radical resection and radiotherapy, and in some patients chemotherapy. A problem remains in local control of inoperable tumors or tumors with gross residual tumor mass after surgery. A further problem concerns local control of highly differentiated tumors (G1 and G2). Neutron therapy offers radiobiological advantages in the treatment of these tumors. From January 1984 to September 1988, 147 patients with soft-tissue sarcomas were treated with fast neutrons. A current analysis of these patients is presented. A second analysis will focus 50 patients through January 1990 with neutrons or photons.

Tumors of neuroepithelial origin constitute approximately one-half of supratentorial tumors and the vast majority of posterior fossa tumors in children [1,2]. The clinical presentation and the treatment approach depend considerably on the anatomical location of the tumor. Tumors of the midline are those located in the third and fourth ventricles, in the pineal region, and the cerebellar vermis. Recent technological advances in diagnosis, intraoperative monitoring, microsurgical technique, and treatment modalities had an impact on treatment of the midline tumors [3, 5–7]. However, certain neoplasms located on the midline are still considered unresectable and even “untouchable” due to the complicated neurovascular anatomy of this region [1].

Gliomas are the most common brain tumours, constituting about one-half of all intracranial neoplasms. Grades 1 and 2 gliomas are not histologically malignant, but their clinical behaviour can be fatal. Gliomas never disseminate lymphatically and very seldom hematogenously. Unfortunately, the site of many gliomas in motoric or other critical areas of the brain does not allow resection.` The location may also even influence the considerations of taking a biopsy. Additionally, the border of a glioma against normal brain tissue is nearly always unclear. Thus radical resection of the tumour may be impossible in most instances.

In the past the debate about the choice of treatment for cranio-orbital fibrous dysplasia revolved about whether it was better to perform a conservative treatment (Ramsey et al. 1968) or a radical one, considering that recurrences were frequent after conservative procedures for cranio-orbital fibrous dysplasia. Derome (1972) referred to four cases of craniofacial fibrous dysplasia treated with radical resection and immediate reconstruction. Rougier, Tessier et al. (1977) discussed the possibility of reconstruction after resection of benign tumours in the fronto-orbital area. Munro et al. (1981) reported five cases of fronto-orbital fibrous dysplasia: these authors developed a technique for one-stage removal and immediate reconstruction with rib grafts fixed together, utilizing the chain-link fence principle. Munro states that radical resection offers better opportunity for treating and correcting the entire deformity.