Introduction Controversy continues over the extent of surgical resection margin required to minimize the risk of local recurrence (LR) in breast conserving therapy (BCT) for stage I and II breast cancer. This thesis explores whether or not a narrow (less than or equal to 2 mm) but negative resection margin in BCT for stage I and II breast cancer affects LR. Methodology To address the question, all patients registered at the Saskatoon Cancer Center between January 1, 1991 and December 31, 2000 with a diagnosis of stage I or II invasive duct carcinoma of the breast treated with BCT were examined. All charts and pathology reports were reviewed with a review of the pathology for all cases where the resection margin was unclear in the original report. Other factors know or thought to effect LR (age, radiation boost, grade, extensive duct carcinoma in situ, ER/PR receptor status, tumor size, and systemic adjuvant therapy) were considered in the statistical analysis. Results Amongst the 200 narrow margin cases 19 LR were detected (19/200=9.5%) while 52 LR were detected in the 491 wide margin cases (52/491=10.6%). This difference was not statistically significant. Conclusions A narrow (less than or equal to 2 mm) surgical resection margin does not result in an increase in local recurrence compared to a surgical resection margin greater than 2 mm in breast conserving therapy for early stage duct carcinoma and does not warrant re-excision.

Introduction Controversy continues over the extent of surgical resection margin required to minimize the risk of local recurrence (LR) in breast conserving therapy (BCT) for stage I and II breast cancer. This thesis explores whether or not a narrow (less than or equal to 2 mm) but negative resection margin in BCT for stage I and II breast cancer affects LR. Methodology To address the question, all patients registered at the Saskatoon Cancer Center between January 1, 1991 and December 31, 2000 with a diagnosis of stage I or II invasive duct carcinoma of the breast treated with BCT were examined. All charts and pathology reports were reviewed with a review of the pathology for all cases where the resection margin was unclear in the original report. Other factors know or thought to effect LR (age, radiation boost, grade, extensive duct carcinoma in situ, ER/PR receptor status, tumor size, and systemic adjuvant therapy) were considered in the statistical analysis. Results Amongst the 200 narrow margin cases 19 LR were detected (19/200=9.5%) while 52 LR were detected in the 491 wide margin cases (52/491=10.6%). This difference was not statistically significant. Conclusions A narrow (less than or equal to 2 mm) surgical resection margin does not result in an increase in local recurrence compared to a surgical resection margin greater than 2 mm in breast conserving therapy for early stage duct carcinoma and does not warrant re-excision.

京都大学 / 0048 / 新制・課程博士 / 博士(医学) / 甲第20800号 / 医博第4300号 / 新制||医||1025(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 武藤 学, 教授 福原 俊一, 教授 福田 和彦 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

<p>The treatment of rectal cancer is complex and comprises: diagnostic measures; different preoperative treatments; a multitude of surgical and technical choices; possibilities of postoperative treatments and postoperative care and follow up. In this thesis, some aspects of this complex paradigm have been further investigated. One of the most feared complications after rectal cancer surgery is anastomotic leakage. The risk of anastomotic leakage is affected by non-influenceable factors related to the tumour and the patient. In the first paper, the risk of anastomotic leakage in relation to a surgical instrument, the circular stapler, was investigated. The risk of leakage was 7% or 11%, depending on the choice of instrument. In the second paper, a long-term evaluation of survival and local recurrence rates in the Swedish Rectal Cancer Trial was made. Randomisation was to either preoperative radiotherapy followed by surgery or surgery alone. After 13 years median follow-up, survival was 38% in the radiotherapy group and 30% in the surgery alone group. Differences in local recurrence rates were seen in all stages. Most rectal cancer operations carry a high risk of morbidity and mortality. For early stage cancers, a local procedure may be sufficient and in the third paper, population-based results of local excision of rectal cancer were explored. In stage I, cancer specific survival was the same after local excision as after major resection, but the relative survival was lower. The risk of local recurrence was higher after local excision than after resections. In the fourth paper, differences in survival rates in the Nordic countries and Scotland were investigated. The relative excess risk of death was highest in Denmark, but only in the first 90 postoperative days. </p><p>Through applying already existing knowledge and successively introducing new treatments, the results for rectal cancer treatment will be further improved.</p>

The treatment of rectal cancer is complex and comprises: diagnostic measures; different preoperative treatments; a multitude of surgical and technical choices; possibilities of postoperative treatments and postoperative care and follow up. In this thesis, some aspects of this complex paradigm have been further investigated. One of the most feared complications after rectal cancer surgery is anastomotic leakage. The risk of anastomotic leakage is affected by non-influenceable factors related to the tumour and the patient. In the first paper, the risk of anastomotic leakage in relation to a surgical instrument, the circular stapler, was investigated. The risk of leakage was 7% or 11%, depending on the choice of instrument. In the second paper, a long-term evaluation of survival and local recurrence rates in the Swedish Rectal Cancer Trial was made. Randomisation was to either preoperative radiotherapy followed by surgery or surgery alone. After 13 years median follow-up, survival was 38% in the radiotherapy group and 30% in the surgery alone group. Differences in local recurrence rates were seen in all stages. Most rectal cancer operations carry a high risk of morbidity and mortality. For early stage cancers, a local procedure may be sufficient and in the third paper, population-based results of local excision of rectal cancer were explored. In stage I, cancer specific survival was the same after local excision as after major resection, but the relative survival was lower. The risk of local recurrence was higher after local excision than after resections. In the fourth paper, differences in survival rates in the Nordic countries and Scotland were investigated. The relative excess risk of death was highest in Denmark, but only in the first 90 postoperative days. Through applying already existing knowledge and successively introducing new treatments, the results for rectal cancer treatment will be further improved.

Locally recurrent renal cell carcinoma and multiple pulmonary metastases were successfully resected in a patient 20 years after nephrectomy. / Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich.

京都大学 / 新制・課程博士 / 博士(医学) / 甲第23785号 / 医博第4831号 / 新制||医||1057(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 伊達 洋至, 教授 中本 裕士, 教授 鈴木 実 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

INTRODUÇÃO: Os macrófagos associados aos tumores (MAT) sólidos estão relacionados à progressão ou à involução das neoplasias, dependendo da diferenciação em M1 ou M2. No carcinoma basocelular (CBC), as formas mais agressivas apresentam aumento de macrófagos às custas do fenótipo M2, se comparadas às formas não invasivas. O tratamento do CBC sólido pela Cirurgia Micrográfica de Mohs (CMM) proporciona elevados índices de cura, porém recidivas podem ocorrer. OBJETIVOS: Comparar a população total de macrófagos e as subpopulações M1 e M2 nos casos de CBC sólidos recidivados e não recidivados após exérese pela CMM. METODOLOGIA: Cortes histológicos obtidos a partir dos blocos de parafina de nove casos de CBC sólidos recidivados após CMM e de 18 casos de CBC sólido operados pela CMM não recidivados foram marcados imunoistoquimicamente para iNOS, CD204, CD163 e CD68. A expressão desses marcadores foi analisada pelo método de análise de imagens. RESULTADOS: Não foram encontradas diferenças significativas entre os grupos em relação à porcentagem média de células M1 (INOS), células M2 (CD163 e CD204) e total de células (CD68). CONCLUSÃO: A recidiva dos tumores estudados não ocorreu por influência do MAT, mas pode ser decorrente da falha técnica na realização da CMM ou de algum outro mecanismo imunológico desconhecido / INTRODUCTION: The macrophages associated with solid tumors (MAT) are related to the progression or regression of tumors, depending on the differentiation in M1 or M2. In basal cell carcinoma (BCC), the most aggressive forms show an increase in macrophages at the expense of M2 phenotype compared to non-invasive forms. The treatment of BCC solid by Mohs micrographic surgery (MMS) provides high cure rates, but relapses can occur. OBJECTIVES: To compare the total population of macrophages and subpopulations M1 and M2 in cases of recurrent BCC solid and not recurrent after excision by MMS. METHODS: Histological sections obtained from paraffin blocks of 9 cases of recurrent solid CBC after MMS and 18 cases of solid CBC operated by MMS not relapsed were labeled immunohistochemically for iNOS, CD204, CD163 and CD68. The expression of these markers was analyzed by image analysis. RESULTS: No significant differences were found between the groups in relation to the average percentage of M1 cells (INOS), M2 cells (CD163 and CD204) and total cells (CD68). CONCLUSION: The recurrence of the tumors studied did not occur under the influence of MAT, but may be due to technical failure in achieving MMS or some other unknown immune mechanism

INTRODUÇÃO: Os macrófagos associados aos tumores (MAT) sólidos estão relacionados à progressão ou à involução das neoplasias, dependendo da diferenciação em M1 ou M2. No carcinoma basocelular (CBC), as formas mais agressivas apresentam aumento de macrófagos às custas do fenótipo M2, se comparadas às formas não invasivas. O tratamento do CBC sólido pela Cirurgia Micrográfica de Mohs (CMM) proporciona elevados índices de cura, porém recidivas podem ocorrer. OBJETIVOS: Comparar a população total de macrófagos e as subpopulações M1 e M2 nos casos de CBC sólidos recidivados e não recidivados após exérese pela CMM. METODOLOGIA: Cortes histológicos obtidos a partir dos blocos de parafina de nove casos de CBC sólidos recidivados após CMM e de 18 casos de CBC sólido operados pela CMM não recidivados foram marcados imunoistoquimicamente para iNOS, CD204, CD163 e CD68. A expressão desses marcadores foi analisada pelo método de análise de imagens. RESULTADOS: Não foram encontradas diferenças significativas entre os grupos em relação à porcentagem média de células M1 (INOS), células M2 (CD163 e CD204) e total de células (CD68). CONCLUSÃO: A recidiva dos tumores estudados não ocorreu por influência do MAT, mas pode ser decorrente da falha técnica na realização da CMM ou de algum outro mecanismo imunológico desconhecido / INTRODUCTION: The macrophages associated with solid tumors (MAT) are related to the progression or regression of tumors, depending on the differentiation in M1 or M2. In basal cell carcinoma (BCC), the most aggressive forms show an increase in macrophages at the expense of M2 phenotype compared to non-invasive forms. The treatment of BCC solid by Mohs micrographic surgery (MMS) provides high cure rates, but relapses can occur. OBJECTIVES: To compare the total population of macrophages and subpopulations M1 and M2 in cases of recurrent BCC solid and not recurrent after excision by MMS. METHODS: Histological sections obtained from paraffin blocks of 9 cases of recurrent solid CBC after MMS and 18 cases of solid CBC operated by MMS not relapsed were labeled immunohistochemically for iNOS, CD204, CD163 and CD68. The expression of these markers was analyzed by image analysis. RESULTS: No significant differences were found between the groups in relation to the average percentage of M1 cells (INOS), M2 cells (CD163 and CD204) and total cells (CD68). CONCLUSION: The recurrence of the tumors studied did not occur under the influence of MAT, but may be due to technical failure in achieving MMS or some other unknown immune mechanism

Objective: In this study, 22 cases of locally recurrent urological malignant fibrous histiocytoma were reviewed considering therapeutic options, follow-up and prognosis. Patients and Methods: In the available literature on this topic we identified 19 cases of locally recurrent genitourinary malignant fibrous histiocytoma. Three additional cases are discussed, primarily arising from the kidney, the bladder and the paratesticular region. Results: The prognosis of locally recurrent urological malignant fibrous histiocytoma was found to be extraordinarily poor. Only 2 of 22 patients have survived for longer than 3.5 years. One of them reported herein is still alive 10 years after extensive lymphatic spread accompanying the first local recurrence. In this case, late local recurrence occurred after an 8-year interval free of disease. Conclusion: Malignant fibrous histiocytoma is an unusual urological malignancy with a high rate of local recurrence. The latter is frequently accompanied by metastatic disease and unrelenting progression. Despite the poor prognosis early detection of local failure and aggressive salvage therapy might offer the chance of long-term survival in selected cases. Close and life-long follow-up is advisable for patients once treated for recurrent urological malignant fibrous histiocytoma. / Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich.