Carcinoma of the ductus choledochus

Article Abstract:

Patients with cancer of the common bile duct (the lower biliary duct system outside the liver) can be more easily treated surgically and have a better chance of long-term survival than do patients with upper bile duct cancer, which is more common. A study was undertaken to evaluate the impact of diagnostic evaluation and surgery on outcome of 62 patients with common bile duct cancer. These patients accounted for 35 percent of all bile duct cancers seen. The ratio of men to women was 2:1, and the average patient age was 58. The first group of patients (39 patients) was treated before June 1978; the second group (23 patients) was treated between July 1978 and December 1988. Preoperative evaluation has changed with the improvement in computed tomographic (CT) scanning and ultrasound techniques, and the development of percutaneous transhepatic cholangiography and endoscopic retrograde cholangiopancreatography or ERCP. Seventy percent of group 2 patients had one or the other of these imaging procedures performed preoperatively. These technological improvements led to earlier surgery. The ability to remove these tumors is directly related to improvement in survival. Unfortunately, preoperative determination of malignancy is often difficult because of the difficulty to obtain an adequate tissue specimen. The most useful biopsies are obtained using choledochoscopic and incisional techniques. Biopsy could confirm cancer in only 60 percent of patients who had surgery. Without biopsy confirmation of malignancy, the surgeon in the operating room must rely on clinical findings and diagnostic tests to make his decision before beginning radical tumor removal. Treatment of common bile duct cancer currently involves a combination of surgery and chemotherapy, with or without adjuvant radiotherapy. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Cancer, Cancer treatment, Common bile duct, Bile ducts, Gallbladder cancer

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A descriptive experience of total thyroidectomy as the initial operation for differentiated carcinoma of the thyroid

Article Abstract:

Cancer of the thyroid has a low mortality, is slow growing and requires vigorous long-term follow-up. Surgical treatment of these tumors is controversial. Although removal of the thyroid gland makes diagnosis and treatment easier and lowers the rate of cancer recurrence, it is not the recommended initial treatment because of possible risk of injury to the laryngeal nerve or of permanent hypoparathyroidism (inadequate hormonal secretion by the parathyroid glands). A retrospective study was undertaken of 65 patients listed in the tumor registry of a naval hospital who had cancer of the thyroid gland, to determine whether the risks of total thyroidectomy are significant enough to justify performing a different procedure. Fifty-four patients were being actively followed, 19 for more than 20 years, and 18 from 10 to 20 years. There were 11 tumor recurrences but no cancer-caused deaths. Total thyroidectomy was the initial procedure for 26 patients; the recurrence rate for these patients was much lower than for any other operation. In 23 patients the total thyroidectomy was performed by naval surgeons, and three patients were operated on by community surgeons. The outcomes were excellent despite the fact that none of the surgeons was an expert in thyroid surgery. It is concluded that the average, properly trained surgeon can safely perform total thyroidectomy, the acknowledged superior operation for thyroid cancer. (Consumer Summary produced by Reliance Medical Information, Inc.)

Usage, Evaluation, Registries (in medicine), Registries (Medicine), Thyroidectomy, Thyroid cancer

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The operation was a success, but..

Article Abstract:

Successful surgical careers, like successful operations, require preparation, execution, and completion. Surgeons, in particular, are examples of the slogan 'Americans want to succeed not just survive.' Preparation for a specific operation requires a thorough knowledge of basic sciences, anatomy, pathology and good technical skills. These skills can be developed by observing and working with skilled surgeons. A surgeon must have self-confidence if he is to instill that confidence in others, namely his patients. Execution of a surgical procedure should be expeditious. The surgeon's prime responsibility is to his patient, and it is necessary for the surgeon to make an accurate assessment of his own abilities. Good relationships with various groups (families, colleagues, patients) are important for the surgeon, as is good communication. The cultivation of hobbies and interests outside of surgery is important and helpful in attaining a full and balanced life. (Consumer Summary produced by Reliance Medical Information, Inc.)

Practice, Beliefs, opinions and attitudes, Vocational guidance, Surgeons, editorial

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