Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 2/2007

01-02-2007

Neoplastic Mesorectal Microfoci (MMF) following Neoadjuvant Chemoradiotherapy: Clinical and Prognostic Implications

Authors: Carlo Ratto, MD, Riccardo Ricci, MD, Vincenzo Valentini, MD, Federica Castri, MD, Angelo Parello, MD, Maria A. Gambacorta, MD, Numa Cellini, MD, Fabio M. Vecchio, MD, Giovanni B. Doglietto, MD

Published in: Annals of Surgical Oncology | Issue 2/2007

Login to get access

Abstract

Background

Neoplastic microfoci have frequently been found in the mesorectum, with poor outcome. In this study, incidence and clinical significance of mesorectal microfoci (MMF) were analyzed in patients operated on for rectal cancer following neoadjuvant chemoradiation.

Methods

A case series of 68 patients with extraperitoneal rectal cancer treated with neoadjuvant chemoradiation and surgery (including total mesorectal excision) were investigated for presence of neoplastic MMF.

Results

MMF were found in 26 cases (38.2%). Increasing incidence of microfoci was statistically related to pathologic involvement of the bowel wall (P = 0.0006), Mandard’s tumor regression grading (P = 0.0006), and pathologic neoplastic mesorectal involvement (P < 0.00001). None of the nine patients with complete tumor disappearance displayed both microfoci and lymph node metastasis. Only one local recurrence developed in a patient with multiple MMF. One out of nine pT0 or TRG1 patients (11.1%) had distant metastases compared with 15 out of 59 pT1–4 or TRG2–5 (25.4%, P = 0.70).

Conclusions

A remarkable incidence of MMF was found following chemoradiation. However, when this therapy induced complete regression of primary tumor (pT0–TRG1), we found that node metastases and neoplastic MMF also disappeared. These features should be confirmed to assess the impact of these microfoci in treatment decision making in rectal cancers.
Literature
1.
Heald RJ, Husband EM, Ryall RD. The mesorectum in rectal cancer surgery—the clue to pelvic recurrence? Br J Surg 1982; 69:613–6PubMedCrossRef
2.
Heald RJ. The ‘holy plane’ of rectal surgery. J R Soc Med 1988; 81:503–8PubMed
3.
MacFarlane JK, Ryall RD, Heald RJ. Mesorectal excision for rectal cancer. Lancet 1993; 341:457–60PubMedCrossRef
4.
Joyce WP, Dolan J, Hyland J. The mesorectum: re-appraisal of its morphology and its unique importance in rectal cancer (abstract). Int J Colorectal Dis 1993; 8:235
5.
Scott N, Jackson P, al-Jaberi T, Dixon MF, Quirke P, Finan PJ. Total mesorectal excision and local recurrence: a study of tumour spread in the mesorectum distal to rectal cancer. Br J Surg 1995; 82:1031–3PubMedCrossRef
6.
Ueno H, Mochizuki H. Clinical significance of extrabowel skipped cancer infiltration in rectal cancer. Surg Today 1997; 27:617–22PubMedCrossRef
7.
Reynolds JV, Joyce WP, Dolan J, Sheahan K, Hyland JM. Pathological evidence in support of total mesorectal excision in the management of rectal cancer. Br J Surg 1996; 83:1112–5PubMedCrossRef
8.
9.
Hida J, Yasutomi M, Maruyama T, Fujimoto K, Uchida T, Okuno K. Lymph node metastases detected in the mesorectum distal to carcinoma of the rectum by the clearing method: justification of total mesorectal excision. J Am Coll Surg 1997; 184:584–8PubMed
10.
Enker WE. Total mesorectal excision–the new golden standard of surgery for rectal cancer. Ann Med 1997; 29:127–33PubMed
11.
Heald RJ, Moran BJ, Ryall RD, Sexton R, MacFarlane JK. Rectal cancer: the Basingstoke experience of total mesorectal excision, 1978–1997. Arch Surg 1998; 133:894–9PubMedCrossRef
12.
Leong AF. Selective total mesorectal excision for rectal cancer. Dis Colon Rectum 2000; 43:1237–40PubMedCrossRef
13.
Tocchi A, Mazzoni G, Lepre L, et al. Total mesorectal excision and low rectal anastomosis for the treatment of rectal cancer and prevention of pelvic recurrences. Arch Surg 2001; 136:216–20PubMedCrossRef
14.
Ono C, Yoshinaga K, Enomoto M, Sugihara K. Discontinuous rectal cancer spread in the mesorectum and the optimal distal clearance margin in situ. Dis Colon Rectum 2002; 45:744–9PubMedCrossRef
15.
Heald RJ, Ryall RD. Recurrence and survival after total mesorectal excision for rectal cancer. Lancet 1986; 1:1479–82PubMedCrossRef
16.
Moriya Y, Sugihara K, Akasu T, Fujita S. Patterns of recurrence after nerve-sparing surgery for rectal adenocarcinoma with special reference to loco-regional recurrence. Dis Colon Rectum 1995; 38:1162–8PubMedCrossRef
17.
Enker WE, Thaler HT, Cranor ML, Polyak T. Total mesorectal excision in the operative treatment of carcinoma of the rectum. J Am Coll Surg 1995; 181:335–46PubMed
18.
Arbman G, Nilsson E, Hallbook O, Sjodahl R. Local recurrence following total mesorectal excision for rectal cancer. Br J Surg 1996; 83:375–9PubMedCrossRef
19.
20.
Merchant NB, Guillem JG, Paty PB, et al. T3N0 rectal cancer: results following sharp mesorectal excision and no adjuvant therapy. J Gastrointest Surg 1999; 3:642–7PubMedCrossRef
21.
GITSG 7175: Prolongation of the disease-free interval in surgically treated rectal carcinoma. Gastrointestinal Tumor Study Group. N Engl J Med 1985; 12:1565–72
22.
Baslev I, Pedersen M, Teglbjaerg PS, et al. Postoperative radiotherapy in Dukes’ B and C carcinoma of the rectum and rectosogmoid. Randomized multicenter study. Cancer 1986; 58:22–8CrossRef
23.
Fisher B, Wolmark N, Rockette H, et al. Postoperative adjuvant chemotherapy or radiation therapy for rectal cancer. Results from NSABP protocol R-01. J Nat Cancer Inst 1988; 80:21–9PubMedCrossRef
24.
Treurniet Donker AD, Van Putten WL, Werwldsma JC. Postoperative radiation therapy for rectal cancer. An interim analysis of a prospective, randomized multicenter trial in the Netherlands. Cancer 1991; 67:2028–42CrossRef
25.
Krook JE, Moertel CG, Gunderson LL, et al. Effective surgical adjuvant therapy for high risk rectal carcinoma. N Engl J Med 1991; 324:709–15PubMedCrossRef
26.
Bentzen SM, Baslev I, Pederesen M, et al. Time to locoregional recurrence after resection of Dukes’ B and C colorectal cancer with or without adjuvant postoperative radiotherapy. A multivariate regression analysis. Br. J. Cancer 1992; 65:102–7PubMed
27.
GISTG 7180. Radiation therapy and fluorouracil with or without semustine for treatment of patients with surgical adjuvant adenocarcinoma of rectum. Gastrointestinal Tumor Study Group. J Clin Oncol 1992; 10:549–57
28.
O’Connel MJ, Martenson JA, Wieand HS, et al. Improving radiation therapy for rectal cancer by combining protracted infusion fluorouracil with radiation therapy after curative surgery. Engl J Med 1994; 331:502–7CrossRef
29.
Medical Research Council Rectal Cancer Working Party. Randomized trial of surgery alone versus surgery followed by radiotherapy for mobile cancer of the rectum. Lancet 1996; 348:1605–10CrossRef
30.
Arnaud JP, Nordlinger B, Bosset JF, Boes GH, Sahmoud T, Schlag PM, Pene F. Radical surgery and postoperative radiotherapy as combined treatment in rectal cancer. Final results of phase III study of the European Organization for Research and Treatment of Cancer. Br J Surg 1997; 84:352–7PubMedCrossRef
31.
Tveit KM, Guldvog S Hagen E, et al. Randomized controlled trial of postoperative radiotherapy and short-term time-scheduled 5-fluorouracil against surgery alone in the treatment of Dukes’ B and C rectal cancer. Br J Surg 1997; 84:1130–5PubMedCrossRef
32.
Wolmark N, Wieand HS, Hyams DM, et al. Randomized trial of postoperative adjuvant chemotherapy with or without radiotherapy for carcinoma of the rectum: National Surgical Adjuvant Breast and Bowel Project Protocol R-02. J Nat Cancer Inst 2000; 92:338–96CrossRef
33.
Tepper JE, O’Connel M, Niedzwiecki D, et al. Adjuvant therapy in rectal cancer: analysis of stage, sex, and local control. Final report of Intergroup 0114. J Clin Oncol 2002; 20:1774–50CrossRef
34.
Lee HL, Lee JH, Ahn JH. Randomized trial of postoperative adjuvant therapy in stage II and III rectal cancer to define the optimal sequence of chemotherapy and radiotherapy: a preliminary report. J Clin Oncol 2002; 20:1751–8PubMedCrossRef
35.
Enami B, Pilepich M, Willett C, Munzenrider JE, Miller HH. Effect of preoperative irradiation on resectability of colorectal carcinomas. Int J Radiat Oncol Biol Phys 1982; 8:1335–9
36.
Kapiteijn E, Marijnen CA, Nagtegaal ID, et al. Dutch Colorectal Cancer Group. Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer. N Engl J Med 2001; 34:638–46CrossRef
37.
Minsky BD, Cohen AM, Kemeny N, et al. Combined modality therapy of rectal cancer. Decreased acute toxicity with the preoperative approach. J Clin Oncol 1992; 10:1218–24PubMed
38.
Coco C, Valentini V, Cogliandolo S, Cosimelli MO, Picciocchi A. Surgery and radiotherapy in rectal cancer: indications for anal sphincter conservation. Ann Ital Chir 2001; 72:611–7PubMed
39.
Valentini V, Coco C, Cellini N, et al. Ten years of preoperative chemoradiation for extraperitoneal T3 rectal cancer: acute toxicity, tumor response, and sphincter preservation in three consecutive studies. Int J Radiat Oncol Biol Phys 2001; 51:371–83PubMed
40.
Onaitis MW, Noone RB, Hartwig M, et al. Neoadjuvant chemoradiation for rectal cancer: analysis of clinical outcomes from a 13-year institutional experience. Ann Surg 2001; 233:778–85PubMedCrossRef
41.
Valentini V, Doglietto GB, Morganti AG, et al. Preoperative chemoradiation with raltitrexed (‘Tomudex’) for T2/N+ and T3/N+ rectal cancers: a phase I study. Eur J Cancer 2001; 37:2050–5PubMedCrossRef
42.
Kim JS, Kim JS, Cho MJ, Song KS, Yoon WH. Preoperative chemoradiation using oral capecitabine in locally advanced rectal cancer. Int J Radiat Oncol Biol Phys 2002; 54:403–8PubMed
43.
Gerard J, Chapet O, Romestaing P, Baulieux J, Hartwig J, Nemoz C. Improved sphincter preservation of low rectal cancer with high dose preoperative radiotherapy: the Lyon R96-02 randomized trial. Int J Radiat Oncol Biol Phys 2003; 57:S179–80
44.
Roedel C, Grabenbauer GG, Hohenberger W, Papadopoulos T, Sauer R. PhaseI/II trial of preoperative chemoradiotherapy with capecitabine and oxaliplatin in locally advanced rectal cancer. Int J Radiat Oncol Biol Phys 2003; 57:S178
45.
Crane CH, Skibber JM, Birnbaum EH, et al. The addition of continuous infusion 5-FU to preoperative radiation therapy increases tumor response, leading to increased sphincter preservation in locally advanced rectal cancer. Int J Radiat Oncol Biol Phys 2003; 57:84–9PubMed
46.
Crane CH, Skibber JM, Feig BW, et al. Response to preoperative chemoradiation increases the use of sphincter-preserving surgery in patients with locally advanced low rectal carcinoma. Cancer 2003; 97:517–24PubMedCrossRef
47.
Ciabattoni A, Cavallaro A, Potenza AE, Colli R, Maurizi F, Micciche F, Valentini V. Preoperative concomitant radiochemotherapy with a 5-fluorouracil plus folinic acid bolus in the combined treatment of locally advanced extraperitoneal rectal cancer: a long-term analysis on 27 patients. Tumori 2003; 89:157–63PubMed
48.
Luna-Perez P, Rodriguez-Ramirez S, Hernandez-Pacheco F, Gutierrez De La Barrera M, Fernandez R, Labastida S. Anal sphincter preservation in locally advanced low rectal adenocarcinoma after preoperative chemoradiation therapy and coloanal anastomosis. J Surg Oncol 2003; 82:3–9PubMedCrossRef
49.
Pacelli F, Di Giorgio A, Papa V, et al. Preoperative radiotherapy combined with intraoperative radiotherapy improves results of total mesorectal excision in patients with T3 rectal cancer. Dis Colon Rectum 2004; 47:170–9PubMedCrossRef
50.
Gambacorta MA, Valentini V, Morganti AG, et al. Chemoradiation with raltitrexed (“Tomudex”) in preoperative treatment of stage II/III resectable rectal cancer: a phase II study. Int J Radiat Oncol Biol Phys 2006 (in press)
51.
Chan A, Wong A, Langevin J, Khoo R. Preoperative concurrent 5FU infusion, mitomycin and pelvic radiation therapy in tethered and fixed rectal carcinoma. Int J Radiat Oncol Biol Phys 1993; 25:791–9PubMed
52.
Bosset JF, Pavy JJ, Hamers HP, et al. Determination of the optimal dose of 5-fluorouracil when combined with low-dose D.L-Leucovorin and irradiation in rectal cancer: results of 3 consecutive Phase II studies. Eur J Cancer 1993; 33A:1406–10CrossRef
53.
Rich TA, Skibber JM, Ajani JA, et al. Preoperative infusional chemoradiation therapy for stage T3 rectal cancer. Int J Radiat Oncol Biol Phys 1995; 32:1025–9PubMedCrossRef
54.
Minsky BD, Cohen AM, Enker WE, et al. Preoperative 5FU, low-dose leucovorin and radiation therapy for locally advanced and unresectable rectal cancer. Int J Radiat Oncol Biol Phys 1997; 40:515–22
55.
Graf W, Dahlberg M, Osman MM, Holmberg L, Pahlman L, Glimelius B. Short-term preoperative radiotherapy results in downstaging of rectal cancer: a study of 1316 patients. Rad Oncol 1997; 43:133–7CrossRef
56.
Morgan MJ, Koorey DJ, Painter D, Findlay M, Tran K, Stevens G, Solomon MJ. Histological tumour response to pre-operative combined modality therapy in locally advanced rectal cancer. Colorectal Dis 2002; 4:177–83PubMedCrossRef
57.
Uzcudun AE, Batlle JF, Velasco JC, et al. Efficacy of preoperative radiation therapy for resectable rectal adenocarcinoma when combined with oral tegafur-uracil modulated with leucovorin: results from a phase II study. Dis Colon Rectum 2002; 45:1349–58PubMedCrossRef
58.
Theodoropoulos G, Wise WE, Padmanabhan A, Kerner BA, Taylor CW, Aguilar PS, Khanduja KS. T-level downstaging and complete pathologic response after preoperative chemoradiation for advanced rectal cancer result in decreased recurrence and improved disease-free survival. Dis Colon Rectum 2002; 45:895–903PubMedCrossRef
59.
Valentini V, Coco C, Picciocchi A, et al. Does downstaging predict improved outcome after preoperative chemoradiation for extraperitoneal locally advanced rectal cancer? A long-term analysis of 165 patients. Int J Radiat Oncol Biol Phys 2002; 53:664–74PubMed
60.
Hiotis SP, Weber SM, Cohen AM, et al. Assessing the predictive value of clinical complete response to neoadjuvant therapy for rectal cancer: an analysis of 488 patients. J Am Coll Surg 2002; 194:131–5PubMedCrossRef
61.
Grillo-Ruggieri F, Mantello G, Cardinali M, et al. Down-staging after two different preoperative chemoradiation schedules in rectal cancer. Tumori 2003; 89:164–7PubMed
62.
Garcia-Aguilar J, Hernandez de Anda E, Sirivongs P, Lee SH, Madoff RD, Rothenberger DA. A pathologic complete response to preoperative chemoradiation is associated with lower local recurrence and improved survival in rectal cancer patients treated by mesorectal excision. Dis Colon Rectum 2003; 46:298–304PubMedCrossRef
63.
Ota DM, Jacobs L, Kuvshinoff B. Rectal cancer: the sphincter-sparing approach. Surg Clin North Am 2002; 82:983–93PubMedCrossRef
64.
Marks JH, Marchionni C, Marks GJ. Transanal endoscopic microsurgery in the treatment of select rectal cancers or tumors suspicious for cancer. Surg Endosc 2003 May 6 [Epub ahead of print]
65.
Kim CJ, Yeatman TJ, Coppola D, et al. Local excision of T2 and T3 rectal cancers after downstaging chemoradiation. Ann Surg 2001;234:352–8PubMedCrossRef
66.
Singh AK, Myerson RJ, Birnbaum EH, Fleshman JW, Kodner IJ, Lockett MA, Read TE. Outcome of patients with rectal adenocarcinoma and localized pelvic non-nodal metastatic foci. Dis Colon Rectum 2000;43:1217–21PubMedCrossRef
67.
Ratto C, Ricci R, Rossi C, Morelli U, Vecchio FM, Doglietto GB. Mesorectal microfoci adversely affect the prognosis of patients with rectal cancer. Dis Colon Rectum 2002;45:733–42PubMedCrossRef
68.
Ono C, Yoshinaga K, Enomoto M, Sugihara K. Discontinuous rectal cancer spread in the mesorectum and the optimal distal clearance margin in situ. Dis Colon Rectum 2002;45:744–9PubMedCrossRef
69.
Chan AK, Wong A, Jenken D, Heine J, Johnson D, Buie D. Post-treatment TNM staging is a prognostic indicator of survival and recurrence in tethered or fixed rectal carcinoma after preoperative chemotherapy and radiation. Int J Radiat Oncol Biol Phys 2003;57:S181
70.
Quirke P, Durdey P, Dixon MF, Williams NS. Local recurrence of rectal adenocarcinoma due to inadequate surgical resection. Histopathological study of lateral tumour spread and surgical excision. Lancet 1986; 2:996–9PubMedCrossRef
71.
Mandard AM, Dalibard F, Mandard JC, et al. Pathologic assessment of Tumor Regression Grade after preoperative chemoradiotherapy of esophageal carcinoma. Cancer 1994; 73:2680–6PubMedCrossRef
72.
Royal College of Surgeons of England, Association of Coloproctology of Great Britain, and Ireland. Guidelines for the management of colorectal cancer. 1996; p25
73.
Camma C, Giunta M, Fiorica F, Pagliaro L, Craxi A, Cottone M. Preoperative radiotherapy for resectable rectal cancer. JAMA 2000; 23:30
74.
Colorectal Cancer Collaborative Group: adjuvant radiotherapy for rectal cancer: a systematic overview of 8507 patients from 22 randomized trial. Lancet 2001; 358:1291–304CrossRef
75.
National Institute of Health Consensus Conference. Adjuvant therapy for patients with colon and rectal cancer. JAMA 1990; 264:1444–50CrossRef
76.
Byfield JE. Theoretical basis and clinical applications of 5-fluorouracil as a radiosensitizer. An overview. In Rotman M, Rosenthal CT eds. Concomitant continuous infusion chemotherapy and radiation. Springer, Berlin, Heidelberg, New York.1991. pp. 115–27
77.
Lawrence TS, Maybaum J. Fluoropyrimidines as radiation sensitizer. Sem Radiat Oncol 1993; 3:20–8CrossRef
78.
Ahmad NR, Nagle DA, Topham A. Pathologic complete response predicts long-term survival following preoperative radiation therapy for rectal cancer (abstract). Int J Radiat Oncol Biol Phys 1997; 39:284
79.
Berger C, De Muret A, Garaud P, et al. Preoperative radiotherapy (RT) for rectal cancer: predictive factors of tumor downstaging and residual tumor cell density (RTCD): prognostic implications. Int J Radiat Oncol Biol Phys 1997; 37:619–27PubMed
80.
Janjan NA, Khoo VS, Abbruzzese J, et al. Tumor downstaging and sphincter preservation with preoperative chemoradiation in locally advanced rectal cancer: the M. D. Anderson Cancer Center experience. Int J Radiat Oncol Biol Phys 1999; 44:1027–38PubMed
81.
Vauthey JN, Marsh R, Zlotecki RA, et al. Recent advances in the treatment and outcome of locally advanced rectal cancer. Ann Surg 1999; 229:745–54PubMedCrossRef
82.
Tjandra JJ, Reading DM, McLachlan SA, et al. Phase II clinical trial of preoperative combined chemoradiation for T3 and T4 resectable rectal cancer: preliminary results. Dis Colon Rectum 2001; 44:1113–22PubMedCrossRef
83.
Sanfilippo NJ, Crane CH, Skibber J, et al. T4 rectal cancer treated with preoperative chemoradiation to the posterior pelvis followed by multivisceral resection: patterns of failure and limitations of treatment. Int J Radiat Oncol Biol Phys 2001; 51:176–83PubMed
84.
Garcia-Aguilar J, Hernandez de Anda E, Sirivongs P, Lee SH, Madoff RD, Rothenberger DA. A pathologic complete response to preoperative chemoradiation is associated with lower local recurrence and improved survival in rectal cancer patients treated by mesorectal excision. Dis Colon Rectum 2003; 46:298–304PubMedCrossRef
85.
Read TE, Ogunbiyi OA, Fleshman JW, Birnbaum EH, Fry RD, Myerson RJ, Kodner IJ. Neoadjuvant external beam radiation and proctectomy for adenocarcinoma of the rectum. Dis Colon Rectum 2001; 44:1778–90PubMedCrossRef
86.
Brown CL, Ternent CA, Thorson AG, Christensen MA, Blatchford GJ, Shashidharan M, Haynatzki GR. Response to preoperative chemoradiation in stage II and III rectal cancer. Dis Colon Rectum 2003; 46:1189–93PubMedCrossRef
87.
Luna-Perez P, Rodriguez-Ramirez S, Rodriguez-Coria DF, Fernandez A, Labastida S, Silva A, Lopez MJ. Preoperative chemoradiation therapy and anal sphincter preservation with locally advanced rectal adenocarcinoma. World J Surg 2001; 25:1006–11PubMedCrossRef
88.
Gerard A, Buyse M, Nordlinger B, et al. Preoperative radiotherapy as adjuvant treatment in rectal cancer. Final results of a randomized study of the European Organization for Research and Treatment of Cancer (EORTC). Ann Surg 1988; 208:606PubMedCrossRef
89.
Marsh PJ, James RD, Schofield PF. Adjuvant preoperative radiotherapy for locally advanced rectal carcinoma: results of a prospective randomized trial. Dis Colon Rectum 1994; 37:1205–14PubMedCrossRef
90.
Swedish Rectal Cancer Trial. Improved survival with preoperative radiotherapy in resectable rectal cancer. N Engl J Med 1997; 336:980–7CrossRef
91.
Fleshman JW, Myerson RJ. Adjuvant radiation therapy for adenocarcinoma of the rectum. Surg Clin North Am 1997; 77:15–25PubMedCrossRef
Metadata
Title
Neoplastic Mesorectal Microfoci (MMF) following Neoadjuvant Chemoradiotherapy: Clinical and Prognostic Implications
Authors
Carlo Ratto, MD
Riccardo Ricci, MD
Vincenzo Valentini, MD
Federica Castri, MD
Angelo Parello, MD
Maria A. Gambacorta, MD
Numa Cellini, MD
Fabio M. Vecchio, MD
Giovanni B. Doglietto, MD
Publication date
01-02-2007
Publisher
Springer-Verlag
Published in
Annals of Surgical Oncology / Issue 2/2007
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-006-9163-0

Other articles of this Issue 2/2007

Annals of Surgical Oncology 2/2007 Go to the issue

OriginalPaper

Correlation Between Melphalan Pharmacokinetics and Hepatic Toxicity Following Hyperthermic Isolated Liver Perfusion for Unresectable Metastatic Disease

OriginalPaper

Surgical Treatment of Solitary Thyroid Nodules Via Fine-Needle Aspiration Biopsy and Frozen-Section Analysis

OriginalPaper

Influence of Overweight on Surgical Complications for Gastric Cancer: Results From a Randomized Control Trial Comparing D2 and Extended Para-aortic D3 Lymphadenectomy (JCOG9501)

OriginalPaper

Incidence and Treatment of Tracheal Cancer: A Nationwide Study in The Netherlands

OriginalPaper

Detection of Disseminated Tumor Cells in Liver Biopsies of Colorectal Cancer Patients Is not Associated with a Worse Prognosis

OriginalPaper

Quality of Life After Bilateral Prophylactic Mastectomy