Harvey W. Baker

Management and survival of carcinoma of the colon: results of a national survey by the American College of Surgeons.

Survey results of long- and short-term outcome audits of colon cancer in participating hospitals with cancer programs conducted during 1976–7 by the American College of Surgeons are presented. In the long-term audit of 38,621 cases reported by 327 hospitals in 46 states, the overall percentage of cases in localized stage (29.3%) is significantly lower than in the recent series from the National Cancer Institute. The observed survival was substantially lower than the survival rates published in recent smaller series; however, survival approaches the end results for the period 1967–1973. In the short-term audit, the analysis of 11,655 cases diagnosed in 1976 and reported by 491 hospitals from fifty states showed that while 41% of patients had symptoms for less than a month, only 29.5% were diagnosed in the localized stage. Surgery was the predominant treatment modality with an overall resectable rate of 83%. No difference was observed in the stage at diagnosis when the short-term audit (1976) was compared with that found in the long-term audit (1971). The results suggest that the early diagnosis of symptomatic patients may not always substantially improve the cure and survival rate. The screening of asymptomatic patients is suggested as the more promising approach to the substantial improvement of presently less than ideal end results.

Tumors of the deep lobe of the parotid gland.

Abstract Thirty-five patients with tumors originating in the deep lobe of the parotid gland have been presented. A definite similarity in pathology and distribution of benign and malignant tumors with the superficial lobe has been noted. However, surgical removal is more difficult because of the position of the tumor to the nerve and the bizarre clinical behavior of some benign tumors. Very few articles have been found in literature on tumors of the deep lobe of the parotid gland. Our experience leads us to believe that patients undergoing surgical removal of tumors of the deep lobes have an excellent chance of cure from their disease in spite of the technical difficulties encountered when removing these tumors.Abstract 1. 1. The anatomy of the deep portion of the parotid and “deep lobe tumors” is reviewed. 2. 2. The symptomatology and diagnosis of benign tumors of the deep lobe of the parotid is described. 3. 3. Surgical treatment consists in removal of the superficial lobe of the parotid followed by retraction and preservation of the facial nerve and removal of the deep lobe containing the tumor. 4. 4. Eight patients with benign tumors of the deep lobe of the parotid are reported on. All tumors were successfully removed without permanent facial nerve damage and without recurrence to date.

Clinical staging of cancer of the head and neck: A new “new” system☆☆☆

A revised clinical staging system for cancers arising in head and neck sites has been prepared. It utilizes a uniform N classification for cervical node metastases. The T classifications describing the extent of the primary tumor are generally similar but differ in specific details for each site. Although the present system makes use of past field trials and more recent clinical studies, it cannot be considered final. Clinicians managing cancer in head and neck sites are encouraged to test the system with their own patient data to elicit further areas for improvement.

Regional hyperthermia for cancer

The clinical use of regional hyperthermia combined with radiation therapy, chemotherapy, or both in 107 patients with advanced cancer is reported. Surgery was subsequently carried out in eight patients. The radiofrequency equipment used is capable of heating tumors at any depth with few adverse side effects. Complete responses to therapy occurred in 16 percent of patients, and partial responses in 52 percent. Striking pain relief was observed in both responders and nonresponders.

Free jejunal graft reconstruction after extensive head and neck surgery

Seven patients with benign and malignant head and neck lesions underwent reconstruction with free jejunal grafts using microvascular techniques. Benefits included preservation and maximal tongue function, acceptable cosmetic appearance and a short, one-stage reconstructive period.

Aggressive surgical management of pyriform sinus carcinoma: A 15 year experience

A total of 51 patients with pyriform sinus carcinoma were treated surgically. Fifty had pharyngolaryngectomy and radical neck dissection and 1 had a pharyngolaryngectomy. The surgical mortality was zero. No patients were lost to follow-up and all were followed for a minimum of 2 years. Stage IV patients had a 2 year survival rate of 15 percent and stage III patients, a 45 percent rate. Eighty-four percent of radical neck specimens contained involved nodes. The 2 year survival rates correlated with the number of pathologically involved nodes were as follows: 50 percent for those with zero to one node, 31 percent for two to three nodes, and 16 percent for four or more nodes. Perioperative radiotherapy increased the survival rate in those patients with zero to three involved nodes (47 percent survival rate with radiotherapy versus 25 percent without radiotherapy). Tumor recurrence was most frequent at the primary site (32 percent) and directly affected survival and control of disease elsewhere. Pyriform sinus carcinoma often presents with advanced local and nodal disease. Local control is essential, and adequate resection may require a cervical esophagectomy. Survival may be enhanced by the addition of radiotherapy in those patients with minimal nodal involvement.

Biologic control of cancer. The James Ewing lecture.

There is abundant clinical and laboratory evidence that host defenses are a significant factor in the progression and the control of cancer. The host immune system plays the major role, primarily through cell-mediated responses to the neoplastic threat. Great progress has been made in evaluating immune competence, although the specific defects have not been identified in all patients. The history of immunotherapy includes numerous trials, with few successes and many failures. Advances in knowledge and technology, however, indicate that efforts to manipulate and strengthen host defenses have great potential in the fight against cancer.

Cheek island flap for replacement of critical limited defects of the upper aerodigestive tract

Our experience thus far indicates that the island cheek flap is a satisfactory reconstructive method for small but critical defects in the upper aerodigestive tract. The mucosal lining is an ideal replacement for the lining of the mouth, pharynx, and esophagus. Only a single stage procedure is required. The surgical technique is relatively simple and does not unnecessarily prolong an extensive operation for tumor resection. We have found the procedure to be reliable with no instances of flap loss or necrosis.

Repair of limited or segmental defects of the cervical esophagus with mucosa-lined flaps

Repair of limited cervical esophageal defects can now be accomplished safely with mucosa-lined flaps. Free jejunal grafts have demonstrated excellent durability and function for circumferential defects. The axial cheek flap and laryngeal flap have also shown excellent functional results for noncircumferential defects. In addition, all three of these procedures offer the advantage of immediate reconstruction. The size of the esophageal defect, the physical condition of the patient, and the rehabilitative goals are critical in patient selection.

Squamous cell carcinoma radioimmunoassay in squamous cell carcinoma of the head and neck

Tumor-associated antigen has shown promise as a clinical aid in the detection and monitoring of uterine cervical squamous cell carcinoma. Antigen levels have been shown to reflect the extent of disease and response to treatment. These findings have suggested that measurements of tumor-associated antigen may be useful in monitoring other squamous cell carcinomas. To test this hypothesis, we measured tumor-associated antigen using the squamous cell carcinoma radioimmunoassay in 103 patients with previously treated squamous cell head and neck tumors and 28 patients with known squamous cell carcinoma of the head and neck. Increased squamous cell carcinoma antigen levels were found in 39 percent of patients with known tumors and in 19 percent of the patients with previous curative resection. The sensitivity of the assay limited its usefulness in predicting the presence of new and recurrent tumors.