LWBK1006-06 LWW-Govindan-Review November 24, 2011 11:20
82 DeVita, Hellman, and Rosenberg’s CANCER: Principles and Practice of Oncology ReviewAnswer 6.6. The answer is D.
Sarcoma must be considered in the differential diagnosis of soft-tissue
masses. Imaging by magnetic resonance imaging can provide information
on size, tumor characteristics, and relationship to adjacent structures.
Subsequent tissue sampling is essential to obtain a diagnosis.Answer 6.7. The answer is A.
Several prospective cohort studies have contributed to the development
of a risk index for postoperative pulmonary complications after surgi-
cal procedures. The American Society of Anesthesiologists has summa-
rized these data. The relative risk of pulmonary complications in an obese
patient undergoing a thoracic procedure is 0.8 to 1.7.Answer 6.8. The answer is A.
A prospective study of 483 patients conducted by Smithers et al.
(Smithers BM, Cotley DC, Martin I, et al. Comparison of the out-
comes between open and minimally invasive esophagectomy.Ann Surg.
2007;245(2):232–240) revealed no differences in lymph node retrieval
and 3-year survival between open and laparoscopic procedures.Answer 6.9. The answer is B.
A recent study of patients undergoing laparoscopic colectomy for car-
cinoma demonstrated increased mean arterial pressure, central venous
pressure, mean pulmonary artery pressure, pulmonary capillary wedge
pressure, and systemic vascular resistance. Cardiac index and ejec-
tion fraction decreased significantly, although heart rate remained un-
changed.Answer 6.10. The answer is A.
Retrospective reviews have demonstrated a wound site recurrence rate of
less than 1% in patients undergoing surgery for colon cancer. Port site
recurrence rates for a similar population of patients have been reported
to be approximately 1%. Port site metastases have been associated with
aerosolization caused by the pneumoperitoneum, tumor manipulation,
and degree of tumor burden.Answer 6.11. The answer is D.
One of the most important aspects of laparoscopic staging is the exclusion
of patients from undergoing a major operation by identifying metastatic
or unresectable disease (e.g., carcinomatosis), which is easily missed in
imaging studies. Undetected metastatic disease has been found in 13% to
57% of patients initially staged with having no metastatic disease by con-
ventional imaging. However, laparoscopy is not yet performed as a rou-
tine procedure because many patients are often symptomatic and require
palliative resection.