
Cancer 1989 Mar 1;63(5):935-8 
<b>Patterns of metastasis in uterine sarcoma. An autopsy study. </b>
Rose PG, Piver MS, Tsukada Y, Lau T. Department of Gynecologic Oncology, Roswell Park Memorial Institute, Buffalo, NY 14263. 

The autopsy findings of 73 patients with uterine sarcoma were studied to determine the sites and possible modes of metastasis. Homologous mixed mesodermal tumors were the most frequent (41%) followed by leiomyosarcoma (26%),.... The peritoneal cavity and omentum were the most frequently involved sites (59%), followed by the lung (52%), pelvic lymph nodes (41%), paraaortic lymph nodes (38%), and liver parenchyma (34%). The presence of lung metastasis was not associated with pelvic or paraaortic node metastasis or intraperitoneal disease. Metastasis to other distant sites including the brain, heart, kidney, and bone were independent of pelvic and paraaortic nodal metastasis or intraperitoneal disease. Metastatic sites were not different among various histologic types. Distant metastatic sites were statistically associated with lung metastasis. Hematogenous metastasis best explains this metastatic pattern and adjuvant systemic therapy seems indicated. 
&&url PMID: 2914299


J Clin Oncol 1985 Mar;3(3):353-66 
<b>Patterns of recurrence in patients with high-grade soft-tissue sarcomas.</b> 
Potter DA, Glenn J, Kinsella T, Glatstein E, Lack EE, Restrepo C, White DE, Seipp CA, Wesley R, Rosenberg SA. 

From July 1975 to December 1982, 563 patients were referred to the Surgery Branch of the National Cancer Institute with the diagnosis of soft-tissue sarcoma. Three hundred and seven of these patients had fully resectable, localized high-grade soft-tissue sarcomas and were treated at the National Cancer Institute using standard protocols with surgery alone, or in combination with chemotherapy and/or radiotherapy. An aggressive surgical approach was undertaken in the management of patients who subsequently developed recurrent disease. These 307 cases have been reviewed, with a median duration of follow-up of 30 months, to determine the frequency of recurrent disease, the patterns of recurrence, and the impact of surgery on the survival of patients who developed recurrent disease. Disease recurred in one hundred seven patients (107/307, 35%), with a median disease-free interval of 18 months (range, 0.5 to 72.0 months). The frequency of recurrence by site of primary sarcoma was extremity, 31% (65/211); head and neck, 33% (4/12); trunk, 40% (17/42); retroperitoneum, 47% (17/36); and breast, 67% (4/6). Isolated pulmonary metastatic disease was the most common pattern of initial recurrence (56/107, 52%) followed by isolated local recurrence (21/107, 20%). ... The relative frequency of each of these four patterns of recurrence varied with the site of the primary sarcoma. The outcome for patients with recurrent disease depended on the site of recurrence, rather than on the site of the primary sarcoma. Sixty-six patients (66/107, 62%) with recurrent disease were rendered surgically disease-free with the first recurrence, including 40 (40/56, 72%) patients with isolated pulmonary metastases, 20 patients (20/21, 96%) with isolated local recurrences, five patients (5/15, 33%), with isolated other sites of recurrence and one patient (1/15, 7%) with multiple sites of initial recurrence. Following surgical resection, the actuarial three-year survival for the 66 patients rendered disease-free was 51%. The median survival for the 41 patients not rendered surgically disease-free with the first recurrence was only 7.4 months. Thirty of the sixty-six patients (30/66, 45%) rendered disease-free with the first recurrence remained disease-free at follow-up, with a median follow-up of 28 months from the time of resection of the first recurrence. The remaining 36 patients (36/66, 55%) subsequently recurred, with a median disease-free interval of 7.3 months... 
&&url PMID: 3973646


Arch Surg 1983 Aug;118(8):915-8 
<b>Metastatic patterns in soft-tissue sarcomas.</b> 
Vezeridis MP, Moore R, Karakousis CP. 

In 242 patients with recurrent soft-tissue sarcomas, the most common sites of initial recurrence were the primary site in 47.5% of patients and the lungs in 38% of patients. Further recurrences in the course of the disease concerned the lungs, bones, liver, and brain. Total survival and survival after recurrence were influenced by the histologic type, which also affected the site of recurrence. In the management of local recurrence, a five-year disease-free survival rate of 38% was achieved with surgical treatment, while radiation or chemotherapy alone was ineffective. Local recurrences resulted in significantly higher survival rates than those involving other organs. The disease-free interval was a significant prognostic indicator of subsequent survival in the whole group of patients and among those with local recurrence. 
&&url PMID: 6307217


Surg Clin North Am 2000 Apr;80(2):603-32 
<b>Hepatic malignancies. </b>
Tsao JI, DeSanctis J, Rossi RL, Oberfield RA. Department of Surgery, Tufts University School of Medicine, Burlington, Massachusetts, USA. 

... tremendous strides have been made in the past decade, such as improved diagnostic capabilities, safe surgical resection, availability of safe nonsurgical ablative modalities, multimodality therapy, and aggressive approach to recurrent disease. ...recurrence of primary and secondary malignancies of the liver continues to be the cause of demise for more than 70% of treated patients. ... investigations are focused on delineating the pathophysiology of cancer on the molecular and genetic levels and mapping the patterns of cancer emergence and spread. The new millennium holds promise for formulating therapies that may improve disease-free survival for patients with malignancies of the liver.  
&&url PMID: 10836009
                                                                                                                                                       

Cancer J Sci Am 2000 Apr;6 Suppl 2:S159-68 
<b>The role of laparoscopy in the treatment of intra-abdominal malignancies.</b> 
Lefor AT. Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California 90048, USA. 

"The role of laparoscopy in the care of patients with cancer is currently evolving. Numerous experimental and clinical studies have attempted to elucidate the nature and cause of port-site metastases--particularly to discern whether they simply are a marker of advanced disease, or if they are a result of the laparoscopic intervention." 
Laparoscopy has a role in establishing the diagnosis of cancer in some situations: 
... allowing biopsy of intraperitoneal and retroperitoneal masses, lymph nodes, and visceral lesions, 
... examination of abdominal contents under direct vision or with ultrasound probes
... staging of established malignancies such as pancreatic cancer, hepatic lesions, lymphoma, and esophageal cancer. ... surgical treatment of a variety of malignancies, including gastric, pancreatic, splenic and adrenal cancers, [safety of laparoscopy for resection of colon cancer has not yet been proven]
... palliative care of the cancer patient -- feeding-tube placement or intestinal stoma creation. 

"It is imperative that using laparoscopy in the care of patients with malignancies be carefully and thoroughly evaluated since this technique can either benefit or adversely affect survival or quality of life."  
&&url PMID: 10803831 

