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World Journal of Surgery

Erschienen in:

01.03.2007 | GREY TURNER LECTURE—DURBAN, SOUTH AFRICA

The Role of Prophylactic Surgery in Cancer Prevention

verfasst von: Y. Nancy You, MD, MHSc, Vipul T. Lakhani, MD, Samuel A. Wells Jr, MD

Erschienen in: World Journal of Surgery | Ausgabe 3/2007

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Abstract

Background

Since the human genome has been sequenced many mysteries of cell biology have been unravelled, thereby clarifying the pathogenesis of several diseases, particularly cancer. In members of kindreds with certain hereditary diseases, it is now possible early in life to predict with great certainty whether or not a family member has inherited the mutated allele causing the disease. In hereditary malignancies this has been particularly important, because in affected family members there is the possibility of removing the organ destined to develop cancer before malignancy develops or while it is in situ. At first consideration, it would appear that “prophylactic surgery” would have a place in many hereditary malignancies; however, the procedure has applicability only if certain criteria are met: (1) the genetic mutation causing the hereditary malignancy must have a very high penetrance and be expressed regardless of environmental factors; (2) there must be a highly reliable test to identify patients who have inherited the mutated gene; (3) the organ must be removed with minimal morbidity and virtually no mortality; (4) there must be a suitable replacement for the function of the removed organ; and (5) there must be a reliable method of determining over time that the patient has been cured by “prophylactic surgery.”

Conclusions

In this monograph we review several hereditary malignancies and consider those where prophylactic surgery might be useful. As we learn, there are various barriers to performing the procedure in many common hereditary cancer syndromes. The archetype disease syndromes, which meet each of the five criteria mentioned above and where prophylactic surgery is most useful, are the type 2 multiple endocrine neoplasia (MEN) syndromes: MEN2A, MEN2B, and the related familial medullary thyroid carcinoma. An additional benefit of the Human Genome Project, has been the development of pharmacologic and biologic compounds that block the metabolic pathway(s) activated by specific genetic mutations. Many of these compounds have shown efficacy in patients with locally advanced or metastatic cancers, and there is the likelihood that they will prove beneficial in preventing the outgrowth of malignant cells in patients destined to develop a hereditary cancer.

Skinner MA, Moley JA, Dilley WG, et al. Prophylactic thyroidectomy in multiple endocrine neoplasia type 2A. N Engl J Med 2005;353:1105–1113PubMed

Garber JE, Offit K. Hereditary cancer predisposition syndromes. J Clin Oncol 2005;23:276–292PubMed

Eisen A, Rebbeck TR, Wood WC, et al. Prophylactic surgery in women with a hereditary predisposition to breast and ovarian cancer. J Clin Oncol 2000;18:1980–1995PubMed

Walsh T, Casadei S, Coats KH, et al. Spectrum of mutations in BRCA1, BRCA2, CHEK2, and TP53 in families at high risk of breast cancer. JAMA 2006;295:1379–1388PubMed

Miki Y, Swensen J, Shattuck-Eidens D, et al. A strong candidate for the breast and ovarian cancer susceptibility gene BRCA1. Science 1994:266:66–71PubMed

Hall JM, Lee MK, Newman B, et al. Linkage of early-onset familial breast cancer to chromosome 17q21. Science 1990;250:1684–1689PubMed

Wooster R, Bignell G, Lancaster J, et al. Identification of the breast cancer susceptibility gene BRCA2. Nature 1995;378:789–792PubMed

Wooster R, Neuhausen SL, Mangion J, et al. Localization of a breast cancer susceptibility gene, BRCA2, to chromosome 13q12-13. Science 1994;265:2088–2090PubMed

Narod SA, Foulkes WD. BRCA1 and BRCA2: 1994 and beyond. Nat Rev Cancer 2004;4:665–676PubMed

10.

Probability of Breast Cancer in American Women. National Cancer Institute Fact Sheet. Available at http://www.cancer.gov/cancertopics/factsheet/Detection/probability-breast-cancer

11.

Ford D, Easton DF, Stratton M, et al. Genetic heterogeneity and penetrance analysis of the BRCA1 and BRCA2 genes in breast cancer families. The Breast Cancer Linkage Consortium. Am J Hum Genet 1998;62:676–689PubMed

12.

King MC, Marks JH, Mandell JB. Breast and ovarian cancer risks due to inherited mutations in BRCA1 and BRCA2. Science 2003;302:643–646PubMed

13.

Lakhani SR, Jacquemier J, Sloane JP, et al. Multifactorial analysis of differences between sporadic breast cancers and cancers involving BRCA1 and BRCA2 mutations. J Natl Cancer Inst 1998;90:1138–1145PubMed

14.

BRCA1 and BRCA2 Hereditary Breast/Ovarian Cancer. Molecular Testing. Available at http://www.geneclinics.org

15.

Plevritis SK, Kurian AW, Sigal BM, et al. Cost-effectiveness of screening BRCA1/2 mutation carriers with breast magnetic resonance imaging. JAMA 2006;295:2374–2384PubMed

16.

Meijers-Heijboer H, van Geel B, van Putten WL, et al. Breast cancer after prophylactic bilateral mastectomy in women with a BRCA1 or BRCA2 mutation. N Engl J Med 2001;345:159–164PubMed

17.

Hartmann LC, Sellers TA, Schaid DJ, et al. Efficacy of bilateral prophylactic mastectomy in BRCA1 and BRCA2 gene mutation carriers. J Natl Cancer Inst 2001;93:1633–1637PubMed

18.

Rebbeck TR, Friebel T, Lynch HT, et al. Bilateral prophylactic mastectomy reduces breast cancer risk in BRCA1 and BRCA2 mutation carriers: the PROSE Study Group. J Clin Oncol 2004;22:1055–1062PubMed

19.

Kauff ND, Satagopan JM, Robson ME, et al. Risk-reducing salpingo-oophorectomy in women with a BRCA1 or BRCA2 mutation. N Engl J Med 2002;346:1609–1615PubMed

20.

Rebbeck TR, Lynch HT, Neuhausen SL, et al. Prophylactic oophorectomy in carriers of BRCA1 or BRCA2 mutations. N Engl J Med 2002;346:1616–1622PubMed

21.

Finch A, Beiner M, Lubinski J, et al. Salpingo-oophorectomy and the risk of ovarian, fallopian tube, and peritoneal cancers in women with a BRCA1 or BRCA2 Mutation. JAMA 2006;296:185–192PubMed

22.

Dowdy SC, Stefanek M, Hartmann LC. Surgical risk reduction: prophylactic salpingo-oophorectomy and prophylactic mastectomy. Am J Obstet Gynecol 2004;191:1113–1123PubMed

23.

Spear SL, Carter ME, Schwarz K. Prophylactic mastectomy: indications, options, and reconstructive alternatives. Plast Reconstr Surg 2005;115:891–909PubMed

24.

Barton MB, West CN, Liu IL, et al. Complications following bilateral prophylactic mastectomy. J Natl Cancer Inst Monogr 2005;35:61–66PubMed

25.

Contant CM, Menke-Pluijmers MB, Seynaeve C, et al. Clinical experience of prophylactic mastectomy followed by immediate breast reconstruction in women at hereditary risk of breast cancer (HB(O)C) or a proven BRCA1 and BRCA2 germ-line mutation. Eur J Surg Oncol 2002;28:627–632PubMed

26.

Gabriel SE, Woods JE, O’Fallon WM, et al. Complications leading to surgery after breast implantation. N Engl J Med 1997;336:677–682PubMed

27.

Lostumbo L, Carbine N, Wallace J, et al. Prophylactic mastectomy for the prevention of breast cancer. Cochrane Database Syst Rev 2004:CD002748

28.

Gayther SA, Warren W, Mazoyer S, et al. Germline mutations of the BRCA1 gene in breast and ovarian cancer families provide evidence for a genotype–phenotype correlation. Nat Genet 1995;11:428–433PubMed

29.

Hohenstein P, Fodde R. Prophylactic mastectomy for the prevention of breast cancer. Hum Mol Genet 2003;12(Spec No 2):R271–277PubMed

30.

Schrag D, Kuntz KM, Garber JE, et al. Life expectancy gains from cancer prevention strategies for women with breast cancer and BRCA1 or BRCA2 mutations. JAMA 2000;283:617–624PubMed

31.

Schrag D, Kuntz KM, Garber JE, et al. Decision analysis—effects of prophylactic mastectomy and oophorectomy on life expectancy among women with BRCA1 or BRCA2 mutations. N Engl J Med 1997;336:1465–1471PubMed

32.

Grann VR, Panageas KS, Whang W, et al. Decision analysis of prophylactic mastectomy and oophorectomy in BRCA1-positive or BRCA2-positive patients. J Clin Oncol 1998;16:979–985PubMed

33.

Frost MH, Schaid DJ, Sellers TA, et al. Long-term satisfaction and psychological and social function following bilateral prophylactic mastectomy. JAMA 2000;284:319–324PubMed

34.

Armstrong K, Schwartz JS, Randall T, et al. Hormone replacement therapy and life expectancy after prophylactic oophorectomy in women with BRCA1/2 mutations: a decision analysis. J Clin Oncol 2004;22:1045–1054PubMed

35.

Wainberg S, Husted J. Utilization of screening and preventive surgery among unaffected carriers of a BRCA1 or BRCA2 gene mutation. Cancer Epidemiol Biomarkers Prev 2004;13:1989–1995PubMed

36.

Axell L, Ahnen D, Markey K. Basic concepts for genetic testing in common hereditary colorectal cancer syndromes. Current Colorectal Cancer Rep 2005;1:73–84

37.

Lindor NM, Rabe K, Petersen GM, et al. Lower cancer incidence in Amsterdam-I criteria families without mismatch repair deficiency: familial colorectal cancer type X. JAMA 2005;293:1979–1985PubMed

38.

Howe JR, Roth S, Ringold JC, et al. Mutations in the SMAD4/DPC4 gene in juvenile polyposis. Science 1998;280:1086–1088PubMed

39.

Lynch HT, de la Chapelle A. Hereditary colorectal cancer. N Engl J Med 2003;348:919–932PubMed

40.

Merg A, Lynch HT, Lynch JF, et al. Hereditary colorectal cancer–part II. Curr Probl Surg 2005;42:267–333PubMed

41.

Groden J, Thliveris A, Samowitz W, et al. Identification and characterization of the familial adenomatous polyposis coli gene. Cell 1991;66:589–600PubMed

42.

Kinzler KW, Nilbert MC, Su LK, et al. Identification of FAP locus genes from chromosome 5q21. Science 1991;253:661–665PubMed

43.

Galiatsatos P, Foulkes WD. Familial adenomatous polyposis. Am J Gastroenterol 2006;101:385–398PubMed

44.

Bertario L, Russo A, Sala P, et al. Multiple approach to the exploration of genotype–phenotype correlations in familial adenomatous polyposis. J Clin Oncol 2003;21:1698–1707PubMed

45.

Lynch HT, Lanspa SJ, Boman BM, et al. Hereditary nonpolyposis colorectal cancer—Lynch syndromes I and II. Gastroenterol Clin North Am 1988;17:679–712PubMed

46.

Peltomaki P, Vasen H. Mutations associated with HNPCC predisposition—update of ICG-HNPCC/INSiGHT mutation database. Dis Markers 2004;20:269–276PubMed

47.

Rowley PT. Inherited susceptibility to colorectal cancer. Annu Rev Med 2005;56:539–554PubMed

48.

Bisgaard ML, Fenger K, Bulow S, et al. Familial adenomatous polyposis (FAP): frequency, penetrance, and mutation rate. Hum Mutat 1994;3:121–125PubMed

49.

Sieber OM, Lamlum H, Crabtree MD, et al. Whole-gene APC deletions cause classical familial adenomatous polyposis, but not attenuated polyposis or “multiple” colorectal adenomas. Proc Natl Acad Sci USA 2002;99:2954–2958PubMed

50.

Colorectal Cancer Screening. The National Comprehesive Cancer Network Clinical Practice Guidelines in Oncology. JNCCN 2006;4:384–420

51.

Kievit W, de Bruin JH, Adang EM, et al. Current clinical selection strategies for identification of hereditary non-polyposis colorectal cancer families are inadequate: a meta-analysis. Clin Genet 2004;65:308–316PubMed

52.

Pinol V, Castells A, Andreu M, et al. Accuracy of revised Bethesda guidelines, microsatellite instability, and immunohistochemistry for the identification of patients with hereditary nonpolyposis colorectal cancer. JAMA 2005;293:1986–1994PubMed

53.

Hampel H, Frankel WL, Martin E, et al. Screening for the Lynch syndrome (hereditary nonpolyposis colorectal cancer). N Engl J Med 2005;352:1851–1860PubMed

54.

Wijnen JT, Vasen HF, Khan PM, et al. Clinical findings with implications for genetic testing in families with clustering of colorectal cancer. N Engl J Med 1998;339:511–518PubMed

55.

Aaltonen LA, Salovaara R, Kristo P, et al. Incidence of hereditary nonpolyposis colorectal cancer and the feasibility of molecular screening for the disease. N Engl J Med 1998;338:1481–1487PubMed

56.

Kievit W, de Bruin JH, Adang EM, et al. Cost effectiveness of a new strategy to identify HNPCC patients. Gut 2005;54:97–102PubMed

57.

Barnetson RA, Tenesa A, Farrington SM, et al. Identification and survival of carriers of mutations in DNA mismatch-repair genes in colon cancer. N Engl J Med 2006;354:2751–2763PubMed

58.

Bertario L, Presciuttini S, Sala P, et al. Causes of death and postsurgical survival in familial adenomatous polyposis: results from the Italian Registry. Italian Registry of Familial Polyposis Writing Committee. Semin Surg Oncol 1994;10:225–234PubMed

59.

Heiskanen I, Luostarinen T, Jarvinen HJ. Impact of screening examinations on survival in familial adenomatous polyposis. Scand J Gastroenterol 2000;35:1284–1287PubMed

60.

Church J, Simmang C. Practice parameters for the treatment of patients with dominantly inherited colorectal cancer (familial adenomatous polyposis and hereditary nonpolyposis colorectal cancer). Dis Colon Rectum 2003;46:1001–1012PubMed

61.

Burke W, Petersen G, Lynch P, et al. Recommendations for follow-up care of individuals with an inherited predisposition to cancer. I. Hereditary nonpolyposis colon cancer. Cancer Genetics Studies Consortium. JAMA 1997;p277:915–919PubMed

62.

Church JM. Prophylactic colectomy in patients with hereditary nonpolyposis colorectal cancer. Ann Med 1996;28:479–482PubMed

63.

Lynch HT. Is there a role for prophylactic subtotal colectomy among hereditary nonpolyposis colorectal cancer germline mutation carriers? Dis Colon Rectum 1996;39:109–110PubMed

64.

Syngal S, Weeks JC, Schrag D, et al. Benefits of colonoscopic surveillance and prophylactic colectomy in patients with hereditary nonpolyposis colorectal cancer mutations. Ann Intern Med 1998;129:787–796PubMed

65.

Merg A, Lynch HT, Lynch JF, et al. Hereditary colon cancer–part I. Curr Probl Surg 2005;42:195–256PubMed

66.

Caspari R, Friedl W, Mandl M, et al. Familial adenomatous polyposis: mutation at codon 1309 and early onset of colon cancer. Lancet 1994;343:629–632PubMed

67.

Friedl W, Caspari R, Sengteller M, et al. Can APC mutation analysis contribute to therapeutic decisions in familial adenomatous polyposis? Experience from 680 FAP families. Gut 2001;48:515–521PubMed

68.

Nugent KP, Phillips RK, Hodgson SV, et al. Phenotypic expression in familial adenomatous polyposis: partial prediction by mutation analysis. Gut 1994;35:1622–1623PubMed

69.

Debinski HS, Love S, Spigelman AD, et al. Colorectal polyp counts and cancer risk in familial adenomatous polyposis. Gastroenterology 1996;110:1028–1030PubMed

70.

Church J, Burke C, McGannon E, et al. Risk of rectal cancer in patients after colectomy and ileorectal anastomosis for familial adenomatous polyposis: a function of available surgical options. Dis Colon Rectum 2003;46:1175–1181PubMed

71.

Bertario L, Russo A, Radice P, et al. Genotype and phenotype factors as determinants for rectal stump cancer in patients with familial adenomatous polyposis. Hereditary Colorectal Tumors Registry. Ann Surg 2000;231:538–543PubMed

72.

Vasen HF, van Duijvendijk P, Buskens E, et al. Decision analysis in the surgical treatment of patients with familial adenomatous polyposis: a Dutch–Scandinavian collaborative study including 659 patients. Gut 2001;49:231–235PubMed

73.

Rodriguez-Bigas MA, Vasen HF, Pekka-Mecklin J, et al. Rectal cancer risk in hereditary nonpolyposis colorectal cancer after abdominal colectomy. International Collaborative Group on HNPCC. Ann Surg 1997;225:202–207PubMed

74.

Groves CJ, Beveridge G, Swain DJ, et al. Prevalence and morphology of pouch and ileal adenomas in familial adenomatous polyposis. Dis Colon Rectum 2005;48:816–823PubMed

75.

Nugent KP, Spigelman AD, Phillips RK. Life expectancy after colectomy and ileorectal anastomosis for familial adenomatous polyposis. Dis Colon Rectum 1993;36:1059–1062PubMed

76.

Bulow C, Vasen H, Jarvinen H, et al. Ileorectal anastomosis is appropriate for a subset of patients with familial adenomatous polyposis. Gastroenterology 2000;119:1454–1460PubMed

77.

Elton C, Makin G, Hitos K, et al. Mortality, morbidity and functional outcome after ileorectal anastomosis. Br J Surg 2003;90:59–65PubMed

78.

Larson DW, Cima RR, Dozois EJ, et al. Safety, feasibility, and short-term outcomes of laparoscopic ileal-pouch-anal anastomosis: a single institutional case-matched experience. Ann Surg 2006;243:667–670PubMed

79.

Nyam DC, Brillant PT, Dozois RR, et al. Ileal pouch-anal canal anastomosis for familial adenomatous polyposis: early and late results. Ann Surg 1997;226:514–519PubMed

80.

Aziz O, Athanasiou T, Fazio VW, et al. Meta-analysis of observational studies of ileorectal versus ileal pouch-anal anastomosis for familial adenomatous polyposis. Br J Surg 2006;93:407–417PubMed

81.

Schmeler KM, Lynch HT, Chen LM, et al. Prophylactic surgery to reduce the risk of gynecologic cancers in the Lynch syndrome. N Engl J Med 2006;354:261–269PubMed

82.

Saad MF, Ordonez NG, Rashid RK, et al. Medullary carcinoma of the thyroid. A study of the clinical features and prognostic factors in 161 patients. Medicine (Baltimore) 1984;63:319–342

83.

Heshmati HM, Gharib H, van Heerden JA, et al. Advances and controversies in the diagnosis and management of medullary thyroid carcinoma. Am J Med 1997;103:60–69PubMed

84.

Donis-Keller H, Dou S, Chi D, et al. Mutations in the RET proto-oncogene are associated with MEN2A and FMTC. Hum Mol Genet 1993;2:851–856PubMed

85.

Mulligan LM, Kwok JB, Healey CS, et al. Germ-line mutations of the RET proto-oncogene in multiple endocrine neoplasia type 2A. Nature 1993;363:458–460PubMed

86.

Carlson KM, Dou S, Chi D, et al. Single missense mutation in the tyrosine kinase catalytic domain of the RET protooncogene is associated with multiple endocrine neoplasia type 2B. Proc Natl Acad Sci USA 1994;91:1579–1583PubMed

87.

Kouvaraki MA, Shapiro SE, Perrier ND, et al. RET proto-oncogene: a review and update of genotype–phenotype correlations in hereditary medullary thyroid cancer and associated endocrine tumors. Thyroid 2005;15:531–544PubMed

88.

Eng C. RET proto-oncogene in the development of human cancer. J Clin Oncol 1999;17:380–393PubMed

89.

Brandi ML, Gagel RF, Angeli A, et al. Guidelines for diagnosis and therapy of MEN type 1 and type 2. J Clin Endocrinol Metab 2001;86:5658–5671PubMed

90.

Farndon JR, Leight GS, Dilley WG, et al. Familial medullary thyroid carcinoma without associated endocrinopathies: a distinct clinical entity. Br J Surg 1986;73:278–281PubMed

91.

Eng C, Clayton D, Schuffenecker I, et al. The relationship between specific RET proto-oncogene mutations and disease phenotype in multiple endocrine neoplasia type 2. International RET mutation consortium analysis. JAMA 1996;276:1575–1579PubMed

92.

MEN2 mutation screen. Available at http://www.mayoclinic.org

93.

Wells SA Jr, Chi DD, Toshima K, et al. Predictive DNA testing and prophylactic thyroidectomy in patients at risk for multiple endocrine neoplasia type 2A. Ann Surg 1994;220:237–247; discussion 247–250PubMed

94.

Wells SA Jr, Baylin SB, Leight GS, et al. The importance of early diagnosis in patients with hereditary medullary thyroid carcinoma. Ann Surg 1982;195:595–599PubMed

95.

Wells SA Jr, Franz C. Medullary carcinoma of the thyroid gland. World J Surg 2000;24:952–956PubMed

96.

Lallier M, St-Vil D, Giroux M, et al. Prophylactic thyroidectomy for medullary thyroid carcinoma in gene carriers of MEN2 syndrome. J Pediatr Surg 1998;33:846–848PubMed

97.

Sanso GE, Domene HM, Garcia R, et al. Very early detection of RET proto-oncogene mutation is crucial for preventive thyroidectomy in multiple endocrine neoplasia type 2 children: presence of C-cell malignant disease in asymptomatic carriers. Cancer 2002;94:323–330PubMed

98.

van Heurn LW, Schaap C, Sie G, et al. Predictive DNA testing for multiple endocrine neoplasia 2: a therapeutic challenge of prophylactic thyroidectomy in very young children. J Pediatr Surg 1999;34:568–571PubMed

99.

Dralle H, Gimm O, Simon D, et al. Prophylactic thyroidectomy in 75 children and adolescents with hereditary medullary thyroid carcinoma: German and Austrian experience. World J Surg 1998;22:744–750; discussion 750–741PubMed

100.

Niccoli-Sire P, Murat A, Baudin E, et al. Early or prophylactic thyroidectomy in MEN 2/FMTC gene carriers: results in 71 thyroidectomized patients. The French Calcitonin Tumours Study Group (GETC). Eur J Endocrinol 1999;141:468–474PubMed

101.

Rodriguez GJ, Balsalobre MD, Pomares F, et al. Prophylactic thyroidectomy in MEN2A syndrome: experience in a single center. J Am Coll Surg 2002;195:159–166PubMed

102.

Ukkat J, Lorenz K, Hinze R, et al. Importance of early screening and prophylactic thyroidectomy in asymptomatic nonindex RET germline carriers. World J Surg 2001;25:713–717PubMed

103.

Lips CJ, Landsvater RM, Hoppener JW, et al. Clinical screening as compared with DNA analysis in families with multiple endocrine neoplasia type 2A. N Engl J Med 1994;331:828–835PubMed

104.

Pacini F, Romei C, Miccoli P, et al. Early treatment of hereditary medullary thyroid carcinoma after attribution of multiple endocrine neoplasia type 2 gene carrier status by screening for ret gene mutations. Surgery 1995;118:1031–1035PubMed

105.

Wells SA Jr, Gunnells JC, Leslie JB, et al. Transplantation of the parathyroid glands in man. Transplant Proc 1977; 9:241–243PubMed

106.

Wells SA Jr, Stirman JA Jr, Bolman RM 3rd, et al. Transplantation of the parathyroid glands. Clinical and experimental results. Surg Clin North Am 1978;58:391–402PubMed

107.

Olson JA Jr, DeBenedetti MK, Baumann DS, et al. Parathyroid autotransplantation during thyroidectomy. Results of long-term follow-up. Ann Surg 1996;223:472–478; discussion 478–480PubMed

108.

Breast cancer prevention trials information. Available at http://www.nsabp.pitt.edu/STAR/Index.asp

109.

King MC, Wieand S, Hale K, et al. Tamoxifen and breast cancer incidence among women with inherited mutations in BRCA1 and BRCA2: National Surgical Adjuvant Breast and Bowel Project (NSABP-P1) Breast Cancer Prevention Trial. JAMA 2001;286:2251–2256PubMed

110.

Duffy SW, Nixon RM. Estimates of the likely prophylactic effect of tamoxifen in women with high risk BRCA1 and BRCA2 mutations. Br J Cancer 2002;86:218–221PubMed

111.

Bresalier RS. Primary chemoprevention of familial adenomatous polyposis with sulindac: more questions than answers. Gastroenterology 2002;123:379–381PubMed

112.

Giardiello FM, Yang VW, Hylind LM, et al. Primary chemoprevention of familial adenomatous polyposis with sulindac. N Engl J Med 2002;346:1054–1059PubMed

113.

Carlomagno F, Vitagliano D, Guida T, et al. ZD6474, an orally available inhibitor of KDR tyrosine kinase activity, efficiently blocks oncogenic RET kinases. Cancer Res 2002;62:7284–7290PubMed

114.

Wells SA Jr, You YN, Lakhani V, et al. A phase II trial of ZD6474 in patients with hereditary metastatic medullary thyroid cancer. J Clin Oncol 2006;18S:5533

Titel: The Role of Prophylactic Surgery in Cancer Prevention
verfasst von: Y. Nancy You, MD, MHSc
Vipul T. Lakhani, MD
Samuel A. Wells Jr, MD
Publikationsdatum: 01.03.2007
Verlag: Springer-Verlag
Erschienen in: World Journal of Surgery / Ausgabe 3/2007
Print ISSN: 0364-2313
Elektronische ISSN: 1432-2323
DOI: https://doi.org/10.1007/s00268-006-0616-1

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The Role of Prophylactic Surgery in Cancer Prevention

Abstract

Background

Conclusions

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S3-Leitlinie „Diagnostik und Therapie des Karpaltunnelsyndroms“

S2e-Leitlinie „Distale Radiusfraktur“

S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“

Die Highlights vom Kongress des American College of Cardiology 2024

Springer Medizin

Abstract

Background

Conclusions

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Weitere Artikel der Ausgabe 3/2007

Steroids and One-Stage Restorative Proctocolectomy in Ulcerative Colitis: Unnatural Bedfellows

Factors Predicting Postoperative Infectious Complications and Early Induction of Inflammatory Mediators in Ulcerative Colitis Patients

End-to-End Compression Anastomosis of The Rectum: A Pig Model

Rural Surgery in Southern Sudan

Is Esophageal Adenocarcinoma Occurring Late After Antireflux Surgery Due to Persistent Postoperative Reflux?

Surgical and Interventional Visceral Revascularization for the Treatment of Chronic Mesenteric Ischemia—When to Prefer Which?

Update Chirurgie