Lebermetastasen kolorektaler Karzinome - wie oft kann man operieren?

Recurrent liver metastases of colorectal carcinoma are frequent. The repeat hepatectomy is superior to other therapeutic options. In about 20 % of patients with recurrent liver metastases a complete resection (R 0) is possible. The morbidity of repeat hepatectomy is similar to that of first hepatectomy. The 5-year survival rate after repeat hepatectomy ranges between 30 and 40 %. Often in the follow-up additional operations become necessary for extrahepatic recurrencies. For determination of the optimal therapy an interdisciplinary approach must be chosen.

Die laparoskopische Cholecystektomie beim Hochrisikopatienten

Den Vorteilen der laparoskopischen Cholecystektomie steht eine erhohte Gefahrdung kardiopulmonal vorgeschadigter Patienten durch die hamodynamischen und respiratorischen Auswirkungen des Pneumoperitoneums gegenuber. In der Zeit von Juni 1990 bis Dezember 1995 wurden 19 Hochrisikopatienten (ASA IV) und 465 Patienten mit minderem Operationsrisiko (ASA I–III) laparoskopisch cholecystektomiert. Bei insgesamt 5 % (n = 24) an intraoperativen, kardiopulmonalen Komplikationen traten diese bei den Hochrisikopatienten mit 15,8 % (n = 3) vs. 4,5 % (n = 21) haufiger (p = 0,027) auf. Allgemeine, postoperative Komplikationen sahen wir bei 2,9 % (n = 14) aller Falle, wobei ebenfalls die Patienten der Grup…

Subtotal esophageal resection in motility disorders of the esophagus.

<i>Background:</i> Esophagectomy for motility disorders is performed infrequently. It is indicated after failed medical therapy, pneumatic dilation, non-resecting surgical and redo procedures. Patient selection in this group is challenging and the operative risk has to be weighted carefully against the poor quality of life with persistent or recurrent dysphagia. <i>Patients and Methods:</i> Between September 1985 and April 2004, subtotal esophageal resections for advanced esophageal motility disorders of the esophagus not responding to previous therapy were carried out in 8 patients (6 females, 2 males). The median age of these patients was 59.5 (43–78) years. Six pa…

Ischämietoleranz durch α-Liponsäure — pharmakologische Präkonditionierung zur Verringerung des Reperfusionsschadens nach Leberischämie

Reaktive Sauerstoffspezies spielen in der Reperfusion nach Ischamie eine wichtige Rolle. Ob eine Verringerung des Reperfusionsschadens der Leber in vivo moglich ist durch die systemische Gabe des membranpermeablen Antioxidativum α-Liponsaure vor Ischamie im Sinne einer pharmakologischen Prakonditionierung ist nicht bekannt.

Indikationen zur konventionellen Adrenalektomie

INTRODUCTION: Conventional adrenalectomy still plays an important role, even in the era of minimally invasive endocrine surgery. It was the aim of our study to analyse the indications for conventional adrenalectomy in our own patients since the introduction of the minimally invasive technique in the year 1994 - laparoscopically and retroperitoneoscopically. PATIENTS AND METHODS: Between January 1994 and September 2006, a total of 412 adrenalectomies were performed in 380 patients. Out of these, 106 operations (25.7 %) were carried out conventionally in 98 patients, and 306 operations (74.3 %) endoscopically in 282 patients. RESULTS: Indications for conventional adrenalectomy were - as compa…

Effects of pneumatic dilation and myotomy on esophageal function and morphology in patients with achalasia.

Only two treatment modalities–pneumatic dilation and Heller myotomy–promise long-term relief from dysphagia and regurgitation in patients with achalasia. The objective of this study was to determine whether both options differ in their effects on esophageal function, morphology, and improvement in symptoms. Eighty-nine patients diagnosed with achalasia between January 1980 and December 2002 at a single center were enrolled in this study. Sixty-four patients underwent pneumatic dilation and 25 Heller myotomy in combination with an anterior semifundoplication (Dor procedure). Clinical evaluation (Eckardt-Score), esophageal manometry, and barium swallow were performed before and within 6 mont…

Die perkutane Dilatationstracheotomie - Welche Technik sollte angewendet werden?

Die endoskopisch gesteuerte Punktionstracheotomie hat sich auf vielen Intensivstationen etabliert. Von der Industrie werden fertige Tracheotomie-Sets angeboten, die auf den von Ciaglia (Cook®-Set) bzw. von Griggs (Portex®-Set) beschriebenen Techniken basieren. Ziel dieser Untersuchung war es, die Vor- und Nachteile, die Kosten und Risiken der Punktionstracheotomien aufzuzeigen und mit der konventionellen Vorgehensweise zu vergleichen.

Neue Perspektiven der laparoskopischen Simulation: Vom Studententrainingslabor bis zur Stressevaluation

Hintergrund: Die Anwendung eines LapSim®-Trainingsmodells im Studententrainingslabor sowie die objektive Evaluation von Stress in einem virtuellen Operations-Szenario bieten neue Perspektiven der laparoskopischen Simulation. Methodik: Im Studententrainingslabor erfolgte bei 28 Probanden am LapSim® Virtual-Reality (VR)-Simulator in einem Trainingscurriculum, bestehend aus 9 Einheiten, die Erfassung von Lernkurven laparoskopischer Basisfertigkeiten sowie komplexer Prozesse. In einem virtuellen Operations-Szenario wurde des Weiteren bei 18 Chirurgen eine Stressevaluation mittels eines Sympathikografen vorgenommen und dabei die laparoskopische Fehler- und Komplikationsrate erfasst. Hierbei konn…

Pretherapeutic MRI for decision-making regarding selective neoadjuvant radiochemotherapy for rectal carcinoma: interim analysis of a multicentric prospective observational study.

Purpose: To study the accuracy of different cutoffs for an involved circumferential resection margin (CRM) compared with T and N categories measured by MRI as basis for selective application of neoadjuvant radiochemotherapy (nRCT) in rectal carcinoma. Materials and Methods: In a prospective multicenter observational study involving 153 primarily operated patients, the preoperative results of MRI with pathohistological findings of resected specimens were compared. Results: For a cutoff of ≤1 mm for involvement of the CRM, the accuracy of preoperative MRI was 90.9% (139/153). The negative predictive value was 98.5% (134/136). The four participating departments did not differ significantly. Fo…

Local staging of rectal carcinoma and assessment of the circumferential resection margin with high-resolution MRI using an integrated parallel acquisition technique

Purpose To assess the diagnostic accuracy of integrated parallel acquisition technique (iPAT) in local staging of rectal carcinoma in comparison to conventional high-resolution MRI. Materials and Methods A total of 28 patients with a neoplasm of the rectum and 15 control patients underwent MRI of the pelvis. High-resolution images were acquired conventionally and with iPAT using a modified sensitivity encoding (mSENSE). Image quality, signal-to-noise and contrast-to-noise ratios (SNR, CNR), tumor extent, nodal status, and delineation of the circumferential resection margin (CRM) were compared. In 19 patients with a carcinoma, MR findings were correlated with the histopathological diagnosis.…

Langzeitergebnisse nach rekonstruktiven Eingriffen im aortoiliakalen Abschnitt

Im Zeitraum von September 1985 bis Februar 1994 wurde bei 183 Patienten ein rekonstruktiver Eingriff im aortoiliakalen Bereich durchgefuhrt. Die Grunderkrankung war in 108 Fallen eine arterielle Verschluskrankheit, in 75 Fallen ein abdominales Aortenaneurysma. Bei 120 Patienten wurde eine Bifurkationsprothese, bei 63 Patienten eine Rohrprothese implantiert. Die Fruh- und Spatkomplikationen werden beschrieben, differenziert nach chirurgisch und nichtchirurgisch, wobei die chirurgischen Komplikationen im wesentlichen durch die Prothesenart und durch den Leistenanschlus bedingt waren, wahrend die nichtchirurgischen Komplikationen vom Risikoprofil des Krankenguts abhangig waren. Die Unterschied…

Pseudoachalasia: a case series and analysis of the literature.

Pseudoachalasia frequently cannot be distinguished from idiopathic achalasia by manometry, radiologic examination or endoscopy. Mechanisms proposed to explain the clinical features of pseudoachalasia include a circumferential mechanical obstruction of the distal esophagus or a malignant infiltration of inhibitory neurons within the myenteric plexus.Between January 1980 and December 2002, the clinical features of 5 patients with pseudoachalasia and 174 patients with primary achalasia, diagnosed in a single center, were compared. A literature analysis of the etiology of pseudoachalasia for the time period 1968 to December 2002 was performed. The search concentrated on the databases and online…

Image of the Month—Quiz Case

Akute Gefäßverschlüsse — interdisziplinäres Therapiespektrum

Unter dem speziellen Gesichtspunkt der Verbesserung der Behandlungsergebnisse des akuten Ischamie-Syndroms der unteren Extremitaten erfolgte eine retrospektive Analyse von 344 Patienten. Eine arterielle Embolie lag in 46,4%, eine akute Thrombose in 32,7%, den akuten Verschlussen zugrunde. In 20,9% war eine eindeutige Zuordnung der Verschlusursache nicht moglich. Das Zeitintervall zwischen Symptom und Beginn der Therapie betrug bei den Embolien in 29% und bei den Thrombosen in 41% mehr als zwolf Stunden. In 67% wurde eine transfemorale indirekte Thrombembolektomie durchgefuhrt. Durch den Einsatz neuerer risikoarmer Behandlungsmethoden (Aspirationsembolektomie, Lyse und PTA etc.) last sich da…

Tumor-, patienten- und operateurbezogene Einflussfaktoren der Identifikation und Schonung autonomer Beckennerven bei TME

Nachdem die onkologischen Ergebnisse durch Einfuhrung der Totalen Mesorektum Exzision (TME) zur Behandlung des Rektumkarzinoms verbessert wurden, war es Ziel einer prospektiven Untersuchung zu klaren wie haufig die Darstellung und Schonung autonomer Beckennerven moglich ist und ob ein Zusammenhang zu postoperativ auftretenden Blasenentleerungsstorungen besteht.

Technique and results of the retroperitoneoscopic adrenalectomy via a lumbar approach

Introduction: Since 1992, endoscopic techniques have been used increasingly in adrenal-gland surgery. In the present paper, the technique of the retroperitoneoscopic adrenalectomy via a lumbar approach is described. Methods: The patient is placed in a lateral decubitus position. In the first step, a dilatation trocar is introduced in the retroperitoneal space to create an artificial cavity. The dilatation trocar is replaced by a blocking trocar to close off the operating field. After insufflation of CO2, two additional trocars are introduced in the area of the conventional flank incision. Adrenalectomy is performed via these ports. Once the adrenal gland is completely mobilized, it is inser…

Cryotherapy for liver metastases

Cryotherapy is undergoing a renaissance in the treatment of nonresectable liver tumors. In a prospective case control study we assessed the morbidity, mortality, and efficacy of hepatic cryotherapy for liver metastases. Between January 1996 and September 1999 a total of 54 cryosurgical procedures were performed on 49 patients (median age 66 years, 21 women) with liver metastases. Patient, tumor, and operative details were recorded prospectively. Liver metastases originated from colorectal cancer (n=37), gastric cancer (n=3), renal cell carcinoma (n=2), and other primaries (n=7). Median follow-up was 13 months (1-32). The median number of liver metastases was 3 (range 1-10) with a median dia…

Retroperitoneale Sarkome: Diagnostik und Therapie

Background Due to the fact that there are no distinct anatomical compartments, retroperitoneal sarcomas are moreover diagnosed with evidence of large tumors and infiltration of adjacent organs. In spite of improvement of the diagnostic facilities and surgical techniques, quite frequently local recurrences with unfavourable prognosis turn up even after complete removal. It was the aim of this study to analyze diagnosis, therapy and long-term prognosis in patients with retroperitoneal sarcomas over a period of 10 years. Patients and methods Between January 1995 and January 2005, 379 patients underwent surgery for a primary retroperitoneal tumor at our clinic. Among the 67 (17.1 %) malignant l…

Die Kryotherapie von Lebermetastasen des colorectalen Carcinoms

Mit 55.000 Todesfallen war das colorectale Carcinom 1995 die dritthaufigste malignombedingte Todesursache in den USA (Wingo et al. 1995). Lebermetastasen sind bei 15–25% der Patienten bei Diagnose des Primartumors vorhanden, und weitere 20% entwickeln Lebermetastasen im weiteren Krankheitsverlauf (Ballantyne und Quin 1993). Nach Resektion isolierter colorectaler Lebermetastasen sind in zahlreichen Publikationen 5-Jahres-Uberlebensraten von 20–50% bei vertretbarer perioperativer Morbiditat (23%) und Letalitat (4,7%) angegeben worden (Ballantyne und Quin 1993, Seifert und Junginger 1996). Allerdings besteht nur bei maximal 25% der Patienten mit colorectalen Lebermetastasen technische Resektab…

Ungewöhnliche Häufung von partiell endokrin aktiven Tumoren

Wir berichten uber eine Patientin, bei der zwischen ihrem 53. und 62. Lebensjahr 5 zum Teil endokrin aktive Tumoren auftraten: Uterusmyom, Hamangiopericytom der Meningen, Pleuramesotheliom, praperitoneales Leiomyom, medullares Schilddrusencarcinom (sporadische Form) in hyperthyreoter Struma multinodosa. Es wird auf die Seltenheit der Koinzidenz von Hyperthyreose und medullarem Schilddrusencarcinom sowie auf die durch das Pleuramesotheliom und das praperitoneale Leiomyom induzierte paraneoplastische Hypoglykamie und deren Genese hingewiesen. Epitheliale bzw. mesenchymale Tumoren konnen paraneoplastische Nuchternhypoglykamien durch im Tumor gebildete niedermolekulare Peptide mit insulinahnlic…

[Bilateral elastofibroma dorsi].

Ein 75 jahriger Patient stellte sich mit seit 2 Jahren langsam grosenprogredienten Raumforderungen unterhalb beider Schulterblatter vor. Anamnestisch bestand ein Zustand nach proximaler Oberarmamputation linksseitig mit folgender prothetischer Versorgung. Klinisch zeigten sich direkt unter den Schulterblattspitzen beidseits 2 faustgrose Tumoren, die fest mit dem tiefer gelegenen Gewebe verwachsen waren. Sowohl magnetresonanztomographisch als auch intraoperativ stellte sich ein infiltratives Wachstum dieser Raumforderungen in die seitliche Thoraxmuskulatur und das Periost der Rippen sowie des Schulterblatts dar, so das ein maligner Tumor vermutet wurde. Histopathologisch zeigte sich Bindegew…

Expression von CD44 und seiner Isoformen v4, v5, v6, v7, v10 – neue prognostische Parameter beim duktalen Pankreascarcinom?

Einleitung: Prognostisch relevante Faktoren sind beim Pankreascarcinom, basierend auf klinischen, laborchemischen und histopathomorphologischen Parametern bekannt. Aufgrund der grosen Variabilitat des biologischen Tumorverhaltens sind fur die Beurteilung der individuellen Prognose weitere Parameter notwendig. Ein Zusammenhang zwischen der Expression von CD44v6 und Tumorprogression bzw. Metastasierung konnte bei bestimmten Tumorentitaten nachgewiesen werden. Zum Pankreascarcinom liegen nur einzelne Untersuchungen vor. Methode: Immunhistochemisch wurden an archiviertem paraffineingebetteten Tumormaterial von 40 Patienten, bei welchen wegen eines duktalen Pankreascarcinoms eine partielle Duode…

Morbidity and mortality after esophagectomy for esophageal carcinoma: A risk analysis

Abstract Background The study was aimed to identify pre- and intraoperative risk factors that potentially influence morbidity and mortality after esophagectomy for esophageal carcinoma with particular emphasis on the predominant tumor types. Patients and methods Between September 1985 and March 2004, 424 patients underwent esophagectomy for esophageal carcinoma. Of these, 186 (43.9%) patients had a transhiatal, and 231 (54.5%) patients underwent a transthoracic procedure with two-field lymphadenectomy. Pre-, intraoperative risk factors and tumor characteristics were included in the risk analysis to assess their influence on postoperative morbidity and mortality. Results Multivariate analysi…

Prospective Evaluation of Positron Emission Tomography in the Preoperative Staging of Esophageal Carcinoma

Hypothesis Positron emission tomography (PET) is a useful tool in the selection of patients with esophageal cancer who may not benefit from esophageal resection. Design Case series. Setting Tertiary care hospital. Patients Eighty-one patients with newly diagnosed esophageal cancer who underwent PET and computer tomography (CT) of the chest and abdomen (and of the neck in 45 patients) within 45 days were included. Main Outcome Measures We calculated the sensitivity and specificity in detecting metastatic sites on the basis of 31 histologically verified lesions. In addition to results obtained on CT, the information provided by PET was evaluated with a view to the choice of management strateg…

Laparoscopic gastric banding as a universal method for the treatment of patients with morbid obesity.

Introduction: This study analyzed the influence of potentially negative predictors such as sweet-eating behavior, super-obesity, social and psychological status, family and education situation, intake of sedative drugs, and the distance between hospital and home on the outcome of laparoscopic adjustable gastric banding (LAGB). Methods: 77 women and 29 men with mean age 40.6 years (28-47) underwent LAGB. Preoperative mean body weight was 146 kg (99-179), and mean BMI was 48.1 kg/m 2 (36.4-73.5). The influence of the above-mentioned potentially negative predictors on weight loss was the primary end point. Results: Mean follow-up was 44.6 ′ 19.7 months. Follow-up was possible in all but 6 pati…

Comparison of iceball diameter and temperature distribution achieved with 3-mm accuprobe cryoprobes in porcine and human liver tissue and human colorectal liver metastases in vitro.

Abstract We aimed to assess the thermal profile and size of iceballs produced by Accuprobe cryoprobes in fresh porcine and human liver and human colorectal cancer liver metastases in vitro to allow better planning of cryosurgical treatment of liver metastases. Iceballs were produced by a 20-min single freeze cycle using 8-mm cryoprobes in pig liver in a waterbath at 37°C ( n = 8) and 3-mm cryoprobes in pig liver ( n = 8), human liver ( n = 3), and human colorectal cancer liver metastases ( n = 8). The iceball diameters and the temperatures at different distances from the cryoprobe were measured. Mean iceball diameters produced by 8-mm cryoprobes in pig liver were 56.3 mm and varied from 38.…

Transanale endoskopische Operationen bei benignen Rektumpolypen

In einer retrospektiven Untersuchung wurden die Behandlungsergebnisse der transanalen endoskopischen Operationstechnik bei benignen Rektumpolypen analysiert. Im Zeitraum Januar 1986 bis Dezember 1995 wurden an der Klinik fur Allgemein- und Abdominalchirurgie der Johannes-Gutenberg-Universitat Mainz 238 Patienten (115 Manner und 123 Frauen) mit benignen Rektumpolypen transanal endoskopisch operiert (Durchschnittsalter 64 Jahre ±11,5 Jahre). Die durchschnittliche Operationsdauer betrug im Mittel 93,5 min (±54,9 min), die Grose der exzidierten Polypen war 4,2 cm (±2 cm). Die Komplikationsrate lag bei 3%, die Klinikletalitat bei 1,2% Bei einer durchschnittlichen Nachbeobachtungszeit von 56 Mona…

Influence of splenectomy on perioperative morbidity and long-term survival after esophagectomy in patients with esophageal carcinoma

The aim of this study was to determine the influence of splenectomy on perioperative morbidity and mortality, as well as on the long-term survival after esophageal resection for carcinoma of the esophagus. From September 1985 to July 2003, 404 patients underwent surgery for esophageal carcinoma in our institution. Splenectomy was performed in 34 (8.4%) patients. Perioperative morbidity and long-term survival were compared in patients with and without concomitant splenectomy. Splenectomy was associated with an increase in intraoperative blood loss and the need for transfusions of blood preserves (P0.0001). However, there were no significant differences in pulmonary, general, or surgical comp…

Rat liver preservation by hypothermic oscillating liver perfusion compared to simple cold storage.

Rat livers were preserved hypothermically for 10 or 24 h in vitro as if for transplantation. Two methods of preservation were compared using physiological and biochemical parameters: simple storage and oscillating perfusion. By measuring the nucleotides after preservation the calculated energy charge was significantly higher after 10 and 24 h of oscillating perfusion compared to the simple storage group. In addition, a significant energy charge loading was demonstrated by 10 h oscillating perfusion compared to the initial value prior to perfusion. The oscillating, computer-controlled perfusion permits continuous monitoring of perfusate temperature, O2 consumption, pCO2, portal vein pressure…

Adipositaschirurgie bei monogenetisch bedingter Adipositas

Surgical treatment of patients suffering from monogenetic forms of morbid obesity is considered to be the poorest investigated theme in bariatric surgery. This review article presents aspects of genetic disorders in morbid obesity as well as some aspects of surgical treatment in patients with monogenetic forms of morbid obesity (Prader-Willi-Syndrome). Gastric restrictive procedures such as vertical banded gastroplasty or adjustable gastric banding as well as malabsorptive and mix procedures such as biliopancreatic diversion or Roux-en-Y gastric bypass are used for treatment, similar to polygenetic forms of morbid obesity. Until to now there is no evidence-based data because of the small nu…

Prognostic significance of tumor ploidy and histomorphological parameters in adenocarcinoma of Barrett's esophagus.

<i>Background:</i> Despite recent advances in surgical and multidisciplinary treatment, the prognosis for patients with adenocarcinoma of Barrett’s esophagus remains poor. The low prognostic accuracy of even surgical pathologic TNM staging suggests that additonal parameters are necessary in determining the prognosis. <i>Method:</i> In a retrospective analysis of 50 patients who underwent transhiatal or transthoracic esophageal resection due to adenocarcinoma of Barrett’s esophagus, a quantitative DNA analysis using image cytometry was performed in addition to the TNM classification and usual morphological criteria. At the time of DNA analysis the histomorphological p…

Preoperative diagnostics in pancreatic carcinoma: would less be better?

Objective: The objective of this study was to investigate the value of preoperative diagnostics in patients with pancreatic carcinoma in terms of tumor diagnosis and evaluation of resectability. Patients/Methods: From 1 September 1985 to 31 December 1997, 408 patients shown by histology to have a ductal (n=330) or periampullary carcinoma (n=78) were treated at our hospital. Results: In determining the presence of tumor, ultrasonography and computed tomography (CT) had a sensitivity of 88.3% and 94.0%, respectively; combined, they had a sensitivity of 96.2%. Endoscopic retrograde cholangiopancreatography (ERCP) had a sensitivity of 96.2%. Preoperative aspiration biopsy cytology had a sensiti…

Long-term urinary dysfunction after mesorectal excision: a prospective study with intraoperative electrophysiological confirmation of nerve preservation.

Bladder dysfunctions are well-recognized complications after nerve-sparing mesorectal excision for rectal cancer. This study sought to symptomatically analyze the extent of recovery from major and minor urinary symptoms in patients with signs of bladder denervation.Sixty-two patients with mesorectal excision for rectal cancer were investigated prospectively. Pelvic autonomic nerve preservation (PANP) was assessed macroscopically and with the aid of intraoperative electrical stimulation of pelvic autonomic nerves (INS). Bladder function was evaluated with the International Prostate Symptom Score (IPSS) and the Quality of life index (Qol). Median follow-up was 20 months (range 3-40 months).Fo…

Chirurgische Therapie des Ösophaguskarzinoms: Eine prospektive 20-Jahres-Analyse

BACKGROUND: The aim of our study was the analysis of long-term developments in the surgical therapy for esophageal carcinoma at our hospital over a period of 20 years with a differentiated view on the two predominant histological tumour types. PATIENTS AND METHODS: Between September 1985 and September 2005, esophageal resections were performed in 470 patients at our clinic on account of a malignant tumour of the esophagus. The abdomino-thoracic resection with abdominal and extended mediastinal lymph node dissection as well as intrathoracic anastomosis was the standard treatment in the case of squamous cell carcinoma, whereas in adenocarcinoma a transhiatal resection with abdominal and dorsa…

231. Bedeutung der Lymphknotendissektion f�r die Prognose beim Magenfr�hcarcinom

Insgesamt 167 Patienten, die wegen eines Magenfruhcarcinoms operiert wurden, wurden hinsichtlich der Uberlebensrate und der Rezidivfreiheitsrate untersucht. Dabei zeigte sich ein signifikanter Unterschied bei der Rezidivfreiheits- und Uberlebensrate bei durchgefuhrter Ulcusoperation (BII) und durchgefuhrter Gastrektomie bzw. subtotaler Resektion jeweils mit Lymphknotendissektion. (5-Jahresuberlebensrate 65% gegenuber 95% und Rezidivfreiheitsrate 68% gegenuber 97%). Die Lymphknoten der Gruppe I waren beim Mucosacarcinom bei 3,3% bis 5,6% und beim Submucosacarcinom bei 8,1% bis 9,6% der Patienten befallen. Es ist daher eine Krebsoperation mit Lymphknotendissektion der Lymphknotenstation I und…

Validity of Pelvic Autonomic Nerve Stimulation With Intraoperative Monitoring of Bladder Function Following Total Mesorectal Excision for Rectal Cancer

This prospective study was designed to clarify whether the results of the intraoperative stimulation of parasympathetic pelvic nerves performed in 31 patients after mesorectal excision for rectal carcinoma allowed predictions in terms of the postoperative bladder function of the patients.After monopolar stimulation of the splanchnic pelvic nerves using a constant voltage stimulator (Screener 3625), intravesical pressure increase was measured manometrically. The results were related to the postoperative residual urine volume, requirement of recatheterization and long-term catheterization, just as to the results of the validated International Prostatic Symptom Scores and the Quality of Life I…

Transarterielle Chemoembolisation (TACE) des Hepatozellulären Karzinoms (HCC) bei Patienten mit Pfortaderthrombose - Erfahrungen

PURPOSE: Comparative analysis of the course of disease in patients with initial diagnosis of portal vein thrombosis in HCC treated with sequential TACE. Evaluation of the efficacy and safety of the method in a selected patient cohort. PATIENTS AND METHODS: The study included 22 patients with HCC that were palliatively treated at least 3 times with TACE. All patients presented a portal vein thrombosis in the initial CT investigation. The TACE-procedure was carried out in regular intervals using a suspension consisting of a fixed dosage of Mitomycin C (10 mg) and 10-20 ml Lipiodol. Follow-up investigations were carried out with contrast enhanced Multislice-CT before and after TACE and control…

Hypothermic Oscillating Liver Perfusion Stimulates ATP Synthesis prior to Transplantation

Abstract Background. ATP and glycogen depletion often have been demonstrated during cold storage of the liver prior to transplantation. Suppression of events that lead to metabolic depression and to lipid peroxidation could contribute to improvement of liver preservation. A new method of liver preservation for transplantation is therefore suggested, an oscillating oxygenated hypothermic liver perfusion. Methods. Biochemical analysis of liver tissue samples and perfusate after 10 h of perfusion by the presented oscillating perfusion model were compared with results after continuous liver perfusion for 10 h as well as with data derived from cold-stored livers over a period of 10 h. Particular…

Major urinary dysfunction after mesorectal excision for rectal carcinoma

Abstract Background Urinary dysfunction may occur after mesorectal excision and pelvic autonomic nerve preservation (PANP) in patients with rectal carcinoma. The aim of this prospective study was to identify factors predictive of long-term urinary catheterization. Methods Two hundred and ten patients without significant urological problems underwent resection of rectal cancer with mesorectal excision. The number of patients with complete, partial or no identification of the nerves was documented and correlated with possible predictive factors for postoperative major urinary dysfunction. Results Eight patients (3·8 per cent) required long-term urinary catheterization: two after complete PANP…

Novel therapeutic targets in esophageal cancer: impact of chemokine receptor CXCR4

Ines Gockel†, Carl C Schimanski, Markus Moehler & Theodor Junginger †Author for correspondence Johannes GutenbergUniversity of Mainz, Department of General and Abdominal Surgery, Langenbeckstr. 1, 55131 Mainz, Germany Tel.: +49 6131 177 291; Fax: +49 6131 176 630; gockel@ach.klinik.unimainz.de ‘The interaction between esophageal cancer-expressed CXCR4 and SDF-1α may have a key role in directing malignant cells to ‘homing’ organs ... thus, this mechanism may account for metastasis.’

Laparoscopic Anterior Semifundoplication in Patients with Intrathoracic Stomach

The laparoscopic management of the intrathoracic stomach is still controversial. Laparoscopic semifundoplication in gastroesophageal reflux disease results in effective long-term reflux control and is, as compared with 360° Nissen fundoplication, associated with less frequent side effects such as dysphagia and gas bloat syndrome. The aim of our study was to evaluate the results of laparoscopic anterior semifundoplication in patients with intrathoracic stomach. Enrolled in this study are 19 patients (67.1 years of age; range, 37.5–83.7 years) with intrathoracic stomach undergoing laparoscopic anterior semifundoplication and a minimal follow up of 5 months postoperatively. The study covers t…

Prognostische Bedeutung des e-Cadherin beim papillären Schilddrüsencarcinom

The prognostic significance of e-cadherin in papillary thyroid carcinoma was evaluated in a retrospective study. From September 1985 to December 1996, 113 patients underwent surgery for papillary thyroid carcinoma. Seventy-eight formalin-fixed, paraffin-embedded tissue samples were available for immunohistochemical analysis of e-cadherin expression. In 74 of these 78 patients the postoperative course is known for 2 months to 35.2 years (median 3.6 years, mean: 4.9 +/- 4.8 years). Reduced or negative e-cadherin expression ( 20%. Statistical analysis revealed e-cadherin expression ( 20%), synchronous distant metastasis (M0/pM1, cM1) and radicality of resection (R0/R1, 2) as significant risk f…

111-Indium-DTPA-Octreotid-Szintigraphie bei kolorektalen Lebermetastasen

The somatostatin analogue octreotide is effective in the treatment of neuroendocrine and other tumours. 111-In-labelled DTPA-octreotide scintigraphy is successful in localizing primary neuroendocrine tumours and metastases and other tumours containing somatostatin receptors. An antiproliferative effect of octreotide was also demonstrated for colorectal carcinoma. Since only about 40% of colorectal carcinomas express somatostatin receptors, we tried to establish whether 111-In-labelled DTPA-octreotide scintigraphy is able to reveal the receptor status of liver metastases in patients with colorectal liver metastases. This would be useful in selecting patients for adjuvant therapy studies with…

Die anteriore Semifundoplicatio — Die Alternative zur Fundoplicatio

Bei der Behandlung der gastroosophagealen Refluxkrankheit (GERD) ist die Semifundoplicatio nach randomisierten Studien mit einer geringeren Dysphagierate im Vergleich zur Fundoplicatio bei vergleichbarer Refluxkontrolle verbunden. Ziel der Studie war es, an einem groseren Krankengut den Einfluss der anterioren Semifundoplicatio bei GERD unter besonderer Berucksichtigung des Langzeitverlaufes aufzuzeigen und damit den Stellenwert als Alternative zur Fundoplicatio nach Nissen zu ermitteln.

The Link Between Local Recurrence and Distant Metastases in Patients With Rectal Cancer.

BACKGROUND/AIM The relationships between local recurrence (LR), the development of distant metastases (DM) and prognosis in patients with rectal cancer remain unclear. PATIENTS AND METHODS In 606 patients who underwent curative resection, the role of LR was assessed retrospectively by time-dependent multivariate Cox models with inverse probability of treatment weighting taking into account competing risks. RESULTS Patients with LR had more DM than patients without LR (49/79, 62% vs. 86/524, 16.4%; p<0.001); 37% of LR-associated DM developed before or at LR, 63% after diagnosis of LR. Fifty-five percent of patients without DM at diagnosis of LR later developed DM. In these patients, the inci…

Significance of preoperative C-reactive protein as a parameter of the perioperative course and long-term prognosis in squamous cell carcinoma and adenocarcinoma of the oesophagus

AIM: C-reactive protein (CRP) is an acute-phase reactant and a known indicator of the malignant potential of the tumour. The aim of this study was to investigate the significance of preoperative CRP as a parameter of the perioperative course and long-term prognosis in patients with squamous cell carcinoma and adenocarcinoma of the oesophagus. METHODS: Serum CRP was determined preoperatively in 291 of 371 patients undergoing oesophagectomy for cancer from December 1989 to March 2004. Median patient age was 59 (28-79) year, 82.5% of patients were males. Squamous cell carcinoma was diagnosed in 151 (51.9%) and adenocarcinoma in 122 patients. Transhiatal oesophagectomy was done in 151 (51.9%) p…

Prätherapeutisches Staging und der interdisziplinäre Therapieansatz bei malignen Weichteiltumoren — Ergebnisse der Registerstudie der CAO

Ziel: Ziel der Weichteiltumor-Registerstudie der Chirurgischen Arbeitsgemeinschaft Onkologie (CAO) der Deutschen Gesellschaft fur Chirurgie war die Erfassung des aktuellen multimodalen Therapiekonzepts bei malignen Weichteiltumoren. Methodik: In einem Zeitraum von 19 Monaten konnten die Daten von 292 Patienten mit der Primarmanifestation eines malignen Weichteiltumors aus 99 Kliniken prospektiv erfast werden und die individuelle Behandlungsstrategie von Krankenhausern unterschiedlichen Versorgungsgrades evaluiert werden. Ergebnisse: 18% der Patienten wurden vor definitiver chirurgischer Therapie unzureichend vorbehandelt, uberwiegend in Form einer nicht-onkologischen Tumorexzision. Diese er…

A comparison of transhiatal and transthoracic resections on the prognosis in patients with squamous cell carcinoma of the esophagus

The aim of this study was to investigate the long-term prognosis for squamous cell carcinoma of the esophagus treated either by the transhiatal (TH) or by the transthoracic (TT) operative approach.Two hundred and twenty-nine patients (median age: 56 (29-84) years) with squamous cell carcinoma of the esophagus underwent esophageal resection between September 1985 and April 2004. In 70 patients, the transhiatal approach and in 159, the transthoracic approach was applied. An extended mediastinal lymph-node dissection was only carried out in the course of the transthoracic technique.Demographic data and tumor stages were comparable in both groups. A significantly better long-term survival was o…

Langzeitergebnisse nach Heller-Myotomie mit anteriorer Semifundoplikatio bei Achalasie

INTRODUCTION The positive success rate of cardiomyotomy in the treatment of achalasia has recently - especially in young patients - resulted in a primary operative treatment concept. Few studies of long-term effects of myotomy concerning the removal of dysphagia and the development of gastroesophageal reflux have been submitted. PATIENTS AND METHODS In the period between September 1985 and March 2003, an open, transabdominal Heller-myotomy combined with a Dor-semifundoplication was carried out in 93 patients with achalasia. 77 patients were followed for more than 6 months postoperatively (median follow-up: 70 months). The procedure was prospectively observed, and patients were questioned co…

Darstellung autonomer Beckennerven bei partieller und totaler Mesorektumexzision

Untersucht werden sollte, wie haufig die autonomen Beckennerven bei totaler Mesorektumexzision (TME) wegen Rektumkarzinom dargestellt und geschont werden konnen und ob ein Zusammenhang mit der postoperativen neurogenen Blasenentleerungsstorung besteht. Zwischen 3/1997 und 2/2003 wurden 229 Patienten bei Adenokarzinom des Rektums operiert. Der Sphinkter wurde bei 178 (78%) der Patienten erhalten. Bei 101 (48%) Erkrankten war der Tumor wandbegrenzt. Fur alle Patienten wurde intraoperativ die Darstellung der Nerven im Verlauf (Plexus hypogastricus superior bis zu den neurovascularen Bundeln) dokumentiert. In multivariater Analyse wurde auf Faktoren mit unabhangigem Einfluss auf Schonung und Da…

Ergebnisse der endoskopischen, retroperitonealen Adrenalektomie unter besonderer Berücksichtigung des intraoperativen Verlaufs

Bei 20 Patienten wurden retrospektiv die Auswirkungen eines Pneumoretroperitoneums auf die intraoperative Ventilation und Hamodynamik wahrend endoskopischer, retroperitonealer Adrenalektomie uberpruft. Intraoperativ war ein Anstieg des systolischen Blutdrucks feststellbar [Median 180 mmHg (130–200)]. Hinsichtlich der Ventilation muste das Atemminutenvolumen (AMV) intraoperativ im Median um 4,25 l (0,4–13) erhoht werden, um den als Folge der Anlage des Pneumoretroperitoneums ansteigenden arteriellen Kohlendioxid-Partialdruck zu senken. Die Anlage des Pneumoretroperitoneums fuhrte zu keiner wesentlichen Komplikation, so das uns die endoskopische, retroperitoneale Adrenalektomie auch bei Risik…

Assessment of tumor microcirculation with dynamic contrast-enhanced MRI in patients with esophageal cancer: initial experience.

PURPOSE: To investigate the feasibility and impact of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) on tumor characterization and response to radiochemotherapy (RCT) in patients with esophageal cancer. MATERIALS AND METHODS: A total of 48 patients underwent DCE-MRI to assess tumor microcirculation based on a two-compartment model function. Effects of RCT on kinetic parameters were studied in 12 patients with squamous cell carcinoma. RESULTS: Tumor microcirculation differs with respect to histological subtype: squamous cell carcinomas showed lower values of amplitude A (leakage space, P = 0.015) and higher contrast agent exchange rates (k(21), P = 0.225) compared with adenoc…

Cryoablation of Human Colorectal Cancerin Vivoin a Nude Mouse Xenograft Model

Abstract Objective: To establish the minimum required temperature in cryoablation of human colorectal cancer cell lines grown as subcutaneous tumors in mice. Methods: Male nu/nu nude mice were inoculated by a sc injection of 1 × 10 6 LoVo ( n = 30) or C170 ( n = 32) cells. After 2 weeks the tumors were frozen using a 3-mm cryotherapy probe (LCS 3000, Cryotech, UK) to temperatures ranging from −8 to −84°C. Results: (LoVo) Of 21 mice evaluable for analysis no tumors recurred in 3 mice which had their tumors frozen to less than −60°C as measured at the presumed tumor/host boundary, whereas all but one tumor recurred in 18 mice which had their tumors frozen to >−60°C. (C170) Of 18 mice evaluabl…

Abrikossoff-Granulosazelltumor: Ein seltener Tumor des Oesophagus

Es wird uber einen 41 jahrigen Patienten berichtet, bei dem eine abdominothorakale Oesophagusresektion durchgefuhrt wurde nachdem ein Granulosazelltumor der Speiserohre in der praoperativen Diagnostik als malignes Plattenepithelcarcinom verkannt worden war. Granulosazelltumoren des Oesophagus sind sehr seltene zumeist benigne Tumoren neuroektodermalen Ursprungs. Die Diagnose ergibt sich aus dem endoskopischen Aspekt und der histologischen Untersuchung und immunohistochemischen Aufarbeitung des Biopsats. Aufgrund der histologischen Eigenart des Tumors besteht Verwechslungsgefahr mit Plattenepithelcarcinomen.

Rektummelanome – Stellenwert der modernen Therapie

Rectal melanoma is a rare disease. There is much controversy concerning cause, incidence and treatment of the disease and the spreading of recurrence. In this article, we discuss actual aspects of diagnostic, therapy and prognosis on the basis of our series of seven patients as well as a literature review. The surgical therapy in the form of local tumour excision with a disease-free margin of up to 1-2 cm is the initial therapeutic modality of choice. Large tumours that obviously could not be removed in sano should be treated with a multimodal concept. Such tumours should be treated by a combination of neoadjuvant radiation and chemotherapy for down-staging with subsequent local excision (L…

Transanal endoscopic microsurgical excision of pT2 rectal cancer: results and possible indications.

In previous studies, local excision was predominantly established for "low-risk" pT1 rectal cancer. The results obtained with T2 tumors are unclear; recurrence rates of 0 to 67 percent were reported. This study was designed to determine the value of local excision for T2 rectal carcinomas, prognostic factors, and the need for reoperation.After local excision of 649 patients with rectal tumors, pT2 carcinoma was found in 44 patients. In general, immediate reoperation was recommended; however, 24 patients declined further surgery or were not reoperated because of comorbidities. The results were analyzed separately for local R0 resection of low-risk carcinomas and for prognostically unfavorabl…

Long-term results of conventional myotomy in patients with achalasia: a prospective 20-year analysis.

Myotomy has proved to be an efficient primary therapy in patients with achalasia, especially in younger patients (<40 years of age). The results of laparoscopic myotomy cannot be finally assessed, on account of the shorter postoperative follow-up. Thus, there are considerable data regarding intermediate-term outcomes after laparoscopic myotomy. The aim of our study was a 20-year analysis of the conventional cardiomyotomy as the underlying basis assessing the results of minimal-invasive surgery. Within 20 years (September 1985 through September 2005), 161 operations for achalasia were performed in our clinic. Enrolled in this study were 108 patients with a conventional, transabdominal myotom…

Coexpression of receptor-tyrosine-kinases in gastric adenocarcinoma-a rationale for a molecular targeting strategy?

AIM: To define the (co-)expression pattern of target receptor-tyrosine-kinases (RTK) in human gastric adenocarcinoma. METHODS: The (co-)expression pattern of VEGFR1-3, PDGFRα/β and EGFR1 was analyzed by RT-PCR in 51 human gastric adenocarcinomas. In addition, IHC staining was applied for confirmation of expression and analysis of RTK localisation. RESULTS: The majority of samples revealed a VEGFR1 (98%), VEGFR2 (80%), VEGFR3 (67%), PDGFRα (82%) and PDGFRβ (82%) expression, whereas only 62% exhibited an EGFR1 expression. 78% of cancers expressed at least four out of six RTKs. While VEGFR1-3 and PDGFRα revealed a predominantly cytoplasmatic staining in tumor cells, accompanied by an additiona…

BCL-2 UPREGULATION AFTER 3-NITROPROPIONIC ACID PRECONDITIONING IN WARM RAT LIVER ISCHEMIA

We aimed to determine whether 3-nitropropionic acid (3-NPA) preconditioning protects rat livers against warm ischemia/reperfusion injury. We hypothesized that 3-NPA mediates its protective effects by Bcl-2 upregulation. Brown-Norway rats (200 g) were injected with 3-NPA (10 mg/kg intraperitoneally) 24 h before 90 min of selective warm in situ ischemia. In additional experiments, 30-day survival was studied after 90 min of warm liver ischemia and resection of nonischemic liver tissue. We demonstrate increased mRNA and protein levels of Bcl-2 by real-time polymerase chain reaction, immunohistochemistry, and Western blot analysis in 3-NPA-pretreated rats. All treated animals survived, whereas …

Reduktion des Ischämie/Reperfusionsschadens nach warmer Leber Ischämie am Menschen durch alpha Liponsäure

Die Studie zeigt, dass alpha Liponsaure einen protektiven Einfluss auf den IRS der Leber im Rahmen von elektiven Leberresektionen ausubt. Prospektiv randomisierte Studien mussen diese vielversprechenden Ergebnisse belegen. Dennoch erscheint bei einem geringem Nebenwirkungsspektrum, niedrigen Kosten und einer einfachen sowie schnellen Applikation ein routinemasiger Einsatz von alpha Liponsaure in der Leberchirurgie denkbar.

Prospektive Beobachtungsstudie zur operativen Therapie des renalen Hyperparathyreoidismus

In einer prospektiven Beobachtungsstudie bei Patienten mit renalem Hyperparathyreoidismus wurden nach Eingriffen an den Nebenschilddrusen der Verlauf und die Abhangigkeit der Symptomatik von praoperativ ermittelten Laborparametern analysiert. Zwischen dem 1. 8. 1987 und dem 31. 12. 1995 wurden 79 Patienten operiert. Bei 72 Patienten erfolgten erstmalige Eingriffe an den Nebenschilddrusen. Bevorzugtes Operationsverfahren war die totale Parathyreoidektomie mit autologer Epithelkorperchenreplantation (n = 67). Informationen zum postoperativen Verlauf liegen von allen Patienten vor. Bei 74 der 79 Patienten erfolgten regelmasige Nachuntersuchungen (1–9, Median = 4) mit einer Nachbeobachtungszeit…

Veränderungen der extrazellulären Matrix in der Venenwand — Ursache der primären Varikosis?

Die kontraren Theorien zur Entstehung der primaren Varikosis fuhrten zur molekularbiologischen Untersuchung der Venenwand, genauer der extrazellularen Matrix. Das Ziel war, die Matrixexpression zu quantifizieren und die pathologischen Veranderungen der Venenwand mit der klappenorientierten Stadieneinteilung der Varikosis zu vergleichen, um so Hinweise auf eine primare Ursache der Varizenbildung zu erhalten.

Resektion von lebermetastasen kolorektaler tumoren

In der Klinik fur Allgemein- und Abdominalchirurgie der Johannes-Gutenberg-Universitat Mainz wurden in der Zeit von September 1985 bis Dezember 1994 76 Patienten mit Metastasen kolorektaler Primartumoren unter kurativer Zielsetzung an der Leber reseziert. Die 30-Tage-Letalitat und die Komplikationsrate betrugen 6,6 und 30,3%. Die 3- und 5-Jahres-Uberlebens-wahrscheinlichkeit nach Lebermetastasenresektion lagen bei 53 und 36%. Innerhalb der Patienten mit R0-Resektion (ohne Letalitat) hatten bein univariater Analyse folgende Faktoren einen gunstigen Einflu\ auf dieUberlebens-wahrscheinlichkeit: N1-Klassifikation des Primartumors im Vergleich zu N2 (bei Patienten mit mesenterialem Lymphknotenb…

Chirurgische Radikalität und Indikation zur adjuvanten Therapie bei malignen Weichteiltumoren — Ergebnisse einer Registerstudie / The Extent of Radical Surgery and Indication for Adjuvant Therapy of Soft Tissue Sarcomas: Results of an Evaluation Study

Ziel dieser Studie der Chirurgischen Arbeitsgemeinschaft Onkologie (CAO) der Deutschen Gesellschaft fur Chirurgie war die Erfassung eines aktuellen Status des chirurgisch-onkologischen Vorgehens bei malignen Weichteiltumoren des Erwachsenen. In 19 Monaten wurden die Daten von 292 Patienten aus 99 Kliniken prospektiv erfast. 39% wurden an Uni-Kliniken, 36% in Schwerpunkt- und 24% in Krankenhausern der Grundversorgung therapiert. An den Extremitaten konnte in 96% ein extremitatenerhaltender Eingriff durchgefuhrt werden. Die Haufigkeit einer RO-Resektion unterschied sich in den einzelnen Kliniken nicht signifikant, jedoch kamen lokal ausgedehntere Verfahren und additive Masnahmen an Uni-Klinik…

Intraoperative identification and neurophysiologic parameters to verify pelvic autonomic nerve function during total mesorectal excision for rectal cancer.

Abstract Background Preservation of parasympathetic and sympathetic nerves is required to avoid urogenital function disturbances after total mesorectal excision (TME) for rectal carcinoma. This study sought to determine whether intraoperative stimulation of parasympathetic nerves with monitoring of bladder contraction is useful in meeting this demand. Study design In a prospective pilot study, 17 patients, 11 men and 6 women, underwent TME with pelvic autonomic nerve preservation performed by an experienced surgeon. The parasympathetic nerves were stimulated by an electrostimulation device (Screener 3625, Medronic), and the resulting bladder contraction was measured manometrically in all pa…

pT2 Adenocarcinoma of the Esophagus: Early or Advanced Cancer?

Background There is an increasing trend to include patients with esophageal carcinoma invading the muscularis propria (pT2) in neoadjuvant therapy regimens. But it is unclear which patients have prognostic benefit from this strategy. The aim of this study was to assess the prognosis and prognostic factors in patients with pT2 esophageal adenocarcinoma to further optimize treatment strategies. Methods Included were patients with pT2 esophageal adenocarcinoma treated operatively at three centers specializing in upper gastrointestinal surgery. There were 159 patients (139 male) without induction therapy; median age was 64.5 years. Survival was analyzed by univariate and multivariate analysis. …

Dissemination of hepatocellular carcinoma is mediated via chemokine receptor CXCR4

In different tumour entities, expression of the chemokine receptor 4 (CXCR4) has been linked to tumour dissemination and poor prognosis. Therefore, we evaluated, if the expression of CXCR4 exerts similar effects in human hepatocellular carcinoma (HCC). Expression analysis and functional assays were performed in vitro to elucidate the impact of CXCL12 on human hepatoma cells lines. In addition, expression of CXCR4 was evaluated in 39 patients with HCC semiquantitatively and correlated with both, tumour and patients characteristics. Human HCC and hepatoma cell lines displayed variable intensities of CXCR4 expression. Loss of p53 function did not impact on CXCR4 expression. Exposure to CXCL12 …

Multimodal treatment of gastric cancer

Although radical surgical R0 resections are the basis of cure for gastric cancer, surgery alone only provides long-term survival in 20-30% of patients with advanced-stage disease. Thus, in Western and European countries, advanced gastric cancer has a high risk of recurrence and metachronous metastases. Very recently, multimodal strategies combining different neoadjuvant and/or adjuvant protocols have improved the prognosis of gastric cancer when combined with surgery with curative intent. As used in palliative regimens, the combination of cisplatin with intravenous or oral fluoropyrimidines has been the integral component of such (neo)adjuvant strategies. However, the cytotoxic agents docet…

Positron Emission Tomography for Staging Esophageal Cancer: Does It Lead to a Different Therapeutic Approach?

Accurate preoperative staging is essential for the indication and selection of the appropriate surgical procedure in patients with esophageal cancer. The present prospective study was designed to determine if the preoperative use of (18)F-fluorodeoxyglucose positron emission tomography (FDG-PET) increases the accuracy of staging esophageal cancer compared with computed tomography (CT) and if it thereby leads to a different therapeutic approach. A total of 58 patients, 46 men and 12 women (mean age 61 years), with histologic proof of esophageal carcinoma underwent FDG-PET of the neck, chest, and abdomen, as well as CT of the chest and abdomen, to determine tumor stage. FDG-PET and CT data we…

Follow-up after transanal endoscopic microsurgery or transanal excision of large benign rectal polyps

Methods: Between January 1986 and December 1995, 238 patients with benign rectal polyps under-went either transanal endoscopic microsurgery (n = 226) or transanal excision (n = 12) at the Clinic of General and Abdominal Surgery, Johannes Gutenberg-University, Mainz. Results: Mean polyp size was 4.2 cm; 89.1% of polyps measured more than 2 cm in diameter. In 89.1% of cases, histological analysis revealed polyps containing tubulovillous or villous adenomas. Synchronous colonic polyps were detected in 12.5% of patients. Follow-up data are available on 222 patients (94%). At follow-up examination, 169 of the 193 surviving patients (87.6%) were recurrence free. Seven of 193 patients (3.6%) had d…

Permanent Stoma After Low Anterior Resection for Rectal Cancer

BACKGROUND AND OBJECTIVES: A low anterior resection procedure for removing a rectal tumor aims to preserve the sphincter and avoid a permanent stoma. Permanent stomas are primarily necessary in cases of poor anorectal function and local recurrence. The aim of this study was to clarify whether anastomosis-related complications and local recurrence influenced the rate of permanent stomas in a long-term follow-up. METHODS: Of 1032 consecutive patients with rectal cancer, 397 were treated by low anterior resection (R0 and R1 resections) between 1985 and 2007 at the Department of General and Abdominal Surgery of the University Hospital, Mainz (Germany). All patient data were collected prospectiv…

(Neo)adjuvant Strategies of Advanced Gastric Carcinoma: Time for a Change?

Despite surgical R0 resections, patients with gastric cancer stage UICC II–III have a high risk of recurrence and metachronic metastases. Preliminary evidence exists that adjuvant chemotherapy or neoadjuvant chemo(radio)therapy protocols may improve the prognosis of these patients undergoing surgery of gastric cancer with curative intention. As for palliative regimens, 5-fluorouracil and cisplatin are integral components of such (neo)adjuvant strategies. Upcoming cytostatic agents, i.e. irinotecan, docetaxel, oxaliplatin, and oral fluoropyridines are currently under investigation in new multimodality treatment regimens and may further increase R0 resection rates and may prolong disease-free…

Endoluminal sonography in follow-up of rectal carcinoma.

Fourteen patients who had undergone local excision, anterior resection or low anterior resection for rectal carcinoma were examined by endoscopic ultrasonography. In two of three cases of local recurrent carcinomas, endoscopic sonography was superior to computed tomography in determining the depth of tumor infiltration. There were difficulties in differentiating scar tissue from local tumor formation when the mucosa appeared normal upon endoscopic examination. Only repeated follow-up examinations starting in the postoperative period, will allow a differentiation between scar tissue and local tumor recurrence.

3-NPA induziert Ischämietoleranz der Rattenleber nach warmer Ischämie

Until now little is known about the potential of 3-nitroproprionic acid (3-NPA) to reduce ischemia/ reperfusion injury (IRI) of the rat liver in vivo.

Endoluminal ultrasonic examination of sessile polyps and early carcinomas of the rectum

The results of conventional endosonographic techniques in the assessment of early carcinomas and sessile polyps of the rectum have been unsatisfactory. We therefore developed a new technique in which the rectal cavity is filled directly with water. Using this technique, the anatomy of small rectal tumors is preserved and the layers of the rectal wall are easier to differentiate, especially with a 10-MHz scanner. The clinical results in 66 patients demonstrate that this new technique is very accurate in the preoperative staging of adenomas and T1-carcinomas of the rectum.

The influence of histopathologic criteria on the long-term prognosis of locally excised pT1 rectal carcinomas: results of local excision (transanal endoscopic microsurgery) and immediate reoperation.

Local excision of early rectal cancer is a controversial issue, which is in part because of differences in the evaluation of histopathologic criteria. This prospective study was designed to determine prognostic factors for recurrences and the need for reoperation.In 105 of 118 patients with pT1 carcinomas and local excision, results of recurrence rates and ten-year cancer-free survival were studied separately according to different histologic criteria (R0, R1, Rx, Ror = 1 mm, high-/low-risk situation), tumor localization (anterior, posterior, lateral wall and third of rectum), size, and degree of resection (full-thickness/partial wall). Patients were grouped into local excision (n = 89) and…

Long-Term Results of Endoscopic Adrenalectomy for Conn's Syndrome

The long-term effect of adrenalectomy on aldosterone-producing adenomas of the adrenal gland is controversially discussed. The aim of this study was to analyze the long-term course, with special consideration of factors of persisting hypertension after endoscopic adrenalectomy, for Conn's syndrome. Between February 1994 and March 2004, 40 patients with Conn's syndrome underwent endoscopic adrenalectomy. Data were recorded prospectively. Adrenalectomy was carried out unilaterally in all patients. Twenty-three patients (57.5%) were women; the median age was 51.7 (31.2–71.4) years. Preoperatively, all patients presented with arterial hypertension persisting over a median period of 84 (5–240) …

Selektion von Patienten mit Rektumtumoren zur lokalen Exzision aufgrund der pr�operativen Diagnostik

Ziel unserer Studie war die Erfassung der Genauigkeit der praoperativen Diagnostik (rektal-digitale Untersuchung, Biopsie und transanale Endosonographie) bei durch lokale Exzision behandelten Rektumtumoren. 552 Patienten mit Rektumkarzinom, Adenom, Karzinoiden oder seltenen benignen Tumoren wurden lokal exzidiert. Die Ergebnisse der rektal-digitalen Untersuchung, der Biopsie und der transanalen Endosonographie wurden mit dem postoperativen pathohistologischen Befund verglichen. Der praoperative histologische Nachweis des Karzinoms ist abhangig von der Tumorgrose (52% bei Karzinomen 3 cm; p=0,001) und war korrekt in 56% aller Karzinome. Die transanale Endosonographie (uT0/1) ist sensitiver (…

Selective approach to the treatment of oesophageal cancer

Abstract Between September 1985 and December 1994, 322 patients with oesophageal cancer were treated. Of the 190 patients who underwent operation, 173 had an oesophageal resection; in 124 this was performed as an abdominothoracic resection and in 49 by the transhiatal approach. The assessment of radicality after histological examination revealed a curative (R0) resection in 121 patients (70 per cent) and a palliative (R1-R2) resection in 52 (30 per cent). Prognosis was correlated with the extent of mediastinal lymph node dissection. In 77 patients with stage pT1–3 pN0–1 pM0 the 5-year survival rate was 40 per cent after abdominothoracic resection with two-field lymph node dissection and zer…

Randomised phase II evaluation of irinotecan plus high-dose 5-fluorouracil and leucovorin (ILF) vs 5-fluorouracil, leucovorin, and etoposide (ELF) in untreated metastatic gastric cancer

An open-label randomised comparison of efficacy and tolerability of irinotecan plus high-dose 5-fluorouracil (5-FU) and leucovorin (LV) (ILF) with etoposide plus 5-FU/LV (ELF) in patients with untreated metastatic or locally advanced gastric cancer. One cycle of ILF comprised six once-weekly infusions of irinotecan 80 mg m(-2), LV 500 mg m(-2), 24-h 5-FU 2000 mg m(-2), and ELF comprised three once-daily doses of etoposide 120 mg m(-2), LV 300 mg m(-2), 5-FU 500 mg m(-2). In all, 56 patients received ILF and 58 ELF. Median age was 62 years, Karnofsky performance 90%, and disease status was comparable for both arms. The objective clinical response rates after 14 weeks treatment (primary end p…

Ist die transhiatale Oesophagusresektion mit unterer posteriorer mediastinaler sowie abdomineller Lymphknotendissektion onkologisch ausreichend beim distalen Plattenepithelkarzinom des Oesophagus

Einleitung: Die transhiatale Oesophagusresektion wird aus onkologischer Sicht aufgrund der eingeschrankteren Moglichkeit einer mediastinalen Lymphknotendissektion haufig als palliative Therapie des Plattenepithelkarzinom des Oesophagus angesehen im Gegensatz zur abdominothorakalen Oesophagusresektion mit 2- oder 3-Feld Lymphknotendissektion. Andererseits kann auch im Rahmen einer transhiatalen Resektion eine Lymphknotendissektion des unteren posterioren Mediastinums bis zur Trachealbifurkation durchgefuhrt werden, so dass bei distaler Tumorlokalisation das transhiatale Vorgehen moglicherweise vertretbar erscheint. Ziel dieser Analyse des eigenen Krankenguts war es, den Langzeitverlauf der P…

Expression of chemokine receptor CXCR4 correlates with progression of pancreatic cancer

14018 Background: Despite many pathophysiological analyses, the process of tumor dissemination of pancreatic cancer remains vague. In diverse other tumor entities, expression of the chemokine receptor CXCR4 has been linked to tumor dissemination and poor prognosis. Therefore, we evaluated, if the expression of this chemokine receptor exerts similar effects in human pancreatic cancer. Methods: Expression of CXCR4 was evaluated in 120 patients with histologically confirmed pancreatic cancer and eight different pancreatic cancer cell lines. Expression intensities of tumor samples were correlated with both, tumor and patients characteristics. Results: Human pancreatic cancer samples and cell l…

Influence of identification and preservation of pelvic autonomic nerves in rectal cancer surgery on bladder dysfunction after total mesorectal excision.

PURPOSE: Given the improvement in oncologic outcome after the introduction of total mesorectal excision for the treatment of rectal cancer, the objective of the present study was to determine the frequency of identification and preservation of the pelvic autonomic nerves and to identify a possible link between postoperative micturition disturbances and the extent of the radical resection. METHODS: Between March 1997 and December 2001, 150 patients with adenocarcinoma of the rectum (≤16 cm from the anal verge) underwent surgery, with sphincter preservation in 112 cases (74.7 percent). Sixty-three patients (42 percent) were classified as American Society of Anesthesiologists Stage III and two…

Treatment of Metachronous and Simultaneous Liver Metastases of Pancreatic Cancer

&lt;i&gt;Aim:&lt;/i&gt; Patients were analyzed who underwent treatment of liver metastases from pancreatic cancer. &lt;i&gt;Methods:&lt;/i&gt; Selection criteria were the possibility of R0 resection of the primary and/or the liver metastases, no other sites of metastases, and the presentation of liver metastases. A comparison of treatment by surgery versus chemotherapy regarding overall survival and disease-free interval was performed. &lt;i&gt;Results:&lt;/i&gt; Between 1996 and 2008, a total number of 23 patients were retrospectively identified from a prospective database of 193 cases of pancreatic cancer. In 14 cases, liver metastases were found simultaneously, and in 9 cases metachronou…

DNA-gehalt der tumorzelle

Aufgrund der hohen Morbiditat und Mortalitat nach Leberresektion wegen eines hepatozellularen Karzinoms ist es sinnvoll, prognostisch relevante Faktoren zu evaluieren, um die Patienten zu definieren, die von einer Resektion profitieren um den anderen das Risiko eines komplikationstrachtigen Eingriffs zu ersparen. Am archivierten paraffineingebetteten Tumormaterial von 21 Patienten mit einem hepatozellularen Karzinom wurde nach Leberresektion mittels bildanalytischer DNA-Analyse die Ploidie bestimmt. Im DNA-Histogramm fanden sich diploide, hypotriploide, triploide, hypertriploide, tetraploide und nicht naher klassifizierbare aneuploide Tumoren. Es fand sich eine statistisch signifikante Korr…

Rectal cancer: Dynamic contrast-enhanced MRI correlates with lymph node status and epidermal growth factor receptor expression

Purpose To evaluate correlations between dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) and clinicopathologic data as well as immunostaining of the markers of angiogenesis epidermal growth factor receptor (EGFR) and CXC-motif chemokine receptor 4 (CXCR4) in patients with rectal cancer. Materials and Methods Presurgical DCE-MRI was performed in 41 patients according to a standardized protocol. Two quantitative parameters (k21, A) were derived from a pharmacokinetic two-compartment model, and one semiquantitative parameter (TTP) was assessed. Standardized surgery and histopathologic examinations were performed in all patients. Immunostaining for EGFR and CXCR4 was performed an…

Malignant and Unclear Histological Findings in Incidentalomas

&lt;i&gt;Background:&lt;/i&gt; The management of incidentalomas with tumor size 3 cm and larger is still under controversial discussion. &lt;i&gt;Study Design:&lt;/i&gt; Clinical charts of 65 patients who underwent adrenalectomy for an incidentaloma were reviewed. &lt;i&gt;Results:&lt;/i&gt; Sixty-five patients were operated. There were 28 men and 37 women with a median age of 56.9 years. Median size of all resected lesions was 4.1 cm. Indications for surgery were tumor size equal and larger than 3 cm, recurrent pain, hormone status and patients’ fear of malignancy. In 45 patients, the adenomas did not meet the defined criteria of malignancy. There were 9 cases of adrenal hyperplasia, and t…

Effect of Chemokine Receptors CXCR4 and CCR7 on the Metastatic Behavior of Human Colorectal Cancer

AbstractPurpose: The expression of chemokine receptors CXCR4 and CCR7 has been associated with tumor dissemination and poor prognosis in a limited number of tumor entities. However, no data are currently available on the impact of chemokine receptor expression on disease progression and prognosis in human colorectal cancer.Experimental Design: The expression of CXCR4 and CCR7 was evaluated in 96 patients with histologically confirmed colorectal cancers and in four colorectal cancer cell lines by immunohistochemical staining. Furthermore, cell migration assays were done with SW480, SW620, and LS174T cancer cells to confirm the effect of the CXCR4 ligand stromal cell–derived factor 1α on migr…

A pig model of hepatic cryotherapy. In vivo temperature distribution during freezing and histopathological changes

We aimed to assess the temperature distribution in the cryolesion during hepatic cryotherapy and the association with postoperative histological changes to optimise the technique and allow better preoperative planning. Hepatic cryolesions were produced in 22 pigs following laparotomy using a CMS-cryosystem and 8mm-AccuProbe-Cryoprobes. The temperature was measured in 1 min intervals at different distances from the probe during freezing. The animals were treated in 5 groups: (i) single freezing of 20 min; (ii) double freezing of 20 min each; (iii) single freezing of 40 min; (iv) single freezing of 20 min (n=4), histology at 1 week p.o., and (v) single freezing of 20 min and Pringle manoeuvre…

Morbidität von Begleiteingriffen bei der Halsexploration wegen primärem Hyperparathyreoidismus Ergebnisse einer prospektiven Untersuchung

In einer prospektiven Beobachtungsstudie nach operativer Therapie eines primaren Hyperparathyreoidismus wurden die Incidenz durchgefuhrter Begleiteingriffe und deren Einflus auf die Morbiditat der Halsrevision analysiert. Vom 1. 8. 1987 bis 15. 10. 1995 wurden 231 Patienten operiert. Bei 16 Patienten erfolgten simultan 18 (7,8 %) abdominal-, thoraxchirurgische Operationen sowie Eingriffe bei Weichgewebstumoren und bei 133 Patienten (57,6 %) Schilddrusenresektionen unterschiedlichen Ausmases, bei 4,8 % bestanden Schilddrusencarcinome. Von 94,4 % aller Patienten liegen im Rahmen einer standardisierten Verlaufsbeobachtung katamnestische Daten vor (1–9 Nachuntersuchungen bei 216 Patienten). Nac…

Reduction of Interstitial Cells of Cajal (ICC) Associated With Neuronal Nitric Oxide Synthase (n-NOS) in Patients With Achalasia

The etiology of achalasia is still unknown. The current theories of chronic inflammation leading to autoimmune response with destruction and loss of the inhibitory myenteric ganglion cells enlighten its pathogenesis in a limited way only. Interstitial cells of Cajal (ICC) have been shown to be involved in nitrergic neurotransmission of the lower esophageal sphincter (LES).To investigate the significance of ICC and neuronal nitric oxide synthase (n-NOS) in esophageal wall tissue of patients undergoing surgery for achalasia.In 53 patients with a median age of 45 (6-78) yr undergoing surgery for achalasia, the immunoreactivity of ICC (CD117/c-kit) and n-NOS was assessed. In 42 patients, biopsi…

Chemokine receptor CCR7 enhances intrahepatic and lymphatic dissemination of human hepatocellular cancer.

Despite many pathophysiological analyses, the process of tumor dissemination of hepatocellular carcinoma (HCC) remains vague. In diverse tumor entities, expression of the chemokine receptor, CCR7, has been linked to tumor dissemination and poor prognosis. Therefore, we evaluated, whether CCR7 exerts similar effects in human HCC. CCR7 expression analysis was performed in vitro on human hepatoma cell lines (Huh7, Hep3B, wt HepG2, p53 dominant negative transfected HepG2). In addition, CCR7 expression was evaluated in 39 patients with hepatocellular cancer and correlated with both, tumor and patients characteristics. Human hepatocellular carcinoma samples and hepatoma cell lines displayed varia…

Local excision for more advanced rectal tumors

Over the past 20 years, local excision (LE) of T1 rectal cancer was increasingly established and represents an oncologically established technique. In contrast, the situation for T2 tumors is less clear and has only been investigated in small patient collectives. LE for T2 tumors is thus discussed controversially.In addition to our own patients with T2 rectal cancer treated locally (n=40), we have analysed the local recurrence (LR) rates after LE alone (n=124), after immediate conventional radical reoperation (n=29), after adjuvant (chemo)-radiotherapy (n=294) and those after neoadjuvant chemoradiotherapy (nCRT) (n=269) using a PubMed search.LR rates of low-grade T2 tumors after R0 resectio…

Achalasie im Kindesalter: Eine separate Entität?

Background Achalasia in childhood is rare, also the etiology and the pathogenesis of the early onset ort he disease is practically unknown. Little is known about the neuropathological changes in structure of the esophageal wall in non-hereditary, sporadic achalasia in children and ist differentiation to that in adults. The aim of our study was to examine the morphological properties or high-pressure zone of the lower esophageal sphincter in children who had undergone a Heller myotomy because of achalasia as well as to compare them with the pathological findings in adults. Methods Muscle biopsies of the smooth musculature, a 20 x 10 mm long segment of the myenteric of the distal esophagus (l…

Der Einfluß des Operateurs auf die Behandlungsqualität bei akuter Appendicitis

Die Behandlungsqualitat bei akuter Appendicitis wird von der Quote an Appendixperforationen, der Rate entfernter blander Appendices und der perioperativen Morbiditat bestimmt. Im Rahmen einer prospektiven Datenerfassung wurden zwischen 1. 4. 1993 und 30. 7. 1996 alle 271 unter dem Verdacht einer akuten Appendicitis operierten Patienten erfast. Die Rate einer perforierten Appendicitis betrug 3,7 %, bei 19,6 % der Patienten fand sich eine blande Appendix. Bezogen auf den fur die Indikationsstellung verantwortlichen Facharzt ergaben sich keine signifikanten Unterschiede in der Rate an Appendixperforationen, jedoch signifikante Unterschiede der Quote von Patienten mit blander Appendix (6,5–26 %…

Die Cholecystektomie beim Hochrisikopatienten Ein Vergleich zwischen konventionellem und laparoskopischem Verfahren

Die laparoskopischen Cholecystektomie bietet eine Reihe von Vorteilen, denen eine erhohte Gefahrdung kardiopulmonal vorgeschadigter Patienten durch die hamodynamischen und respiratorischen Auswirkungen des Pneumoperitoneums gegenubersteht. In der Zeit von Juni 1990 bis Dezember 1995 wurden 19 Hochrisikopatienten (ASA IV) laparoskopisch und 26 Patienten mit gleichem operativem Risiko (ASA IV) konventionell cholecystektomiert. Bei insgesamt 11,1 % (n = 5) an intraoperativen, kardiopulmonalen Komplikationen traten diese in beiden Gruppen annahernd gleichhaufig auf. Allgemeine, postoperative Komplikationen sahen wir in 33,3 % (n = 15) aller Falle, wobei die konventionell operierten Patienten ve…

REDUCED OXIDATIVE STRESS DURING ACELLULAR REPERFUSION OF THE RAT LIVER AFTER HYPOTHERMIC OSCILLATING PERFUSION

Background ATP resynthesis during reperfusion after liver preservation has been shown to be well correlated with the function of transplanted grafts. Nevertheless, the advantages of a cellular energy charge loading during the preservation period are yet not fully understood. This study evaluates the effects of different nucleotide levels at the end of preservation on metabolic changes and oxidative stress during reperfusion. Methods Two experimental groups were chosen reflecting different energy charge states after preservation: static cold storage for 10 hr and hypothermic oxygenated oscillating perfusion for 10 hr. In both experimental groups, normothermic ex vivo acellular reperfusion ov…

Magenentleerung nach Magenresektion mit und ohne erhaltene Duodenalpassage

Bei Hausschweinen wurden 2/3-Magenresektionen mit erhaltener sowie ausgeschalteter Duodenalpassage durchgefuhrt, die Magenentleerung szintigraphisch uber 4 h gemessen und einer Vergleichsgruppe nichtresezierter Tiere gegenubergestellt. Fur die halbfeste, mit 99mTc markierte Testmahlzeit fanden sich experimentell keine Hinweise fur eine verzogerte Magenentleerung nach Ausschaltung der Duodenalpassage durch Roux-Rekonstruktion. B-I- and B-II-Roux-Resektion differierten in der Magenentleerung nicht. Die Langenanderung der bei der Roux-Rekonstruktion verwendeten Jejunumschlinge von 40 auf 20 cm hatte keinen Einflus auf die Magenentleerung. Die Roux-Rekonstruktion mit trunkularer Vagotomie fuhrt…

Laparoscopic resection of an epiphrenic diverticulum of the esophagus

Diverticulectomy of epiphrenic diverticula of the esophagus is conventionally performed via left thoracotomy. We report the case of a 57-year-old man who presented with an epiphrenic diverticulum that was resected using a transperitoneal laparoscopic technique.

Detection of mitochondrial electron chain carrier redox status by transhepatic light intensity during rat liver reperfusion.

The aim of the study was to investigate mitochondrial electron transfer during rat liver reperfusion after cold storage and hypothermic machine perfusion. Livers from male Brown Norway rats were preserved (UW) for 10h either by cold storage (CS) or by hypothermic oxygenated perfusion extracorporal (HOPE). Transhepatic photometric analysis allowed determination of the redox status of mitochondrial cytochromes during preservation, rewarming and reperfusion. Mitochondrial electron chain carriers were inhibited at different sites with rotenone and cyanide in some experiments. reversed transcriptional polymerase chain reaction (RT-PCR) was performed after reperfusion concerning transcription of …

Stimulation of Anaerobic Glycolysis Enhances Liver Cell Viability During Cold Hypoxic Incubation of Liver Slices

Oncological outcome after MRI-based selection for neoadjuvant chemoradiotherapy in the OCUM Rectal Cancer Trial

Abstract Background It is not clear whether all patients with rectal cancer need chemoradiotherapy. A restrictive use of neoadjuvant chemoradiotherapy (nCRT) based on MRI findings for rectal cancer was investigated in this study. Methods This prospective multicentre observational study included patients with stage cT2–4 rectal cancer, with any cN and cM0 status. Carcinomas in the middle and lower third that were 1 mm or less from the mesorectal fascia, all cT4 tumours, and all cT3 tumours of the lower third were classified as high risk, and these patients received nCRT followed by total mesorectal excision (TME). All other carcinomas with a minimum distance of more than 1 mm from the mesore…

Results of endoscopic retroperitoneal adrenalectomy

Background: From March 1994 to August 1995 we performed extraperitoneal endoscopic adrenalectomy in 18 patients with adrenal gland tumors. Methods: Two of these patients underwent bilateral adrenalectomy. For the extraperitoneal approach a pneumoret-roperitoneum was established and three 10-mm trocars were inserted in the area of the conventional flank incision. Adrenalectomy was performed via these ports. Endoscopic retroperitoneal adrenalectomy was successful in 15 patients; three patients required a conventional operation via an extraperitoneal lumbar approach because of inadequate exposure of the adrenal gland. In patients with endoscopic retroperitoneal adrenalectomy median operative t…

Surgery for obesity.

PURPOSE OF REVIEW Bariatric surgery today is the only effective therapy for morbid obesity. Commonly performed procedures include adjustable gastric banding and vertical banded gastroplasty, variations of the Roux-en-Y gastric bypass, biliopancreatic diversion or duodenal switch, and mixed procedures. This review discusses key issues in the surgical management of morbid obesity. RECENT FINDINGS The two most common bariatric procedures performed worldwide are laparoscopic adjustable gastric banding and laparoscopic Roux-en-Y gastric bypass. Controversy exists regarding the best surgical procedure. Weight loss decreases according to the procedures performed in following decreasing order: bili…

Passagere Kolostomieanlagen nach Eingriffen am Colon Sigmoideum und Rektum—Sind Sie Noch Gerechtfertigt?

Abstract Primary anastomosis is increasingly favored even in emergency colorectal surgery. Two-stage procedures are frequently considered obsolete. The aim of this study is to define conditions when a two-staged operative strategy with a temporary colostomy is still appropriate. We analyzed a series of 126 patients who were treated by a colostomy following resection and subsequent closure of the colostomy. In 44 cases the primary operation was a Hartmann resection, in 39 cases a resection with colostomy and mucous fistula and in 43 cases a resection with primary anastomosis and proximal loop colostomy. Complications of diverticular or neoplastic disease were generally managed by resection w…

Tierexperimentelle Langzeitanalyse zur Anwendung resorbierbarer Klammern�hte bei Magenteilresektionen

Im Rahmen eines Tierexperiments wurden resorbierbare Laktomerklammern (Polyester auf Polyglykol/Polylaktatsaurebasis) bzgl. ihrer Sicherheit und Gewebevertraglichkeit bei Magenresektionen untersucht. Bei Hausschweinen erfolgten Magenresektionen nach Billroth I (n = 10) sowie Roux-Y (n = 12) unter Einsatz resorbierbarer Klammern zum partiellen Verschlus des Magens sowie zum Duodenalstumpfverschlus. Die Nachbeobachtungszeit betrug 12 Monate. In ihrer Anwendung erwiesen sich die mit resorbierbaren Klammern bestuckten Nahtgerate bzw. die resultierenden linearen Nahtreihen als technisch unproblematisch und sicher. Bei einem von 22 Tieren (4,5%) trat fruh-postoperativ eine Insuffizienz im Bereich…

Anterior partial fundoplication for gastroesophageal reflux disease.

This study examined the effect of anterior partial fundoplication on reflux symptoms and dysphagia in gastroesophageal reflux disease. Perioperative results in 249 patients were evaluated retrospectively for 93 conventional and prospectively for 156 laparoscopic procedures. The patients were followed up by standardized questionnaire. Median clinical follow-up period was 9 months (range 6–44) after laparoscopic and 88 months (range 15–194) following partial open fundoplication. The median operating time was 58 and 115 min for laparoscopic and open partial fundoplication. Intraoperative complications were rare (1%) for both approaches. After introduction of the laparoscopic procedure the morb…

Methode der systematischen internen Qualitätssicherung in der Chirurgie

Im Zeitraum vom 1.4.1993 bis zum 31.12.1995 wurden an der Klinik und Poliklinik fur Allgemein-und Abdominalchirurgie Mainz 3183 Patienten mit Hilfe eines Programms zur internen Qualitatssicherung erfast und ausgewertet. Mit Hilfe von 8 verschiedenen operationsspezifischen Dokumentationsbogen und den Daten aus dem Operationsbuchprogramm konnten mit vertretbarem Aufwand eine aktuelle Erfassung des perioperativen Risikos, eine Ermittlung von pra- und intraoperativen Einflusgrosen und nicht zuletzt eine objektive Bewertung der Behandlungsqualitat erfolgen. Das System bietet die Moglichkeit der Feststellung von Unterschieden, sowohl zwischen den einzelnen Operateuren der Klinik als auch gegenube…

Rectal cancer: mucinous carcinoma on magnetic resonance imaging indicates poor response to neoadjuvant chemoradiation.

Purpose To assess response of locally advanced rectal carcinoma to chemoradiation with regard to mucinous status and local tumor invasion found at pretherapeutic magnetic resonance imaging (MRI). Methods and Materials A total of 88 patients were included in this prospective study of patients with advanced mrT3 and mrT4 carcinomas. Carcinomas were categorized by MRI as mucinous (mucin proportion >50% within the tumor volume), and as nonmucinous. Patients received neoadjuvant chemoradiation consisting of 50.4 Gy (1.8 Gy/fraction) and 5-fluorouracil on Days 1 to 5 and Days 29 to 33. Therapy response was assessed by comparing pretherapeutic MRI with histopathology of surgical specimens (minimum…

Administration of Second-Generation Extracorporeal Shock Waves without Waterbath for Fragmentation of Extra- and Intrahepatic Bile Duct Stones

First-generation extracorporeal shock-wave sources disintegrate 97% of kidney stones [1, 2]. Recently, in selected patients gallbladder and common bile duct stones were also treated. The technique available so far, however, requires immersion of the patient’s body in a tank of degassed water. The procedure is therefore inconvenient, time consuming, and relatively expensive. The high pressure of shocks (up to 1000 bar) generated by underwater spark discharge causes pain, and general anesthesia is necessary in most patients [3, 4].

Preoperative detection of intrathoracic tumor spread of esophageal cancer: endosonography versus computed tomography.

The results of endosonography and computed tomography, using an optimized CT technique, have been compared in the preoperative detection of intrathoracic tumor spread of esophageal cancer. In 22/40 patients with esophageal tumors complete passage of the ultrasonic endoscope was possible. Endosonography was superior to CT in the assessment of early stage of esophageal tumor (T1-2). Out of 9 tumors confined to the esophageal wall, 8 were classified correctly by endosonography and only 5 by computed tomography. The results in advanced T3 and T4 tumors (13 patients) were comparable following endosonography and computed tomography. Endosonography is an important means of selecting patients with …

Spectrum of histopathologic findings in patients with achalasia reflects different etiologies

Background:  The etiology of achalasia is still unknown. The aim of the present study was to illucidate its underlying pathologies and their chronology by investigation of esophageal specimens in patients undergoing surgery (esophageal resection or myotomy) for achalasia. Methods:  In 17 patients with achalasia, histopathologic examinations of the esophageal wall focussing on the myenteric plexus were performed. Preoperative diagnosis was based on clinical evaluation, esophagogastroscopy, barium esophagogram in all, and esophageal manometry in eight patients. The median age at the time of surgery was 54 years (range: 14–78 years). In eight cases, the complete esophageal, body and in nine ca…

Co-expression of receptor tyrosine kinases in esophageal adenocarcinoma and squamous cell cancer.

This study aimed to define the co-expression pattern of target receptor tyrosine kinases (RTKs) in human esophageal adenocarcinoma and squamous cell cancer. The co-expression pattern of vascular endothelial growth factor receptor (VEGFR)1-3, platelet-derived growth factor receptor (PDGFR)alpha/beta and epidermal growth factor receptor 1 (EGFR1) was analyzed by RT-PCR in 50 human esophageal cancers (35 adenocarcinomas and 15 squamous cell cancers). In addition, IHC staining was applied for the confirmation of the expression and analysis of RTK localisation. The adenocarcinoma samples revealed VEGFR1 (97%), VEGFR2 (94%), VEGFR3 (77%), PDGFRalpha (91%), PDGFRbeta (85%) and EGFR1 (97%) expressi…

Rectal cancer: Assessment of response to neoadjuvant chemoradiation by dynamic contrast-enhanced MRI

Purpose To assess pretreatment functional and morphological tumor characteristics with magnetic resonance imaging (MRI) in advanced rectal carcinoma and to identify factors predicting response to neoadjuvant chemoradiation. Materials and Methods In a prospective study, 95 patients with rectal carcinoma underwent dynamic contrast-enhanced MRI before and after chemoradiation. Quantitative parameters were derived from a pharmacokinetic two-compartment model. Tumors were also characterized with regard to mucinous status at pretreatment high-resolution MRI as nonmucinous or mucinous. Response to treatment was defined as a downshift in the local tumor stage. Results The parameter k21 (contrast me…

Chemoembolization for primary liver cancer

Abstract Aims: For most patients with primary liver cancer surgical treatment is not feasible and prognosis without treatment is poor. We aimed to assess the morbidity and efficacy of transarterial chemoembolization (TACE) with lipiodol and mitomycin C in these patients in a prospective case-control study. Methods: From August 1996 to May 2000 22 patients with non-resectable hepatocellular carcinoma were treated with TACE. In case of radiological or tumour-marker response, treatment was repeated after 4–6 weeks, up to seven times per patient. Results: Morbidity was 23% and usually minor, no patient died within 30 days of treatment. A decrease in size of the reference tumour or constant tumo…

Hat das Ausmaß der Lymphknotendissektion einen Einfluß auf die Morbidität und Prognose nach Pankreaskopfresektion wegen eines duktalen oder periampullaren Pankreaskarzinoms?

We examined the influence of lymph node dissection on morbidity and mortality of 13 patients after resection of the head of pancreas due to a ductal or periampullary carcinoma. In both groups the radicality of the operation was the main prognostic factor. In ductal pancreatic carcinoma the R-status was able to be determined better by normalisation of the postoperative Ca 19-9 serum level than by the evaluation of the surgeon or pathologist. For prognosis, the quotient of metastatic lymph nodes to resected lymph nodes indicates that an extensive lymph node dissection may increase the long term survival. A lymph node dissection is therefore to be recommended, especially since it does not incr…

Adrenalectomy for Bilateral and Recurrent Pheochromocytoma: Increased Intraoperative Risk?

Adrenalectomy for pheochromocytoma is per se associated with a specific intraoperative cardiovascular risk caused by catecholamine secretion during manipulation of the tumor. Bilateral or multiple, and recurrent chromaffine tumors are special subentities with a potentially more intensified and longer surgical preparation. The aim of our study was to examine these effects on hemodynamic changes compared with those observed for primary, solitary tumors. Of the 82 studied interventions between February 1992 and May 2005, 58 were seen to involve primary, unilateral tumors, 17 involved bilateral (1 trilateral) findings, and there were 7 cases of recurrency. The hemodynamic changes related to pri…

Avoidance of Overtreatment of Rectal Cancer by Selective Chemoradiotherapy: Results of the Optimized Surgery and MRI-Based Multimodal Therapy Trial.

Background Neoadjuvant chemoradiotherapy (nCRT) in patients with rectal cancer carries a high risk of adverse effects. The aim of this study was to examine the selective application of nCRT based on patient risk profile, as determined by MRI, to find the optimal range between undertreatment and overtreatment. Study Design In this prospective multicenter observational study, nCRT before total mesorectal excision (TME) was indicated in high-risk patients with involved or threatened mesorectal fascia (≤1 mm), or cT4 or cT3 carcinomas of the lower rectal third. All other patients received primary surgery. Results Of the 1,093 patients, 878 (80.3%) were treated according to the protocol, 526 pat…

Systematische klinikinterne Qualitätssicherung in der Chirurgie

An der Klinik und Poliklinik fur Allgemein- und Abdominalchirurgie der Johannes Gutenberg-Universitat Mainz wurden im Rahmen eines Programms zur systematischen klinikinternen Qualitatssicherung zwischen dem 1. 4. 1993 und 31. 12. 1995 3183 Patienten und deren perioperativer Verlauf erfast. Es zeigte sich eine signifikante Zunahme des Alters und der Morbiditat der operierten Patienten. Bei Zunahme der Notwendigkeit intensivmedizinischer Masnahmen blieben Morbiditat und Letalitat gleich. Die postoperativen Komplikationsraten waren abhangig von der Art und der Dringlichkeit des Eingriffs und schwankten bei den einzelnen Operateuren. Hohe Operationszahlen bedeuteten nicht immer niedrige postope…

Modified cryopreservation and xenotransplantation of human parathyroid tissue.

Introduction: A modified cryopreservation technique for human parathyroid tissue was compared with the standard method using a programmed freezer. Methods: Total parathyroidectomy was performed in three groups of 6-week-old Rowett nude rats. Group I (control) underwent no transplantation of parathyroid tissue (n=9). After 10 days, the rats of groups II (n=15) and III (n=15) underwent xenotransplantation of 20 mg cryopreserved human parathyroid tissue, which had been stored in liquid nitrogen at –196°C for 1–22 months prior to xenotransplantation. The parathyroid tissue was derived from 15 parathyroidectomized patients with renal hyperparathyroidism. Two tissue samples were obtained from eve…

Prätherapeutische Selektion von Patienten mit Rektumkarzinom zur lokalen Excision

Ziel einer retrospektiven Analyse des eigenen Krankengutes war die Klarung der Frage, wie oft sich die Indikationsstellung zur lokalen Excsion von Rektumtumoren anhand des postoperativen pathohistologischen Befundes als adaquate Therapiemasnahme erweist und wie oft sie lediglich eine diagnostische Masnahme darstellt.

Is Routine Preoperative Upper Endoscopy in Gastric Banding Patients Really Necessary?

Background: Preoperative evaluation for bariatric surgery is complex. Our investigation focused on the necessity for upper gastrointestinal (GI) endoscopy as a routine procedure before performing gastric banding. Methods: A consecutive series of 145 patients underwent laparoscopic adjustable gastric banding (LAGB). Gastroscopy was performed routinely before LAGB. All patients were interviewed before gastroscopy regarding gastroesophageal symptoms. Gastroscopic findings and the results of the interview were blinded and set in comparison. Furthermore, we analyzed whether upper GI symptoms, BMI, age or gender were predictive parameters for pathological findings on gastroscopy. Small hiatal her…

Identifikation und Schonung der autonomen Beckennerven bei TME durch selektive Nervenstimulation

Zur Vermeidung urologenitaler Funktionsstorungen nach Totaler Mesorektum Exzision (TME) bei Rektumkarzinom mussen die autonomen Beckennerven identifiziert und geschont (PANP) werden, was insbesondere fur die parasympathischen Anteile im tiefen Becken problematisch ist. In einer prospektiven Studie sollte gepruft werden, ob die intraoperative Stimulation der zur Blase ziehenden Aste bzw. des Plexus hypogastricus inferior geeignet ist autonome Beckennerven zu identifizieren und ihre Funktionsfahigkeit zu erhalten.

Stellenwert des Tumormarkers CA 19–9 in der Differentialdiagnose von Raumforderungen im Pankreaskopf

In 96 patients (ductal pancreatic carcinoma, n = 34; periampullary carcinoma, n = 43; chronic pancreatitis, n = 19) the role of CA 19-9 in the diagnosis of lesions of the head of the pancreas were evaluated. The sensitivity for ductal pancreatic carcinoma was 73.3%, for periampullary carcinoma 48.8%, and specificity was 63.2%. Carcinoembryonic antigen was elevated only in every fifth patient. Even when combining the two tumor markers no increase in sensitivity could be observed. The low specificity of 63%, which decreased to 33% in the case of obstructive jaundice, does not allow adequate preoperative differentiation between cancer patients and those with chronic pancreatitis. In cases of p…

Operative Interdisziplinarit�t?Abdomen (ohne Becken)

Operative Interdisziplinaritat ergibt sich bei Einsatz nicht operativer Verfahren als Erganzung der operativen Behandlung (sequenzielle multidisziplinare Eingriffe), bei synchronen oder simulatenen multidisziplinaren Eingriffen. Erganzende praoperative Masnahmen sind die endoskopische Entfernung von Gallengangssteinen, die interventionelle Pfortaderembolisation, die perkutane Abszessdrainage und das sogenannte Stenting bei einem mechanischen Dickdarmileus. Intraoperative Kooperationen ergeben sich bei abdominalchirurgischen Erkrankungen vor allem mit der Gefaschirurgie. Der Viszeralchirurg, der entsprechende Eingriffe durchfuhrt, sollte die gefaschirurgischen Techniken beherrschen. Ziel der…

PDGFRa/β expression correlates with the metastatic behavior of human colorectal cancer: A possible rationale for a molecular targeting strategy

As new multi-target tyrosine kinase inhibitors are emerging in the therapy of various malignancies, our aim was to define the co-expression pattern of receptor-tyrosine-kinase platelet-derived growth factor receptors alpha and beta (PDGFRalpha/beta) in human colorectal cancer. The co-expression pattern of PDGFRalpha/beta was analyzed by RT-PCR in 99 histologically confirmed human colorectal carcinomas and five colorectal cancer cell lines. In addition, immunohistochemical (IHC) staining was applied for confirmation of expression and analysis of receptor tyrosine kinase (RTK) localisation. The colorectal cancer cell lines that were analysed revealed varying expression intensities of PDGFRalp…

Image cytometric DNA analysis of mucosal biopsies in patients with primary achalasia.

(P < 0.0001), and 9c- (P = 0.0001) exceeding rate with progredient DNA alterations in the respective order. CONCLUSION: The finding that DNA aneuploidy was identifi ed by image cytometry in esophageal specimens of patients with achalasia, which may be due to specifi c chromosomal alterations presenting as precancerous lesions in 27% of patients, leads us to conclude that image cytometry represents a valuable screening tool. Abstract AIM: To determine DNA aneuploidy in mucosal biopsies of achalasia patients for subsequent rapid diagnosis. METHODS: Biopsies from the middle third of the esophagus were obtained in 15 patients with achalasia. Immunohistochemical staining was carried out with mon…

Ösophagusresektion bei unspezifischer Motilitätsstörung der Speiseröhre - Bedeutung der neuropathologischen Befunde

A 47-year-old patient presented with a history of dysphagia for solid food for almost 10 years and weight loss of more than 50 kg. Non-resecting surgical as well as endoscopic procedures (laparoscopic cardiomyotomy with secondary antireflux operations, balloon dilation, Botulinum-toxin injection) were without success. A barium esophagogram showed a confinement of the distal esophagus with a filiform passage of the contrast medium and undigested food in the prestenotic dilated esophageal corpus. Manometry displayed a hypertensive lower esophageal sphincter with a resting pressure of 43.8 mmHg - although completely relaxing. The tubular esophagus was aperistaltic with 100 % simultaneous and r…

Does expression of receptor tyrosine kinases in gastric adenocarcinoma correlate with clinicopathological parameters?

Introduction: The prognosis for patients with gastric cancer depends on the stage of the disease. Radical surgery and lymph node dissection represent the only curative intent and are the standard therapeutic option for patients with limited disease. As new multi-targeted receptor tyrosine kinase inhibitors (RTK) are ermerging in the therapy of diverse malignomas, our aim was to analyze the relevance of the targeted receptor tyrosine kinases on local growth, lymphatic dissemination and overall survival in gastric adenocarcinoma. Methods: The (co-)expression pattern of VEGFR1, VEGFR2, VEGFR3, PDGFRα, PDGFRβ and EGFR1 was analyzed by RT-PCR in 56 consecutive samples of human gastric adenocarci…

Persistent and recurrent achalasia after Heller myotomy: analysis of different patterns and long-term results of reoperation.

Hypothesis Two groups of patients with inadequate therapeutic success after surgical treatment for achalasia can be identified, patients with type 1 recurrence (early recurrence after technical failure of myotomy or a scarring process requiring remyotomy) and patients with type 2 recurrence (late recurrence with irreversible progression of the disease and development of megaesophagus requiring esophagectomy). Design Prospective study. Setting University-based tertiary care center. Patients One hundred sixty-three patients undergoing surgery for achalasia during 20.3 years. Interventions Conventional remyotomy for type 1 recurrence (group 1) and esophagectomy (transhiatal or transthoracic) f…

Residual urine volume after total mesorectal excision: an indicator of pelvic autonomic nerve preservation? Results of a case-control study.

Objective  The rate of bladder dysfunctions after total mesorectal excision (TME) for rectal cancer can be decreased by bilateral pelvic autonomic nerve preservation (PANP). However, it is not clear yet, how often partial nerve impairment may lead to bladder dysfunction. It was the aim of a case-control study, to examine the residual urine volume in patients before and after TME with and without complete PANP, in order to clarify, whether this parameter allows conclusions on the quality of PANP. Patients and methods  Regarding bladder function, a case group (n = 26) without complete PANP was compared with a control group (n = 26) with complete identification and nerve preservation according…

Resection of the mesopancreas (RMP): a new surgical classification of a known anatomical space

Abstract Background Prognosis after surgical therapy for pancreatic cancer is poor and has been attributed to early lymph node involvement as well as to a strong tendency of cancer cells to infiltrate into the retropancreatic tissue and to spread along the peripancreatic neural plexuses. The objective of our study was to classify the anatomical-surgical layer of the mesopancreas and to describe the surgical principles relevant for resection of the mesopancreas (RMP). Immunohistochemical investigation of the mesopancreatic-perineural lymphogenic structures was carried out with the purpose of identifying possible routes of metastatic spread. Methods Resection of the mesopancreas (RMP) was per…

Strong expression of chemokine receptor CXCR4 by pancreatic cancer correlates with advanced disease

Certain chemokines have been proposed to distinctly contribute to tumor growth, dissemination and local immune escape. Expression of the chemokine receptor CXCR4 has been linked to tumor progression in diverse tumor entities. The aim of this study was to evaluate if the expression of CXCR4 influences progression of human pancreatic cancer. CXCR4 expression of pancreatic cancer was retrospectively assessed by immunohistochemistry in 103 patients with pancreatic cancer. Intensity of CXCR4 expression was correlated with both tumor and patient characteristics. Human pancreatic cancer revealed variable intensities of CXCR4 expression. Strong CXCR4 expression was significantly associated with adv…

Long-term Oncologic Outcome After Transanal Endoscopic Microsurgery for Rectal Carcinoma

Transanal endoscopic microsurgery is superior to other methods of local excision of rectal cancer, but few studies report long-term follow-up data.This study investigated the use of transanal endoscopic microsurgery alone as curative and compromise therapy based on long-term disease recurrence and mortality.This was a retrospective review of prospectively collected data.The study was conducted at a tertiary care university medical center.The study included 133 patients treated between 1985 and 2007. There were 3 groups, including transanal endoscopic microsurgery in curative intent (low-risk rectal carcinoma, including pT1, G1/2, L0, and LX with clear margins and a minimal distance between …

Nachwort der Herausgeber

Krankheit, Leid und Tod gehoren zur Existenz der Menschen, sie werden verdrangt und drangen sich doch mit Macht immer wieder auf, sei es in Form von Kriegen, Naturkatastrophen, Seuchen, Terroranschlagen oder von personlichen Schicksalsschlagen. Sie zerstoren die Illusion einer heilen und gerechten Welt, die Illusion der eigenen Unverletzlichkeit und das Selbstwertgefuhl. Wer Leid erfahrt, fragt nach Grunden fur sein Schicksal, mochte Verantwortlichkeiten und Schuld benennen, sucht nach dem Sinn der Muhsal, nach einer Antwort auf die Frage: Wozu soll dies am Ende gut sein? Diese Frage stellt sich umso intensiver, je schwerer das Leid, je groser die existenzielle Krise und je junger der Betro…

Prognostic scoring system predictive of survival after surgical resection of esophageal carcinoma.

BACKGROUND The aim of our study was to develop a prognostic index score for patients undergoing surgical resection for esophageal cancer that accurately determines survival with specific clinicopathological characteristics. METHODS Clinical, histological, and demographical variables of 475 patients were entered in an univariate and multivariate regression model, followed by individual calculation of the Prognostic Indicator Score and model validation via simulation. RESULTS Significant variables included in the scoring system were number of positive lymph nodes, pT, pL, R, obesity, and American Society of Anesthesiologist classification. Survival probability and its associated hazard functi…