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  • 1
    Electronic Resource
    Electronic Resource
    Pathomorphological and Histological Prognostic Factors in Curatively Resected Ductal Adenocarcinoma of the Pancreas (2000)
    Springer
    Surgery today 30 (2000), S. 582-587 
    Details
    ISSN: 1436-2813
    Keywords: Key Words Ductal pancreatic carcinoma ; Curative resection ; Prognostic factors
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The fate of patients with potentially resectable carcinomas is not only determined by the pTNM tumor stage, but also possibly by tumor-biological factors. The aim of this study was to identify these prognostic factors in patients undergoing primary curative (R0) resection. The study retrospectively analyzed 113 patients with ductal adenocarcinoma who were operated on between 1986 and 1995. R0 resection was able to be performed in 93 patients. Lymph node metastases were found in 73%. The rates of lymph vessel and perineural invasion were 83.5% and 45%, respectively. Among the 25 carcinomas without lymph node metastases, 64% already had lymph vessel invasion and 48% had perineural invasion. The cumulative 5-year survival rate of the 91 surviving patients analyzed was 10.5%. Depending on the tumor stage we found a significant difference in 5-year survival rates between patients without lymph node metastases (26.5%) and those with lymph node involvement (5%) (P = 0.008). A multivariate analysis only identified lymph vessel invasion (L0/1), tumor size (≦/≦2 cm), and tumor grading (G) to have significant and independent prognostic value. Lymph vessel invasion, tumor size, and tumor grading proved to be independent factors determining long-term prognosis.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s005950070096
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  • 2
    Electronic Resource
    Electronic Resource
    Prognostic factors in the operative treatment of ductal pancreatic carcinoma (2000)
    Springer
    Langenbeck's archives of surgery 385 (2000), S. 14-20 
    Details
    ISSN: 1435-2451
    Keywords: Key words Ductal pancreatic carcinoma ; Prognostic factors ; Surgical treatment
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  Background and aims: The average 5-year survival rate following resection of a ductal adenocarcinoma of the pancreas is 10%, worldwide. Despite increasing resection rates, only about 20% can be operated on with curative intent. A differential histopathological analysis of the resected tumors may help to justify expanding the surgical procedure by extended lymph-node dissection. Patients/methods: Between January 1986 and December 1995, a total of 113 patients underwent resection with curative intent for a ductal pancreatic carcinoma with regional lymph-node dissection. All histological findings were reviewed and reclassified in accordance with the 1997 Union Internationale Contra la Cancrum (UICC) classification. Survival data for all of these patients were obtained from family doctors and registration offices. Independent prognostic factors were statistically analyzed. Results: Of the 113 patients, 93 received an R0 resection. The postoperative mortality rate was 2.2% (2 of 93). More than one-half of the tumors had a diameter of between 2.1 cm and 4 cm. Among the 22 tumors measuring up to 2 cm in diameter, 41% already had lymph-node metastasis and 86% invasion of the lymphatic vessels. Carcinomas measuring between 4.1 cm and 6 cm were all associated with lymph-vessel invasion. Perineural invasion was present in 50% of the tumors. A noteworthy finding was the fact that 64% of the 25 tumors with negative lymph nodes had lymph-vessel invasion, and 48% perineural invasion. The cumulative 5-year survival rate of the R0-resected patients was 10.5%. Patients with lymph-node-negative stages survived significantly longer (26.5%) than patients with lymph-node-positive stages (5%). Furthermore, a significant difference was seen between pN1a and pN1b (16.7% vs 2.2%). Multivariate analysis identified tumor grading, tumor size and lymph vessel invasion as independent prognostic factors. Conclusions: Apart from the factors tumor size and tumor grading, lymph-vessel invasion appears to be of special significance for the long-term prognosis. Already in the pN0 stage, the latter was present in 64% of the cases and must be considered a precursor of lymphogenic metastasization. Since lymph-vessel invasion was demonstrated in 86% of tumors measuring less than 2 cm, the therapeutic consequence for all ductal pancreatic tumors is an extended lymphatic and soft tissue dissection that goes beyond the regional lymph-node stations.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004230050004
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  • 3
    Electronic Resource
    Electronic Resource
    Behandlungsstrategien bei der akuten komplizierten Divertikulitis (2000)
    Springer
    Coloproctology 22 (2000), S. 205-210 
    Details
    ISSN: 1615-6730
    Keywords: Schlüsselwörter Akute Divertikulitis ; Komplikationen ; Chirurgische Behandlungsstrategien ; Key Words Acute diverticulitis ; Complications ; Surgical management
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract Interval single stage resection with primary anastomosis is the new strategy in management of acute complicated colonic diverticulitis. With increasing tendency localized complications are treated with minimally invasive techniques. Life threatening peritonitis with evidence of free perforation in old, multimorbid, bad conditioned patients should be further an indication for 2-stage resection. Laparoscopic assisted Hartmann reversal can be done with minimally invasive risk in experienced hands.
    Notes: Zusammenfassung Die möglichst einzeitige, elektive Resektion ist der Trend in der chirurgischen Behandlung der akuten komplizierten Divertikulitis. Lokalisierte Komplikationen werden nach Abklingen der akuten Entzündung zunehmend minimalinvasiv reseziert. Auch bei der vital bedrohlichen Perforationsperitonitis ist eine Tendenz zur primär einzeitigen Resektion erkennbar. Im Stadium der fortgeschrittenen Peritonitis hat bei multimorbiden Patienten in schlechtem Allgemeinzustand die Diskontinuitätsresektion weiterhin ihre Berechtigung. Die Hartmann-Wiederanschlussoperation kann heute risikoarm und zunehmend laparoskopisch assistiert durchgeführt werden.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/PL00001867
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  • 4
    Electronic Resource
    Electronic Resource
    Frequency and Late Results of Local Recurrence and Metachronous Distant Metastases in Rectal Cancer (2000)
    Springer
    Coloproctology 22 (2000), S. 96-98 
    Details
    ISSN: 1615-6730
    Keywords: Key Words Rectal cancer ; Local recurrence ; Lymphatic vessel invasion ; Schlüsselwörter Rektumkarzinom ; Lokalrezidiv ; Lymphgefäßeinbruch
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung In einem Zeitraum von fünf Jahren (1990 bis 1995) wurden 425 Patienten wegen eines Rektumkarzinoms operiert. 48 Patienten entwickelten ein lokales Tumorrezidiv, 15 hatten zusätzlich Fernmetastasen und 61 Patienten nur Fernmetastasen. Wir fanden bei unseren Patienten die bekannten Einflussfaktoren bestauml;tigt, nämlich steigende Rate an Lokalrezidiven und Metastasen mit höherem T- und N-Stadium, keine Metastasen bei Tumoren niedriger Malignität (28/425 G1), aber eine deutliche Zunahme bei den Fällen mit Blutgefäßeinbruch (V0 12,3%, V1 42,9%). Lymphgefäßeinbruch des Tumors führte ebenfalls zu einer deutlich höheren Rate an Lokalrezidiven oder Fernmetastasen (L0, N0, V0 6,7%, L1, N0, V0 60%). L- und V-positive Patienten sollten wie die Fälle des UICC-Stadiums II und III in ein adjivantes postoperatives Therapieregime mit einbezogen werden.
    Notes: Abstract Over a 5-year period (1990 to 1995) 425 patients were operated on for rectal cancer. There were 48 local recurrences, 15 with additional distant metastases, 61 patients only had distant metastases. In our patients we found as a well known fact an increasing number of local recurrences and distant metastases with an increasing T- or N stage, no metastases in cases of low tumor grading (28/425 G1), but a high increase comparing patients with or without blood vessel invasion (V 12.3%, V1 42.9%). Lymphatic vessel invasion also shows a higher rate of local recurrences and distant metastases, even in nodal and blood vessel negative patients (L0, N0, V0, L1, N0, V0 60%). L- and V-positive patients should be included in a postoperative adjuvant therapy regime as well (together with all cases Stage II and III UICC), even in nodal negative cases.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s000530050011
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