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  • 1
    Electronic Resource
    Electronic Resource
    Treatment of dysphagia in esophageal carcinoma: Transthoracic En-Bloc esophagectomy and reconstruction 48 hours later (1988)
    Springer
    Dysphagia 2 (1988), S. 222-227 
    Details
    ISSN: 1432-0460
    Keywords: Esophageal cancer ; Transthoracic esophagectomy ; Mediastinal lymphadenectomy ; Delayed reconstruction ; Blunt esophageal dissection
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract In 82 consecutive patients with esophageal cancer (90% squamous cell carcinoma, 10% adenocarcinoma) transthoracic “en bloc” esophagotomy with regional lymphadenectomy was performed. The reconstruction with gastric interposition was carried out with delayed urgency in a second operation 48–72 h after the initial procedure. The results of this group were compared to a group of 65 patients who had transmediastinal esophagectomy without thoractotomy and mediastinal as well as suprapancreatic lymphadenectomy and immediate reconstruction by gastric interposition. The number of postoperative risk situations concerning cardiopulmonary features were comparable in both groups. The 30-day mortality rate and postoperative morbidity was not significantly different between both patient groups (mortality rate: transthoracic: 6.6%, transmediastinal: 7.7%). The advantages of a 2-stage procedure are that esophagectomy and especially mediastinal lymphadenectomy can be performed precisely without time pressure. After 2 days the stomach is hypotonic and dilated as a result of truncal vagotomy and can easily be elevated to the neck. The interval of 48–72 hours was chosen because the postoperative right-to-left shunt has nearly normalized after this time period. En bloc esophagectomy and reconstruction with delayed urgency can be performed without disadvantages compared to a 1-stage procedure. It can especially be recommended for operations in which esophagectomy and mediastinal lymphadenectomy are difficult and wearisome.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02414431
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  • 2
    Electronic Resource
    Electronic Resource
    The “Steakhouse syndrome” (1989)
    Springer
    Surgical endoscopy and other interventional techniques 3 (1989), S. 195-198 
    Details
    ISSN: 1432-2218
    Keywords: Food impaction of the esophagus ; Endoscopy ; Esophageal dysfunction ; Malignant tumors
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Over a period of 5 years, 28 instances of acute food impaction of the esophagus were documented in 26 patients at our institution. In all patients the impacted bolus was successfully removed without complication using a flexible endoscope. Underlying diseases were identified during primary endoscopy in 31% of the cases. Further diagnostic workup was performed in all but 5 of the patients. After adequate evaluation pathologic findings were demonstrated in 90% of the cases (38% malignant and 52% benign diseases). Long-term therapy was deemed necessary in 17 of these 21 patients. Operative intervention was indicated in 4 cases, 2 of which were for malignant tumors. Acute food impaction should always be regarded as a symptom of esophageal disorders. In patients with esophageal cancer or other mediastinal tumors bolus impaction generally indicates an advanced tumor stage.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02171545
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  • 3
    Electronic Resource
    Electronic Resource
    Transmediastinale Oesophagektomie (1986)
    Springer
    Langenbeck's archives of surgery 367 (1986), S. 203-213 
    Details
    ISSN: 1435-2451
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01258939
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  • 4
    Electronic Resource
    Electronic Resource
    40. Der Endobrachyoesophagus als Präcancerose (1986)
    Springer
    Langenbeck's archives of surgery 369 (1986), S. 217-223 
    Details
    ISSN: 1435-2451
    Keywords: Barrett's esophagus ; Precancerous stage ; Risk factors ; Indication ; Endobrachyoesophagus ; Precanceroue ; Risikofaktoren ; Indikation
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung Der Endobrachyoesophagus ist eine Präcancerose, da in etwa 15 der Fälle eine maligne Entartung auftritt. Nach prospektiven Studien liegt das Risiko einer Carcinomentwicklung 30- bis 42mal höher als bei der Normalbevölkerung. Risikofaktoren für die maligne Degeneration sind Alkohol- und Nicotinabusus, chronischer gastro-oesophagealer Reflux, Zugehörigkeit zur weißen Rasse und zum männlichen Geschlecht. Eine Indikation zur Antirefluxchirurgie besteht nur beim Endobrachyoesophagus mit florider Reflux-oesophagitis. Der blande Endobrachyoesophagus bedarf einer endoskopischen Kontrolle. Das Adenocarcinom des Endobrachyoesophagus ist als Speiseröhrencarcinom anzusehen und kann wegen der vorwiegend aboralen Metastasierung durch transmediastinale Oesophagektomie behandelt werden.
    Notes: Summary Barrett's esophagus is a precancerous stage as a malign degeneration occurs in about 15 %. According to prospective studies the risk of development of cancer is 30 to 42 times higher than in the normal population. Risk factors for malign degeneration, which mostly concerns white males, are abuse of alcohol or nicotine and chronic gastroesophageal reflux. Antireflux surgery is only indicated in Barrett's esophagus in combination with active reflux esophagitis. The uncomplicated Barrett's esophagus should be controlled by endoscopy. The adenocarcinoma in Barrett's esophagus has to be considered as an esophageal carcinoma. Due to its metastatic spread in mostly aboräl direction it can be treated by blunt dissection of the esophagus.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01274357
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  • 5
    Electronic Resource
    Electronic Resource
    284. Intragastrale Langzeit-pH-Metrie zur Identifikation einer Risikogruppe für Rezidivulcera nach proximal gastrischer Vagotomie (PGV) (1987)
    Springer
    Langenbeck's archives of surgery 372 (1987), S. 901-902 
    Details
    ISSN: 1435-2451
    Keywords: Proximal gastric vagotomy ; Gastric secretion tests ; Intragastric long-term pH-monitoring ; Ulcer recurrence ; Proximal gastrische Vagotomie ; Magensekretionsanalyse ; Intragastrale Langzeit-pH-Metrie ; Rezidivulcus
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung In einem 4-Jahreszeitraum ( $$\bar x$$ 1,6 Jahre) blieben von 47 Patienten mit PGV wegen Ulcera duodeni 38 rezidivfrei, während 9 endoskopisch nachgewiesene Rezidivulcera entwickelten. Die 2–4 Tage präoperativ und am 10. postoperativen Tag durchgeführte Magensekretionsanalyse mit Stimulation durch Scheinfütterung bzw. Pentagastrin ergab keinen signifikanten Unterschied zwischen den Patienten mit bzw. ohne Rezidiv. Die einzige signifikante Differenz zwischen beiden Gruppen bestand in der postoperativen intragastralen pH-Metrie der Schlafphase für den Median-pH und den Prozentsatz der pH-Werte 52.
    Notes: Summary Forty-seven patients were followed-up for 4 years ( $$\bar x$$ 1.6 years) after PGV because of duodenal ulcers. Thirty-eight remained free of recurrent ulcers, whereas 9 developed new ulcers, which were verified endoscopically. The gastric secretion test, which was performed 2–4 days preoperatively and on postoperative day 10 with stimulation by sham feeding and pentagastrin, showed no significant differences between the patients with or without ulcer recurrence. The only significant difference between the two groups was found in postoperative intragastric pH-monitoring of the sleep-phase for the median pH value and a percentage of pH values of ≦ 2.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01298068
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  • 6
    Electronic Resource
    Electronic Resource
    En-bloc Resektion der Speiseröhre beim Oesophaguscarcinom (1988)
    Springer
    Langenbeck's archives of surgery 373 (1988), S. 367-376 
    Details
    ISSN: 1435-2451
    Keywords: Esophageal cancer ; En bloc esophagectomy ; Mediastinal lymphadenectomy
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung Die en-bloc Oesophagektomie erfaßt neben der Entfernung der Speiseröhre die mediastinale Lymphadenektomie incl. der Resektion von V. azygos und Ductus thoracicus. Zusätzlich beinhaltet sie die suprapankreatische abdominelle Lymphadenektomie und bei oberhalb der Trachealbifurkation gelegenen Tumoren auch die cervicale Lymphadenektomie. Die Operationstechnik kann als ausgereift und standardisiert angesehen werden. Mögliche Komplikationen sind Nachblutungen (3,3%), Chylothorax (1,6%) und Trachealäsionen (4,9%). Die Letalität liegt in erfahrenen Zentren unter 10%, im eigenen Krankengut bei 6,6%. Die en-bloc Oesophagektomie ermöglicht ein exaktes Staging des Oesophaguscarcinoms, führt in einem hohen Prozentsatz zur kompletten Tumorentfernung (R0-Resektion) und scheint die Prognose früher Tumorstadien (T1/2 N0/1) zu verbessern.
    Notes: Summary En-bloc esophagectomy not only comprises the elimination of the esophagus but also the mediastinal lymphadenectomy and the resection of the azygos vein and thoracic duct. Additionally the suprapancreatic abdominal lymphadenectomy is included and in tumors located orally of the tracheal bifurcation also the cervical lymphadenectomy. The surgical technique can be estimated as fully developed and standardized. Possible complications are postoperative hemorrhage (3.3%), chylothorax (1.6%) and tracheal lesions (4.9%). The mortality rate ranges under 10% in experienced centers, in our own patients around 6.6%. With en-bloc esophagectomy an exact staging of esophageal cancer becomes possible. In a high percentage complete tumor elimination (R0-resection) can be achieved and it seems that herewith prognosis in early tumor stages (T1/2 N0/1) can be improved.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01272555
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  • 7
    Electronic Resource
    Electronic Resource
    41. Speiseröhrenersatz (1985)
    Springer
    Langenbeck's archives of surgery 366 (1985), S. 233-239 
    Details
    ISSN: 1435-2451
    Keywords: Esophageal replacement ; Gastric interposition ; Speiseröhrenersatz ; Mageninterposition
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung Das Verfahren der ersten Wahl für den Speiseröhrenersatz ist die Mageninterposition. Als Alternative steht bei Voroperationen am Magen der Ersatz durch Colon zur Verfügung. In eigenen Nachuntersuchungen fanden wir bei Patienten mit Mageninterposition eine beschleunigte Entleerung, nach Coloninterposition dagegen insgesamt eine verzögerte Entleerung. Trotz persistierender Säuresekretion des interponierten Magens spielte der gastro-oesophageale Reflux bei kompletter Intrathorakalverlagerung des Magens keine nennenswerte Rolle.
    Notes: Summary The procedure of first choice for esophageal replacement is gastric interposition. Alternatively the replacement by colon is possible after gastric surgery. In our own examinations patients with gastric interposition had an accelerated emptying while those with colon interposition showed a delayed emptying. In spite of persisting acid secretion of the interpositioned stomach the gastroesophageal reflux was of minor importance after total intrathoracic position of the stomach.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01836640
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  • 8
    Electronic Resource
    Electronic Resource
    133. Operative Behandlung des Kardiacarcinoms —Ergebnisse einer europäischen Umfrage (1985)
    Springer
    Langenbeck's archives of surgery 366 (1985), S. 598-598 
    Details
    ISSN: 1435-2451
    Keywords: Carcinoma of the cardia ; Operative results ; Questionnaire ; Kardiacarcinom ; Operative Ergebnisse ; Umfrage
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung In einer Umfrage wurden aus 22 europäischen Kliniken Operationsergebnisse der letzten 5 Jahre von insgesamt 1200 Patienten mit Kardiacarcinomen ausgewertet. Die Resektionsrate lag im Mittel bei 63% (30–97%). 45,5% der Teilnehmer führten trotz Fernmetastasen eine palliative Tumorresektion durch. Folgendes Vorgehen wurde bevorzugt: abdomino-links-thorakaler Zugang (1 Incision, 50%), totale Gastrektomie (Stadium 1 und 11 81,8%, III und IV 64%), distale Oesophagusresektion (81,8%), intrathorakale Oesophagojejunostomie (59%). Postoperative Ergebnisse (Mittelwerte): Anastomoseninsuffizienz 9,0%, Letalität 11,9%, 2-Jahres-überlebensrate 33,6%, 5-Jahres-Überle-bensrate 24,8%.
    Notes: Summary By means of a questionnaire the operative results of the last 5 years were evaluated on a total of 1200 patients with carcinoma of the cardia from 22 surgical departments in Europe. The resection rate averaged 63% (30%–97%); 45.5% of the participants had performed a resection of tumor in spite of distant metastases. The following procedures were preferred: abdomino-left-thoracic approach (1 incision, 50%), total gastrectomy (stages I and 11, 81.8%; III and IV, 64%), distal esophageal resection (81.8%), and intrathoracic esophagojejunostomy (59%). The average postoperative results were: anastomotic insufficiency, 9%; mortality, 11.9%; 2-year survival rate, 33.6%; 5-year survival rate 14.8%.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01836732
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  • 9
    Electronic Resource
    Electronic Resource
    Die Behandlung der iatrogenen Oesophagusperforation (1989)
    Springer
    Langenbeck's archives of surgery 374 (1989), S. 251-256 
    Details
    ISSN: 1435-2451
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01359562
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  • 10
    Electronic Resource
    Electronic Resource
    Intraoperative Sonographie zum Nachweis occulter Lebermetastasen beim colorectalen Carcinom (1989)
    Springer
    Langenbeck's archives of surgery 374 (1989), S. 363-369 
    Details
    ISSN: 1435-2451
    Keywords: Colorectal cancer ; Liver metastases ; Intraoperative ultrasonography ; Ultrasonography ; Computed tomography
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung In einer prospektiven Studie wurde bei 85 Patienten mit Operation colorectaler Carcinome eine intraoperative Sonographie der Leber zum Nachweis von Lebermetastasen durchgeführt. Die Befunde wurden verglichen mit den Ergebnissen der präoperativ vorgenommenen Sonographie und Computertomographie sowie der intraoperativen Inspektion und Palpation der Leber. Siebzehn (24,3%) der insgesamt 70 Metastasen dieser Untersuchungsserie konnten allein durch die intraoperative Sonographie nachgewiesen werden. Dieses betraf 12 (14,1%) der untersuchten Patienten. Vier (5,7%) dieser Herde waren solitär und betrafen 4,7% der Fälle. In 15,3% der Patienten wurde aufgrund der intraoperativen Ultraschallbefunde die Operationstaktik geändert. Beim Nachweis von Lebermetastasen colorectaler Carcinome hat die intraoperative Sonographie eine signifikant höhere Sensitivität als die präoperative Sonographie und Computertomographie bzw. die intraoperative Inspektion und Palpation. Die intraoperative Ultraschalluntersuchung sollte bei allen Patienten ohne präoperativen Nachweis von Lebermetastasen und bei Patienten mit geplanter Metastasenresektion durchgeführt werden.
    Notes: Summary In a prospective study of 85 patients with operation of colorectal cancer intraoperative ultrasonography of the liver was performed for the detection of liver metastases. The findings were compared with the results of preoperative ultrasonography and CT-scan as well as the findings of intraoperative inspection and palpation of the liver. Seventeen (24.3%) of a total of 70 metastases of this series could only be detected by intraoperative ultrasonography. This was related to 12 (14.1 %) of the examined patients. Four (5.7%) of these lesions were solitary and concerned 4.7% of the cases. Due to the intraoperative sonographic findings the tactics of operation was changed in 15.3% of the patients. Intraoperative ultrasonography has a significantly higher sensitivity for the detection of liver metastases from colorectal cancer than preoperative ultrasonography and computed tomography or intraoperative inspection and palpation. Intraoperative ultrasonography of the liver should be applied in all patients without preoperative evidence of liver metastases and in patients with a planned resection of metastases.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01262816
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