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  • 1
    Electronic Resource
    Electronic Resource
    Barrett's esophagus: Pathogenesis, epidemiology, functional abnormalities, malignant degeneration, and surgical management (1993)
    Springer
    Dysphagia 8 (1993), S. 276-288 
    Details
    ISSN: 1432-0460
    Keywords: Barrett's esophagus ; Gastroesophageal reflux ; Adenocarcinoma ; High grade dysplasia ; Deglutition ; Deglutition disorders
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Barrett's esophagus (i.e. columnar epithelial metaplasia in the distal esophagus) is an acquired condition that in most patients results from chronic gastroesophageal reflux. It is a disorder of the white male in the Western world with a prevalence of about 1/400 population. Due to the decreased sensitivity of the columnar epithelium to symptoms, Barrett's esophagus remains undiagnosed in the majority of patients. Gastroesophageal reflux disease in patients with Barrett's esophagus has a more severe character and is more frequently associated with complications as compared with reflux patients without columnar mucosa. This appears to be due to a combination of a mechanically defective lower esophageal sphincter, inefficient esophageal clearance function, and gastric acid hypersecretion. Excessive reflux of alkaline duodenal contents may be responsible for the development of complications (i.e., stricture, ulcer, and dysplasia). Therapy of benign Barrett's esophagus is directed towards treatment of the underlying reflux disease. Barrett's esophagus is associated with a 30- to 125-fold increased risk for adenocarcinoma of the esophagus. The reasons for the dramatic rise in the incidence of esophageal adenocarcinoma, which occurred during the past years, are unknown. High grade dysplasia in a patient with columnar mucosa is an ominous sign for malignant degeneration. Whether an esophagectomy should be performed in patients with high grade dysplasia remains controversial. Complete resection of the tumor and its lymphatic drainage is the procedure of choice in all patients with a resectable carcinoma who are fit for surgery. In patients with tumors located in the distal esophagus, this can be achieved by a transhiatal en-bloc esophagectomy and proximal gastrectomy. Early adenocarcinoma can be cured by this approach. The value of multimodality therapy in patients with advanced tumors needs to be shown in randomized prospective trials.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01354551
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  • 2
    Electronic Resource
    Electronic Resource
    Lymphadenektomie bei Tumoren des oberen Gastrointestinaltrakts (1996)
    Springer
    Der Chirurg 67 (1996), S. 877-888 
    Details
    ISSN: 1433-0385
    Keywords: Key words: Lymph node dissection ; Lymphadenectomy ; Esophageal cancer ; Cancer of the cardia ; Gastric cancer. ; Schlüsselwörter: Oesophaguscarcinom ; Kardiacarcinom ; Magencarcinom ; Lymphadenektomie.
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung. Bei den Tumoren des oberen Gastrointestinaltrakts ist wie auch bei allen anderen Tumoren das Erreichen der Residualtumorfreiheit wichtigstes Operationsziel. Dazu muß nicht nur der Primärtumor in allen 3 Dimensionen mit adäquatem Sicherheitsabstand entfernt werden, das gleiche Ziel muß auch im Bereich der Lymphabflußwege erreicht werden. Dazu müssen befallene Lymphknoten und Lymphknoten mit sog. „microinvolvement“ entfernt werden. Im Minimum ist hierfür eine Lymphadenektomie der zwei tumornahen Compartmente (D2-Lymphadenektomie) notwendig. Der notwendige Sicherheitsabstand der Lymphadenektomie kann über die sog. Lymphknoten-Ratio abgeschätzt werden. Dabei handelt es sich um das Verhältnis zwischen der Anzahl der chirurgisch entfernten Lymphknoten und der Anzahl der tumorbefallenen Lymphknoten. Die Prognose kann durch die Lymphadenektomie immer dann nachhaltig verbessert werden, wenn die Lymphknoten-Ratio kleiner als 0,2 ist. Diese Operationsziele sind zumindest bei beginnender Lymphknotenmetastasierung zu erreichen. Bei fortgeschrittener Lymphknotenmetastasierung kann die Lymphadenektomie nur zu einer Reduktion lokaler Rezidive beitragen. Beschränkt sich die Lymphadenektomie nur auf die operative Entfernung von Lymphknoten, geht sie mit keinem erhöhten Operationsrisiko einher. Diese grundsätzlichen therapeutischen Prinzipien gelten in gleicher Weise für das Oesophagus-, Kardia- und Magencarcinom.
    Notes: Summary. Similar to other tumor entities, complete tumor removal with an adequate safety margin in all three dimensions (the oral margin, the aboral margins and the tumor bed) must be the primary aim of any surgical approach to carcinoma of the upper gastrointestinal tract. The same goal has to be achieved in the area of the lymphatic drainage. All positive nodes and nodes with a so-called ’microinvolvement' have to be removed together with the primary tumor. The safety margin of lymphadenectomy can be estimated by the lymph node ratio, i. e. the ratio between the number of removed and positive nodes. Several studies have shown that for carcinoma of the upper gastrointestinal tract the prognosis can be improved markedly if the lymph node ratio is below 0.2. For tumors in the early phase of lymphatic metastasis this can be achieved by extensive lymph node dissection. In practice, this requires as a minimum a lymphadenectomy of compartments I and II of the tumor's lymphatic drainage (D2 lymphadenectomy). The individual compartments are determined by the embryogenesis of the affected organ and defined by the tumor location. In patients with advanced lymphatic metastases, lymphadenectomy does not improve the prognosis and can only result in a reduction of local recurrences. Lymphadenectomy does not increase the risk and morbidity of the surgical procedure, provided it is restricted to the removal of nodes. These basic principles of lymphadenectomy are valid for carcinomas of the esophagus, cardia and stomach.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/PL00002535
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  • 3
    Electronic Resource
    Electronic Resource
    Indikation zur Antirefluxchirurgie des Oesophagus (1998)
    Springer
    Der Chirurg 69 (1998), S. 132-140 
    Details
    ISSN: 1433-0385
    Keywords: Key words: Gastroesophageal reflux disease ; Antireflux surgery ; Nissen fundoplication ; Barrett's esophagus ; Peptic strictures. ; Schlüsselwörter: Gastrooesophageale Refluxkrankheit ; Antirefluxchirurgie ; Nissen-Fundoplicatio ; Barrett-Oesophagus ; peptische Stenose.
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung. In der westlichen Welt ist die gastrooesophageale Refluxkrankheit die häufigste gutartige Erkrankung des oberen Gastrointestinaltrakts. Die Akuttherapie der gastrooesophagealen Refluxkrankheit ist heute eine unumstrittene Domäne der Protonenpumpenhemmer. Jedoch kommt es bei bis zu 50 % der betroffenen Patienten nach Absetzen der Medikation innerhalb weniger Tage zu einem Rezidiv der Erkrankung, so daß häufig eine Dauertherapie erforderlich wird. Bei diesen Patienten stellt die laparoskopische Fundoplicatio eine attraktive und kosteneffektive therapeutische Alternative zur medikamentösen Langzeittherapie dar. Dementsprechend ist jeder Patient mit persistierender oder rezidivierender Oesophagitis und/oder Refluxsymptomatik, der auf eine medikamentöse Langzeittherapie angewiesen ist, auch ein potentieller Kandidat für die laparoskopische Antirefluxchirurgie. Eine Indikation zur Fundoplicatio besteht vor allem dann, wenn es sich um einen jungen Patienten handelt, wenn eine medikamentöse Dauertherapie aufgrund von Nebenwirkungen nicht möglich ist oder wenn Bedenken über die Langzeitsicherheit der verfügbaren medikamentösen Alternativen bestehen. Eine sorgfältige Selektion der Patienten, die objektive Dokumentation der gastrooesophagealen Refluxkrankheit mittels 24-Std-pH-Metrie und eine gewissenhafte Beachtung der technischen Details des operativen Eingriffs stellen die Schlüssel zum Erfolg der Antirefluxchirurgie dar.
    Notes: Summary. In the Western world gastroesophageal reflux disease constitutes the single most common benign disorder of the upper gastrointestinal tract. Current medical therapy with proton pump inhibitors allows physicians to provide complete symptom relief and healing of acute esophageal mucosal injury in practically all affected patients. However, up to 50 % of patients require maintenance therapy to prevent relapse. In these patients laparoscopic antireflux surgery offers an attractive and cost-effective alternative to potentially life-long medical therapy. Consequently, every patient with persistent or recurrent symptoms and/or complications of gastroesophageal reflux who depends on maintenance medical therapy to remain in remission is a potential candidate for laparoscopic antireflux surgery, particularly if of young age, suffering from side effects of medical therapy or worrying about long-term safety of the conservative treatment alternatives. A careful selection of patients, objective documentation of gastroesophageal reflux disease by 24-h esophageal pH monitoring, and meticulous attention to the technical details of the procedure are essential for a successful outcome of antireflux surgery.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001040050387
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  • 4
    Electronic Resource
    Electronic Resource
    103. Lymphadenektomie: Indikation — Technik — Ausdehnung — Dokumentation (1987)
    Springer
    Langenbeck's archives of surgery 372 (1987), S. 587-592 
    Details
    ISSN: 1435-2451
    Keywords: Lymphadenectomy ; Indication ; Results ; Lymphadenektomie ; Indikation ; Ergebnisse
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung Von 01. 07. 1982 bis 31. 12. 1986 wurden 359 Patienten mit Magencarcinomen operiert. Im Mittel wurden pro Patient 27,1 ±7,2 Lymphknoten entnommen, von denen 9,8 ± 6,1 LK befallen waren. Die Anzahl der LK wird durch erweiterte Gastrektomie + Splenektomie + Pankreaslinksresektion, also durch Ausräumung des Compartments 111 auf 42,2±8,8 gesteigert. Durch die radikale Lymphadenektomie des Compartments I und II scheint eine Prognoseverbesserung für das N 1-Stadium erreichbar zu sein, indem sie sich in ihren Überlebenszeiten den N 0-Stadien angleichen.
    Notes: Summary From July 1st, 1982 until December 31st, 1986 359 patients were operated on carcinoma of the stomach. On an average 27.1 ± 7.2 lymphnodes were removed and of these 9.8 ± 6.1 lymphnodes were positive. The number of lymphnodes may be increased up to 42.2 ± 8.8 by extended gastrectomy + splenectomy + left resection of the pancreas, that means by clearing out compartment 1111. It seems that radical lymphadenectomy of compartment I and II improves prognosis for stage N 1 by adjusting the median survival time to stage N0.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01297887
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  • 5
    Electronic Resource
    Electronic Resource
    Lymph-node dissection in squamous cell esophageal cancer – who benefits? (1999)
    Springer
    Langenbeck's archives of surgery 384 (1999), S. 141-148 
    Details
    ISSN: 1435-2451
    Keywords: Key words Lymph-node dissection ; Lymphadenectomy ; Esophageal cancer
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract A complete tumor removal with an adequate safety margin in all three dimensions (the oral margin, the aboral margins and the tumor bed) must be the primary aim of any surgical approach to esophageal cancer. The same goal has to be achieved in the area of the lymphatic drainage. The safety margin of lymphadenectomy can be estimated by the so-called lymph-node ratio, i.e., the ratio between the number of positive nodes and removed nodes. Several studies have shown that, for esophageal carcinoma, a lymph-node ratio below 0.2 constitutes an independent prognostic factor. Although controlled trials are still lacking, these data suggest that extensive lymphadenectomy may thus improve the prognosis in patients at an early stage of lymphatic spread, i.e., patients with only lymph-node `micro-involvement' or patients with a limited number of positive regional nodes on standard histopathologic assessment. In practice, this requires, as a minimum, a two-field lymphadenectomy. In patients with more advanced lymphatic metastases, two-field lymphadenectomy does not improve the prognosis and can only result in a reduction of local recurrences. A more extensive lymphadenectomy, i.e., three-field lymph-node dissection, increases the risk and morbidity of the surgical procedure, while a prognostic gain, if any, appears to be limited to a subgroup of patients with proximal tumors and less than five involved lymph nodes. Since, in the Western world, these patients are usually submitted to multimodal therapeutic protocols, extended three-field lymphadenectomy can currently not be recommended as standard therapy.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004230050184
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  • 6
    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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