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Background and Methods: Based on data obtained in the prospective multicenter observational study on the surgical treatment of gastric cancer "East German Gastric Cancer Study 2002 (EGGCS)", the cohort of patients with gastric cancer who underwent palliative surgical interventions during the study period from 1(st) January to 31(st) December 2002 was investigated., Results: Out of 1,139 documented patients with gastric cancer, 1,031 underwent a surgical intervention (operation rate 90.5%). In 70.4% (n=726) of the patients with surgical interventions, R0 resection status could be achieved whereas in 305 patients (29.6%), only a palliative (R1/2 resection status) result was possible using resection and non-resection procedures in 165 and 140 cases, respectively. The hospital mortality rate was 7.3% (n=53) in the group of curative R0 resection patients and was almost identical with 7.8% (n=13) in the group of R1/2 resection patients. The highest hospital mortality of 14.4% (n=20) was found in subjects who primarily underwent palliative surgical interventions (R2 resection or non-resection procedures). In the subgroup analysis the highest overall morbidity of 57.1% was found in the group of palliative (R2) resection patients. Curatively intended but palliatively operated patients (from the perspective of the final histopathological result) showed a significantly longer overall survival time (11 months) compared with patients who primarily underwent a surgical intervention with palliative intention (6.3 months). Even patients who underwent tumor resection with palliative intention were observed to have a longer survival time of 2.3 months (in total, 6.9 months) compared with patients with non-resection surgical intervention (4.6 months). In the group of R2 resection patients with a preoperatively detected pyloric stenosis/dysphagia, an increased overall morbidity (62.5% with stenosis versus 47.7% without stenosis) and an increased hospital mortality rate (25% versus 11.6%, respectively) were seen. This favors more interventional endoscopic procedures if possible considering the only marginal prolongation in survival time. In contrast, palliative resection in cases without stenosis is associated with an acceptable rate of postoperative complications (47.7%) and mortality (11.6%) resulting in the recommendation of a palliative resection under specific conditions considering the improved oncosurgical long-term outcome., Conclusion: Radical tumor resection with palliative intentions (if possible from a technical point of view) resulted in a prolongation of the median survival time of 3 months with an acceptable postoperative morbidity and mortality compared with non-resection procedures. According to the results of individual analysis of each tumor resection intervention, palliative gastrectomy showed a significant prolongation of survival time of 5 months compared with more limited subtotal resection (6 versus 11 months).

Many different causes have been described for dysphagia. An uncommon one is trichobezoars, which are mainly caused by trichotillomania. This may lead to mechanical obstruction and peritonitis due to perforation of the gut. Here we report a case of a giant trichobezoar (30x20x10 cm) in the stomach of a 20-year-old female. The patient presented unclear dysphagia and a palpable tumor in the epigastrium. Computed tomography showed an inhomogeneous tumor spreading from the upper belly to the pelvis. A B1 resection was performed and the patient recovered uneventfully.

Background: In spite of dynamic development of modern diagnostic and therapeutic methods, the long-term results of surgical therapy in pancreatic cancer are still unsatisfying. The aim of this study was to analyse long-term results of surgical palliation for pancreatic cancer in a pancreatic surgery centre., Methods: We performed a retrospective analysis of 418 patients who underwent non-resective, palliative procedures for pancreatic cancer between 1975 and 1999. In order to compare two consecutive periods of time, the patients were divided in 2 groups; group I treated from 1975 to 1990 (n = 204), and group II from 1991 to 1999 (n = 214)., Results: Of all patients qualified for surgery, 281 (67.2 %) underwent surgical bypass, 107 (25.6 %) laparotomy, and in 30 cases surgical intervention was limited to implantation of endoprosthesis. A significant tendency towards double (i. e. biliary and gastric) anastomosis was observed (32.3 % vs. 74.8 %; p < 0.01) in patients who underwent bypass procedures. The postoperative morbidity was 16.3 %. The postoperative mortality rate was 5.7 % and significantly (p < 0.01) decreased from 10.3 % (group I) to 1.4 % (group II). No differences neither in mortality nor morbidity related to the type of performed surgery were found. The mean time of hospital stay was 15.5 +/- 6.9 days and showed no differences related to the type of intervention. Jaundice or symptoms of gastric outlet obstruction were observed in 16 % of patients in the follow-up period and concomitantly performed biliary and gastric bypasses were associated with the lowest rate of the late gastrointestinal obstruction (4 %). The median survival time was 169 days and only 4 % of patients survived 12 months. The univariate analysis of prognostic factors showed that location and stage of the tumour, the type of surgical intervention and bypass procedure influenced 1-year survival. The multivariate analysis using Cox proportional hazard model proved that only stage and location of the tumour had independent prognostic value., Conclusion: Surgical palliation for pancreatic cancer can be performed with acceptable morbidity and mortality rates. For tumours located in the head and body of the pancreas combined biliary and gastric bypass should be preferred. For cancers located in the tail of the pancreas gastric bypass should be performed routinely. Because surgical palliation can prevent gastric outlet obstruction by gastroenterostomy, endoscopic biliary stenting should be only performed in patients with pancreatic head cancers and simultaneous evidence of distal metastases as well as in older patients with high comorbidity.