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Copyright of Colo-Proctology is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Hintergrund: Die Rate der Hospitalletalität („in-hospital mortality") nach komplexen Pankreasresektionen kann ohne weitere Analyse nicht als Entscheidungskriterium verwendet werden. Die Analyse muss einen risikoadjustierten Klinikvergleich mit kontinuierlicher Auswertung unter Berücksichtigung der Eingriffshäufigkeit und des perioperativen Managements einbeziehen.Material und Methoden: Im Rahmen der Prospektiven Evaluationsstudie Elektive Pankreaschirurgie (PEEP) wurden im 3‑Jahres-Zeitraum vom 01.01.2006 bis zum 31.12.2008 insgesamt 2003 Patienten eingeschlossen, die in 27 Kliniken einem elektiven Pankreaseingriff unterzogen wurden. Dabei wurden nur Kliniken berücksichtigt, die resektive Eingriffe am Pankreas durchführen. Neben der Evaluierung der aktuellen chirurgischen Behandlungssituation interessierte insbesondere die komplexe Untersuchung der Hospitalletalität als härtestes Qualitätskriterium.Ergebnisse: Im Gesamtkrankengut (n = 2003) verstarben während des Klinikaufenthaltes 75 Patienten (3,7 %). Insgesamt wurden nach 1045 partiellen Pankreatikoduodenektomien (PD) 43 Verstorbene (4,1 %) registriert. Ähnlich niedrige Hospitalletalitätsraten wurden nach totaler Duodenopankreatektomie (3,8 %) sowie nach Pankreaslinksresektion (1,9 %) beobachtet. Hinsichtlich der univariaten Risikostratifizierung zeigte im Gesamtkrankengut nur das fortgeschrittene Alter und ein ASA-3- und -4-Stadium einen signifikanten Einfluss auf die Hospitalletalität. Die multivariate Regressionsanalyse in der Pankreatikoduodenektomiegruppe unterstreicht mit einem gesteigerten Transfusionsbedarf und dem verzögerten enteralen Kostaufbau als Folge spezifischer Komplikationen den engen Zusammenhang mit der Hospitalletalität. Signifikante Unterschiede hinsichtlich der Hospitalletalität wurden in den beiden „Volume"-Gruppen 10-20 vs. >20 für die 831 partiellen Duodenopankreatektomien bei Adenokarzinomen und chronischer Pankreatitis nachgewiesen.Diskussion: Eine adäquate Hospitalletalitätsrate im kontinuierlichen Benchmarking ist Ausdruck einer akzeptablen Struktur- und Behandlungsqualität im Rahmen der resektiven Pankreaschirurgie. Die Teilnahme der Kliniken mit komplexen onkochirurgischen Eingriffen an multizentrischen klinischen Beobachtungsstudien im Rahmen der chirurgischen Versorgungsforschung erscheint sinnvoll, denn die Ergebnisse solcher Studien können einen Beitrag zu praxisrelevanten Entscheidungen leisten. [ABSTRACT FROM AUTHOR]

Copyright of Der Chirurg is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: The impact of hospital and surgeon volume on the treatment outcome based on data obtained from cohort and register studies has been controversially discussed in the international literature. The results of large-scale prospective observational studies within the framework of clinical healthcare research may lead to relevant recommendations in this ongoing discussion. Material and methods: Within the framework of the prospective multicenter German Gastric Cancer Study 2 (QCGC 2), from 1 January 2007 to 31 December 2009 a total of 2897 patients with the histological diagnosis of gastric cancer from 140 surgical departments were registered and analyzed. The departments were subdivided according to the number of cases into 4 volume groups: I) <5, II) 5-10, III) 11-20 and IV) >20 patients with surgical interventions per year. Results: Overall 1163 patients (65.6 %) underwent surgical interventions in the departments of groups III and IV. Of the patients 521 (18 %) were scheduled for neoadjuvant treatment but with no significant differences among the various volume groups. In the departments of volume groups I and II subtotal gastric resection was performed significantly more often. Transthoracic extended surgical interventions in cases of a proximal tumor site were significantly more frequent in departments from volume group IV ( p <0.001). The proportion of intraoperative fresh frozen sections correlated with the case volume: group I 23.2 % vs. group IV 61.2 %. Overall hospital mortality was 6.1 % and slightly higher in volume group I with 7.8 %. The median survival time and the 5-year survival rate showed no significant differences between the various volume groups independent of tumor stages. There was a tendency towards a longer median survival time in volume group IV only for proximal tumor sites, i.e. adenocarcinoma of the esophagogastric junction (AEG). Using Cox regression analysis hospital volume did not have an independent impact on long-term survival. Conclusion: Hospital volume effects could only be detected for the treatment of AEG. To improve oncological long-term outcome, centralization of treatment of proximal gastric cancer appears to be recommendable. [ABSTRACT FROM AUTHOR]

Background: The benefits of primary tumor resection in metastatic disease remains a matter of debate. Existing data are almost exclusively limited to results from retrospective analyses. Data from prospective, randomized trials are currently not available. Aim: The results from two prospective observational studies involving gastric and rectal cancer patients are presented and discussed in the context of the available literature. Method: Based on data collected within the prospective quality assurance studies on gastric and rectal cancer conducted by the Institute for Quality Assurance in Surgery at Otto von Guericke University, Magdeburg, Germany, the long-term outcome after palliative primary tumor resection in patients with International Union Against Cancer (UICC) stage IV rectal cancer (2005-2008, n = 2046) and metastatic gastric cancer (2007-2009, n = 687) was analyzed and compared to published data. Results: The median survival time following palliative primary tumor resection of UICC stage IV rectal cancer in the patients analyzed was 20 months. In patients with hepatic metastases undergoing metastasectomy the median survival was 38 months. This increased to 58 months for patients with lymph node negative primary tumors. In metastatic gastric cancer patients undergoing palliative (R2) gastric resection and also patients not undergoing surgery showed a prognostic benefit from palliative chemotherapy; however, the median survival time was significantly prolonged if palliative chemotherapy was preceded by resection of the primary tumor (11 versus 7 months, p < 0.001). Discussion: Together with previously published data, the results from the two observational studies on rectal and gastric cancer presented here suggest a prognostic benefit from palliative resection of the primary tumor in metastatic disease. [ABSTRACT FROM AUTHOR]

Data are available on two multicenter observational studies, the East German Gastric Cancer Study (EGGCS) '02 (surgical interventions only) and the German Gastric Cancer Study II (QCGC) from 2007 to 2009 (after inauguration of multimodal therapeutic concepts) with regard to palliative treatment of advanced gastric cancer. Through the first investigation period from January to December 2002 (EGGCS) overall 1139 patients with primary gastric cancer were registered and evaluated and then from 2007 to 2009 (QCGC) another 2897 patients were included. Comparing both time periods, there were no significant changes in the distribution of tumor sites and stages according to the Union Internationale Contre le Cancer (UICC) classification, in particular, there was no significant reduction of advanced tumor stages. From 2007 to 2009 in total 521 patients (18 %) received neoadjuvant therapy, 401 patients (13.9 %) out of the group with curative intention and 120 (4.1 %) out of the group of patients with palliative intention. The proportion of palliative patients who underwent chemotherapy (with neoadjuvant intention and/or postoperatively) was 32.5 % (n = 223). Thus, the rate of palliative treatment (rate of no R0 resection status 29.6 %, rate of patients who did not undergo surgical intervention at all 9.5 %) could be diminished from almost 40 % in 2002 to 24.5 % through the time period from 2007 to 2009. Taking all patients together (with curative and palliative intention) an increase of the 4-year survival probability from 40.0 % to 48.5 % was observed after inauguration of multimodal therapy. After a 5-year follow-up median survival time was 34 months during the investigation period from 2007 to 2009 considering all study subjects. Patients who had undergone palliative surgical interventions benefited from postoperative palliative chemotherapy; however, as expected this was of greater benefit to patients with resecting surgical interventions than those with non-resecting operations. Palliative tumor resection (even R2 resection status) should be part of a concept of multimodal palliative therapy in cases of acceptable perioperative risk. [ABSTRACT FROM AUTHOR]

Copyright of Der Chirurg is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Prospective randomized studies and meta-analyses have shown that laparoscopic resection for colonic cancer is equivalent to open resection with respect to the oncological results and has short-term advantages in the early postoperative outcome. The aim of this study was to investigate whether laparoscopic colonic resection has become established as the standard in routine treatment. Methods: Data from the multicenter observational study 'Quality assurance colonic cancer (primary tumor)' from the time period from 1 January 2009 to 21 December 2011 were evaluated with respect to the total proportion of laparoscopic colonic cancer resections and tumor localization and specifically for laparoscopic sigmoid colon cancer resections. A comparison between low and high volume clinics (< 30 versus ≥ 30 colonic cancer resections/year) was carried out. Results: Laparoscopic colonic cancer resections were carried out in 12 % versus 21.4 % of low and high volume clinics, respectively (p < 0.001) with a significant increase for low volume clinics (from 8.0 % to 15.6 %, p < 0.001) and a constant proportion in high volume clinics (from 21.7 % to 21.1 %, p = 0.905). For sigmoid colon cancer laparoscopic resection was carried out in 49.7 % versus 47.6 % (p = 0.584). Differences were found between low volume and high volume clinics in the conversion rates (17.3 % versus 6.6 %, p < 0.001), the length of the resected portion (Ø 23.6 cm versus 36.0 cm, p < 0.001) and the lymph node yield (Ø n = 15.7 versus 18.2, p = 0.008). There were no differences between the two groups of clinics regarding postoperative morbidity and mortality. The postoperative morbidity and length of stay were significantly lower for laparoscopic sigmoid resection than for conventional sigmoid resection. Conclusion: The laparoscopic access route for colonic cancer resection is not the standard approach in the participating clinics. The laparoscopic access route has the highest proportion for sigmoid colon resection. The differences in the conversion rates, length of the resected portion and the number of lymph nodes investigated between the low volume and high volume clinics must be viewed critically and must be interpreted in connection with the long-term oncological results. [ABSTRACT FROM AUTHOR]

Copyright of Colo-Proctology is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The age group ≥ 80 years has become of great importance in the surgical treatment of colorectal cancer due to the demographic changes over the years. To assess patient risk, early postoperative and oncologic long-term outcome 64,740 patients with colorectal cancer were enrolled in various nationwide multicenter observational studies through two study periods (2000-2004 and 2009-2011) and analyzed according to various age groups, in particular ≥ 80 years. The percentage of octogenarians increased from 2009 to 2011, which was associated with an increased patient risk. In 70 % of patients ≥ 80 years old the operative risk was preoperatively classified as ASA stages III and IV. There was a high age-independent resection rate of colon cancer; however, the rectal cancer resection rate in octogenarians was significantly lower. In the age group ≥ 80 years there was a relatively high rate of emergency surgical interventions because of an ileus due to tumor-induced lumen obstruction leading to a hospital mortality rate in both study periods of 18.8 % and 17.9 %, respectively. In the octogenarians there were more locally advanced colon cancer lesions of stage T3/4 but less tumor lesions with distant metastases. The age-corrected tumor-free 5-year survival rate of the octogenarians with colon cancer of tumor stage UICC I-III was identical to that of younger patients. [ABSTRACT FROM AUTHOR]

The aim of the review is to compare the results of selected German multicenter observational studies on the surgical treatment of gastric carcinoma within the last two decades. Overall, 6,035 patients with gastric cancer who had been registered in numerous German comprehensive surgical clinics and departments in the time periods 1986-1989, January through December 2002 and 2007-2009 were enrolled in this analysis. In particular, the study aimed to investigate the most important criteria and factors with an impact on the perioperative and early postoperative outcome including the effects on oncological long-term results. In addition to the advances in diagnostic procedures and surgical techniques, the impact of multimodal therapeutic concepts which have been established particularly in the third investigation period is emphasized. [ABSTRACT FROM AUTHOR]

Copyright of Der Chirurg is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Accurate pretherapeutic staging of rectal cancer is crucial for further therapeutic management and important for prognosis. The most accurate diagnostic tools in the assessment of T and N categories of rectal cancer are endorectal ultrasound (EUS) and magnetic resonance imaging (MRI). Furthermore, MRI can accurately predict the distance of the tumor to the colorectal membrane (CRM) and computed tomography (CT) is more suitable for detecting distant metastases. In the routine care of rectal cancer EUS is the most frequently used diagnostic tool for local staging. The achieved accuracy for determining T category by EUS in routine clinical staging is lower than results reported in the literature. Furthermore, the accuracy of EUS depends on the experience of the examiner. Currently the frequency of using MRI for routine clinical staging of rectal cancer is low and in one out of five cases the local staging of rectal cancer is exclusively carried out by CT. [ABSTRACT FROM AUTHOR]

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 January to 31 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). [ABSTRACT FROM AUTHOR]

The creation of a stoma is an established therapeutic concept for the palliation of non-resectable rectal carcinomas and advanced tumours infiltrating the pelvis. In two prospective country-wide multicentre studies, each conducted over a similar period of time, the peri-operative course and postoperative short-term outcomes of laparoscopic vs laparotomy-based stoma construction were compared. A total of 90 patients underwent palliative laparoscopic construction; 550 patients received a stoma via a laparotomy. The intra-operative complication rate was lower after open surgery than after laparoscopic surgery (2.7 vs 5.6%; p = 0.15), although the difference was not significant. With regard to general (30.9 vs 15.6%; p = 0.003) and also specific postoperative complications (13.8 vs 5.6%; p = 0.029), however, a significant advantage of the laparoscopic approach was seen. Furthermore, mortality in the laparoscopic group was also significantly lower (4.4 vs 14.0%; p = 0.011). Palliative stoma done via laparoscopy had significantly better outcomes in terms of postoperative morbidity and mortality in comparison with the open surgical procedure. [ABSTRACT FROM AUTHOR]

Copyright of Der Onkologe is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Actinomycosis is a chronic infectious disease caused by a gram-positive anaerobe. The bacterial disease is known to predominantly affect the oropharyngeal mucosa and soft tissues as well as the gastrointestinal tract. However, renal involvement by actinomycosis is exceedingly rare. Thus, renal actinomycosis is usually diagnosed by means of histopathological assessment of nephrectomy specimens because affected patients seek medical care due to (peri-) renal mass lesion clinically mimicking cancer. To best of our knowledge, we present the first case worldwide reporting on a 65-year-old man diagnosed with renal actinomycosis following ureterosigmoidostomy in whom nephrectomy was performed due the clinical suspicion of renal cancer (stage cT4). Subsequently, calculated antibiotic therapeutic regimens were initiated after the diagnosis was suspected by the pathologist. During the entire postsurgical follow-up comprising a total of 6 months, the patient did not experience any local or systemic recurrence. In summary, detailed information concerning the etiology, the clinical symptoms as well as diagnostic and therapeutic options are discussed in our case report. [ABSTRACT FROM AUTHOR]

Copyright of Der Urologe A is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Palliative surgical interventions for the management of colonic obstruction in cases of metastasized or locally irresectable colorectal carcinoma show remarkable morbidity and mortality rates for mostly older and multimorbid patients. For manifest obstruction, placement of a self-expanding metal stent (SEMS) is considered to be a suitable minimally invasive therapeutic option. This study aimed to investigate the efficacy of stent-based treatment for malignant large bowel obstruction.Methods: From January 1999 to June 2005, consecutive patients who had undergone placement of a SEMS for malignant colorectal obstruction were enrolled and monitored. Manifest incontinence and rectum carcinoma within 5 cm above the anocutaneous line were contraindications for SEMS implantation. For all further locations of tumor-induced stenosis, a stent was implanted using endoscopy and fluoroscopy. This case series was characterized in terms of age, carcinoma localization, complications, morbidity and mortality, and the necessity for further interventions.Results: For 44 of 48 patients (92%), stents were placed successfully and obstruction was abolished. The four remaining patients experienced stent dislocation. The median of age of the patients was 77.7 years (range, 47-96 years). The distribution of malignant stenoses was as follows: rectum (n = 16, 33.3%), sigmoideal colon (n = 21, 43.8%), descending colon (n = 4, 8.3%), splenic flexure (n = 2, 4.2%), transversal colon (n = 3, 6.2%), hepatic flexure (n = 1, 2.1%), and ascending colon (n = 1, 2.1%). There was no peri-interventional morbidity or mortality. The median in situ time for the stents was 251 days (mean, 422 days), with 13 of 44 patients treated with palliative therapy showing complications (29.5%). Six patients were treated endoscopically, and three individuals underwent surgical intervention. For four patients, no further intervention was required. Overall, there was no treatment-related mortality.Conclusions: For palliative treatment of malignancy-induced colorectal obstruction, SEMS is an efficient tool associated with low morbidity and minimal mortality. From a technical point of view, all tumor locations are accessible. [ABSTRACT FROM AUTHOR]

Background: The outcome and quality of surgical treatment in gastric cancer are closely associated with specific postoperative morbidity and mortality, in addition to an oncosurgically adequate resection status. In this context, a preventive concept of decreasing the insufficiency rate of esophageal anastomosis may have a great impact. Method: Over a time period of 12 months (from 1 January 2002 to 31 December 2002), 1,199 patients (from 80 East German hospitals) with gastric carcinoma, carcinoma of the esophagogastral junction, or gastrointestinal stroma tumor (GIST) were enrolled in this prospective multicenter observational study with the aim of evaluating their early postoperative outcome. By means of a logistic regression analysis, independent variables, which alter significantly the healing of esophagojejunal anastomosis, were determined; in addition, their clinical impact on preventive management to lower the insufficiency rate of esophageal anastomosis was investigated. Results: In 1,139 patients, histological investigation revealed gastric carcinoma. Out of these patients, 1,031 subjects underwent surgical intervention (90.5%) and 891 individuals underwent resection (86.4%). In 813 patients, radical resection (subtotal resection and gastrectomy) was executed (78.9%), whereas in 726 cases, R0 resection was achieved (81.5%). Gastrectomy was the preferred procedure in 649 patients, resulting in a gastrectomy rate of 62.9% relating to all patients who underwent operation (curative and palliative intention, 80.3% and 19.7%, respectively). The insufficiency rate of esophagojejunal anastomosis was 5.7% (37/649). Neither the comparison between the various procedures for the reconstruction of the esophagojejunal passage and anastomosing techniques after gastrectomy nor that between gastrectomies with curative and palliative intention revealed any significant difference. Dysphagia and gastric outlet syndrome due to a stenosis were determined as independent variables by a logistic regression analysis of all preoperative and intraoperative variables. In all patients with gastric carcinoma, both parameters were recorded in 9.9% (113/1,139) and 6.7% (76/1,139), respectively. Conclusion: Dysphagia and gastric stenosis, which significantly influence the healing of esophagojejunal anastomosis after gastrectomy, are considered characteristics of an advanced tumor growth and a pretherapeutic lack of an adequate nutrition. This emphasizes the necessity of an early diagnosis of gastric cancer in order to lower perioperative morbidity. In addition, dysphagia is commonly associated with an obstruction of the upper gastrointestinal tract, which can lead to nutritional deficits, and thus deserves specific care during preventive management. [ABSTRACT FROM AUTHOR]

Background Colonic resection according to the procedure by Hartmann is considered a fast and safe surgical intervention, which has been used for years, in particular, in emergency situations. Methods Using data of a prospective multicentre study on the operative treatment of colorectal carcinoma over the time period from 1 January 2000 to 31 December 2002, the value of Hartmann's procedure was investigated in carcinoma of the left colon (n=8825) compared with alternative surgical options under emergency circumstances. The significant impact of independent variables on the type of the selected approach was determined by means of logistic regression. Results While in total 422 primary Hartmann's procedures (4.8%) were executed under curative intention, 213 (50.5%) of those were carried out in emergency situations. Hartmann's procedure was beneficial in cases with tumour-associated obstruction and perforation of the left colon as it resulted in the lowest mortality (7.5%) of the radical operations. Even under palliative intention, Hartmann's procedure was preferred at the left colon but led to a postoperative mortality (32.7%) very similar to that in creation of a colostoma (33.3%) or segmental colonic resection (38.9%). Conclusions Hartmann's procedure has been widely accepted as a curative intervention in emergency cases (oncosurgically adequate RO resection) for the carcinoma of the left colon. Because of the high postoperative morbidity and mortality in emergency situations with only palliative options (RO resection not possible), alternative endoscopic treatment should be considered more frequently. [ABSTRACT FROM AUTHOR]

Wound infections have a significant impact on the postoperative morbidity after abdomino-perineal rectum resection (APR). However, the technique of perineal wound closure after APR has not been standardised yet. The prospective German multicentre trial “Colorectal Carcinoma (primary tumor)” (study I) enrolled 10 335 patients with rectal cancer over a time period from 1 January 2000 to 31 December 2002. The APR rate was 24.7% (n=2517). Four hundred and forty-five patients (17.6%) developed an infectious complication of the perineal incision. In contrast, the data of the reporting single centre participating in study I were as follows: patients with rectal cancer, n=206; APR, n=37; APR rate, n=18.0% (study II). In our surgical department, a standardised technique of perineal wound closure comprising tight sutures of the tissue in three layers (muscle, ischiorectal and subcutaneous fat), local administration of carriers releasing antibiotics and a redon drainage were used. Using these tools, the rate of septic perineal wound complications was considerably lower with 5.4% vs. 17.6% in the multicentre trial. [ABSTRACT FROM AUTHOR]

Objective: In this study, 26 patients with locally recurrent malignant fibrous histiocytoma of the kidney and spermatic cord after initial R0 resection were reviewed with regard to therapeutic options and prognosis.Patients and Methods: Based on a literature query in the PubMed database, we identified 24 cases with locally recurrent malignant fibrous histiocytoma of the kidney and spermatic cord after initial R0 resection. Two of our own patients were included and afterwards the entire patient group was analyzed with regard to the time period of the first local recurrence and the overall survival rate.Results: The average patient age was 58 years; in 17 cases (65%) the left side was affected. After primary therapy the 5-year survival rate was 25%; adjuvant therapy did not achieve any significant improvement in survival time ( p=0.259). The local recurrence was on average diagnosed after 13 months (with a median of 12 months). The prognosis of malignant fibrous histiocytoma after detection of the local recurrence was extraordinary poor, only 4 of 26 patients survived for longer than 3 years. The 1-, 2- and 5-year survival rates then were 34%, 28%, and 14%, respectively. The mean survival time was 31 months with a median survival of 9 months. Patients with a locally recurrent malignant fibrous histiocytoma of the spermatic cord showed a significant better survival prognosis than patients with a local recurrence of a renal malignant fibrous histiocytoma ( p=0.04).Conclusion: Malignant fibrous histiocytoma of the genitourinary tract are rare tumors with a high rate of local recurrence. If there are no distant metastases a R0 resection can result in a curative objective. Nevertheless, the prognosis of this disease is poor. Even early detection of local therapy failure and promptly initiated aggressive salvage therapy may offer the chance of long-term survival only in selected cases. Lifelong follow-up is necessary for patients with a malignant fibrous histiocytoma of the kidney or spermatic cord. [ABSTRACT FROM AUTHOR]

Copyright of Der Chirurg is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Der Chirurg is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Der Chirurg is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

This prospective multicenter study investigated the effect of hospital caseload on early postoperative outcome of surgery for carcinoma of the colon in 75 German hospitals and included 2293 patients. The hospitals were divided into those with a caseload of 1–30 (group A), 31–60 (group B), and more than 60 (group C) operations. Increasing caseload was associated only with fewer general postoperative complications. It was also associated with significantly greater use of antibiotic prophylaxis. No significant differences between the groups were found in resection rates, intraoperative complications, specific postoperative complications, overall postoperative morbidity, hospital mortality, or 30-day mortality. The significance of hospital caseload for the short-term postoperative outcome following surgery on the colon should not be overestimated. Basing conclusions about the results to be expected simply on the case volume is impermissible. On the basis of the available data it is not possible to establish a threshold value, that is, a minimum number of required operations. [ABSTRACT FROM AUTHOR]

Background: The influence of experience on the results of treatment with laparoscopic surgery is indisputable. The establishment of indications and contraindications is relative, and varies depending on the experience of the surgeon. Learning curves have been described for a number of laparoscopic interventions, in particular laparoscopic cholecystectomy. The current prospective multicenter study investigates, among other things, the interrelation between experience and the results of treatment using laparoscopic colorectal surgery. The study makes no pronouncements on the long-term results achieved in patients with colorectal carcinoma who underwent an operation with curative intent, although relevant data were indeed collected.Results: Between August 1, 1995 and February 1, 1999, a total of 1,658 patients were recruited to the prospective multicenter study initiated by the Laparoscopic Colorectal Surgery Study Group. To investigate the influence of surgical experience, two groups were formed. Group A comprised all the institutions and surgeons with experience of more than 100 laparoscopic colorectal operations. Group B contained institutions and surgeons with experience of fewer than 100 such interventions. The results of this study clearly show that in Group A, significantly more procedures involving the rectum were performed (26.7% vs 9.5%), and significantly more carcinomas were surgically managed (37.3% vs 17.3%). Despite this significantly higher level of technically difficult procedures in the patient population of group A, which was comparable in terms of age, gender, height, and weight with the patient in group B, the postoperative mortality and morbidity was, with the exception of urinary tract infections, identical between the two groups. Conversion to open surgery was significantly less frequent in group A (4.3% vs 6.9%), and, finally, the duration of the procedures performed by the more experienced surgeons of group A was appreciably shorter than in institutions with a smaller frequency of such operations.Conclusions: Laparoscopic colorectal surgery is very demanding, and can be performed with low morbidity and mortality rates only by a surgeon with above-average experience with this type of surgery and a large caseload of laparoscopic colorectal procedures. The learning curve for such procedures is appreciably longer than for other laparoscopic operations. With increasing experience, technically more demanding operations, including radical oncologic rectal laparoscopic procedures, can be performed with appreciably reduced operating times and conversion rates, but with no increase in morbidity or mortality. [ABSTRACT FROM AUTHOR]

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Copyright of Arthroskopie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Der Internist is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

A letter to the editor is presented about endoscopic surgery, that was published in a previous issue.