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IntroductionThe daily clinical routine in the operating room includes patient positioning. The number of perioperative positioning-related complications is growing, along with the legal proceedings concerning this topic, and only a few guidelines exist to provide specific recommendations. The aim of this survey was to assess perioperative positioning and associated adverse events during gynecological cancer surgery in Germany.MethodsA total of 633 gynecological departments of primary, secondary, and maximum healthcare hospitals in Germany were invited to participate in this multiple-choice online questionnaire. The survey was conducted anonymously for a period of six months. The survey was divided into five different sections: descriptive information about the respondent department, pre- and postoperative management, management of positioning in the operating room based on two fictional case examples, and quality management.ResultsThe response rate of our survey was 29.1 % (184/633). Nearly half of the departments (46.7 %) reported to have had one to five patients with positioning-related complications during the prior 12 months, and 29.1 % had experienced a legal dispute due to positioning-related complications. Departments with more than 50 gynecologic-oncological surgeries per year more often reported positioning-related complications (p=0.003). Standard operating procedures exist in almost every department for laparoscopic (97 %) and open surgery (95.1 %), respectively.DiscussionThe high number of positioning-related complications throughout all departments of different healthcare levels underlines the relevance of this issue and supports the need for a prospective European registry for further analysis. Training and education for all staff members should be routinely implemented to reduce and prevent positioning-related complications.

e17046 Background: Perioperative positioning injuries occur in approximately 4% of all medical complications. The aim of the present survey was the analysis of positioning-management in gynecologic-oncological surgery, the process- and structure-reliability and the implementation of current guidelines into daily clinical practice. Methods: A multiple-choice anonymous questionnaire about the perioperative positioning management in gynecologic oncology was sent to all gynecological departments in Germany. Sixty questions were divided into five different parts: 1) descriptive information about the department, 2) focus on the pre- and 3) postoperative management, 4) on the quality management, and 5) information regarding the management of positioning in the operation room based on two fictional case examples in gynecologic oncology procedures. Results: 184 of 633 departments participated in the survey between June and September 2016. Complications related to intraoperative positioning occurred in 48.4% of all participating departments, independent from department size. Knowledge of the current guideline on positioning did not impact the incidence of complications. The positioning of the patient was mentioned in the team-time-out procedure in 66.1% of the participating departments. No difference was found between high-volume and low-volume gynecologic oncologic operative departments with regard to the use of supportive tools such as anti-thrombotic leg pumps. The vast majority with 92.7% included information of positioning injuries into the written informed consent. Knowledge of the guideline or a previous legal dispute did not influence the willingness to inform about possible positioning-related complications. Conclusions: Our survey shows, that the awareness of perioperative positioning management in gynecologic cancer surgery is high throughout all sizes departments in Germany. Almost half of all 184 participating departments report positioning-related complications in the previous 12 months, stressing the importance of this often underrated topic.

The interaction among signaling networks of tumor and neighboring stroma cells in complex disease traits is poorly understood, and read-out parameters reflecting tumor-associated functional stages are scarce. A multi-centre phase II trial was designed to prove the hypothesis whether activation of presumably complementary receptor-triggered transcriptional cascades (via pioglitazone and interferon-a) could result in synergistic clinical effects. Therapy consisted of low-dose capecitabine 1 g/m2twice daily po for 14 days, every 3 weeks, day 1+, and etoricoxib 60 mg daily plus pioglitazone 60 mg daily, day 1+, and low-dose interferon-a 4.5 MU sc three times a week, week 1+, until disease progression. Fourty-five patients with renal clear cell carcinoma at a progressive disease stage and ECOG 0–2 were enrolled between March 2003 and April 2008. Forty-two percent of the patients had been systemically pretreated. Objective response was observed in 35% of the patients (PR 27%, CR 9%), which was paralleled by strong CRP decline after 4–6 weeks’ treatment. CRP values decreased from mean 42.3 mg/L, range 9.1–236, to 11.1 mg/L, range 1.1–35.6, P = 0.006. Stable disease >3 months occurred in 40%. Median overall survival and progression-free survival for the total cohort were 26.9 and 7.2 months, for CRP non-responder 13.8 and 2.6 months (95% CI, 6.5–21.1 / 0.4–4.8), and 24.4 and 11.3 months (95% CI, 22.8–31.0 / 5.7–16.9) for CRP responder, P = 0.082 / 0.017 (median observation time 26.1 months). Overall survival at 5 years was 18%. Toxicity >WHO grade 3 was reported: Hand-foot syndrome in 16 patients (36%), diarrhea in 4 patients (9%), depression in 1 patient, and pneumonia in 2 patients. (1) Clinical results of combined anti-inflammatory and angiostatic therapy were comparable with available standard therapies, although 50% of the patients had been systemically pretreated. (2) Control of tumor-associated inflammation is an important therapeutic principle in metastatic renal clear cell carcinoma.