Quality of life and functional results following different types of resection for gastric carcinoma.

In order to evaluate quality of life and functional results following surgery for gastric cancer we studied 89 patients with no evidence of disease at a minimum of 12 months postoperatively. Patients were treated with total gastrectomy and jejunal pouch reconstruction according to Hunt-Lawrence-Rodino (n = 59), distal gastric resection (n = 21) or proximal gastric resection (n = 9). No significant differences were found between total gastrectomy or distal gastric resection with respect to dumping or heartburn, while patients with proximal gastric resection suffered from both.

Hyperthermic limb perfusion for malignant melanoma and soft tissue sarcoma.

From 1982-1989, 113 hyperthermic limb perfusions were carried out in 102 patients. Ninety-three patients were treated for malignant melanoma and nine for soft tissue sarcoma. 47/93 patients had high-risk stage I melanoma with a 5-year survival rate of 89%.

Resection of liver metastases in colorectal cancer--competitive analysis of treatment results in synchronous versus metachronous metastases.

One hundred and twenty-two patients underwent liver resection for metastases of colorectal cancer within 8 years. Seventy-four of them were treated for metachronous metastases detected in a median of 18 months after resection of the primary tumor. In another 48 patients the metastases were resected at the same time as the primary cancer.

The predictive role of bioelectrical impedance analysis (BIA) in postoperative complications of cancer patients.

The correlation between body composition measured by bioelectrical impedance (BIA) and postoperative complications in 115 patients with gastrointestinal cancer was analysed. A significant increase in severe complications was found independent of lean body mass (LBM). In patients with LBM below the normal range the complication rate proved to be 31% (17/55), whereas patients with normal LBM had a complication rate of 10% (6/60).

Re-operation for recurrent colorectal cancer: the importance of early diagnosis for resectability and survival.

Between 1978 and 1986, 179 patients with recurrent colorectal cancer were treated and 137 patients were operated a second time.82.1% of the patients showed elevated CEA levels (greater than or equal to 5 ng/ml) at the time of diagnosis.

Lectins and immunohistochemistry of colorectal cancer, its recurrences and metastases.

In 31 patients resected specimens from primary colorectal cancers, corresponding liver metastases and local recurrences were investigated for the staining pattern of lectins (PNL, UEA, WGA, HPA, SBA, RCA) and tissue antigens (CEA, SP, ACT) by immunohistochemistry. Comparison of staining patterns showed a loss of marker expression from normal colonic mucosa to colorectal primary carcinomas, and a tendency to marker loss from the primary tumour to liver metastases. However, even a neo-expression of markers not present in the primary tumour could be observed.

[Preoperative assessment of perirectal lymph nodes by ultrasound].

Endorectal ultrasound is a new technique which is having an increasing impact on the surgical community. Beyond the assessment of tumor penetration depth two kinds of lymph nodes are to be differentiated by ultrasound in the perirectal fat. 1) Inflammatory enlarged lymph nodes which appear hyperechoic, unsharply limited to the surrounding tissue and 2) lymph node metastases which are hypoechoic having the same density as the tumor.

Endorectal ultrasonography for the assessment of invasion of rectal tumours and lymph node involvement.

Sophisticated therapies for rectal carcinoma, such as sphincter preserving operations, pouch-anal anastomosis, preoperative irradiation or adjuvant chemotherapy, require an exact pretherapy assessment of the tumour and its lymph node involvement. A 7.0 MHz transducer was used before operation in the staging of 117 patients with rectal carcinoma or villous adenoma.

Current status of immunoscintigraphy in colorectal cancer--results of 5 years' clinical experiences.

In 100 patients with suspected colorectal cancer, findings of conventional diagnostic methods were compared with immunoscintigraphy results. In a first trial 131-J-labelled F (ab') 2-fragments against CEA and CA 19-9 were used in 42 patients. Evidence was confirmed by surgical exploration in 69% of cases and by close follow-up examination in 31%.

Influence of endorectal ultrasound on surgical treatment of rectal cancer.

Refined surgical treatment of carcinoma of the rectum, such as sphincter-preserving operations, pouch anal anastomosis, and pre-operative irradation require exact assessment of tumor and lymph-node involvement before therapy. To improve pre-operative staging we used endorectal ultrasound to determine the depth of tumor infiltration and the presence of lymph-node metastases. A 7.

Proposal for a new carcinoid tumour staging system based on tumour tissue infiltration and primary metastasis; a prospective multicentre carcinoid tumour evaluation study. West German Surgical Oncologists' Group.

In order to evaluate the significance of different prognostic factors, a multicentre prospective carcinoid tumour study was launched in early 1987, under the auspices of CAO (Chirurgische Arbeitsgemeinschaft Onkologie, a West German surgical oncologists' collaboration group) and UICC (Union Internationale Contre le Cancer). Up to March 1990 we received and evaluated clinical data from 94 patients from 16 hospitals. Carcinoid localization was distributed as follows: stomach 4, duodenum 7, pancreas 3, jejunum 5, ileum 21, Meckel's diverticulum 1, appendix 29, colon 5, rectum 14, and 5 cases of tumour metastases of unknown origin.

Clinico-pathological features and surgical management of primary epithelial hepatic malignancies.

Between January 1983 and January 1990, 89 patients with primary epithelial hepatic malignancy were admitted to the Department of Surgery, University of Heidelberg, for surgical treatment. Histopathologically, tumours were hepatocellular carcinoma (HCC) 75, fimbrolamellar carcinoma (FLC) 1 and cholangiocellular carcinoma (CCC) 13. Concomitant liver cirrhosis was found in 61%.

Etoposide, adriamycin, and cisplatinum (EAP) combination chemotherapy for advanced gastric cancer. A phase II trial by the "Chemotherapiegruppe Gastrointestinaler Tumoren (CGT)".

In a multicenter trial, 49 patients with histologically proven advanced gastric cancer were treated with a combination chemotherapy consisting of etoposide 120 mg/m2 d 4, 5, 6 adriamycin 20 mg/m2 d 1, 7 and cisplatinum 40 mg/m2 d 2, 8. Therapy was repeated every 4 weeks, 45 patients were evaluable for response after 8 weeks of treatment. Eight patients achieved a partial remission (PR: 18%), 17 patients had no change (NC: 38%), and 20 patients showed tumor progression (P: 44%).

Cytogenetics and DNA amplification in colorectal cancers.

In vitro cultivated cells of 28 colorectal cancers were analyzed for chromosomal abnormalities that might signal amplification of DNA, either as double minutes (DMs) or homogeneously staining chromosomal regions (HSRs). Cells derived from 18 tumors showed DMs in 10 to 100% of all metaphases examined. Surveys that employed a panel of available oncogene probes failed to detect amplification of a known cellular oncogene with the exception of three cases where the ERBB2 gene was amplified.

Hepatic arterial infusion (HAI) chemotherapy for liver metastases of colorectal cancer using 5-FU.

Thirty-three patients with liver metastases of colorectal cancer were treated by intra-arterial 5-FU chemotherapy. The median survival time of all patients was 14 months. A partial remission could be observed in nine patients, and a further 15 patients had stable disease.

Synthesis of positively charged phthalocyanines and their activity in the photodynamic therapy of cancer cells.

Positively charged zinc containing or metal free phthalocyanines 6a-c and 7a-c were prepared via a three step procedure starting from 4-nitrophthalonitrile. The phthalocyanines contain alkyl chains of different length in order to influence the hydrophilic vs lipophilic character of the compounds. The partition between a hydrophilic (water) and lipophilic (octanol-1) phase was determined, and the photoredox activities were investigated.

[Lactic acidosis--recognition and treatment of an important complication of perioperative parenteral nutrition].

We report 5 cases of acute vitamin B-1 induced lactic acidosis in surgical patients receiving parenteral nutrition. In all patients treatment with vitamin B-1 induced a dramatical improvement of clinical findings. 4 patients recovered completely, 1 patient died from already developed irreversible cardiocirculatory failure.

[Psychosocial factors of preserving health? Prospective studies of breast cancer, bronchial cancer and fibrocystic mastopathy].

Do psychosocial factors affect the development of health? 156 patients were interviewed and tested before a breast biopsy or before the initial medical treatment of lung cancer. Multiple regressions examined the influence of age, diagnosis (tumor stage) and different psychosocial parameters as dependent variables the development of health after 2 or 5 years as independent variables. The breastbiopsy-group (n = 52) shows five psychological variables being effective in a positive (health promoting) manner: autonomy, emotional outlet, expression of one's needs, family support, lack of life stress.

[Improved intraoperative leak control in cytostatic drug isolation perfusion of tumors of the extremities].

The success of extremity perfusion and the protection from systemic side effects largely depend upon the prevention of systemic drug leakage from the extremity circulation. The use of autologous 111-Indium labelled erythrocytes for leakage control allows a continuous exact surveillance and timely correction of the tourniquet position in case a major leak should occur. A total of 97 patients were studied.

Postoperative active specific immunization in curatively resected colorectal cancer patients with a virus-modified autologous tumor cell vaccine.

Active specific immunotherapy was performed in a phase I study in 20 colorectal cancer patients after surgical resection of the tumor. An autologous tumor cell vaccine surface modified by Newcastle disease virus (NDV) was used, which showed the following characteristics. After mechanical and enzymatic dissociation of the tumor tissue an average of 5 x 10(7) cells/g tissue was obtained.

[The value of positron emission tomography in the diagnosis of recurrent rectal cancer].

In 21 patients with clinically suspected recurrent rectal cancer showing a mass in the pelvic CT scan, Positron Emission Tomography (PET) was performed to measure metabolic rate of the mass. In 13 of the 21 patients an increased F-18-Fluorodeoxyglucose (FDG) uptake in the suspect tissue could be found. All of these patients were proven to suffer recurrent cancer by biopsy.

[Animal experiment studies of the toxicity of fluorodeoxyuridine (FUDR) and 5-fluorouracil (FU) within the scope of regional liver infusion chemotherapy].

In this study we examined the cytostatic compounds 5 FU and FUDR which are most frequently used in regional chemotherapy for any incidence of hepatobiliary toxicity in animals. For this we compared the intraarterial as well as the intraportal application. Differences between the treatment groups were found in the biliary extraction of these two cytostatic agents.

Expression of epidermal growth factor receptor in normal colorectal mucosa, adenoma, and carcinoma.

Using the monoclonal antibody EGF-R1, the expression of epidermal growth factor receptor (EGFR) was investigated immunohistochemically in normal colonic mucosa distant from and adjacent to colonic neoplasms, in 25 adenomas and in 144 unselected colorectal carcinomas. EGFR expression was an inconsistent phenomenon in each of these conditions. It was not expressed in 23/44 non-neoplastic mucosa specimens distant from and in 26/44 mucosae adjacent to colon tumours; 15/25 adenomas and 71 (49.

Real-time follow-up of 5-fluorouracil metabolism in the liver of tumor patients by means of F-19 MR spectroscopy.

Intraarterial 5-fluorouracil (5-FU) chemotherapy in eight patients, one with primary and seven with secondary liver tumors, was monitored by means of in vivo fluorine-19 magnetic resonance (MR) spectroscopy. F-19 MR spectra were obtained with surface coils and included signal contributions from both liver and tumor tissue. The time course of the relative concentrations of 5-FU and its major catabolite, alpha-fluoro-beta-alanine (FBAL), was followed for up to 100 minutes after the start of drug administration.

[Responsibilities and importance of tumor centers for interdisciplinary tumor therapy].

Early diagnosis, therapy and follow-up of tumor patients rest on the three pillars of medical care: tumor centers, hospitals and physicians. The tumor centers are the pace makers and coordinators in the following functions: definition of primary treatment and additional therapies and their standard of quality; implementation of primary multimodal therapies and treatment of rare tumors; development of improved treatment methods for tumor metastases and local recurrence, including surgical treatment; improvement of diagnostic and therapeutic (surgical) potential through interdisciplinary research, especially in the fields of tumor biology and tumor immunology; and establishment of a standardized follow-up and new care and treatment strategies for the improvement of the patients' quality of life.