Long-term survivors of esophageal cancer: disease-specific quality of life, general health and complications.

Introduction: The aim of our study was to assess the quality of life as well as secondary cancers/diseases and esophagectomy-related or unrelated interventions in the long-term course of surgery.

Patients And Methods: Out of 417 patients who underwent esophageal resection for cancer between September 1985 and November 2003, 85 were defined as long-term survivors (≥5 years). Fifty patients still alive in November 2008 complied with our inclusion criteria.

Prediction model of lymph node metastasis in superficial esophageal adenocarcinoma and squamous cell cancer including D2-40 immunostaining.

Background: It was the aim of our study to establish a model for prediction of lymph node metastases in superficial esophageal cancer.

Methods: We analyzed the clinical and histopathological data of 50 consecutive patients with pT1-esophageal cancer who underwent oncological resection. Submucosal carcinomas (pT1b) were classified according to sm levels 1-3.

Three different types of surgeon-specific stress reactions identified by laparoscopic simulation in a virtual scenario.

Background: Minimally invasive surgery causes higher mental strain for surgeons than conventional surgery and is significantly more stressful in consecutive cases. This study aimed to investigate whether individual stress responses are associated with intraoperative alterations of manual surgical skills and technical errors of the laparoscopic surgeon.

Methods: The LapSim virtual reality simulator was used.

Impact of laparoscopic adjustable gastric banding on obesity co-morbidities in the medium- and long-term.

Background: The authors evaluated the impact of laparoscopic adjustable gastric banding (LAGB) on obesity-associated diseases in a series at 3 to 8 years postoperatively, namely diabetes, pulmonary disease, hypertension and knee joint pain.

Methods: 145 morbidly obese patients underwent LAGB with mean age 38 years and preoperative BMI 48.5 kg/m2 (range 34-77).

Developments in esophageal surgery for adenocarcinoma: a comparison of two decades.

Background: The objective of this study was to examine outcomes in patients undergoing esophageal resection for adenocarcinoma at our institution during a 20-year period and, in particular, to address temporal trends in long-term survival.

Methods: Out of 470 patients who underwent esophagectomy for malignancy between September 1985 and September 2005, a total number of 175 patients presented with esophageal adenocarcinoma. Patients enrolled in this study included AEG (adenocarcinoma of the esophagogastric junction) type I tumors only.

The value of scoring achalasia: a comparison of current systems and the impact on treatment--the surgeon's viewpoint.

Heller myotomy in patients with achalasia promises better long-term success than pneumatic dilation, especially in younger patients, and therefore has evolved as the primary treatment option. The aim of this study was to evaluate the impact of different disease-specific severity scores on achalasia treatment. Fifty consecutive patients undergoing pneumatic dilation (n = 25) or myotomy (n = 25) were assessed pre- and postinterventionally by clinical evaluation using the Eckardt Score, the Vantrappen Classification, and the Adams's Stages, as well as by radiologic and manometric studies and by subjective evaluation.

[Rectal carcinoma: is too much neoadjuvant therapy performed? Proposals for a more selective MRI based indication].

The present-day optimised surgery (concept of total mesorectal excision) with quality assurance by standardized pathologic examination, advances in radiotherapy and the possibilities of high-spatial-resolution MR imaging require reconsideration of pros and contras of neoadjuvant therapy and respective data. According to the resulting new proposal neoadjuvant long-course radiochemotherapy is indicated for patients with 1) fixed questionably R0 resectable tumors, 2) mobile tumors with the MRT finding of tumor involving the mesorectal fascia or 1 mm or less from it, 3) low rectal tumors extending below the levator origin and invading beyond the muscularis propria. If a high risk of local recurrence becomes apparent during surgery (tumor perforation, incision into or through tumor) or after pathologic examination (incomplete mesorectal excision, tumor 1 mm or less from the circumferential resection margin) adjuvant radiochemotherapy is indicated.

[Achalasia in circumscribed scleroderma].

History: A 38-year-old man had been suffering from circumscribed scleroderma for 12 years. Dysphagia had been diagnosed 5 years ago and for the last 2 years he had retrosternal dysphagia for solid and liquid food. His symptoms had increased markedly 6 months before presenting at our hospital and the patient had lost 15 kg of weight.

Changing pattern of the intraoperative blood pressure during endoscopic adrenalectomy in patients with Conn's syndrome.

Background: Primary hyperaldosteronism caused by an aldosterone-producing adenoma of the adrenal gland is regarded as the most common type of endocrine hypertension. The aim of this study was to analyze the changing pattern of the intraoperative blood pressure during endoscopic adrenalectomy recorded in patients with Conn's syndrome compared to patients with hormone-inactive incidentaloma and its possible influence by the surgical approach.

Methods: From February 1994 to March 2004, 40 patients underwent endoscopic adrenalectomy for Conn's syndrome.

Endoscopic adrenalectomy for pheochromocytoma: difference between the transperitoneal and retroperitoneal approaches in terms of the operative course.

Background: Due to the intraoperative catecholamine secretion with hemodynamic changes, a larger tumor size and marked neovascularization, as compared with other adrenal pathologies, endoscopic adrenalectomy for pheochromocytoma represents a particular challenge involving a more difficult and morbid procedure. The aim of this study was to identify the optimal surgical approach for endoscopic adrenalectomy in patients with pheochromocytoma.

Methods: Over a period of 10 years (February 1994 to June 2004), 38 consecutive patients underwent endoscopic adrenalectomy for pheochromocytoma.

[Hamartoma of the duodenum].

History And Admission Findings: A 61-year-old man had been suffering from repeated episodes of postprandial vomiting and a feeling of fullness as well as a weight loss of 8 kg for two months. Three years prior to this, a laparoscopic cholecystectomy had been carried out at a different institution after a pancreatitis on the assumption of a biliary genesis. There were no sings of jaundice or gastro-intestinal bleeding.

Recurrent laryngeal nerve paralysis (RLNP) following esophagectomy for carcinoma.

Background: The aim of this study was to report the frequency of post-operative recurrent laryngeal nerve paralysis (RLNP) following resection for esophageal carcinoma.

Patients And Methods: Four hundred and four patients were studied. Diagnosis of post-operative RLNP was performed by indirect laryngoscopy.

[Quality of life after subtotal resection and gastrectomy for gastric cancer].

Recently, quality of life has become a main objective in surgical therapy. Apart from the oncological consequences, the quality of results after gastric carcinoma resection are mainly determined by social and psychological aspects of life, early postoperative complications, and long-term nutritive/functional parameters. Of 338 patients who underwent gastric resection for adenocarcinoma of the stomach, quality of life was assessed in 73 recurrence-free patients by means of the Gastrointestinal Life Quality Index (GLQI).

Technical alternatives in laparoscopic placement of an adjustable gastric band: experience of two German university hospitals.

Background: The technique of laparoscopic adjustable gastric banding (LAGB), although relatively well standardized, has some "weak points".

Methods: We analysed the experience of 2 German university clinics in order to suggest technical alternatives that can be helpful in difficult situations.

Results: Between April 1997 and May 2002 115 patients in Cologne (87 females, 28 males) with median BMI 49.

[Iatrogenic perforation of the esophagus during transesophageal echocardiography. A rare cause of severe dysphagia].

History: A 65-year-old patient underwent transesophageal echocardiography which caused a perforation of the upper esophagus. Three months after esophagostomy and gastrostomy the reconstruction was accomplished by a colon interposition graft. The patient postoperatively developed an ischemic necrosis of the graft, followed by a cervical fistula.

Heller myotomy for failed pneumatic dilation in achalasia: how effective is it?

Objectives: This long-term prospective study describes the effect of myotomy in patients who fail to respond to repeated pneumatic dilations and compares their clinical course with that of patients responding to dilation therapy.

Methods: Nineteen consecutive patients who had never reached a clinical remission after repeated pneumatic dilation underwent myotomy. Their clinical course was compared with that of patients who had reached a clinical remission after a single (n = 34) or multiple (n = 14) pneumatic dilation(s).

[Dolichomegaesophagus in achalasia. Therapy by esophogectomy in an aged patient].

History And Clinical Findings: A 78-year-old woman suffered from achalasia since 63 years with a progressive decompensation over the last year. 53 years ago, treatment with the Stark Dilator and 24 years ago, pneumatic dilation had been carried out. Currently, the patient presented with dysphagia for liquid and solid food, with permanent retrosternal pain and regurgitation for every meal, leading to a weight loss of 10 kg.

Prognostic factors for cryotherapy of colorectal liver metastases.

Background: Cryotherapy is a local ablative treatment option for non-resectable liver tumours. We aimed to identify prognostic indicators, that may allow better selection or stratification for adjuvant therapies of patients.

Methods: Fifty-five patients had cryotherapy for colorectal liver metastases.

[Surgical treatment of colorectal liver metastases].

Resection is the only curative treatment of colorectal liver metastases proofed by a long-term follow-up. The operation is indicated if the metastases are completely removable with sufficient liver parenchyma remaining after resection and if the patient is fit for surgery. The resection is not indicated in cases with non resectable extrahepatic tumours and lymph node metastases distal the hepatoduodenal ligament.

[Positron emission tomography for preoperative lymph node diagnosis in esophageal carcinoma].

Background: Exact preoperative staging is a prerequisite for the indication and the choice of appropriate operative technique for patients with esophageal carcinoma. The objective of this prospective study was to assess whether positron emission tomography (PET) with 18F-fluorodeoxyglucose (FDG) increases the accuracy of preoperative lymph node staging with standard computed tomography (CT) and thus leads to a different surgical approach.

Patients And Methods: Fifty-eight patients with carcinoma of the esophagus (46 men and 12 women) with a median age of 61 years underwent FDG-PET imaging of the neck, chest, and abdomen as well as CT of the chest and abdomen.

[18F-Deoxyglucose PET for the staging of oesophageal cancer: influence of histopathological subtype and tumour grading].

Aim: Evaluation of the influence of histopathologic sub-types and grading of primaries of oesophageal cancer, relative to their size and location, on the uptake of (18)F-deoxyglucose (FDG) as measured by positron emission tomography (PET).

Methods: 50 consecutive patients were evaluated. There were four drop-outs due to previous surgical and/or chemotherapeutical treatments and thus in 46 patients (28 squamous cell carcinomas and 18 adenocarcinomas) a pretherapeutic PET evaluation of the primary including a standard uptake value (SUV) was obtained.

[Adenocarcinoma of the esophagus: prognostic comparison between transthoracic esophageal resection with expanded 2-field lymph node dissection and trans-hiatal esophageal dissection with abdominal lymph node excision].

A retrospective analysis should compare the two operative approaches, transhiatal or transthoracic resection in patients suffering from adenocarcinoma of the esophagus. Between 1985 and 2002 123 cases were presented with adenocarcinoma of the esophagus, treated in 65% by transhiatal resection including abdominal lymph node dissection and in 35% by the transthoracic approach with standardized extended mediastinal and abdominal lymph node dissection. Hospital mortality was 14% (6/43) after transthoracic resection and 3.