Kooperativer Bibliotheksverbund

Language: English

In: Expert Review of Anticancer Therapy, 01 September 2010, Vol.10(9), pp.1345-1347

Keywords: Endoscopic Resection ; Endoscopic Submucosal Dissection ; Radical Oncologic Surgery ; Superficial Esophageal Cancer ; Medicine

ISSN: 1473-7140

E-ISSN: 1744-8328

DOI: 10.1586/era.10.124

URL: View record in Taylor & Francis

In: Circulation, 2013, Vol.127(3), pp.417-418

Description: A 63-year-old man was admitted to our emergency department because of abdominal pain with distension and ischemia of both lower limbs for the past 2 hours. Previously, he had vomited extremely following alcoholic excess and an opulent meal. In his previous history, distal esophageal stenosis was obvious after surgical therapy of Boerhaave syndrome 3.5 years earlier with primary suturing of the distal esophageal perforation and anterior semifundoplication. At clinical examination, the patient presented with stable cardiopulmonary function. The abdomen was massively distended and tender, and both legs were blue, revealing signs of prolonged ischemia with absent palpable pulses of the femoral artery in both groins. Palsy of the legs was not yet apparent. Computed tomography of the chest and abdomen …

Keywords: Medicine ; Anatomy & Physiology;

ISSN: 0009-7322

E-ISSN: 15244539

DOI: 10.1161/CIRCULATIONAHA.112.131763

URL: View record at Wolters Kluwer Health Ovid Technologies

Language: English

In: Expert Review of Anticancer Therapy, 01 April 2011, Vol.11(4), pp.571-578

Description: There has been much recent debate regarding the best surgical procedure to treat esophageal cancer, in particular with regard to the optimum extent of lymphadenectomy to improve survival while minimizing morbidity. No results obtained by prospective, randomized studies on the comparison of...

Keywords: Esophageal Cancer ; Individualized Lymph Node Dissection Strategies ; Limited Resection and Limited Lymphadenectomy ; Lymph Node Metastasis ; Minimally Invasive Esophagectomy ; Neoadjuvant Therapy ; Three-Field/Two-Field Lymphadenectomy ; Medicine

ISSN: 1473-7140

E-ISSN: 1744-8328

DOI: 10.1586/era.10.157

URL: View record in Taylor & Francis

Language: English

In: The American Journal of Surgery, December 2018, Vol.216(6), pp.1063-1069

Description: Surgical outcome to extremes of age is understudied. The purpose of this study was to evaluate the patient characteristics and incidence of postoperative morbidity and in-hospital mortality among patients aged 90 years and older who underwent surgery in comparison to younger controls. Patients aged 90 years or older (n = 80; mean age, 92.36 ± 2.37) were matched for surgical treatment with patients aged 79 years or younger (n = 80; mean age, 55.98 ± 15.95) taken from the same cohort. The overall morbidity and mortality rates were 57.5% and 31.3% in the elderly vs. 47.5% and 23.1% in the younger group respectively. Patient groups aged 90 years or older and 79 years or younger each had 4 and 6 predictive factors for morbidity and 10 and 9 predictive factors for mortality respectively. while advanced age carries an increased risk of morbidity and mortality, it seems that age in itself is no barrier to surgery. Despite the comparably high prevalence of chronic disease, elderly patients in this study fared quite well.

Keywords: Surgery ; Elderly Patients ; Morbidity ; Mortality

ISSN: 0002-9610

E-ISSN: 1879-1883

DOI: 10.1016/j.amjsurg.2017.11.032

URL: View record in ScienceDirect (Access to full text may be restricted)

Language: English

In: Digestive Diseases and Sciences, 2015, Vol.60(12), pp.3536-3544

Description: Ranking systems and comparisons of quality and performance indicators will be of increasing relevance for complex “high-risk” procedures such as esophageal cancer surgery. The identification of evidence-based standards relevant for key performance indicators in esophageal surgery is essential for establishing monitoring systems and furthermore a requirement to enhance treatment quality. In the course of this review, we analyze the key performance indicators case volume, radicality of resection, and postoperative morbidity and mortality, leading to continuous quality improvement. Ranking systems established on this basis will gain increased relevance in highly complex procedures within the national and international comparison and furthermore improve the treatment of patients with esophageal carcinoma.

Keywords: Quality management ; Key performance indicators ; Oncologic esophageal surgery ; Ranking systems

ISSN: 0163-2116

E-ISSN: 1573-2568

DOI: 10.1007/s10620-015-3790-x

URL: View full text in Springer (Subscribers only)

Language: English

In: Langenbeck's archives of surgery, January 2012, Vol.397(1), pp.69-74

Description: The efficacy of Heller myotomy in patients 〉40 years-a significant predictor suggesting a favorable response to pneumatic dilation-has been questioned. The aim of our study was to evaluate the results obtained in patients aged 40 years undergoing minimally invasive surgery (MIS) for achalasia. In January 2008, we established the MIS technique for achalasia in our clinic. In the following period from January 2008 to March 2011, 74 patients underwent primary laparoscopic myotomy for achalasia. The procedure was accomplished with an anterior 180° semifundoplication according to Dor in all patients. The Eckardt score and the Gastrointestinal Quality of Life Index (GQLI) served as outcome measures. The median age of patients was 45.5 years (range, 18-85 years) with a median duration of preoperative achalasia symptoms of 57 months (range, 2-468 months). There were no conversions to open surgery and-except for one patient with a sterile pleural effusion-no postoperative complications. At a median follow-up of 12 months, the preoperative Eckardt score of 7.0 (range, 3-12) was found to be significantly decreased to a median of 2 (range, 0-6; P 40 years, the postoperative Eckardt score obtained in the older patient population was not significantly lower (P = 0.074). There was no statistically significant difference between the two groups with respect to the postoperative GQLI (P = 0.860). Neither gender nor preoperative Botox injection or pneumatic dilation inserted a significant influence on the postoperative clinical outcome (P 〉 0.05). Laparoscopic Heller myotomy for achalasia is associated with a high success rate as the primary therapeutic option and after failure of endoscopic therapy. It can be performed safely and with favorable outcomes also in patients 〉40 years. However, the long-term durability of the procedure remains to be established.

Keywords: Esophageal Achalasia -- Surgery ; Esophagus -- Surgery ; Laparoscopy -- Methods

ISSN: 14352443

E-ISSN: 1435-2451

DOI: 10.1007/s00423-011-0832-5

URL: View this record in MEDLINE/PubMed

In: American Journal of Gastroenterology, 2008, Vol.103(4), pp.856-864

Description: BACKGROUND: The etiology of achalasia is still unknown. The current theories of chronic inflammation leading to autoimmune response with destruction and loss of the inhibitory myenteric ganglion cells enlighten its pathogenesis in a limited way only. Interstitial cells of Cajal (ICC) have been shown to be involved in nitrergic neurotransmission of the lower esophageal sphincter (LES). AIM: To investigate the significance of ICC and neuronal nitric oxide synthase (n-NOS) in esophageal wall tissue of patients undergoing surgery for achalasia. METHODS: In 53 patients with a median age of 45 (6–78) yr undergoing surgery for achalasia, the immunoreactivity of ICC (CD117/c-kit) and n-NOS was assessed. In 42 patients, biopsies were taken from the LES high-pressure zone during Heller myotomy, whereas in 11 patients with end-stage achalasia and a decompensated megaesophagus, the complete esophagus was resected. A semiquantitative analysis was carried out and ICC and n-NOS impairments were classified into four grades. Staining intensity was correlated with preoperative clinical, radiologic, and manometric findings and with long-term postoperative Eckardt score. RESULTS: Grade III/IV ICC reduction (severe reduction to complete loss) was seen in 59.5% of all biopsy specimens of the LES high-pressure zone. Patients with grade III/IV ICC reduction had a significantly longer duration of achalasia symptoms (3 [0–43] yr) than patients with minor to marked (grade I/II) impairment (1 [0–16] yr, P= 0.028). A majority (72.5%) of tissue samples revealed severe reduction to complete loss of n-NOS immunoreactivity. The preoperative Eckardt score was statistically significantly different between patients with grade I/II and those with grade III/IV n-NOS reductions (P= 0.031). CD117 (c-kit) positivity was statistically significantly correlated with n-NOS staining intensity (correlation coefficient r= 0.781, P 〈 0.0001). CONCLUSION: The present results suggest that in the pathogenesis of achalasia, especially in the development of the LES high-pressure zone, depletion of ICC networks and potential changes in the electrical activity of smooth muscle cells may play a crucial role. The reduction in CD117-positive ICC in a few patients also seemed to be of relevance, even if the cells of Auerbachʼs plexus were unscathed. The associated reduced NOS release might underlie the profound ICC impairment and could possibly be responsible for the lack of LES relaxation, because of missing inhibitory neurotransmission. It is unclear, however, whether the ICC loss is primarily caused by the accelerated attrition of mature cells or their impaired regeneration.

Keywords: Achalasia -- Development And Progression ; Achalasia -- Care And Treatment ; Neurons ; Nitric Oxide;

ISSN: 0002-9270

E-ISSN: 15720241

DOI: 10.1111/j.1572-0241.2007.01667.x

URL: View record at Wolters Kluwer Health Ovid Technologies

Language: English

In: Deutsches Arzteblatt international, 06 August 2018, Vol.115(31-32), pp.513-519

Description: Early gastro-esophageal cancer is staged as m1 to m3 depending on the infiltration of the anatomical layers of the mucosa or, analogously, as sm1 to sm3 depending on the depth of infiltration into the submucosa. The risk of lymph node metastases is low in mucosal carcinoma but increases with the depth of infiltration into the submucosa. This review is based on pertinent publications retrieved by a selective search in MEDLINE, PubMed, the Cochrane Library, and the International Standard Randomised Controlled Trial Number (ISRCTN) registry. New technologies such as narrow-band imaging have improved the endo- scopic diagnosis and staging of early gastro-esophageal cancer. The development of endoscopic submucosal dissection has led to a higher R0 resection rate, a lower risk of recurrence, and an increase in the number of endoscopic resections that are performed with curative intent. In squamous-cell carcinoma of the esophagus, surgical oncological esophagectomy is indicated if the cancer infiltrates into the third mucosal layer (T1a, m3) or deeper. In esophageal adenocarcinoma, the prevalence of lymph node metastases is low if the cancer is restricted to the mucosa and in- creases only when the submucosa is infiltrated. In the current German S3 guideline, endoscopic resection is recommended for intramucosal adenocarcinoma as long as there are no further histopathological risk factors. Lymph node metastasis in gastric carcinoma begins in the deep mucosal infiltration stage (m3). If certain special con- ditions ("extended criteria") are met, carcinoma expanding into the first submucosal layer (sm1) can be removed endoscopically. All further stages must be treated with total or subtotal gastrectomy with systematic D2 lymphadenectomy. Borderline cases between endoscopic and surgical resection of early carcinoma of the esophagus or stomach must be managed with an interdisciplinary treatment algorithm. If there is a risk of lymph node metastasis, surgical oncological resection is indicated. Such resections of gastroesophageal cancer in the locally advanced stage should always be part of a multimodal treatment approach.

Keywords: Digestive System Surgical Procedures -- Methods ; Endoscopy -- Methods ; Esophageal Neoplasms -- Surgery ; Stomach Neoplasms -- Surgery

E-ISSN: 1866-0452

DOI: 10.3238/arztebl.2018.0513

URL: View this record in MEDLINE/PubMed

Language: German

In: MMW Fortschritte der Medizin, July 2016, Vol.158(13), pp.43-6

Keywords: Gastric Cancer Surgery ; Enhanced Recovery ; Fast Track Surgery ; Hyperthermic Intraperitoneal Chemotherapy (Hipec) ; Minimally Invasive/Robotic Gastrectomy ; Risk and Complication Management ; Stomach Neoplasms -- Surgery

ISSN: 1438-3276

E-ISSN: 16133560

DOI: 10.1007/s15006-016-8514-4

URL: View this record in MEDLINE/PubMed

Language: English

In: Journal of Gastrointestinal Surgery, Feb, 2010, Vol.14(1), p.46(12)

Description: Byline: Ines Gockel (1), Stephan Timm (1), George G. Sgourakis (1), Thomas J. Musholt (1), Andreas D. Rink (1), Hauke Lang (1) Keywords: Myotomy; Achalasia; LES; Laparoscopic myotomy; Heller myotomy Abstract: Introduction Heller myotomy leads to good--excellent long-term results in 90% of patients with achalasia and thereby has evolved to the "first-line" therapy. Failure of surgical treatment, however, remains an urgent problem which has been discussed controversially recently. Materials and Methods A systematic review of the literature was performed to analyze the long-term results of failures after Heller's operation with emphasis on treatment by remedial myotomy. Discussion Other reinterventions and their causes after failure of surgical treatment in patients with achalasia are discussed. Author Affiliation: (1) Department of General and Abdominal Surgery, Johannes Gutenberg-University of Mainz, Langenbeckstr. 1, 55131, Mainz, Germany Article History: Registration Date: 25/08/2009 Received Date: 29/04/2009 Accepted Date: 25/08/2009 Online Date: 24/10/2009

Keywords: Surgery -- Analysis

ISSN: 1091-255X

E-ISSN: 18734626

DOI: 10.1007/s11605-009-1018-0

Source: Cengage Learning, Inc.