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  • Springer (CrossRef)  (31)
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Year
  • 1
    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
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  • 2
    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
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  • 3
    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
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  • 4
    Language: English
    In: Digestive diseases and sciences, May 2011, Vol.56(5), pp.1432-7
    Description: This study investigated the long-term clinical course of patients with Schatzki rings, who were treated by single bougie dilation. Furthermore, it analyzed possible predictors for the time of recurrence. A total of 133 patients (100 males, 33 females) with a mean age of 57 ± 14.6 years who were treated by single dilation with the use of Maloney bougies without the aid of fluoroscopy were prospectively registered and followed-up for a mean duration of 58.3 months (range 12-240 months). Duration of remission was evaluated by Kaplan-Meier estimates with regard to recurrence. Log-rank test was performed to analyze possible predictors for the time to second dilation (recurrence). No complications occurred and all patients were symptom-free at the first follow-up examination 4 weeks after dilation. However, later on, 73 patients required a second dilation. The estimate remission rates were 63.8% (95% CI: 55.6-72.0%) after 2 years, 44.3% (95% CI: 35.4-53.4%) after 5 years, and 39.9% (95% CI: 30.5-49.3%) after 10 years. Neither the initial morphological findings, nor age or gender determined the need for repeated dilation. Only patients treated with a large bougie diameter (≥52 F) seemed to have a tendency for a longer time until symptomatic recurrence. Single dilation of symptomatic Schatzki rings is a safe and effective therapy. However, more than half of the patients will need a second treatment. Recurrences are unrelated to initial morphological findings, age, or gender. Only the treatment with a large bougie diameter (≥52 F) showed a tendency for a longer time of remission.
    Keywords: Dilatation -- Methods ; Esophageal Stenosis -- Surgery ; Esophagogastric Junction -- Pathology
    ISSN: 01632116
    E-ISSN: 1573-2568
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  • 5
    Language: English
    In: Digestive Diseases and Sciences, 2009, Vol.54(12), pp.2763-2764
    Description: Byline: Ines Gockel (1), Hauke Lang (1) Author Affiliation: (1) Department of General and Abdominal Surgery, Johannes Gutenberg-University of Mainz, Mainz, Germany Article History: Registration Date: 25/06/2009 Received Date: 07/06/2009 Accepted Date: 25/06/2009 Online Date: 23/07/2009
    Keywords: Surgery;
    ISSN: 0163-2116
    E-ISSN: 1573-2568
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  • 6
    Language: English
    In: Journal of Cancer Research and Clinical Oncology, 2011, Vol.137(7), pp.1139-1145
    Description: Byline: Carl C. Schimanski (1), Markus Moehler (1), Ines Gockel (2), Tim Zimmermann (1), Hauke Lang (2), Peter R. Galle (1), Martin R. Berger (3) Keywords: CCR5; Chemokine receptor; Colorectal cancer; Liver metastases; Molecular metastases; Micrometastases; Tumor cells Abstract: Background Molecular metastases are precursors of postoperative recurrence, detected by molecular-biological tools. Chemokines and their receptors contribute to dissemination and local immune recognition. A strong expression of the chemokine receptor CCR5 is associated with non-metastatic colorectal cancer and increased CD8+ T-cell infiltration. The aim of this study was to analyze whether CCR5 expression correlates with the presence of hepatic molecular metastases (MM). Methods Ninety-three patients undergoing elective surgery for colorectal cancer were assessed. The K-ras mutation status was defined by PCR--RFLP, and the CCR5 expression status was analyzed by CCR5-specific reverse transcription (RT-PCR) analysis. Liver biopsy samples had been intra-operatively taken to screen for MM. MM were detected by K-ras-specific PCR--RFLP and nested CK20/GCC RT-PCR. Prevalence of MM was correlated with CCR5 expression status. Results Human colorectal cancer harboured K-ras mutations in 53% (codon 12: 47% codon 13: 6%) of cases. Among K-ras mutants, MM were detected in 27--53% of patients, dependent on the technique applied (K-ras-specific PCR--RFLP assay vs. nested CK20/GCC RT-PCR approach (P = 0.004)). CCR5 expression of K-ras mutants ranged from absent (23/49: 47%), weak (17/49: 35%), intermediate (4/49: 8%) to strong (5/49: 10%). MM were found in 30% of CCR5 negative and in 23% of CCR5 positive cancer patients by the K-ras-specific PCR--RFLP assay. The nested CK20/GCC RT-PCR assay detected MM in 87% of CCR5 negative and in 27% of CCR5 positive colorectal cancer patients (P = 0.00002). Conclusion Thus, CCR5 expression of the primary cancer might be a valuable biomarker indicating the absence of hepatic molecular metastases. Author Affiliation: (1) Department of Internal Medicine, Johannes Gutenberg University of Mainz, Langenbeckstrasse 1, 55101, Mainz, Germany (2) Department of general and abdominal surgery, Johannes Gutenberg University of Mainz, Langenbeckstrasse 1, 55101, Mainz, Germany (3) German Cancer Research Center, INF 280, 69120, Heidelberg, Germany Article History: Registration Date: 22/03/2011 Received Date: 24/08/2010 Accepted Date: 22/03/2011 Online Date: 06/04/2011 Article note: Electronic supplementary material The online version of this article (doi: 10.1007/s00432-011-0980-6) contains supplementary material, which is available to authorized users.
    Keywords: CCR5 ; Chemokine receptor ; Colorectal cancer ; Liver metastases ; Molecular metastases ; Micrometastases ; Tumor cells
    ISSN: 0171-5216
    E-ISSN: 1432-1335
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  • 7
    Language: English
    In: Surgical endoscopy, July 2013, Vol.27(7), pp.2526-41
    Description: The aim of this study is to evaluate the most cost-effective treatment strategy using preperitoneal mesh for patients with recurrent inguinal hernia. Currently, the issue of cost-effectiveness is entirely unresolved. A decision analysis was carried out based on the results of a systematic literature review of articles concerning recurrent inguinal hernia repair that were published between 1979 and 2011. A virtual cohort was programmed to undergo three different treatment procedures: (1) laparoscopic totally extraperitoneal hernia repair (TEP), (2) open preperitoneal mesh repair according to Stoppa, and (3) open preperitoneal mesh repair according to Nyhus. We carried out a base-case analysis and varied all variables over a broad range of reasonable hypotheses in multiple one-way and two-way sensitivity analyses. The average cost-effectiveness ratio of Nyhus, Stoppa, and TEP per quality-adjusted life year was US $ ($)1,942, $1,948, and $2,011, respectively. In terms of the incremental cost-effectiveness ratio (ICER), Stoppa was dominated. The choice between TEP or Nyhus procedure depends on the combination of a specific center's rates of recurrence and morbidity as disclosed by three-way sensitivity analysis. Nyhus and TEP repairs are possible optimal choices depending primarily on the institution's rates of recurrence and morbidity. Based on our net benefit-related decision analysis, a hypothetical "fixed budget trade-off" suggests potential annual incremental health system cost savings of $200,000 attained by shifting care for 1,000 patients from TEP to Nyhus repair (depending on clinical end-points, which is a decisive factor).
    Keywords: Decision Trees ; Surgical Mesh ; Hernia, Inguinal -- Economics ; Laparoscopy -- Economics
    ISSN: 09302794
    E-ISSN: 1432-2218
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  • 8
    Language: English
    In: Langenbeck's archives of surgery, 14 December 2018
    Description: This observational study explored the association between hospital volume and short-term outcome following gastric resections for non-bariatric indication, aiming to contribute to the discussion on centralization of complex visceral surgery in Germany. Based on complete national hospital discharge data from 2010 to 2015, the association between hospital volume and in-hospital mortality was evaluated according to volume quintiles and volume deciles. Case-mix differences regarding surgical indication, age, sex, and comorbidities were considered for risk adjustment. In addition, rates of major complications and failure to rescue were analyzed across hospital volume categories. Inpatient episodes (72,528) with gastric resection were analyzed. Risk-adjusted mortality in patients treated in very low volume hospitals (median volume of 5 surgeries per year) was higher (12.0% [95% CI 11.4 to 12.5]) compared to those treated in very high volume hospitals (50 surgeries per year; 10.6% [10.0 to 11.1]). Failure to rescue patients with complications was 28.1% [27.0 to 29.3] in very low volume hospitals and 22.7% [21.6 to 23.8] in very high volume hospitals. Differences were similar within the subgroup of patients operated for gastric cancer. Treatment in very high volume hospitals is associated with a lower in-hospital mortality compared to treatment in very low volume hospitals. This effect seems to be determined by the ability to rescue patients who experience complications. As the observed benefit is only related to very high volumes, the results do not clearly indicate that centralization may improve short-term results substantially, unless a very high degree of centralization would be achieved. Possibly, further research focusing on other outcome measures, such as clinical processes or long-term results, might lead to divergent conclusions.
    Keywords: Centralization ; Failure to Rescue ; Gastric Surgery ; Hospital Discharge Data ; Volume Outcome Relation
    ISSN: 14352443
    E-ISSN: 1435-2451
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  • 9
    Language: German
    In: MMW - Fortschritte der Medizin, 12/2016, Vol.158(21-22), pp.80-83
    ISSN: 1438-3276
    E-ISSN: 1613-3560
    Source: Springer (via CrossRef)
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  • 10
    Language: English
    In: Human Genetics, 2010, Vol.128(4), pp.353-364
    Description: Despite increasing understanding of the pathophysiology of achalasia, the etiology of this esophageal motility disorder remains largely unknown. However, the occurrence of familial achalasia and its association with well-defined genetic syndromes suggest the involvement of genetic factors. Mutant mouse models display gastrointestinal disturbances that are similar to those observed in achalasia patients. The candidate gene approach has revealed some promising results; however, it has not established conclusive links to specific genes so far. The aim of this review was to summarize current knowledge of the genetics of achalasia. We also discuss the extent to which our understanding of achalasia is likely to be enhanced through future molecular genetic research.
    Keywords: Genetic Research -- Analysis ; Achalasia -- Development And Progression ; Achalasia -- Analysis;
    ISSN: 0340-6717
    E-ISSN: 1432-1203
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