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  • SpringerLink  (23)
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  • 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: 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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  • 3
    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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  • 4
    Language: English
    In: Annals of Surgical Oncology, 2013, Vol.20(7), pp.2428-2433
    ISSN: 1068-9265
    E-ISSN: 1534-4681
    Source: Springer Science & Business Media B.V.
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  • 5
    Language: English
    In: Langenbeck's Archives of Surgery, 2012, Vol.397(1), pp.69-74
    Keywords: Achalasia ; Minimally invasive Heller myotomy ; Dor semifundoplication ; Eckardt score ; Gastrointestinal quality of life index (GQLI)
    ISSN: 1435-2443
    E-ISSN: 1435-2451
    Source: Springer Science & Business Media B.V.
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  • 6
    Language: English
    In: Journal of Gastrointestinal Surgery, 2006, Vol.10(10), pp.1400-1408
    Description: Myotomy has proved to be an efficient primary therapy in patients with achalasia, especially in younger patients (〈40 years of age). The results of laparoscopic myotomy cannot be finally assessed, on account of the shorter postoperative follow-up. Thus, there are considerable data regarding intermediate-term outcomes after laparoscopic myotomy. The aim of our study was a 20-year analysis of the conventional cardiomyotomy as the underlying basis assessing the results of minimal-invasive surgery. Within 20 years (September 1985 through September 2005), 161 operations for achalasia were performed in our clinic. Enrolled in this study were 108 patients with a conventional, transabdominal myotomy in combination with an anterior semifundoplication (Dor procedure) and a minimal follow-up of 6 months. All patients were prospectively followed and, in addition to radiologic and manometric examinations of the esophagus, the patients were asked for their clinical symptoms by structured interviews in 2-year intervals. The median age at the time of surgery was 44.5 (range, 14–78) years, and 72.2% of the patients were males. The median length of the preoperative symptoms was 3 years (3 months to 50 years), and the postoperative follow-up was 55 (range, 6-206) months. In 70 (64.8%) patients, a pneumatic dilation had been performed. The preoperative Eckardt score of 6 (range, 2–12) could be reduced to 1 (range, 0–4) after myotomy ( P 〈0.0001). Consequently, with 97.2% of all patients, a good-to-excellent result was achieved in the long-term follow-up, corresponding to a clinical stage I-II. Postoperatively, 69 patients (63.9%) gained weight. The radiologically measured maximum diameter of the esophagus decreased from preoperatively 45 (range, 20–75) mm to postoperatively 30 (range, 20–60) mm, while the minimum diameter of the cardia increased from 3.4 (range, 1–10) mm to 10 (range, 5–15) mm. The resting pressure of the lower esophageal sphincter could be reduced from 28.4 (range, 9.4–56.0) mm Hg to 8.6 (range, 3.0–22.5) mm Hg. Conventional myotomy leads in the long run with high efficiency to an improvement of the symptoms evident in achalasia. These results may be regarded as the basis for assessment of the minimal-invasive procedure.
    Keywords: Achalasia ; conventional myotomy ; prospective 20-year analysis ; basis for assessing the laparoscopic procedure
    ISSN: 1091-255X
    E-ISSN: 1873-4626
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  • 7
    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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  • 8
    Language: English
    In: Digestive Diseases and Sciences, 2010, Vol.55(11), pp.3031-3040
    Description: Byline: George Sgourakis (1,2), Ines Gockel (1), Arnold Radtke (1), Thomas J. Musholt (1), Stephan Timm (1), Andreas Rink (1), Achilleas Tsiamis (3), Constantine Karaliotas (2), Hauke Lang (1) Keywords: Minimally invasive esophagectomy; Open esophagectomy; Meta-analysis; Evidence based medicine; Publication bias; Barrett's esophagus Abstract: Background A meta-analysis of the current literature was performed to compare the perioperative outcome measures and oncological impact between minimally invasive and open esophagectomy. Methods Using the electronic databases Medline, Embase, Pubmed and the Cochrane Library, we performed a meta-analysis pooling the effects of outcomes of 1,008 patients enrolled into eight comparative studies, using classic and modern meta-analytic methods. Results Two comparisons were considered for this systematic review: (I) open thoracotomy vs. VATS/laparoscopy esophagectomy and (II) open thoracotomy vs. VATS esophagectomy. In comparison I: both procedures report equally comparable outcomes (removed lymph nodes, 30-day mortality, 3-year survival) with the exception of overall morbidity (P = 0.038 in favor of the MIE arm) and anastomotic stricture (P 〈 0.001 in favor of the open thoracotomy arm). In comparison II: No differences were noted between treatment arms concerning postoperative outcomes and survival. Conclusions In summary, both arms were comparable with regard to perioperative results and prognosis. Further prospective comparative or randomized-controlled trials focusing on the oncological impact of MIE are needed. Author Affiliation: (1) Department of General and Abdominal Surgery, Johannes Gutenberg University Hospital, Mainz, Germany (2) 2nd Surgical Department and Surgical Oncology Unit, Korgialenio--Benakio Red Cross Hospital, 11 Mantzarou St., Neo Psychiko, 15451, Athens, Greece (3) Department of Colorectal and Laparoscopic Surgery, James Paget University Hospital, Norfolk, UK Article History: Registration Date: 03/02/2010 Received Date: 15/11/2009 Accepted Date: 03/02/2010 Online Date: 26/02/2010
    Keywords: Minimally invasive esophagectomy ; Open esophagectomy ; Meta-analysis ; Evidence based medicine ; Publication bias ; Barrett’s esophagus
    ISSN: 0163-2116
    E-ISSN: 1573-2568
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  • 9
    Language: English
    In: Digestive Diseases and Sciences, 2010, Vol.55(11), pp.3018-3030
    Description: Byline: George Sgourakis (1,2), Ines Gockel (2), Arnold Radtke (2), Georgia Dedemadi (1), Konstantinos Goumas (1), Sofia Mylona (1), Hauke Lang (2), Achilleas Tsiamis (3), Constantine Karaliotas (1) Keywords: Meta-analysis; Evidence based; Publication bias; Jadad composite scale; Esophageal stents; Esophageal palliation; Brachytherapy; Thermal tumor ablation; Reflux; Malignant dysphagia Abstract: Background The objective of this study was to examine the impact of self-expanding stents versus locoregional treatment modalities in the setting of esophageal cancer palliation. Methods The present meta-analysis pooled the effects of outcomes of 1,027 patients enrolled in 16 randomized controlled trials. Results The meta-analysis revealed an advantage to the use of stents compared to locoregional modality treatments with respect to the number of patients requiring reinterventions, although the latter treatment arm had a higher 1-year survival. No difference was observed between the use of the antireflux stents and conventional stents in relieving reflux. Previous chemoradiotherapy had no impact on complications, procedural deaths, and overall patient survival. Differences in outcomes among stents were minimal. Conclusions Conventional self-expanding stents and anti-reflux stents are equally effective. Although the risk difference for 1-year survival favoured locoregional palliative treatment modalities, the latter were associated with a higher number of patients requiring reintervention. Author Affiliation: (1) 2nd Surgical Department and Surgical Oncology Unit, "Korgialenio--Benakio" Red Cross Hospital, 11 Mantzarou Str., Neo Psychiko, Athens, 15451, Greece (2) Department of General and Abdominal Surgery, Johannes Gutenberg University Hospital, Mainz, Germany (3) Department of Colorectal and Laparoscopic Surgery, James Paget University Hospital, Norfolk, UK Article History: Registration Date: 12/04/2010 Received Date: 13/11/2009 Accepted Date: 12/04/2010 Online Date: 04/05/2010
    Keywords: Meta-analysis ; Evidence based ; Publication bias ; Jadad composite scale ; Esophageal stents ; Esophageal palliation ; Brachytherapy ; Thermal tumor ablation ; Reflux ; Malignant dysphagia
    ISSN: 0163-2116
    E-ISSN: 1573-2568
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  • 10
    Language: English
    In: Surgical Endoscopy, 2013, Vol.27(7), pp.2526-2541
    Keywords: TEP ; Stoppa procedure ; Nyhus procedure ; Decision analysis ; Quality-adjusted life years ; Incremental cost-effectiveness ratio
    ISSN: 0930-2794
    E-ISSN: 1432-2218
    Source: Springer Science & Business Media B.V.
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