[Recurrent colorectal liver metastases: who benefits from a second hepatic resection?]. / Rezidivlebermetastasen kolorektaler Karzinome: Wer profitiert von einer zweiten Leberresektion?

BACKGROUND: Hepatic recurrence is seen in approximately 40 % of patients undergoing hepatectomy for colorectal metastases. The authors assessed the benefit and the main prognostic factors for a second liver resection of recurrent colorectal metastases. METHODS: This study reports the experience with second liver resections for recurrent liver metastases at a German University Hospital. A total of 39 parameters from 60 patients were identified from a prospective database and analysed as to their influence on recurrence-free survival and overall survival. RESULTS: At a median follow-up of 26 months (range: 2-173 months) after second hepatic resection, recurrence-free survival at 3 and 5 years were 50 % and 37 %, respectively. The overall survival at three and five years were 61 % and 52 %, respectively. Recurrence was identified in 58.3 % of the patients. Recurrences involved exclusively the liver in 19 patients (31.6 %). By multivariate analysis (Cox proportional hazard model), a time interval between diagnosis of the liver metastases of less than 24 months after operation for colorectal primary carcinoma (HR: 6.47, p = 0.002), a CEA level of 4.0 ng/mL or more (HR: 3.48, p = 0.004) at the time of first liver metastases and a size of second liver metastases of 80 mm or more (HR: 4.73, p = 0.007) were independent prognostic factors for a reduced recurrence-free survival. A repeat recurrence of liver metastases without the option of curative resection was the only risk factor for overall survival after second hepatic resection (p = 0.009). In these cases, mortality risk was 4.51-fold, however, when the second liver recurrence was resectable, the mortality risk increased only 1.4-fold. CONCLUSIONS: Technically resectable recurrent colorectal hepatic metastases should be resected the same as the first metastases. Characteristics of the primary metastasis as well as parameters of the hepatic recurrence are shown to influence the prognosis of patients after resection of recurrent liver metastases. Repeat resection of colorectal liver metastases allows for improved survival in patients even after two previous liver operations.

[Multiple endocrine neoplasia type 1]. / Multiple endokrine Neoplasie Typ 1.

Owing to the growing use of ultrasound in the head and neck and to technical progress, the number of tumours diagnosed in the thyroid region is increasing. The rare differential diagnosis of multiple endocrine neoplasm type 1 in a case with a unilateral intrathyroidal lump and two lumps located dorsal to the contralateral thyroid is discussed.

Contrast-enhanced ultrasonography to detect liver metastases : a prospective trial to compare transcutaneous unenhanced and contrast-enhanced ultrasonography in patients undergoing laparotomy.

BACKGROUND/AIMS: The advent of contrast-enhanced ultrasound (CEUS) has called into question the efficacy of standard ultrasonographic techniques. In this study, we evaluated B-mode and color-duplex imaging and CEUS in the detection of liver metastases, using intraoperative and histological findings as a reference. MATERIALS AND METHODS: Before laparotomy, 108 patients suspected of having liver metastases were prospectively examined with B-mode and color-duplex imaging, followed by contrast-enhanced ultrasound (2.4 ml SonoVue). Patients with unresectable tumors (n=8) were excluded from the analysis. The sonographic diagnosis in the remaining 100 patients was compared to the intraoperative and histological findings. RESULTS/FINDINGS: CEUS improved the sensitivity for detecting liver lesions from 56.3% (B-mode) to 83.8% (CEUS) (p=0.004). In particular, the contrast agent led to an improvement in ultrasonographic detection in the following cases: nodular metastases smaller than one centimeter; after adjuvant chemotherapy; for tumors near the surface of the liver; and for lesions situated around the ligamentum teres. INTERPRETATION/CONCLUSIONS: CEUS provides significant improvement in the detection of liver metastases, and should therefore, be performed routinely in the surveillance of cancer patients.

[Early results of esophageal surgery in carcinoma]. / Frühergebnisse der Osophaguschirurgie beim Karzinom.

AIMS: The aim of this study was the evaluation of early results of esophageal resection for cancer including the assessment of pre-operative risk factors and post-operative mortality (risk score developed by Barthels et al. 1998). METHODS: One hundred and eighty one patients with esophageal cancer were operated with curative intention between October 1993 and December 2002. In a prospective analysis were reviewed: patient characteristics, characteristics of the esophageal cancer, part and type of esophageal resection, radicality, complications and mortality. CONCLUSION: In total, a resection of the tumor could be achieved in 143 cases (79.0%). The overall complication rate was 52.5%, mainly cardio-pulmonary complications (25.9%) were seen. The surgical complications were determined by anastomotic leak (12.6%) and recurrent nerve injury (9.1%). Both types of complications were observed significantly more often after esophageal resection with a cervical anastomosis (p = 0.03 and p < 0.01). The hospital mortality was 8.4%. The 30 days mortality was 4.9%. Using a preoperative risk score retro- and prospectively, our data showed a lower mortality in patients with a low risk profile (2.4% and 2.3%) compared to those with a medium risk profile (7.4% and 6.4%). The only patient with a high risk profile died after resection. DISCUSSION AND SUMMARY: The results of this analysis show that resection of esophageal cancer can be accomplished with acceptable morbidity and mortality. However, it has to be taken into account that the increase of pre-operative factors leads to an increase in post-operative mortality.