Peritoneal metastasis in gastric cancer: results from the German database.

BACKGROUND: Patients with peritoneal metastases of gastric cancer have a poor prognosis with a median survival of 7 months. A benefit of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) could be shown in several selected patient cohorts but remains controversial. The aim of this study was, to reflect the results of a national German HIPEC registry initiated by the German Society of General and Visceral Surgery (DGAV). METHODS: The DGAV HIPEC registry StuDoQ|Peritoneum documents patients with peritoneal malignancy contributed from 52 hospitals. All consecutive documented patients from 2011 until 2016 (n = 3078) were treated with CRS and HIPEC and were analysed. A total of 315 (10%) suffered from gastric cancer and were analysed. RESULTS: A complete data set of 235 patients was available for this study, including 113 male (48.1%) and 122 female (51.9%) patients with a median age of 53.4 years (SD ± 11.9). The median PCI was 8.0 (range 1-30). A complete cytoreduction was achieved in 121 patients (71.6%). Postoperative complications (Clavien-Dindo grades 3-4) occurred in 40 patients (17%). The median overall survival (OS) time was 13 months. The 5-year survival rate was 6%. According to the PCI from 0-6 (n = 74); 7-15 (n = 70) and 16-39 (n = 24) the median OS differs significantly (18 months vs. 12 months vs. 5 months; p = 0.002). CONCLUSIONS: CRS and HIPEC in selected patients with gastric cancer and peritoneal spread can improve survival when they are treated in centers. An accurate staging and patient selection are of major importance to achieve long-term survival.

[Low Anterior Resection Syndrome - Diagnosis - Therapy - Prophylaxis]. / Das Low anterior Resection Syndrome (LARS).

BACKGROUND: As 5-year survival after rectal cancer surgery has reached 80%, there is increasing interest in quality of life. Low anterior resection syndrome (LARS) is an overall measure of the postoperative functional disorder due to the surgical resection. MATERIAL AND METHODS: A thorough review of the literature was undertaken to help to define LARS and develop an understanding of its pathophysiology, diagnosis, therapy, and prophylaxis. RESULTS: LARS is observed after up to 80% of stoma sparing procedures performed for rectal carcinoma. The capacity of the rectal remnant as well as intraoperative damage to neuronal structures seem to be the most important pathogenetic factors resulting in a substantial impairment of the quality of life. Pelvic floor rehabilitation, rectal balloon distension training, biofeedback, anal irrigation, and sacral nerve stimulation are multimodal treatment options for LARS. CONCLUSIONS: Various therapeutic approaches exist to attenuate the consequences of LARS for the individual patient. Nevertheless, considerable work has to be done in the future not only to improve survival but also the quality of live after rectal carcinoma.