[Surgical and adjuvant therapy of neuroendocrine tumors of the gastrointestinal tract and their metastases. A retrospective analysis of personal patient group]. / Die operative und adjuvante Therapie neuroendokriner Tumoren des Gastrointestinaltrakts und ihrer Metastasen. Eine retrospektive Analyse des eigenen Patientenguts.

INTRODUCTION: Carcinoid tumors are the most common neuroendocrine tumors of the gastrointestinal tract. Surgical treatment and prognosis depend on the location of the tumor. METHOD: Between 01.01.1985 and 31.12.1999 25 patients with neuroendocrine tumors of the gastrointestinal tract or their metastases were treated in our institution. The records of these patients were reviewed retrospectively. Patients still alive were reexamined clinically. RESULTS AND CONCLUSIONS: The most frequent primary sites were the ileum and jejunum (36%), appendix (36%), stomach (12%), pancreas (8%), colon (4%) and bronchus with hepatic metastasis (4%). A malignant carcinoid syndrome was present in 8 patients. In patients with neuroendocrine tumors, curative, radical tumor removal should be attempted. Some patients with advanced disease needed some surgery for tumor debulking and resection of metastases. In non-resectable liver metastases hepatic arterial chemotherapy and chemoembolization after implantation of port catheters seem to be very beneficial therapeutic options. A fixed part of the therapeutic regime in progressive disease is adjuvant chemotherapy with 5-fluorouracil and streptozotocin and symptomatic therapy with octreotide.

Perioperative management in thoracic surgery.

The quality of perioperative treatment for patients undergoing thoracic surgery is of the utmost importance for postoperative morbidity and mortality. Hence, it was the purpose of this study to examine various aspects of our own procedure. The clinical course following 812 successive thoracotomies in 792 patients over a period of 3 years was documented and analysed. The overall complication rate was found to be 19.7%, with a mortality of 3.8% over a 30-day period. Secretostasis, atelectasis and pneumonia were the most common complications. Owing to the predeposition of autologous blood, the percentage of patients requiring allogeneic blood transfusion was reduced from 27% to 9%. There was no evidence suggesting an increase in the complication rate or a longer stay in hospital. Perioperative antibiotic prophylaxis has reduced postoperative wound infection significantly. Similar reductions in the FEV1 are recorded following thoracic surgery, irrespective of the amount of lung tissue resected. This observation indicates that the remaining lung tissue is severely compromised throughout the postoperative period and that the surgical trauma alone is a major factor influencing postoperative pulmonary function for at least 2 weeks.

[Preoperative autologous blood donation and its effects on pulmonary lobectomy]. / Die präoperative Eigenblutspende und ihre Auswirkungen bei pulmonalen Lobektomien.

It was the aim of the underlying study to determine the value of preoperative autologous blood donation and its importance with regard to pulmonal lobectomies. Over the course of three years and a total number of 220 operations, autologous blood was preoperatively deposited in 74 cases. 21 patients did not meet the criteria for autologous blood donation and hence, were omitted from the study. It was found that only 5.4% of the patients who had donated autologous blood required a homologous blood transfusion versus 27.2% in the non-donor group. This would imply, that the necessity for homologous blood transfusion is reduced by approximately 80% in patients depositing autologous blood prior to surgery. Observing a similar haemoglobin in both groups at admission, it was found that autologous blood donors went into surgery with an hb 1.5 g/dl lower than non donors; the levels however adjusting themselves immediately postoperatively. No increased complication rate was found as a result of preoperative autologous blood donation. The data indicate that only 30% of patients undergoing pulmonal lobectomy require homologous blood transfusions. 80% of these patients could profit from preoperative autologous blood donation. For 70% of all patients the procedure would be of no benefit. Bearing in mind the immunosuppressive effect of homologous blood transfusions, which may result in a higher rate of tumor recurrence, we find preoperative autologous blood donation a justifiable procedure even under these circumstances. It would however be beneficial if studies were conducted hereby investigating to what extent similar results could be achieved by preoperative acute isovolemic hemodilution.

[Differed autologous blood transfusion and its effects during pulmonary lobectomy]. / L'autotransfusion différée et ses effets lors de la lobectomie pulmonaire.

The aim of our study was to determine the value of preoperative autologous blood donation and its importance with regard to pulmonary lobectomies. Over the course of three years and a total number of 220 operations, autologous blood was preoperatively deposited in 74 cases. 21 patients did not meet the criteria for autologous blood donation and were excluded from the study. It was found that only 6.8% of the patients who had donated autologous blood required a homologous blood transfusion versus 27.2% in the non-donor group. This would imply, that the necessity for homologous blood transfusion is reduced by approximately 75% in patients depositing autologous blood prior to surgery. While we observed similar haemoglobin levels in both groups at admission, it was found that autologous blood donors went into surgery with an Hb 1.5 g% lower than non donors; the levels however adjusted themselves immediately postoperatively. No increased complication rate was found as a result of preoperative autologous blood donation. The data indicate that only 30% of patients undergoing pulmonary lobectomy require homologous blood transfusions. 80% of these patients could benefit from preoperative autologous blood donation. For 70% of all patients the procedure would be of no benefit. Bearing in mind the immunosuppressive effect of homologous blood transfusions, which may result in a higher rate of tumor recurrence, we find preoperative autologous blood donation a justifiable procedure even under these circumstances. It would however be beneficial if studies were conducted to investigate to what extent similar results could be achieved by preoperative acute isovolemic hemodilution.