Post-exercise pulsatility index indicates treatment effects in peripheral arterial occlusive disease (PAOD).

BACKGROUND: Hypothesis: Post-exercise measurements better discriminate PAOD-patients from healthy persons and they more sensitively detect hemodynamic improvements after treatment procedures than resting measurements. METHODS: A total of 19 healthy volunteers and 23 consecutive PAOD-patients underwent measurements of peak systolic velocity (PSV), end-diastolic velocity (EDV), minimal diastolic velocity (MDV), time-averaged maximum velocities (TAMAX), resistance index (RI) and pulsatility index (PI) before and after a standard exercise test (at 1, 2, 3, 4 and 5 min) before and after treatment (incl. epidemiological data, PAOD risk factors and comorbidities). RESULTS: In resting values, healthy persons and PAOD-patients did not differ significantly in any of the hemodynamic parameters. PSV increased after treatment in PAOD-patients by 5 cm/s (paired t­test, p: 0.025); however, when the amplitude of autoregulatory changes related to the resting values were calculated, PAOD-patients showed clearly less hemodynamic changes after exercise than healthy persons (p: 0.04; 0.002; <0.001 for PSV, TAMAX and PI, resp.). The time course after exercise was compared by repeated measures of ANOVA. Healthy persons differed significantly in PI, RI and PSV from PAOD patients before and after treatment (p<0.001 each). The PAOD-patients revealed a significantly improved PI after treatment (p: 0.042). The only factor contributing significantly to PI independently from grouping was direct arterial vascularization as compared to discontinuous effects by an obstructed arterial tree. CONCLUSION: Healthy persons cannot be well differentiated from PAOD-patients solely by hemodynamics at rest but by characteristic changes after standard exercise. Treatment effects are reflected by higher PI-values after exercise.

High incidence of deep vein thrombosis during the treatment of pseudoaneurysms - a retrospective nonrandomized study.

Background: Pseudoaneurysms (PSAs) are concerning complications after arterial invasive interventions. Therapeutic options include manual ultrasound-assisted compression, pressure dressings, surgical intervention and thrombin injection. Compression of neighboring veins is obvious. However, the incidence of deep vein thrombosis (DVT) in patients with PSA has not previously been investigated. Patients and methods: In this retrospective, nonrandomized study 238 patients with PSA were analyzed from 2013 to 2018. In 149 patients, all of the parameters were complete for participating. PSAs were treated according to the local standard therapy with either ultrasound-guided compression followed by compression bandage or thrombin injection. Treatment success was evaluated 24 hours later, and the venous system was examined for the presence of DVT. Results: Peripheral DVT was found in 25.4% patients after ultrasound-assisted compression and subsequent pressure bandages, but only 6.4% of patients had DVT after thrombin injection (p = 0.013). Lower leg veins, particularly veins of the crural muscles, were primarily affected. Significantly more PSAs were successfully treated without the occurrence of DVT in the thrombin injection group compared to the compression group (93.6 vs. 69.0%; p = 0.001). Conclusions: Our study revealed that the use of thrombin injections resulted in a significantly lower rate of postinterventional DVT and a higher total number of successfully treated PSAs compared to compression therapy.

Surgical teaching at the Medical School Otto-von-Guericke University of Magdeburg - basic conceptual description.

Teaching in surgery, one of the classical big clinical and main disciplines beside internal medicine, needs to be also associated with great attention in regard to a valuable final result at the end of the study of human medicine. In particular, surgery is not only the subject to a large number of lectures it also represents one third (four months) of the compulsory internship (practical year - in German, "Praktisches Jahr") at the end of the study of medicine. Therefore, medical teaching of students should be always part of serious and steady attempts to optimize course und contents as a component of guiding activities focussing onto the substantial improvement of the study of medicine. In detail, the classical and traditionally established type of teaching, the (oral) lecture, has to be further developed and reasonably completed by numerous interactive and practice-oriented teaching, learning and examining modalities (obligatory or facultative seminars / courses, training in [very] small groups of students, bed-side teaching, individual practical exercises within the SkillsLab, groups of young researchers, research projects in teaching, scientific publications on topics and recommendable experiences ot teaching including students, "Teach-the-teacher" projects etc.). Although many novel concepts have been inaugurated and considerable advances have been achieved, there is a steady need for further improvement. In the presented representative but medical school-specific overview, the current complex surgical teaching concept, which has been continuously optimized over the last couple of years, at the Otto-von-Guericke University Medical School with University Hospital of Magdeburg (Germany) is described as a scientific and systematizing document as well as a manuscript associated with the ongoing preparation of an institutional "Teaching Manual" on surgical teaching and training for medical students. It should - last but not least - provide the basis for a public discussion, which vice versa might hopefully and possibly result in further structural reforms of (surgical) teaching in the near future.

Current diagnostics and treatment of fibrosarcoma -perspectives for future therapeutic targets and strategies.

Adult-type fibrosarcoma is a rare and highly aggressive subtype of soft tissue sarcomas. Due to the existence of other spindle-cell shaped sarcomas, its diagnosis is always one of exclusion. The likelihood of misdiagnoses between similar tumour entities is high, and often leads to inappropriate tumour treatment. We summarize here the main features of fibrosarcoma. When fibrosarcoma is appropriately diagnosed, the patient`s overall prognosis is generally quite poor. Fibrosarcoma is characterized by its low sensitivity towards radio- and chemotherapy as well as by its high rate of tumour recurrences. Thus it is important to identify new methods to improve treatment of this tumour entity. We discuss some promising new directions in fibrosarcoma research, specifically focusing on more effective targeting of the tumour microenvironment. Communication between tumour cells and their surrounding stromal tissue play a crucial role in cancer progression, invasion, metastasis and chemosensitivity. The therapeutic potential of targeting the tumour microenvironment is addressed.

Risk factors, short and long term outcome of anastomotic leaks in rectal cancer.

BACKGROUND: An anastomotic leak (AL) after colorectal surgery is one major reason for postoperative morbidity and mortality. There is growing evidence that AL affects short and long term outcome. This prospective German multicentre study aims to identify risk factors for AL and quantify effects on short and long term course after rectal cancer surgery. METHODS: From 1 January 2000 to 31 December 2010 381 hospitals attributed patients to the prospective multicentre study Quality Assurance in Colorectal Cancer managed by the Otto-von-Guericke-University Magdeburg (Germany). Included were 17 867 patients with histopathologically confirmed rectal carcinoma and primary anastomosis. Risk factor analysis included 13 items of demographic patient data, surgical course, hospital volume und tumour stage. RESULTS: In 2 134 (11.9%) patients an AL was diagnosed. Overall hospital mortality was 2.1% (with AL 7.5%, without AL 1.4%; p < 0.0001). In multivariate analysis male gender, ASA-classification ≥III, smoking history, alcohol history, intraoperative blood transfusion, no protective ileostomy, UICC-stage and height of tumour were independent risk factors. Overall survival (OS) was significantly shorter for patients with AL (UICC I-III; UICC I, II or III - each p < 0.0001). Disease free survival (DFS) was significantly shorter for patients with AL in UICC I-III; UICC II or UICC III (each p < 0.001). Rate of local relapse was not significantly affected by occurrence of AL. CONCLUSIONS: In this study patients with AL had a significantly worse OS. This was mainly due to an increased in hospital mortality. DFS was also negatively affected by AL whereas local relapse was not. This emphasizes the importance of successful treatment of AL related problems during the initial hospital stay.

Possible role of TGF ß1 in inflammatory pseudotumor associated with multiple neuroendocrine tumors of the small intestine.

INTRODUCTION: Inflammatory myofibroblastic tumors (IMTs), a rare condition of unknown etiology, have often been reported to be associated with specific infections or malignant tumors. The question of whether IMT themselves are an inflammatory or a neoplastic process is still going on. CASE REPORT: A 57-year-old female patient was transferred to our hospital with ileus caused by a mesenterial tumor. Intraoperatively, the mesenteric mass and the dependent small intestine segment, as well as a suspect hepatic lesion, were resected. The histopathological investigation revealed 8 malignant neuroendocrine tumors (NET) of the small intestine with lymphatic and hepatic metastasis and a mesenteric IMT. The postoperative course was uneventful, and the patient was discharged on the 18th postoperative day. The last follow-up after 30 months showed no recurrence of the IMT but clinical and radiological evidence of a persistent hepatic metastasis of the NETs. While plasma Chromogranin A remained suppressed by Sandostatin, the TGF ß1 level was markedly elevated. DISCUSSION: Based on the current literature and our previous experiences, we can state that IPT are an aberrant secondary immunological process possibly induced by excessive TGF ß1 and not a neoplasia. Nevertheless, the tumorous behavior points to a continuity between inflammation and neoplasia. Differential diagnoses and the potential molecular pathogenesis are further discussed.

German Bowel Cancer Center: An Attempt to Improve Treatment Quality.

Background. Colorectal cancer remains the second most common cause of death from malignancies, but treatment results show high diversity. Certified bowel cancer centres (BCC) are the basis of a German project for improvement of treatment. The aim of this study was to analyze if certification would enhance short-term outcome in rectal cancer surgery. Material and Methods. This quality assurance study included 8197 patients with rectal cancer treated between 1 January 2008 and 31 December 2010. We compared cohorts treated in certified and noncertified hospitals regarding preoperative variables and perioperative outcomes. Outcomes were verified by matched-pair analysis. Results. Patients of noncertified hospitals had higher ASA-scores, higher prevalence of risk factors, more distant metastases, lower tumour localization, lower frequency of pelvic MRI, and higher frequencies of missing values and undetermined TNM classifications (significant differences only). Outcome analysis revealed more general complications in certified hospitals (20.3% versus 17.4%, p = 0.03). Both cohorts did not differ significantly in percentage of R0-resections, intraoperative complications, anastomotic leakage, in-hospital death, and abdominal wall dehiscence. Conclusions. The concept of BCC is a step towards improving the structural and procedural quality. This is a good basis for improving outcome quality but cannot replace it. For a primary surgical disease like rectal cancer a specific, surgery-targeted program is still needed.

Relevance of primitive carotidobasilar anastomosis for internal carotid artery stenosis.

UNLABELLED: Primitive carotido-basilar anastomoses (PCA) are persistent fetal vessels. The aim of the study was to compare the clinical characteristics of patients operated on for internal carotid artery (ICA) stenosis with or without PCA in order to evaluate the impact of PCA on the treatment. MATERIAL AND METHODS: Consecutive patients operated on for ICA stenosis at our university hospital were included. Surgical treatment consisted in carotid endarterectomy (CEA) with patch plastic. RESULTS: Of the 380 CEA performed between 2006 and 2012, PCA were found in six patients (1.6%). All patients with PCA were symptomatic vs. 54% of patients without PCA (p=0.035). Significantly less posterior collateral flow was present in patients with PCA (33%) compared to those without PCA (85%, p=0.01). Only two of the six patients with PCA were diagnosed prior to surgery, none was ligated intraoperatively. PCA was not associated with stroke and restenosis at long-term follow up. CONCLUSIONS: PCA are rarely diagnosed prior to surgery in patients with ICA stenosis and need not to be ligated during CEA.

In vitro chemo-sensitivity assay guided chemotherapy is associated with prolonged overall survival in cancer patients.

THE AIM OF THE STUDY: The overall survival (OS) of patients suffering From various tumour entities was correlated with the results of in vitro-chemosensitivity assay (CSA) of the in vivo applied drugs. MATERIAL AND METHODS: Tumour specimen (n=611) were dissected in 514 patients and incubated for primary tumour cell culture. The histocytological regression assay was performed 5 days after adding chemotherapeutic substances to the cell cultures. n=329 patients undergoing chemotherapy were included in the in vitro/in vivo associations. OS was assessed and in vitro response groups compared using survival analysis. Furthermore Cox-regression analysis was performed on OS including CSA, age, TNM classification and treatment course. RESULTS: The growth rate of the primary was 73-96% depending on tumour entity. The in-vitro response rate varied with histology and drugs (e.g. 8-18% for methotrexate and 33-83% for epirubicine). OS was significantly prolonged for patients treated with in vitro effective drugs compared to empiric therapy (log-rank-test, p=0.0435). Cox-regression revealed that application of in vitro effective drugs, residual tumour and postoperative radiotherapy determined the death risk independently. CONCLUSIONS: When patients were treated with drugs effective in our CSA, OS was significantly prolonged compared to empiric therapy. CSA guided chemotherapy should be compared to empiric treatment by a prospective randomized trial.

Prediction of outcome in multiorgan resections for cancer using a bayes-network.

BACKGROUND/AIMS: The long-term success of multivisceral resections for cancer is difficult to forecast due to the complexity of factors influencing the prognosis. The aim of our study was to assess the predictivity of a Bayes network for the postoperative outcome and survival. METHODOLOGY: We included each oncologic patient undergoing resection of 4 or more organs from 2002 till 2005 at the Ulm university hospital. Preoperative data were assessed as well as the tumour classification, the resected organs, intra- and postoperative complications and overall survival. Using the Genie 2.0 software we developed a Bayes network. RESULTS: Multivisceral tumour resections were performed in 22 patients. The receiver operating curve areas of the variables "survival >12 months" and "hospitalisation >28 days" as predicted by the Bayes network were 0.81 and 0.77 and differed significantly from 0.5 (p: 0.019 and 0.028, respectively). The positive predictive values of the Bayes network for these variables were 1 and 0.8 and the negative ones 0.71 and 0.88, respectively. CONCLUSIONS: Bayes networks are useful for the prognosis estimation of individual patients and can help to decide whether to perform a multivisceral resection for cancer.

Two-center observational study of the accuracy of a Bayes Network for short-term outcome prediction in cholecystectomy patients.

BACKGROUND: A Bayes Network was developed for individual risk prediction after cholecystectomy. Validity and robustness were compared with logistic regression analysis (LR). METHODS: Clinical databases were created at the Ulm University and St. Franziskus Flensburg hospitals between 2001 and 2010 were comprised of hospitalized cholecystolithiasis patients serving as model and test cohorts, respectively. The probabilities of in-hospital death, prolonged hospitalization (>7 days), relaparotomy and erythrocyte transfusions were predicted based solely on admission data by BN and LR. ROC curves were calculated. RESULTS: The Ulm and Flensburg cohorts consisted of 1,029 and 1,842 patients, respectively. The areas under the ROC curves for predicting death were 94% (p = 0.8) for both BN and LR, 70 vs. 76% (p < 0.001) for prolonged hospitalization, 69 vs. 68% (p = 0.8) for relaparotomy, and 84 vs. 78% (p = 0.1) for ET. Predictability declined for both methods when explanatory values were changed randomly. In contrast to LR, the BN revealed a good robustness to missing values. CONCLUSION: Both BN and MR predicted the death risk quite accurately. The advantage of BN consists of its robustness to missing values. Moreover, its graphical representation may be helpful for clinical decision making.

Omeprazole inhibits proliferation and modulates autophagy in pancreatic cancer cells.

BACKGROUND: Omeprazole has recently been described as a modulator of tumour chemoresistance, although its underlying molecular mechanisms remain controversial. Since pancreatic tumours are highly chemoresistant, a logical step would be to investigate the pharmacodynamic, morphological and biochemical effects of omeprazole on pancreatic cancer cell lines. METHODOLOGY/PRINCIPAL FINDINGS: Dose-effect curves of omeprazole, pantoprazole, gemcitabine, 5-fluorouracil and the combinations of omeprazole and 5-fluorouracil or gemcitabine were generated for the pancreatic cancer cell lines MiaPaCa-2, ASPC-1, Colo357, PancTu-1, Panc1 and Panc89. They revealed that omeprazole inhibited proliferation at probably non-toxic concentrations and reversed the hormesis phenomena of 5-fluorouracil. Electron microscopy showed that omeprazole led to accumulation of phagophores and early autophagosomes in ASPC-1 and MiaPaCa-2 cells. Signal changes indicating inhibited proliferation and programmed cell death were found by proton NMR spectroscopy of both cell lines when treated with omeprazole which was identified intracellularly. Omeprazole modulates the lysosomal transport pathway as shown by Western blot analysis of the expression of LAMP-1, Cathepsin-D and ß-COP in lysosome- and Golgi complex containing cell fractions. Acridine orange staining revealed that the pump function of the vATPase was not specifically inhibited by omeprazole. Gene expression of the autophagy-related LC3 gene as well as of Bad, Mdr-1, Atg12 and the vATPase was analysed after treatment of cells with 5-fluorouracil and omeprazole and confirmed the above mentioned results. CONCLUSIONS: We hypothesise that omeprazole interacts with the regulatory functions of the vATPase without inhibiting its pump function. A modulation of the lysosomal transport pathway and autophagy is caused in pancreatic cancer cells leading to programmed cell death. This may circumvent common resistance mechanisms of pancreatic cancer. Since omeprazole use has already been established in clinical practice these results could lead to new clinical applications.

Elevated transcript levels from the MDM2 P1 promoter and low p53 transcript levels are associated with poor prognosis in human pancreatic ductal adenocarcinoma.

UNLABELLED: OBJECTDIVES: Mouse double minute 2 is a key negative regulator of the p53 protein, a central node in the mediation of tumor suppression. The MDM2 gene contains 2 differently regulated promoters, MDM2-P1 and MDM2-P2, which differ strongly in their biological and clinical importance. METHODS: We assess the clinical significance of the expression of messenger RNA (mRNA) transcripts originating from both MDM2 promoters, measured with quantitative reverse transcription polymerase chain reaction in microdissected tissues from 57 patients with pancreatic ductal adenocarcinoma (PDAC). Furthermore, we determine the clinical relevance of p53 mRNA transcript expression and incorporate the somatic p53 mutational status into our analyses. RESULTS: Interestingly, elevated transcript levels from the P1 promoter, but not the P2 promoter, associate significantly with up to 6.3-fold increased relative risk for tumor-related death (Cox multivariate analysis: P = 0.013). Furthermore, transcripts originating from both MDM2 promoters are found to correlate significantly with p53 mRNA levels (up to r = 0.315; P = 0.017). In addition, low p53 mRNA expression associates with worse PDAC prognosis (relative risk = 2.28; P = 0.021). CONCLUSIONS: This study presents the first differentiated analysis of the MDM2-P1, MDM2-P2, and p53 transcript expression in human PDAC and demonstrates the significant clinical implications of those transcripts. Furthermore, it suggests an additional facet in the regulation of MDM2 via its P1 promoter in this malignancy.

MDM2 SNP309 associates with accelerated pancreatic adenocarcinoma formation.

OBJECTIVES: The G-allele of a single nucleotide polymorphism in the promoter of the MDM2 gene (MDM2 SNP309, T/G) associates with the acceleration of tumor formation and an increased risk for developing various malignancies. In this report, the possible role of the MDM2 SNP309 locus with regard to sex, age, and p53 mutational status in the development and progression of pancreatic ductal adenocarcinoma (PDAC) was examined. METHODS: One hundred three PDAC patients with comprehensive clinical, histopathologic, and follow-up data and 499 controls were included into the study and their MDM2 SNP309 genotypes obtained. RESULTS: Interestingly, the G-allele of MDM2 SNP309 is shown to associate with a 9-year earlier age of PDAC onset (P = 0.021). However, in contrast to studies of other tumor types, these observations are made predominantly in men and not women. Conditions of male PDAC patients with a G/G genotype are diagnosed at a mean of 12 years earlier than T-allele carriers (P = 0.0032). Furthermore, particularly younger male patients present a significant enrichment of the G-allele (P = 0.019). CONCLUSIONS: These observations suggest a novel role of the MDM2 SNP309 locus in regulating PDAC tumor formation in a male-specific manner.

Elevated expression of microRNAs 155, 203, 210 and 222 in pancreatic tumors is associated with poorer survival.

Pancreatic cancer is the eighth most common cancer and has an overall 5-year survival rate lower than 10%. Because of their ability to regulate gene expression, microRNAs can act as oncogenes or tumor-suppressor genes and so have garnered interest as possible prognostic and therapeutic markers during the last decade. However, the prognostic value of microRNA expression in pancreatic cancer has not been thoroughly investigated. We measured the levels of miR-155, miR-203, miR-210, miR-216, miR-217 and miR-222 by quantitative RT-PCR in a cohort of 56 microdissected pancreatic ductal adenocarcinomas (PDAC). These microRNAs were chosen as they had previously been shown to be differentially expressed in pancreatic tumors compared to normal tissues. The possible association of microRNA expression and patients' survival was examined using multivariate Cox's regression hazard analyses. Interestingly, significant correlations between elevated microRNA expression and overall survival were observed for miR-155 (RR = 2.50; p = 0.005), miR-203 (RR = 2.21; p = 0.017), miR-210 (RR = 2.48; p = 0.005) and miR-222 (RR = 2.05; p = 0.035). Furthermore, tumors from patients demonstrating elevated expression levels of all 4 microRNAs possessed a 6.2-fold increased risk of tumor-related death compared to patients whose tumors showed a lower expression of these microRNAs. This study provides the first evidence for an oncogenic activity of miR-155, miR-203, miR-210 and miR-222 in the development of pancreatic cancer as has been reported for other tumor types. Furthermore, the putative target genes for these microRNAs suggest a complex signaling network that can affect PDAC tumorigenesis and tumor progression.

How to treat esophageal perforations when determinants and predictors of mortality are considered.

BACKGROUND: Published lethality rates of esophageal perforation (EP) vary depending on patient- and disease-related factors. This study was designed to evaluate how these factors impact death. Furthermore, we calculated the predictive accuracy of the Mortality Prediction Model (MPM II) and the Simplified Acute Physiology Score (SAPS II) for in-hospital death. Conclusions about treatment decisions were drawn based on our data and analysis of recent literature. METHODS: Every patient who was treated for EP at our department from December 2001 to July 2008 is included in this study. Logistic regression analyses of various risk factors, such as etiology, time interval, size, comorbidities, localization, type of treatment, and preexisting pathologies of the esophagus on death, were performed. RESULTS: Of the 41 patients diagnosed with EP, nine died (21%). The most important risk factor concerning death was cirrhosis of the liver (0 vs. 89% mortality; odds ratio, 208; P<0.001). Accuracy for lethality risk prediction was calculated with MPM II and SAPS II on admission, and afterward the characteristic increase that occurred was evaluated by using receiver operator characteristic curves. Optimal results were achieved by using a characteristic SAPS II increase (AUC 0.86; P: 0.009) after the patient was admitted to the intensive care unit. CONCLUSIONS: Our study was the first to demonstrate that a rapid or continuous increase more than 40 of the daily SAPS II clearly indicates that a high risk of death is imminent. This should be used as a reevaluation factor when choosing a treatment strategy.

Prognostic relevance of hTERT mRNA expression in ductal adenocarcinoma of the pancreas.

Telomerase is thought to play an essential role in tumorigenesis and progression. Its activity is directly correlated with the expression of its catalytic subunit, human telomerase reverse transcriptase (hTERT). A correlation of transcript expression with a poor prognosis has been detected in different human malignancies. However, data on hTERT in pancreatic ductal adenocarcinoma (PDAC) are purely descriptive so far. Therefore, we evaluated the impact of hTERT expression on patients' prognosis. Human telomerase reverse transcriptase mRNA isolates from 56 human microdissected PDAC tissues were analyzed by quantitative reverse transcription-polymerase chain reaction and multivariate Cox regression hazard test. Elevated hTERT transcript levels were measured in 23 of 56 PDAC tissues, 33 patients showed no detectable transcripts. Unexpectedly, a low expression of hTERT mRNA levels was associated with a worse prognosis for overall survival (relative risk = 5.33; P = .013) when compared to high levels, whereas undetectable expression showed an intermediate risk of tumor-related death. These data challenge previous findings outlining hTERT's negative impact on overall survival. The risk pattern obtained in PDAC suggests a more complex regulation of hTERT.

Impact of age on in-hospital mortality of surgical patients in a German university hospital.

Although the frequency of major surgical procedures in elderly patients is increasing, the impact of age as an independent factor on in-hospital mortality and capacity planning is uncertain. Therefore, we analyzed how age, gender, number of diagnoses, and number of operations per patient are reflecting the demographic changes going on in the last decade. Furthermore, we analyzed the influence of age, main diagnoses, and comorbidities on in-hospital mortality, and cost factors, like duration of in-hospital stay, number of operations, and stay at the intensive care unit using multiple regression analysis. One thousand four hundred and sixty-nine patients hospitalized in 1990, and 5,718 patients hospitalized during 1998-2000 at the surgical department of a German university hospital were recruited. The average age of the patients increased significantly from the year 1990 to 1999 (by 4 years). The overall in-hospital mortality of the elderly patients (above 70 years of age) declined from 18.6% in 1990 to 7.6% in 2000. The number of diagnoses increased from 1.27 to 3.5 per patient. Age is a significant, independent risk factor for in-hospital mortality (odd's ratio (OR), 2.2), prolonged stay at intensive care unit (OR, 1.8), reoperation (OR, 1.3), and prolonged hospitalization (OR, 1.8). Nevertheless, oncologic diseases and pre-existing comorbidities are also significant independent factors for the clinical course and costs resulting from treating elderly patients. We conclude that decisions for surgical treatment should not be solely based on patient's age. The demographic changes in Europe result in an over-proportional increase in expenditures, which should be included when planning the capacities of a surgical department.