[Epidemiology and surgical treatment of pancreatic cancer in the State of Brandenburg : Analysis of 5418 cases]. / Epidemiologie und operative Behandlung des Pankreaskarzinoms im Flächenland Brandenburg : Analyse von 5418 Fällen.

BACKGROUND: Pancreatic cancer is the second most frequent cause of death among all forms of cancer in Germany with more than 19,000 deaths per year. The evaluation of the nationwide clinical cancer register aims to depict the reality of treatment and to improve the quality of treatment in the future by targeted analyses. METHOD: The data from the clinical cancer register of Brandenburg-Berlin for the diagnosis years 2001-2017 were analyzed with respect to the treatment of pancreatic cancer. Data from patients resident in the State of Brandenburg were evaluated with respect to epidemiological and therapeutic parameters. RESULTS: A total of 5418 patients with pancreatic cancer were documented in the register from 2001 to 2017 and 49.6% of the patients were diagnosed as having the Union for International Cancer Control (UICC) stage IV. A pancreas resection was carried out in 26.4% of the cases. In cases of cancer of the head of the pancreas the most frequent procedure was a pylorus-preserving resection with 51.8% and a pancreatectomy was carried out in 9.4%. The R0 resection rate of all pancreatic cancers in the period from 2014 to 2017 was 61.9%. After R0 resection the 5­year survival was 19%. Relevant multivariate survival factors were age, UICC stage and the residual (R) tumor classification. The case numbers per hospital had no influence on the absolute survival of patients operated on in the State of Brandenburg. CONCLUSION: The treatment reality in the State of Brandenburg for patients with pancreatic cancer corresponds to the results of international publications with respect to the key performance indicators investigated. A qualitative internationally comparable treatment of these patients is also possible in nonmetropolitan regions.

Outlier classification using autoencoders: Application for fluctuation driven flows in fusion plasmas.

Understanding the statistics of fluctuation driven flows in the boundary layer of magnetically confined plasmas is desired to accurately model the lifetime of the vacuum vessel components. Mirror Langmuir probes (MLPs) are a novel diagnostic that uniquely allow us to sample the plasma parameters on a time scale shorter than the characteristic time scale of their fluctuations. Sudden large-amplitude fluctuations in the plasma degrade the precision and accuracy of the plasma parameters reported by MLPs for cases in which the probe bias range is of insufficient amplitude. While some data samples can readily be classified as valid and invalid, we find that such a classification may be ambiguous for up to 40% of data sampled for the plasma parameters and bias voltages considered in this study. In this contribution, we employ an autoencoder (AE) to learn a low-dimensional representation of valid data samples. By definition, the coordinates in this space are the features that mostly characterize valid data. Ambiguous data samples are classified in this space using standard classifiers for vectorial data. In this way, we avoid defining complicated threshold rules to identify outliers, which require strong assumptions and introduce biases in the analysis. By removing the outliers that are identified in the latent low-dimensional space of the AE, we find that the average conductive and convective radial heat fluxes are between approximately 5% and 15% lower as when removing outliers identified by threshold values. For contributions to the radial heat flux due to triple correlations, the difference is up to 40%.

[Metastasized colonic cancer. When are there no indications for primary resection?]. / Metastasiertes Kolonkarzinom. Wann besteht keine Indikation zur primären Resektion?

The determination of an optimal treatment protocol for colonic cancer with synchronous incurable metastases remains a challenge, especially if the primary tumor is asymptomatic. Available data on whether resection of the primary tumor means a benefit or a danger to the patient are limited and inhomogeneous. A survival benefit could be shown only in retrospective studies with a bias against primary chemotherapy. The important question of the quality of life (QOL) remains completely unanswered in this respect. There are numerous groups and guidelines in favor of a primary palliative chemotherapy for these patients, possibly intensified by antibodies. The results of the currently ongoing randomized multicenter SYNCHRONUS study will deliver objective data facilitating the decision-making process with respect to the indications for resection of the primary tumor or primary chemotherapy.

[Quality assurance in colorectal cancer in Europe AD 2011]. / Qualitätssicherung beim kolorektalen Karzinom in Europa AD 2011.

INTRODUCTION: Malignant tumours are the second largest cause of death in Europe. Colorectal cancer takes second place within this group and is responsible for every eighth tumour-related death. CURRENT SITUATION: Surgical quality assurance requires a prospective observational study, any different type of study is not possible. A complete recording of all treated patients is a prerequisite for quality assurance. Currently, there are quality assurance programmes in Sweden, Norway, Denmark, Great Britain, Spain, Belgium, the Netherlands as well as the multinational study for patients from Germany, Poland and Italy. These projects deliver comprehensive information regarding the treatment of colorectal cancer. However, this information is deeply rooted in the organisation of the health-care system in the given country and is not easily transferable into international settings. Also, an interpretation of the collected data is often possible only within the given health-care system. FUTURE PERSPECTIVES: First, unified initial diagnostics is a prerequisite for quality assurance -  for the local extent and exclusion / confirmation of distant metastases. Until these criteria are unified, any comparison is limited, including a comparison of survival. Second, quality-of-life is not recorded in any of the current projects. Third, the main focus of a quality assurance project must be on therapy-dependent factors. The most sensible method of quality control remains within the connection of preoperative diagnostics (estimate of a best-case scenario), the surgical technique (the actual result) and a standardised pathological examination (evaluation of the actual result). These parameters can be recorded and compared within a quality assurance project regardless of the limitations of the national health-care systems. There is no alternative to a unified diagnostics model and unified histopathological evaluation, a complete picture of treatment quality is also not possible without systematic analysis of the quality of life.

[The development process of colon cancer centres]. / Der Prozess der Entwicklung von Zentren am Beispiel des Darmkrebszentrums.

Colon carcinomas are the most common malignant tumours in the Western world. Important findings about the overall quality of medical care have been reported in multi-centre observational studies. A quality enhancement of therapeutic care can be achieved by an additional increase in diagnostic and therapeutic measures in the interdisciplinary setting. The development of colon cancer centres improves the chance to objectively observe the results of medical care induced by the development of an interdisciplinary and cross-sectoral unit that includes a comprehensive medical care for patients. The implementation of the current medical findings based on evidence in clinical routine, the inspection of the usage of guidelines by external specialists as part of an audit and the continuous correction of analysed deficits in the course of treatment guarantee a continuous improvement of service.

Laparoscopy in the surgical treatment of rectal cancer in Germany 2000-2009.

AIM: The goal of this registry study was to compare open surgery with planned laparoscopy and then with laparoscopic to open conversion for rectal cancer surgery. METHOD: The study included 17,964 rectal cancer patients, operated on between 1 January 2000 and 31 December 2009, from 345 hospitals in Germany. All statistical tests were two-sided, with the χ(2) test (Pearson correlation) for patients and tumour characteristics. Fisher's exact test was used for complications and 30-day mortality. RESULTS: Of the 17,964 rectal cancer patients, 16,308 (90.8%) had an open procedure and 1656 (9.2%) were started with a laparoscopy. The 1455 patients with completed laparoscopic operations had fewer intra-operative and postoperative complications (5.4%vs 7.0%, P = 0.020, and 20.5%vs 25.8%, P < 0.001, respectively) and a lower 30-day mortality rate (1.1%vs 1.9%, P = 0.023). Of the 1656 planned laparoscopies, 201 (12.1%) were converted to open. The converted group suffered more intra-operative complications (18.9%vs 3.6% for completed laparoscopy and 7.0% for open surgery, P < 0.0001) and postoperative complications (32.3%vs 18.9% for completed laparoscopy and 25.8% for open operations, P < 0.0001). The converted group also had a higher 30-day mortality rate (2.0%vs 1.0% for completed laparoscopy and 1.9% for open surgery, P = 0.043). CONCLUSION: The more favourable patient profile provided justification for a laparoscopic procedure. For those converted to an open procedure, however, there were significantly more complications than planned open surgery patients. A move away from the standard open procedure for rectal cancer surgery and towards laparoscopy is not yet feasible.

Incidence of synchronous liver metastases in patients with colorectal cancer in relationship to clinico-pathologic characteristics. Results of a German prospective multicentre observational study.

BACKGROUND: The aim of this prospective observational multicentre study was to evaluate the incidence of synchronous liver metastases in colon and rectal cancer and to determine clinico-pathologic factors of the colorectal cancer that influenced the development of synchronous liver metastases. METHODS: Of 48,894 patients with colorectal cancer and who underwent surgery between January 2000 and December 2004, 7209 developed hepatic metastases and were analyzed. RESULTS: Synchronous liver metastases occurred in 14.7% of the colorectal cancer cases. Colon cancer (15.4%) led significantly more frequently to haematogenous spread to the liver than rectal cancer (13.5%) in a univariate approach. The N, V, and T stage, as well as the number of metastatic-involved local lymph nodes independently influenced the frequency of synchronous liver metastases in colon and rectal cancer in a multivariate analysis. Localization of the cancer in the colon led to a different number of synchronous liver metastases. Localization of the rectal cancer did not influence the rate of synchronous liver metastases. In the case of synchronous liver metastases, patients with colon cancer had significantly more peritoneal metastases (17.9 vs. 9.15%) but less lung (9.7 vs. 14%) and bone (0.7 vs. 1.6%) metastases. Simultaneous curative liver resections were done in 7% of colon cancer cases and in 8.8% of rectal cancer cases. CONCLUSION: In this national study the incidence of synchronous liver metastases in colon and rectal cancer were different. Independent factors leading to synchronous liver metastases could be identified. Venous infiltration seems to be important for the development of distant metastases.

Low-volume centre vs high-volume: the role of a quality assurance programme in colon cancer surgery.

AIM: The study aimed to determine whether hospitals within a quality assurance programme have outcomes of colon cancer surgery related to volume. METHOD: Data were used from an observational study to determine whether outcomes of colon cancer surgery are related to hospital volume. Hospitals were divided into three groups (low, medium and high) based on annual caseload. Cancer staging, resected lymph nodes, perioperative complications and follow up were monitored. Between 2000 and 2004, 345 hospitals entered 31,261 patients into the study: 202 hospitals (group I) were classified as low volume (<30 operations; 7760 patients; 24.8%), 111 (group II) as medium volume (30-60; 14,008 patients; 44.8%) and 32 (groups III) as high volume (>60; 9493 patients; 30.4%). RESULTS: High-volume centres treated more patients in UICC stages 0, I and IV, whereas low-volume centres treated more in stages II and III (P<0.001). There was no significant difference for intra-operative complications and anastomotic leakage. The difference in 30-day mortality between the low and high-volume groups was 0.8% (P=0.023).Local recurrence at 5 years was highest in the medium group. Overall survival was highest in the high-volume group; however, the difference was only significant between the medium and high-volume groups. For the low and high-volume groups, there was no significant difference in the 5-year overall survival rates. CONCLUSION: A definitive statement on outcome differences between low-volume and high-volume centres participating in a quality assurance programme cannot be made because of the heterogeneity of results and levels of significance. Studies on volume-outcome effects should be regarded critically.

Colon carcinoma--classification into right and left sided cancer or according to colonic subsite?--Analysis of 29,568 patients.

BACKGROUND: It is common to distinguish between right and left colon cancer (RCC and LCC). But, little is known about the influence of its exact location on the tumor stage and characteristics when considering the colonic subsite within the right or left colon. METHODS: During a five-year period, 29,568 consecutive patients were evaluated by data from the German multi-centered observational study "Colon/Rectal Carcinoma". Patients were split into 7 groups, each group representing a colonic subsite. They were compared regarding demographic factors, tumor stage, metastatic spread and histopathological characteristics. RESULTS: Analysis of tumor differentiation and histological subtype revealed a linear correlation to the ileocecal valve, supporting the right and left side classification model. However, cancers arising from the RCC's cecum (52.3%) and LCC's splenic flexure (51.0%) showed the highest proportion of UICC stage III/IV tumors and lymphatic invasion, whereas the RCC's ascending colon (46.5%) and LCC's descending (44.7%) showed the lowest, which supports a more complex classification system, breaking down the right and left sides into colonic subsites. CONCLUSIONS: Age, tumor grade and histological subtype support the right and left side classification model. However, gender, UICC stage, metastatic spread, T and N status, and lymphatic invasion correlated with a specific colonic subsite, irrespective of the side. The classification of RCC or LCC provides a general understanding of the tumor, but identification of the colonic subsite provides additional prognostic information. This study shows that the standard right and left side classification model may be insufficient.

[Quality evaluation in colorectal surgery in dependence on health-care categories of hospitals - minor differences in outcome with room for improvement in process quality]. / Qualität der Kolorektalchirurgie in Abhängigkeit von der Versorgungsstufe - geringe Unterschiede in der Ergebnisqualität bei Verbesserungspotenzial in der Prozessqualität leisten der Zertifizierung an deutschen Krankenhäusern Vorschub.

BACKGROUND: In the present study, different variables focusing on quality of colorectal surgery were investigated with respect to hospital categories: university hospital - U; hospital with maximum care responsibility (with a full spectrum of medical disciplines) - M; secondary care hospital with central regional responsibility (6-9 departments) - S; primary care hospital with local responsibility (2-5 departments) - G; The primary goal of this study was to analyse the current standard of care in patients with colorectal carcinoma in Germany. METHODS: From 2000-2004, data of 47 435 patients with colorectal cancer were evaluated, using data compiled in the German multi-centred observational study "Colon/Rectal Carcinoma". Analysis was performed for all variables with respect to hospital categories. Due to the remarkable number of patients, differences between the groups were to be regarded as significant if p<0.01. RESULTS: Preoperative colonoscopy (U: 70.1% M: 70.4% S: 67.9% G: 67.2) and preoperative determination of serum tumour markers (U: 83.8% M: 80.1% S: 81.9% G: 77.1) mainly indicate the quality of gastroenterological work-up before surgical intervention. In general, standards established by the "German Cancer Association" were not met and showed significantly lower rates for primary and secondary care hospitals. In contrast, variables indicating quality of perioperative course and outcome: rate of anastomotic leak (U: 2.1% M: 2.8% S: 2.1% G: 3.1%), rate of surgical intervention (U: 4.3% M: 3.1% S: 3.5% G: 3.1%) and mortality rate (U: 4.4% M: 2.2% S: 3.5% G: 4.1%) were in accordance with the requirements and did not differ significantly between all groups. However, an analysis of surgical and histopathological process quality (complete histology: U: 96.3% M: 93.6% S: 91.9% G: 90.9%) revealed significant differences with results being significantly lower for primary care hospitals. CONCLUSION: There is in principle no necessity to centre colorectal surgery in tertiary care hospitals as quality parameters focusing on results and outcome are comparable. However, in primary care hospitals, there are deficits with regards to process quality. Therefore, all measures aiming to enhance in particular process quality, i. e., hospital certification or participation with quality assurance studies, are highly desirable to further improve patient care.

Quality assessment of colorectal cancer care: an international online model.

AIM: We present an alternative approach to quality assessment in colorectal cancer, enabling a direct comparison of improvement at the level of the care provider. METHOD: In 2000, a quality assessment project in colorectal cancer in Germany was started. Data were provided for every patient treated for colorectal cancer. The enrolment questionnaire described patient data, risk factors, reason for hospitalization, diagnostics prior to surgery, surgical procedures, intraoperative complications, general and surgical complications in postoperative period, pathological report and discharge status. RESULTS: From 2000 to 2007, there were 57 429 patients included in the study. The total number of 372 hospitals that took part in the project varied from 153 to 281 per year. The overall resection rate for colon cancer was 97.1% and 94.8% for rectal cancer. Although the localization of rectal tumours did not vary, the percentage of abdominoperineal excisions fell from 26.1% in 2000 to 21.3% in 2008 (P < 0.001). Hospital mortality for colon cancer varied between 3.2% and 4.2% (P Pearson chi-square 0.032, linear-by-linear 0.257) and for rectal cancer between 2.7% and 3.7% (P Pearson chi-square 0.233). Patient age was not related to in-hospital mortality. CONCLUSION: The proposed model of quality assessment shows validity and results comparable to population-based studies. It does not require support from the health care system, making its implementation possible in every hospital worldwide.

[Right- and left-sided colonic cancer - different tumour entities]. / Karzinome des rechten und linken Kolons - verschiedene Tumorentitäten?

PURPOSE: Colorectal cancer is one of the most common malignancies in the Western world. In the past two decades, a growing amount of data has been reported suggesting that carcinomas of the right and left colon should be considered as different tumour entities. The aim of this review is to present a detailed analysis of the current knowledge regarding differences between right- and left-sided colon cancer and potential consequences for daily practice. METHODS: For this report all articles with relevant information on differences between right- and left-sided colon carcinoma found via Pubmed searches were analysed. Furthermore, findings of a previous study performed by our group were included. RESULTS: Patients with right-sided colon cancer are significantly older, predominantly women, with a higher rate of comorbidities. Most of the large epidemiological studies reported a continued rightward shift of colorectal cancer. Histopathologically, carcinoma of the right colon show a higher percentage of poorly differentiated, locally advanced tumours with a higher rate of mucinous carcinoma and different pattern of metastatic spread. Survival is significantly worse in patients with right-sided carcinomas. There are numerous genetic differences which account for the distinct carcinogenesis and biological behaviour. CONCLUSIONS: The numerous findings regarding differences between right- and left-sided colon cancers should have an impact on colon cancer screening and therapy. Firstly, there are defined risk groups which should receive complete colonoscopy, particularly if they present with symptoms suspicious for colon carcinoma. Furthermore, location of the colon cancer should be considered before group stratification into genetic, clinical and especially chemotherapy trials. A more tailored approach to colon cancer treatment would be highly desirable if future trials further support the hypothesis of two distinct tumour entities.

Primary appendiceal carcinoma--epidemiology, surgery and survival: results of a German multi-center study.

BACKGROUND: While carcinoma of the colon is a common malignancy, primary carcinoma of the appendix is rare. Many retrospective reviews outlined experience from different centers on appendiceal neoplasms. However, the study population is often small because it is so rare. The aim of this study was to analyze the type of surgery and survival of patients with appendiceal malignancies using data from a German multi-center observational study (31 341 patients). METHODS: During a five-year period, 196 consecutive patients with malignant appendiceal tumors were distributed into four groups: appendiceal carcinoids, adenocarcinoma, mucinous adenocarcinoma and adenosquamous carcinoma. The following parameters were analyzed: demographics, clinical presentation, comorbidities, type and appropriateness of surgery, final pathology and survival. RESULTS: Adenocarcinoma had the highest incidence (50.5%). The most common presentation was that of acute appendicitis. Mean age at presentation was youngest for carcinoid tumors. Carcinoid tumors had lowest tumor size and localized disease was present in 72.9%. Metastatic spread at presentation was highest for adenosquamous and mucinous adenocarcinoma and each had a distinct pattern. Right hemicolectomy was performed in 71.4%, limited resection in 11.7%. Overall 5-year survival was 83.1% for carcinoid vs. 49.2% for non-carcinoid tumors. Histological subtype and tumor stage significantly affected survival. CONCLUSIONS: Long-term outcome of carcinoid tumors is superior to non-carcinoid neoplasms. Among all appendiceal neoplasms, adenosquamous carcinoma is the rarest histological subtype which is most commonly associated with advanced tumor stage and worst prognosis. Appropriate oncologic resection is being performed in a significant percentage of cases in Germany. However, the high rate of right hemicolectomy in patients with small carcinoid tumors needs to be critically discussed.

Surgical practices for malignant left colonic obstruction in Germany.

AIM: Data from the multicentric observation study Kolon/Rektum-Karzinome (Primärtumor) (primary colorectal carcinoma) are adduced to assess the status of surgical treatment of this condition in Germany and to compare different operative approaches in the emergency treatment of obstructive left-sided colon cancer, especially diversion (Hartmann's procedure) and primary anastomosis. PATIENTS AND METHODS: Out of 15,911 patients with cancer of the left colon, recorded between 01.01.2000 and 31.12.2004, a total of 743 patients underwent emergency surgery for an obstructive tumour, performed as a radical resection. These patients were compared in respect of their risk profile and postoperative result. RESULTS: In 57.9% (n=430) a one-stage operation (Group I), in 11.7% (n=87) a primary anastomosis with protective stoma (Group II), and in 30.4% (n=226), Hartmann's procedure (Group III) was performed. In Group III more patients were male, overweight and multimorbid, and more had advanced-stage tumours. The morbidity and hospital mortality (overall hospital mortality, 7.7%; n=57) did not differ significantly between the groups. The insertion of a protective stoma did not affect the rate of anastomotic insufficiency (Group I, 7%; Group II, 8.0%). CONCLUSIONS: Primary anastomosis for emergency left colon carcinoma obstruction should only be regarded as indicated in cases where the risk profile is favourable. Our results suggest that in advanced obstruction and in high-risk cases Hartmann's procedure should be used. A protective stoma did not appear to confer any advantage.

Anastomotic leakage after colon cancer surgery: a predictor of significant morbidity and hospital mortality, and diminished tumour-free survival.

AIM: The objective of this study was to find out the effects of anastomotic leakage (AL) following resection of colon cancer upon perioperative outcome and long-term oncological result. PATIENTS AND METHODS: Using the database of a country-wide quality assurance study "Quality Assurance in Primary Colorectal Carcinoma" we analysed the data from the complete sub-population of 844 patients who had AL after resection of colon cancer. These were compared with corresponding data from 27 427 similar patients without AL. Hospital mortality, AL-associated post-operative morbidity and long-term outcome were investigated. RESULTS: Hospital mortality after AL was 18.6%, compared with 2.6% for patients without AI. AL-related secondary complications occurred in 62.7% cases, while patients without AL had a corresponding rate of 19.9%. Those with AL had a poorer long-term oncological result, with a five-year survival rate of 51.0% (p<0.001) and a five-year tumour-free survival rate of 63.0% (compare 74.6% without AL; p<0.001). CONCLUSIONS: Post-operative AL after resection of colon cancer is associated with significant morbidity and hospital mortality rates and with a greater risk of a poor oncological outcome.

[Surgical management of bevacizumab-associated peritonitis due to perforation]. / Chirurgisches Management der perforationsbedingten Peritonitis im Zusammenhang mit einer Bevacizumab-Therapie.

INTRODUCTION: Bevacizumab (Avastin, Fa. Roche, Genentech) is the first anti-angiogenic agent to be approved for the routine clinical treatment of cancer. Its toxicity profile is different to that of standard chemotherapeutic substances. Despite the rarity of gastrointestinal (GI) perforation in patients treated with bevacizumab, this serious adverse event results in significant morbidity and mortality. It was the aim of this study, based on exemplary cases of the reporting clinic as well as on published experiences, to characterise the specific clinical findings, the extraordinary pathogenesis, and the therapeutic outcome of such cases of peritonitis caused by perforation after antibody treatment. METHODS: Data of all patients with perforation-caused peritonitis due to bevacizumab therapy since its clinical inauguration were sought in i) the database of the reporting clinic (case series), ii) in the published literature for comparison (historical comparative group) and iii) analysed with regard to results of the surgical management (evaluated parameters: rate of anastomotic insufficiency / disturbances of wound healing, morbidity, mortality). RESULTS: Over a time period of 4 years (from 2 / 1 / 2004 to 1 / 31 / 2008), overall 15 patients were found in this study, among whom 4 patients came from the reporting clinic (mean age, 57 years; males : females = 2 : 2). The mean duration of antibody (Ab) treatment until occurrence of the complication was 70 days (range: 8-150 days). Thirteen patients underwent surgical intervention, 2 patients died due to severe peritonitis without any operation. The overall morbidity was 73.3 % (n = 11 / 15), the mortality was 33.3 % (n = 5 / 15). All patients with an anastomosis developed an anastomotic insufficiency (100 %). Wound healing complications occurred in 38.5 % of the subjects (n = 5 / 13). CONCLUSIONS: Peritonitis after GI perforation due to bevacizumab-based Ab treatment needs to be considered as a rare but serious and life-threatening complication. Impairment of wound healing because of the inhibition of angiogenesis is the reason for a different management of GI perforation under these conditions compared with the standard surgical treatment of peritonitis of other causes. In particular, it is recommended to avoid primary anastomosis and to prefer application of an intestinal stoma.

[Surgical treatment of esophageal cancer].

Prospective study, included 117 patients with esophageal cancer, all received resection of the esophagus through laparatomy and and right-side thoracotomy without neoadjuvant chemotherapy. 70,0% of patients demonstrated stage higher then IIb UICC. R0 resection was possible in 101 patients (86,3%). Hospital lethality was 5,1%. Overall lethality among the operated patients was 21,4%. Long-term follow-up results were obtained in 96,6%. Surgical treatment alone does not provide satisfactory results for the patients with cancer of esophagus. Further therapy individualization and combination of surgery with modern neoadjuvant chemotherapy can provide better prognosis for these patients.

Conversion from laparoscopic to open colonic cancer resection - associated factors and their influence on long-term oncological outcome.

PURPOSE: Comparisons of open and laparoscopic colon cancer resection have shown that laparoscopy offers an oncologically safe option. However, there are no data on long-term influence of converted resection, despite conversion rates of up to 30% and the general observation that short-term outcome is significantly worsened. The aim was to compare the long-term results of primary open resection (OR), purely laparoscopic resection (LR-p) and converted resection (LR-c). METHODS: In a prospective study at 282 German hospitals demographic, tumor- and treatment-related data and disease-free survival were compared in the three groups. RESULTS: 8015 of 8307 patients with OR, 280 of 290 patients with LR-p and 55 of 56 patients with LR-c were followed for 39.5 months (median). Overall, no statistically significant differences were seen for five-year DFS (74.8%, 81.3% and 65.6%). However, for patients in stage II with conversion, the five-year DFS was significantly poorer (43.3%) than for OR (80.5%; p=0.003) and LR-p patients (92.5%; p=0.001). For stages I and III no differences were observed. CONCLUSION: Conversion of laparoscopic colon cancer resection worsens DFS in locally advanced stage II carcinoma. There is a need to reduce the conversion rate by adequate patient selection for laparoscopic resection by experienced surgeons.

Rectusbanding: a method for the repair of incisional hernias.

BACKGROUND: We report on a new method of incisional hernia repair applicable to any size of hernia and the long-term results of this method. Musculus rectus abdominis is bandaged or partially bandaged in a loose way with a 2-cm-wide band of polypropylene (Prolene) on both sides at a distance of 2 cm, depending on the size of the hernial opening. The aims of this technique, which were defined in 1999 when we started using the method, were to find a simple method for surgeons, a safe mesh fixation and the prevention of a postoperative stiff abdomen. Another aim was to find a method for optimal patient care at reasonable costs. METHODS: Two hundred and seventeen patients underwent an operation according to this method in our department from June 1999 until December 2007. The first 75 patients of this cohort were treated using a technique in which the musculus rectus abdominis was bandaged in a loose way. One hundred and forty-two patients (since October 2001) were treated using a technique in which the muscle was not entirely bandaged. Instead, the polypropylene bands, which had been placed in sublay position, were penetrating the lateral rim through incisions and were fastened there. We included 124 patients (October 2001 to December 2006) in our further examination with a follow-up of 17-79 months. RESULTS: We found a recurrence rate of 6%, 80.1% of the patients had no trouble, 18.1% of the patients had very rarely any complaint, 0.9% of the patients had problems after exercise and 0.9% had permanent problems. All patients had excellent mobility of the abdomen. CONCLUSION: This method was proven to give good results in the long run and can be easily learned by any surgeon. This method is a true alternative to all methods which have been published so far.