Asunto(s)
Testimonio de Experto/legislación & jurisprudencia , Hernia Hiatal/diagnóstico , Hernia Hiatal/cirugía , Mala Praxis/legislación & jurisprudencia , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/cirugía , Estómago/patología , Compensación y Reparación/legislación & jurisprudencia , Conversión a Cirugía Abierta , Femenino , Gastrectomía , Adhesión a Directriz/legislación & jurisprudencia , Humanos , Laparoscopía , Persona de Mediana Edad , Necrosis/diagnóstico , Necrosis/cirugía , Reoperación/legislación & jurisprudenciaRESUMEN
BACKGROUND: The German NOTES registry (GNR) was initiated by the German Society for General and Visceral Surgery (DGAV) as a treatment and outcome database for natural orifice transluminal endoscopic surgery (NOTES). AIM: The aim of this study was the descriptive analysis of all GNR data collected over a 5-year period since its start in 2008 with more than 3000 interventions. MATERIAL AND METHODS: The GNR is an online database with voluntary participation available to all German-speaking clinics. Demographic data, therapy details, complications and data on the postoperative course of patients are recorded. All cases in the GNR between March 2008 and November 2013 were included in the analysis. RESULTS: From a total of 3150 data sets 2992 (95 %) were valid and suited for the analysis. Hybrid transvaginal cholecystectomy was the most frequently used procedure (88.7 %), followed by hybrid transvaginal/transgastric appendectomy (6.1 %) and hybrid transvaginal/transrectal colon procedures (5.1 %). Intraoperative complications occurred in 1.6 %, postoperative complications in 3.7 % and conversions were reported in 1.5 %. Intraoperative bladder injuries and postoperative urinary tract infections were identified as method-specific complications of transvaginal procedures. Bowel injuries occurred as a rare (0.2 %) but potentially serious complication of transvaginal operations. CONCLUSION: The German surgical community ensures a safe and responsible introduction of the new NOTES operation techniques with its active participation in the GNR. Despite an overall low complication rate, the high number of procedures in the GNR permitted the identification of method-specific complications. This knowledge can be used to further increase the safety of NOTES in practice.
Asunto(s)
Apendicectomía/métodos , Colecistectomía/métodos , Colectomía/métodos , Cirugía Endoscópica por Orificios Naturales/métodos , Sistema de Registros , Apendicectomía/estadística & datos numéricos , Apendicectomía/tendencias , Colecistectomía/estadística & datos numéricos , Colecistectomía/tendencias , Colectomía/estadística & datos numéricos , Colectomía/tendencias , Femenino , Alemania , Humanos , Complicaciones Intraoperatorias/etiología , Complicaciones Intraoperatorias/terapia , Masculino , Cirugía Endoscópica por Orificios Naturales/estadística & datos numéricos , Cirugía Endoscópica por Orificios Naturales/tendencias , Evaluación de Procesos y Resultados en Atención de Salud/estadística & datos numéricos , Dolor Postoperatorio/etiología , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/terapia , Revisión de Utilización de Recursos/estadística & datos numéricosRESUMEN
BACKGROUND: The German guidelines for the therapy of rectal carcinoma in Union Internationale Contre le Cancer (UICC) stages II and III raise questions of overtherapy. This is why we have individualized the therapy in suitable isolated cases (localization in the upper third of the rectum and wider safety margins in cases of small T3). MATERIAL AND METHODS: All 131 patients with rectal cancer stages II and III, who were operated on within a time period of 4 years were retrospectively included in the study. In 30 favorable cases no radiotherapy was given and in 15 of these no chemotherapy. After an average of 57 months follow-up the course of the disease could be clarified in 95 % of the patients. RESULTS: The 5-year survival rate in the whole group was 81.5 % with a local recurrence rate of 8 %. Of the patients with no additional therapy (or only adjuvant chemotherapy), 30 had a 5-year survival rate of 100 % (86.7 %) and a local recurrence rate of 6.7 % (6.7 %). CONCLUSIONS: In this study it could be shown that an individualization of guidelines in special cases does not lead to a higher mortality rate or to a higher rate of local recurrence. The study highlights that chemotherapy and radiotherapy with all the negative consequences could be avoided for several patients.
Asunto(s)
Adhesión a Directriz , Planificación de Atención al Paciente , Neoplasias del Recto/patología , Neoplasias del Recto/terapia , Adulto , Anciano , Anciano de 80 o más Años , Quimioterapia Adyuvante , Terapia Combinada , Supervivencia sin Enfermedad , Femenino , Alemania , Humanos , Masculino , Persona de Mediana Edad , Terapia Neoadyuvante , Recurrencia Local de Neoplasia/mortalidad , Radioterapia Adyuvante , Neoplasias del Recto/clasificación , Neoplasias del Recto/mortalidad , Recto/patología , Recto/cirugíaRESUMEN
BACKGROUND: The concept of natural orifice transluminal endoscopic surgery (NOTES) consists of the reduction of access trauma by using a natural orifice access to the intra-abdominal cavity. This could possibly lead to less postoperative pain, quicker recovery from surgery, fewer postoperative complications, fewer wound infections, and fewer long-term problems such as hernias. The Euro-NOTES Foundation has organized yearly meetings to work on this concept to bring it safely into clinical practice. The aim of this Euro-NOTES status update is to assess the yearly scientific working group reports and provide an overview on the current clinical practice of NOTES procedures. METHODS: After the Euro-NOTES meeting 2011 in Frankfurt, Germany, an analysis was started regarding the most important topics of the European working groups. All prospectively documented information was gathered from Euro-NOTES and D-NOTES working groups from 2007 to 2011. The top five topics were analyzed. RESULTS: The statements of the working group activities demonstrate the growing information and changing insights. The most important selected topics were infection issue, peritoneal access, education and training, platforms and new technology, closure, suture, and anastomosis. The focus on research topics changed over time. The principle of hybrid access has overcome the technical and safety limitations of pure NOTES. Currently the following NOTES access routes are established for several indications: transvaginal access for cholecystectomy, appendectomy and colon resections; transesophageal access for myotomy; transgastric access for full-thickness small-tumor resections; and transanal/transcolonic access for rectal and colon resections. CONCLUSIONS: NOTES and hybrid NOTES techniques have emerged for all natural orifices and were introduced into clinical practice with a good safety record. There are different indications for different natural orifices. Each technique has been optimized for the purpose of finding a safe and realistic solution to perform the procedure according to the specific indication.
Asunto(s)
Cirugía Endoscópica por Orificios Naturales/tendencias , Anastomosis Quirúrgica/métodos , Europa (Continente) , Femenino , Humanos , Cirugía Endoscópica por Orificios Naturales/métodos , Peritonitis/epidemiología , Peritonitis/etiología , Peritonitis/prevención & control , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/prevención & control , Pautas de la Práctica en Medicina/estadística & datos numéricos , Estudios Prospectivos , Riesgo , Sociedades Médicas , Infección de la Herida Quirúrgica/epidemiología , Infección de la Herida Quirúrgica/prevención & control , Técnicas de Sutura , Investigación Biomédica Traslacional , Técnicas de Cierre de HeridasRESUMEN
NOTES ("natural orifice transluminal endoscopic surgery") has the potential to optimize minimally invasive surgery. In gynecology there is extensive experience with the transvaginal approach to the abdominal cavity. It is easy to perform, closure is safe and there is little risk of infection. Hence, this is the approach most suitable for NOTES. By means of rigid laparoscopic instruments cholecystectomy can be routinely performed. Such operations could be performed in 149 patients in our hospital and the NOTES register of the DGAV has data on more than 900 transvaginal operations.
Asunto(s)
Colposcopía/métodos , Laparoscopía/métodos , Procedimientos Quirúrgicos Mínimamente Invasivos/métodos , Animales , Colecistectomía Laparoscópica/instrumentación , Colecistectomía Laparoscópica/métodos , Cicatriz/prevención & control , Colposcopios , Diseño de Equipo , Humanos , Laparoscopios , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/prevención & control , Factores de Riesgo , Instrumentos QuirúrgicosRESUMEN
BACKGROUND AND STUDY AIMS: Natural orifice transluminal endoscopic surgery (NOTES) has been tested in the animal model for a multitude of procedures including cholecystectomy. Clinical experience using flexible endoscopes is, however, very limited. Transvaginal cholecystectomy has been shown to be the most feasible approach in which rigid instruments can be used. We report our experience in all patients treated over a 1-year period. PATIENTS AND METHODS: Between June 2007 and June 2008, 68 patients (mean age 50 years) underwent transvaginal cholecystectomy with an additional 5-mm umbilical trocar using rigid laparoscopic instruments. Data about symptoms, operation, and postoperative course were prospectively collected, as were findings of a gynecological follow-up examination 1 week after surgery and the results of an interview at least 3 months after surgery. RESULTS: All 68 operations were finished successfully without conversion, with a mean operation time of 51 minutes; in three additional cases severe pelvic adhesions prevented further transvaginal progress. There were no intraoperative or immediately postoperative complications, but one patient presented with a Douglas pouch abscess 3 weeks after surgery. Gynecologic follow-up exams 1 week after surgery were unremarkable. All patients were interviewed 3-10 months after surgery and had no abdominal or gynecological complaints including in relation to sexual intercourse. CONCLUSION: Transvaginal NOTES cholecystectomy with rigid instruments can be safely and effectively performed in daily routine.
Asunto(s)
Colecistectomía Laparoscópica/instrumentación , Colecistitis/cirugía , Cálculos Biliares/cirugía , Instrumentos Quirúrgicos , Adolescente , Adulto , Anciano , Endosonografía , Diseño de Equipo , Estudios de Factibilidad , Femenino , Estudios de Seguimiento , Humanos , Persona de Mediana Edad , Satisfacción del Paciente , Complicaciones Posoperatorias/diagnóstico por imagen , Complicaciones Posoperatorias/etiología , Estudios Prospectivos , Vagina/cirugía , Adulto JovenRESUMEN
The use of natural orifices for operations in the abdominal cavity (natural orifice transluminal endoscopic surgery, or NOTES) could be a conclusive development in the field of minimally invasive surgery. Early in the 1990s we had experiences with posterior colpotomy for removal of specimens in laparoscopic surgery. This is why we use the transvaginal approach in NOTES and combine it with a trocar hidden in the umbilicus. With this technique we could perform cholecystectomy without a visible scar. The operation could become routine also because of the use of our well-known rigid optics and instruments. From June 2007 until April 2008 we operated on 57 patients using this method. All operations finished successfully, and the mean operation time was 54 min. There was one complication. An abscess in the Douglas room had to be evacuated laparoscopically. All other postoperative courses were uneventful. After a minimum follow-up of 3 months, none of the patients had symptoms in the vagina or during sexual intercourse.
Asunto(s)
Colecistectomía Laparoscópica/métodos , Cicatriz/prevención & control , Complicaciones Posoperatorias/prevención & control , Absceso/etiología , Absceso/cirugía , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Estudios de Seguimiento , Humanos , Laparoscopios , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/cirugía , Reoperación , Estudios de Tiempo y Movimiento , Ombligo/cirugía , Vagina/cirugía , Adulto JovenRESUMEN
BACKGROUND: Laparoscopic surgery has dramatically improved surgical care of patients reducing postoperative pain, wound infection rate, hospital stay, inability to work, risk of hernia, and cosmetic result. Natural orifice transluminal endoscopic surgery (NOTES) is even less traumatic to the abdominal wall and might further improve minimal invasive surgery of patients, but might also increase surgical risk when used by a transgastric or transcolonic approach with flexible endoscopes. Therefore we decided to use a transvaginal approach using rigid laparoscopic instruments for cholecystectomies. METHODS: Through a 5-mm incision deep in the umbilicus a pneumoperitoneum was created. The optic and a dissector were inserted through the posterior fornix of the vagina under laparoscopic control from the umbilicus and a transvaginal gallbladder removal was performed. RESULTS: 20 patients were successfully operated in a 4.5-month period. Operating time was 62 (35-100) min. No intra- or postoperative complications occurred in any patient. Gynecological examination after 8 days showed no negative findings and the cosmetic result was ideal with no visible scars. CONCLUSION: In our series we showed that cholecystectomies can be routinely performed in a NOTES technique without visible scar. The transvaginal approach is the safe in NOTES and common laparoscopic instruments can be used as long as there are no better flexible endoscopes for this purpose.
Asunto(s)
Colecistectomía Laparoscópica/métodos , Cicatriz/prevención & control , Enfermedades de la Vesícula Biliar/cirugía , Femenino , Estudios de Seguimiento , Humanos , Complicaciones Posoperatorias/prevención & control , Estudios Retrospectivos , Resultado del Tratamiento , Ombligo , VaginaRESUMEN
OBJECTIVE: To determine the influence of preoperative esophageal motility on clinical and objective outcome of the Toupet or Nissen fundoplication and to evaluate the success rate of these procedures. Nissen fundoplication (360 degrees ) is the standard operation in the surgical management of gastroesophageal reflux disease (GERD). In order to avoid postoperative dysphagia it has been proposed to tailor antireflux surgery according to pre-existing esophageal motility. Postoperative dysphagia is thought to occur more commonly in patients with esophageal dysmotility and it has been recommended to use the Toupet procedure (270 degrees ) in these patients. We performed a randomized trial to evaluate this tailored concept and to compare the two operative techniques concerning reflux control and complication rate (dysphagia). METHODS: 200 patients with GERD were included in a prospective, randomized study. After preoperative examinations (clinical interview, endoscopy, 24-hour pH-metry and esophageal manometry) 100 patients underwent either a laparoscopic Nissen procedure (50 with and 50 without motility disorders), or Toupet (50 with and 50 without motility disorders). Postoperative follow-up after two years included clinical interview, endoscopy, 24-hour pH-metry, and esophageal manometry. RESULTS: After two years 85% (Nissen) and 85% (Toupet) of patients were satisfied with the operative result. Dysphagia was more frequent following a Nissen fundoplication compared to Toupet (19 vs. 8, p < 0.05) and did not correlate with preoperative motility. Concerning reflux control the Toupet proved to be as good as the Nissen procedure. CONCLUSION: Tailoring antireflux surgery according to the esophageal motility is not indicated, as motility disorders are not correlated with postoperative dysphagia. The Toupet procedure is the better operation as it has a lower rate of dysphagia and is as good as the Nissen fundoplication in controlling reflux.
Asunto(s)
Trastornos de la Motilidad Esofágica/diagnóstico , Fundoplicación/métodos , Reflujo Gastroesofágico/cirugía , Laparoscopía/métodos , Adulto , Anciano , Anciano de 80 o más Años , Trastornos de la Motilidad Esofágica/cirugía , Esofagoscopía/métodos , Femenino , Estudios de Seguimiento , Fundoplicación/efectos adversos , Determinación de la Acidez Gástrica , Reflujo Gastroesofágico/diagnóstico , Humanos , Concentración de Iones de Hidrógeno , Laparoscopía/efectos adversos , Masculino , Manometría/métodos , Persona de Mediana Edad , Cuidados Posoperatorios , Probabilidad , Estudios Prospectivos , Recurrencia , Valores de Referencia , Reoperación , Medición de Riesgo , Índice de Severidad de la Enfermedad , Estadísticas no Paramétricas , Resultado del TratamientoRESUMEN
Laparoscopic surgery has decreased trauma and improved results and natural orifice transluminal endoscopic surgery (NOTES) should be a further step in this direction. However the use of flexible gastroscopes in the abdomen is difficult and the generally chosen transgastric approach is not without risk. Therefore we have carried out a cholecystectomy with a combined transvaginal and transumbilical approach, using laparoscopic instruments. The optic and a dissector were inserted in the posterior fornix of the vagina, and a 5-mm trocar was inserted deep in the umbilicus. After dissection the gallbladder was removed through the vagina. The operation was done without problems within 85 minutes and left no visible scar. The postoperative course was uneventful. In NOTES the transvaginal approach has important advantages over the transgastric method (e. g. regarding sterilization and closure); standard laparoscopic instruments can be used whilst there are no flexible endoscopes that are easier to handle.
Asunto(s)
Colecistectomía Laparoscópica/métodos , Enfermedades de la Vesícula Biliar/cirugía , Laparoscopios , Ombligo , Vagina , Diseño de Equipo , Femenino , Estudios de Seguimiento , HumanosRESUMEN
We present the findings of a 67 year old male patient with an intestinal leiomyomatosis localized in the rectum. To our knowledge, this is the fifth case of intestinal leiomyomatosis reported so far. The most characteristic findings of this rare disease include a cuff-like tumorous proliferation of smooth muscle within the bowel wall which may extend into extramural tissue and result in a stenosis of a longer bowel segment. Because of severe obstructive symptoms over 5 years, the patient had to undergo surgery with resection of the rectum. The histological examination revealed a morphology and immunophenotype comparable to usual leiomyomas with the exception of hyalinosis-like changes in the blood vessels, apparently a special feature of leiomyomatosis. A novel finding in our case was the occurrence of skeinoid fibers which have so far only been reported in gastrointestinal stromal tumors.
Asunto(s)
Neoplasias del Colon/patología , Neoplasias del Colon/cirugía , Leiomioma Epitelioide/patología , Leiomioma Epitelioide/cirugía , Anciano , Humanos , Imagen por Resonancia Magnética , MasculinoRESUMEN
BACKGROUND: Nissen fundoplication (360 degrees ) is the standard operation for the surgical management of gastroesophageal reflux disease (GERD). To avoid postoperative dysphagia, it has been proposed that antireflux surgery be tailored according to the degree of preexisting esophageal motility. Postoperative dysphagia is thought to occur more commonly in patients with esophageal dysmotility and the Toupet procedure (270 degrees ) has been recommended for these patients. We performed a randomized trial to evaluate this tailored concept and to compare the two operative techniques in terms of reflux control and complication rate (dysphagia). Our objective was to determine the impact of preoperative esophageal motility on the clinical and objective outcome, following Toupet vs Nissen fundoplication and to evaluate the success rate of these procedures. METHODS: From May 1999 until May 2000, 200 patients with GERD were included in a prospective randomized study. After preoperative examinations (clinical interview, endoscopy, 24-h pH study and esophageal manometry), 100 patients underwent either a laparoscopic Nissen (50 with and 50 without motility disorders), or a Toupet procedure (50 with and 50 without motility disorders). Postoperative follow-up after 4 months included clinical interview, endoscopy, 24-h pH study and esophageal manometry. RESULTS: Interviews showed that 88% (Nissen) and 90% (Toupet) of the patients, respectively, were satisfied with the operative result. Dysphagia was more frequent following a Nissen fundoplication than after a Toupet (30 vs 11, p <0.001) and did not correlate with preoperative motility. In terms of reflux control, the Toupet proved to be as effective as the Nissen procedure. CONCLUSION: Tailoring antireflux surgery to esophageal motility is not indicated, since motility disorders are not correlated with postoperative dysphagia. The Toupet procedure is the better operation because it has a lower rate of dysphagia and is as effective as the Nissen fundoplication in controlling reflux.
Asunto(s)
Fundoplicación/métodos , Reflujo Gastroesofágico/cirugía , Laparoscopía/métodos , Adulto , Anciano , Anciano de 80 o más Años , Trastornos de la Motilidad Esofágica/complicaciones , Esófago/fisiopatología , Esófago/cirugía , Femenino , Fundoplicación/efectos adversos , Humanos , Laparoscopía/efectos adversos , Masculino , Manometría/métodos , Persona de Mediana Edad , Complicaciones Posoperatorias/etiología , Estudios ProspectivosRESUMEN
BACKGROUND AND AIMS: The purpose of this study was to determine whether esophageal dysmotility affects symptoms of gastroesophageal reflux disease or clinical outcome after laparoscopic fundoplication and whether esophagus motor function changes postoperatively. METHODS: Two hundred patients with a history of long-standing gastroesophageal reflux disease were investigated by clinical assessment, upper gastrointestinal endoscopy, esophageal manometry, and 24-hour pH monitoring between May 1999 and May 2000. Patients were stratified according to presence or absence of esophageal dysmotility (each n = 100) and randomized to either 360 degrees (Nissen) or 270 degrees (Toupet) fundoplication. At a 4-month postoperative follow-up, preoperative tests were repeated. RESULTS: Preoperative esophageal dysmotility was associated with more severe reflux symptoms, more frequent resistance to medical treatment (64% vs. 49%; P < 0.05), and greater decrease in lower esophageal sphincter pressure (9.5 +/- 5.3 vs. 12.4 +/- 6.7 mm Hg; P < 0.0005) compared with normal motility. Postoperatively, clinical outcome and reflux recurrence (21% vs. 14%) were similar. Esophageal motility remained unchanged in 85% of patients and changed from pathologic to normal in 20 (10 Nissen/10 Toupet) and vice versa in 9 (8 Nissen/1 Toupet) patients. CONCLUSIONS: Esophageal dysmotility (1) reflects more severe disease; (2) does not affect postoperative clinical outcome; (3) is not corrected by fundoplication, independent of the surgical procedure performed; (4) may occur as a result of fundoplication; and (5) requires no tailoring of surgical management.
Asunto(s)
Fundoplicación/métodos , Reflujo Gastroesofágico/cirugía , Manometría , Adulto , Anciano , Anciano de 80 o más Años , Trastornos de la Motilidad Esofágica/complicaciones , Esofagoscopía , Femenino , Reflujo Gastroesofágico/etiología , Humanos , Concentración de Iones de Hidrógeno , Masculino , Persona de Mediana Edad , Periodo PosoperatorioRESUMEN
BACKGROUND AND OBJECTIVE: Splenectomy is of great benefit for patients with idiopathic thrombocytopenia (ITP), when medical therapy has failed. It was the aim of this retrospective study to evaluate the results of laparoscopic splenectomy. PATIENTS AND METHODS: All patients with ITP, who had a laparoscopic splenectomy between 1992 and 1999, were included in this study. RESULTS: 53 patients with an average age of 41.8 years had a laparoscopic splenectomy: 48 of these operations were finished laparoscopically, while conversion to the open technique was necessary in five patients. The mean operation time was 95 minutes. In the last 38 cases it was 76 minutes. There were no deaths and no reoperations were necessary. The average postoperative hospital stay was 3.9 days. After a mean follow-up of 24 (1-75) months thrombocytopenia recurred in eight patients, of whom five received medical therapy. CONCLUSION: Splenectomy can be easily performed laparoscopically in patients with ITP and has a low morbidity. The results of therapy of ITP are good. Because of the quick convalescence the patients' comfort is better than with the conventional operation.
Asunto(s)
Laparoscopía , Esplenectomía/métodos , Trombocitopenia/cirugía , Adolescente , Adulto , Anciano , Estudios de Evaluación como Asunto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Recuento de Plaquetas , Recurrencia , Estudios Retrospectivos , Factores de TiempoRESUMEN
We present a 78-year-old patient who suffered from symptomatic transitory psychotic syndrome after laparotomy. Persisting somnolence appeared with cardiopulmonary decompensation and gastrointestinal atony. Due to prolonged hypercalcemia primary hyperparathyreoidism was diagnosed. Resection of a large carcinoma of the parathyroids led to continuous clinical improvement.
Asunto(s)
Adenoma/cirugía , Encefalopatías Metabólicas/diagnóstico , Carcinoma/diagnóstico , Neoplasias del Colon/cirugía , Hipercalcemia/diagnóstico , Neoplasias de las Paratiroides/diagnóstico , Complicaciones Posoperatorias/diagnóstico , Anciano , Encefalopatías Metabólicas/patología , Encefalopatías Metabólicas/cirugía , Carcinoma/patología , Carcinoma/cirugía , Diagnóstico Diferencial , Humanos , Hipercalcemia/patología , Hipercalcemia/cirugía , Masculino , Glándulas Paratiroides/patología , Neoplasias de las Paratiroides/patología , Neoplasias de las Paratiroides/cirugía , Paratiroidectomía , Complicaciones Posoperatorias/patología , Complicaciones Posoperatorias/cirugía , Reoperación , TiroidectomíaRESUMEN
PURPOSE: Vascular endothelial growth factor (VEGF) and basic fibroblast growth factor (bFGF) have been suggested to be important mediators for tumor-induced angiogenesis. We measured serum VEGF and bFGF levels from patients with soft-tissue sarcomas and correlated serum VEGF and bFGF levels with tumor status at surgery and histological grading. MATERIALS AND METHODS: A group of 18 healthy controls and 85 patients with soft-tissue sarcoma were enrolled in this study. The patients were classified according to tumor status at surgery. Serum levels of VEGF and bFGF were also correlated with histological grading. VEGF and bFGF levels were determined by enzyme-linked immunosorbent assay (Quantikine R&D Systems). RESULTS: Serum VEGF and bFGF levels were significantly elevated in the patient group (VEGF: 580pg/ml, bFbF: 21pg/ml, P = 0.0001). The highest concentrations of serum VEGF and bFGF were found in patients with macroscopic tumor lesions or G3 histology. Serum VEGF levels showed a statistically significant correlation with tumor status and grading (P = 0.006 for tumor status, P = 0.0001 for grading). CONCLUSIONS: This study reveals that elevated preoperative serum VEGF and bFGF levels can be detected in the majority of patients with soft-tissue sarcoma. The significant correlation with tumor mass and histological grading suggests that a consecutive monitoring of VEGF and bFGF in the serum of patients with soft-tissue sarcoma might be a valuable marker for tumor follow-up.
Asunto(s)
Biomarcadores de Tumor/sangre , Factores de Crecimiento Endotelial/sangre , Factor 2 de Crecimiento de Fibroblastos/sangre , Linfocinas/sangre , Sarcoma/sangre , Sarcoma/patología , Estudios de Casos y Controles , Ensayo de Inmunoadsorción Enzimática , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias , Sarcoma/cirugía , Factor A de Crecimiento Endotelial Vascular , Factores de Crecimiento Endotelial VascularRESUMEN
BACKGROUND: We report on a prospective observational multicenter study of more than 1,000 consecutive patients undergoing laparoscopic colorectal procedures. The aim of the current study was to investigate the safety of laparoscopic colorectal surgery as reflected by the anastomotic insufficiency rates in the various sections of the bowel, and to compare these rates with those of open colorectal surgery. METHODS: The study was begun on August 1, 1995. Twenty-four centers in Germany, Austria, and Switzerland participated in this prospective multicenter study. All patients undergoing laparoscopic colorectal surgery were included in the study. No selection criteria were applied, which means that every operation begun as a laparoscopic procedure was included. Data on patient demographics, surgical indications, surgical course, and patient outcome were recorded prospectively in a computer database. All data were rendered anonymous. RESULTS: Between August 1995 and February 1998, the 24 participating centers treated 1,143 patients (male/female ratio, 1:1.36; mean age, 60.7 years). In all, 626 operations were performed for benign indications and 517 for cancer. Most procedures involved the sigmoid colon and rectum (80.9%). An anastomosis was performed in 83% of the operations. Most of the anastomoses were laparoscopically assisted using the stapling technique. We observed an overall leakage rate of 4.25% (colon 2.9%; rectum 12.7%), and surgical reintervention was required in 1% of the cases. The rate of conversion to open surgery was 5.6%. Intraoperative complications occurred in 5.9%, and reoperation was necessary in 4.1% of the cases. The overall morbidity rate was 22.3%, and the 30-day mortality rate was 1.57%. CONCLUSIONS: The feasibility and safety of the laparoscopic colorectal approach is demonstrated clearly. The current study shows that the laparoscopic or laparoscopically assisted approach to colorectal surgery is not associated with a higher risk of anastomotic leaks. Morbidity and mortality rates with this method approximate those seen with conventional colorectal surgery.
Asunto(s)
Enfermedades del Colon/cirugía , Laparoscopía , Enfermedades del Recto/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Anastomosis Quirúrgica/métodos , Distribución de Chi-Cuadrado , Femenino , Humanos , Complicaciones Intraoperatorias/epidemiología , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/epidemiología , Estudios Prospectivos , Reoperación , Factores de Riesgo , Resultado del TratamientoRESUMEN
BACKGROUND: Minimal invasive surgery is increasingly used in conditions complicated by peritonitis-e.g., peptic ulcer perforation. This study was devised to assess the effect of a pneumoperitoneum (PP) on the ultrastructural integrity of parietal peritoneum in perforation-induced peritonitis. METHODS: Anesthetized rats were subjected either to standardized gastrotomy simulating gastric perforation (groups Ia-d; IIa-d) or to sham perforation (groups IIIa-d, IVa-d). In group I (a-d) and III (a-d), CO2 was insufflated 12 h after gastrotomy for 60 min (Pia 4 mmHg). Glutaraldehyde was administered intraperitoneally at the end of the PP period while the abdominal wall was still extended (group index a), as well as 30 sec (b), 2 h (c), and 12 h (d) after desufflation. Specimens were taken from the parietal peritoneum of the left diaphragm for scanning electronic-microscopic (SEM) analysis. In groups II (a-d) and IV (a-d), simple puncture of the abdominal cavity was performed, and specimens were taken at corresponding times. RESULTS: In group Ia (gastric perforation with PP), distortion of the mesothelial cell layer with concomittant opening of stomata to the submesothelial tissue was already observed in specimens harvested while the abdominal wall was still extended. Concomitantly, scarce microvilli, which appeared coarse and thickened, were lying flat on top of the mesothelial cells. After desufflation (groups Ib-c), a rapid process of mesothelial disintegration with disruption from the submesothelial layer and vanishing of microvilli occurred. At 12 h after PP (group Id), complete deterioration of mesothelial cell integrity was observed. In groups IIa-c (gastric perforation without PP), microvilli appeared shrunk and coarse, while integrity of the mesothelial cell layer remained intact up to 2 h after the abdominal puncture. At 12 h after abdominal puncture (group IId), the microvilli had nearly completely vanished and the mesothelium was breaking apart into multiple soils. CONCLUSIONS: In SEM analysis of parietal peritoneum, premature distortion, and disintegration of the mesothelial cell layer was observed in animals exposed to increased abdominal pressure in addition to gastric perforation-induced peritonitis.