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H Dienemann

Publications and source records attributed to H Dienemann.

At least 19 recordsLinked to original sources
PubMed2006

[Prognosis after complete surgical resection for non-small cell lung cancer based on the staging classification].

BACKGROUND AND OBJECTIVE: The importance of accurate staging according to the international TNM staging system of non-small cell lung cancer (NSCLC) for patient management and ascertaining individual prognosis cannot be overemphasized. The TNM classification is scheduled to be revised in 2007. In a large single-center collective we investigated the prognosis for patients who had complete resection of a NSCLC. PATIENTS AND METHODS: We retrospectively reviewed hospital records and follow-up data of 2,378 patients operated on between 1996 and 2005 for NSCLC. Complete resection was achieved in 2,083 patients. Systematic hilar and mediastinal lymph node dissection was performed concurrently. Probability of survival was then analysed with the Kaplan-Meier method. The significance of differences between subgroups was calculated using the log-rank test. Odds ratios with 95 % confidence intervals (CI) were calculated for each characteristic. The Cox model was used for multivariate analyses. RESULTS: The 5-year survival for patients after complete resection was 50.7 %. The 5-year survival rates for clinical stages were 72 % for stage IA, 59.8 % for stage IB, not defined for stage IIA, 47,8 % for stage IIB, 45 % for stage IIIA, 38.7 % for stage IIIB, and not defined for stage IV. There were significant differences in survival between stages IIIB and IV (p = 0.013). There was a trend towards significance between patients with IA and IB (p = 0.052). However, there was no significant difference between patients with all the other stages. 5-year survival according to pathological stages was: stage IA 68.5 %; stage IB 66.6 %; stage IIA 55.3 %; stage IIB 49.0 %; stage IIIA 35.8 %; stage IIIB 35.4 %; stage IV not defined. Gender, age and type of histology were found by multivariate analysis to be significant independent prognostic factors for survival. CONCLUSIONS: The TNM and stage grouping classification is valid for defining prognosis and prognosis-related criteria in patients with NSCLC. The difference in prognosis between clinical stages IIIB and IV was significant, but not that between all the other related subgroups. Concordance with histological staging demonstrated the quality of existing clinical staging methods and related strategies. Complete surgical resection, age, gender, histology and stage of the disease significantly influenced long-term survival.

Adult↗
PubMed2006

Endobronchial ultrasound-guided transbronchial needle aspiration of lymph nodes in the radiologically normal mediastinum.

Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) can sample enlarged mediastinal lymph nodes in patients with nonsmall cell lung cancer (NSCLC). To date, EBUS-TBNA has only been used to sample nodes visible on computed tomography (CT). The aim of the present study was to determine the accuracy of EBUS-TBNA in sampling nodes 1 cm) in the mediastinum underwent EBUS-TBNA. Identifiable lymph nodes at locations 2r, 2l, 4r, 4l, 7, 10r, 10l, 11r and 11l were aspirated. All patients underwent subsequent surgical staging. Diagnoses based on aspiration results were compared with those based on surgical results. In 100 patients (mean age 58.9 yrs; 68 males), 119 lymph nodes ranging 5-10 mm in size were detected and sampled. Malignancy was detected in 19 patients but missed in two; all diagnoses were confirmed by surgical findings. The mean diameter of the punctured lymph nodes was 8.1 mm. The sensitivity of EBUS-TBNA for detecting malignancy was 92.3%, specificity was 100%, and the negative predictive value was 96.3%. No complications occurred. In conclusion, endobronchial ultrasound-guided transbronchial needle aspiration can accurately sample even small mediastinal nodes, therefore avoiding unnecessary surgical exploration in one out of six patients who have no computed tomography evidence of mediastinal disease. Potentially operable patients with no signs of mediastinal involvement on computed tomography may benefit from pre-surgical endobronchial ultrasound-guided transbronchial needle aspiration and staging.

Biopsy, Fine-Needle↗
PubMed2006

Outcome following lung resections for pT1 non-small cell lung cancer.

AIMS: To analyse the outcome of patients with pT1 NSCLC treated at our institution by antero-lateral thoracotomy, anatomical lung resections and mediastinal lymph node dissection between 1980 and 2001. METHODS: Follow-up data were obtained retrospectively from 1980 to 1990 and prospectively after 1990. Survival was analysed using the Kaplan-Meier method. RESULTS: Histopathological examinations revealed mediastinal lymph node infiltration in 27.6% (pN1 17.8% and pN2 9.8%). pN2 was classified in 14.1% of adenocarcinomas compared to 6.2% of squamous cell carcinomas. Median overall survival of patients with pT1 carcinomas was 89+16 months (median+standard error). Histopathological N-classification indicates differential prognostic and therapeutic implications in pT1 adeno- and squamous cell carcinomas. CONCLUSIONS: Complete lymph node dissection is required for all patients with T1 NSCLC treated by either open surgery or VATS resection. Histopathological N-classification indicates differential prognostic and therapeutic implications in pT1 adeno- and squamous cell carcinomas.

Carcinoma, Non-Small-Cell Lung↗
PubMed2006

Pulmonary resection for metastatic osteosarcomas: a retrospective analysis of 21 patients.

BACKGROUND: The use of pulmonary resection for metastatic osteosarcoma as an interdisciplinary treatment concept is being established. The purpose of this study was to determine the clinical course, outcome and prognostic factors in a subset of patients having undergone aggressive polychemotherapy in the most recent period and metastasectomy. METHODS: Between 1997 and 2001, 21 patients (8 men, 13 women) with pulmonary metastases from osteosarcoma of the limb underwent surgical resection. Exclusion of primary tumor recurrence and other extrapulmonary metastases was mandatory for inclusion in the study. Complete resection was achieved in 18 patients. The median follow-up was 60.6 months. RESULTS: Cumulative 5-year survival after complete resection was 34.2%. Of the prognostic factors analyzed, age, sex, repeated thoracotomy, and histologic grading did not influence survival. Complete resection was found to be a significant prognostic factor for survival following metastasectomy (p = 0.04). There was a tendency towards longer survival in patients with less than 7 pulmonary metastases compared to patients with more than 7 metastases, but the difference was not statistically significant (p = 0.07). CONCLUSION: With pulmonary metastases of osteosarcoma, every attempt should be made to completely resect all clinically detected metastases. Repeat thoracotomy in recurrent disease is compatible with long-term survival.

Adolescent↗
PubMed2006

Surgical treatment of primary soft tissue sarcomas involving the chest: experiences in 25 patients.

BACKGROUND: Primary soft tissue sarcomas of the chest wall are uncommon and data concerning treatment and results are sparse. We reviewed our experience with chest wall resections of these lesions. METHODS: Retrospective review of our database identified 25 patients (12 men, 13 women) who underwent chest wall resection for primary soft tissue sarcoma during the 18-year study period (January 1984 through to January 2002). The mean follow-up period was 46.5 months. RESULTS: The 30-day mortality was zero. The cumulative 5-year survival rate of all 25 patients was 56.9 %, and the median survival 99.5 months. This compared with 42.2 % and a median survival of 36.0 months after chest wall resection for high grade tumor histology. Histological type grading clearly influenced long-term survival ( P = 0.036). Local recurrence occurred in 9 patients, 6 of 8 who were resected with positive margins and 3 of 17 who were resected with negative margins. Chest wall resections extended with lung resections did not significantly impair postoperative pulmonary function compared to patients without concomitant lung resections. CONCLUSIONS: Chest wall resections in primary soft tissue sarcomas can be accomplished safely with a low mortality rate. Long-term survival can be achieved for primary soft tissue sarcomas but histological grading is of prognostic significance.

Adult↗
PubMed2006

Pulmonary metastasectomy following chemotherapy in patients with testicular tumors: experience in 52 patients.

BACKGROUND: Surgical resection is an important form of treatment for residual post-chemotherapy pulmonary masses in patients with non-seminomatous germ cell tumors. We analyzed the outcome and prognostic factors after surgery. METHODS: Between 1996 and 2001, 52 patients underwent pulmonary resection of thoracic masses following cisplatin-based chemotherapy. These patients' records were subsequently reviewed. RESULTS: The overall 5-year survival rate was 75.8 %. A significantly longer survival was observed using multivariate analysis in patients with normal serum AFP and/or hCG tumor marker levels and after complete surgical resection. In patients with viable malignant tumor cells in the resected specimen and in patients with only necrosis/fibrosis or teratoma, the 5-year survival rates were 49.6 % and 82.8 %, respectively. This difference was only statistically significant in univariate analysis. CONCLUSIONS: We conclude that pulmonary resection in metastatic non-seminomatous germ cell tumors is a safe and effective treatment modality. Incomplete resection and elevated tumor marker levels, AFP and/or hCG, were identified as prognosis-related criteria for a poor outcome in multivariate analysis.

Adolescent↗
PubMed2006

Pulmonary metastasectomy in patients with soft tissue sarcomas: experiences in 50 patients.

BACKGROUND: Pulmonary resection of metastatic soft tissue sarcomas is an accepted method of treatment. The purpose of this study was to determine the clinical course, outcome and prognostic factors after surgery. METHODS: Between 1996 and 2001, 50 patients (27 men, 23 women) with pulmonary metastases from a soft tissue sarcoma underwent surgical resection. Inclusion criteria for the study were the absence of primary tumor recurrence and other extrapulmonary metastases. Complete resection (CR) was achieved in 31 patients. RESULTS: The overall 5-year survival rate was 37.6 %. The 5-year survival rate after complete metastasectomy was 52.7 %, but none of the patients who underwent incomplete resection survived 3 years. Complete resection was found to be a significant prognostic factor for survival following metastasectomy ( P < 0.0001). Of the prognostic factors analyzed, age, sex, repeat thoracotomy, thoracic lymph node involvement, number of metastases, disease-free interval, histology and histological grading did not influence survival. CONCLUSION: We conclude that pulmonary resection of metastatic soft tissue sarcomas is a safe and effective treatment, which offers an improved survival benefit. Prognosis-related criteria are identified which support the necessity of complete surgical resection of all clinically detected metastases.

Adolescent↗
PubMed2005

Dexamethasone-induced cisplatin and gemcitabine resistance in lung carcinoma samples treated ex vivo.

Chemotherapy for lung cancer not only has severe side effects but frequently also exhibits limited, if any clinical effectiveness. Dexamethasone (DEX) and similar glucocorticoids (GCs) such as prednisone are often used in the clinical setting, for example, as cotreatment to prevent nausea and other symptoms. Clinical trials evaluating the impact of GCs on tumour control and patient survival of lung carcinoma have never been performed. Therefore, we isolated cancer cells from resected lung tumour specimens and treated them with cisplatin in the presence or absence of DEX. Cell number of viable and dead cells was evaluated by trypan blue exclusion and viability was measured by the MTT-assay. We found that DEX induced resistance toward cisplatin in all of 10 examined tumour samples. Similar results were found using gemcitabine as cytotoxic drug. Survival of drug-treated lung carcinoma cells in the presence of DEX was longlasting as examined 2 and 3 weeks after cisplatin treatment of a lung carcinoma cell line. These data corroborate recent in vitro and in vivo xenograft findings and rise additional concerns about the widespread combined use of DEX with antineoplastic drugs in the clinical management of patients with lung cancer.

Aged↗
PubMed2005

[Pleural empyema: surgical treatment].

Pleural empyema runs in three stages, if untreated. Because it produces uncharacteristic signs, specific diagnosis and adequate treatment is often delayed. The treatment should be early, according to the stage and adapted to the given situation. Expenditure and morbidity of treatment are the higher the longer it is delayed. In the exudative stage 1, drainage--if necessary combined with antibiotic administration--is likely to be successful. In the fibrinous-purulent stage 3, often not clearly demarked from the other stages, video-assisted thoracoscopy (VATS) in its various forms provides the best therapeutic prerequisite. It makes it possible to open all cavities and free pleural layers from the, usually fibrinous or fibrosing, contents. Furthermore, VATS allows targeted drainage placement as essential precondition of effective irrigation. The definitive stage 3 of organization requires the technically demanding empyema excision or decortication.

Anti-Bacterial Agents↗
PubMed2005

[Thoracic surgery in the elderly].

In the near future, over 40% of patients with lung cancer will be over 70 years old at the time their disease is diagnosed. Age per se, however, should not lead to the denial of a potentially curative surgical intervention. It has been shown that older patients (over 70 years), as well as patients over 80 years of age, may tolerate a lobectomy or even a pneumonectomy quite well. Most patients with lung cancer are present or former smokers and have underlying pulmonary problems, especially chronic obstructive lung disease. They are at high risk of both morbidity and mortality from surgery due to significant cardiovascular disease. The indications for surgical intervention should be based on reliable preoperative tumor staging and pulmonary assessment by an experienced interdisciplinary panel of physicians, taking into consideration the individual cardiopulmonary status of the patient. This assessment, combined with the American Society of Anesthesiologists risk classification and the overall clinical assessment by the surgeon, will provide the best available evidence for carefully weighing the benefits and risks of an operation. The responsibility for this assessment must be viewed-in the case of early stage lung cancer-in relation to the relative lack of alternative treatments for surgical intervention with comparable 5-year survival rates (>50%).

Age Factors↗
PubMed2005

Surgical resection of secondary chest wall tumors.

OBJECTIVE: The objective of this study was to evaluate which factors influence survival following surgical resection of secondary tumors of the chest wall (non-bronchial carcinoma). METHODS: Between 1990 and 2001, 69 patients (23 men, 46 women) underwent chest wall resection with curative intent. All of the patients were retrospectively analyzed for sex and age, presenting symptoms, tumor location, disease-free interval, histology, radiation therapy or chemotherapy, surgical techniques and extent of resection, 30-day mortality and long-term survival. RESULTS: The most common tumors were isolated locally recurrent breast cancer (n = 33) and renal cell carcinoma (n = 17). Resection of chest wall tumors in all of the other patients revealed a kaleidoscope of different pathologies (n = 19). Overall 5-year survival was 38 %. In patients with isolated recurrence of breast cancer and in patients with chest wall metastases of renal cell cancer, the median survival was 40.6 months and 53.7 months, respectively. A disease-free interval of more than 24 months and no systemic chemotherapy after mastectomy were parameters for a favorable prognosis in patients with breast cancer. CONCLUSIONS: We conclude that chest wall resection of secondary chest wall tumors is a safe and effective treatment as part of a multidisciplinary approach. The role of surgery will continue to evolve as improvements in systemic treatment occur.

Adult↗
PubMed2004

[Surgery in non-small cell lung cancer of the superior sulcus: results of a combined preoperative and postoperative irradiation regime].

UNLABELLED: Due to local invasion of the chest wall, patients with non small cell carcinoma (NSCLC) of the superior sulcus have been treated mainly by the Paulson regime with radiotherapy followed by surgical resection. Recent published data on the use of concurrent irradiation and chemotherapy followed by surgical resection seemed very promising. The aim of the present study was to determine the value and benefit of a combined preoperative and postoperative radiotherapy regime (Sandwich irradiation), and which factors predict prognosis following resection. PATIENTS AND METHODS: Between 1986 and 2003, 64 patients with non-small cell carcinoma of the superior sulcus were managed in our department. 28 underwent surgical resection with combined preoperative 40 Gy and postoperative 20 Gy external beam radiotherapy. Time to death was calculated using the method of Kaplan and Meier. Survival after surgery was the end point of the study. The association of factors to end of life end points was analyzed using the log-rank test for univariate analysis. Median follow up was 13.1 months. RESULTS: The actuarial 5-year-survival for the overall population was 30.2 %. For surgically-rendered complete resection (CR) patients with no mediastinal lymph node metastases, the 5-year-survival-rate was 53.2 %. The 30-day-mortality-rate was 0 %. Most significant prognostic factors were the mediastinal lymph node involvement and the stage of the disease. CONCLUSIONS: Results of this retrospective study show that patients with non-small cell carcinoma of the superior sulcus can experience a long-term survival which is well comparative to other patients with NSCLC. Surgical resection with a combined preoperative and postoperative radiotherapy regime is well accepted. Special care should be taken in patient selection to identify patients with advanced stage of the disease and mediastinal lymph node metastases.

Adenocarcinoma↗
PubMed2004

Morgagni hernia in adults: results in 7 patients.

OBJECTIVE: Morgagni's hernia is a relatively uncommon diaphragmatic hernia with a potential for considerable morbidity, if the diagnosis is delayed or missed. This review of cases of Morgagni's hernia was undertaken in order to emphasize methods of diagnosis and treatment. METHODS: From 1992 through 2002, seven patients with Morgagni's hernia (5 right, 2 left) were surgically treated at our hospital. We investigated the patients preoperatively including chest roentgenogram, chest CT scan, and contrast studies of the upper gastrointestinal tract. Operative repair was accomplished with the transabdominal or transthoracic approach. Basic spirometric tests had been carried out on patients presented for elective surgery. RESULTS: The majority of patients experienced dyspnea and two patients presented with acute abdomen due to peritonitis. Diagnosis for Morgagni's hernia was made preoperatively in all but one patient. In cases with uncertain diagnosis or peritonitis, a transabdominal approach was preferred. One patient had died of septic multi-organ failure in the early postoperative course. Following elective repair of Morgagni's hernia, improvement in basic spirometric values was seen. CONCLUSIONS: We conclude that repair for Morgagni's hernia can be performed safely and effectively by using different surgical approaches. The risk of progression and incarceration makes clinical awareness, early diagnosis, and surgical treatment warranted. Improvement in lung function can be expected postoperatively.

Aged↗
PubMed2003

[Endoscopic thoracic surgery: indications, feasibility, and limitations].

Mediastinoscopy and mediastinotomy are used primarily in the staging of lung cancer; they are also of value in biopsying mediastinal masses and lymph nodes to establish diagnoses such as sarcoidosis,lymphoma, and mediastinal tumors. Video-assisted thoracic surgery (VATS) was introduced in 1990 and has now replaced open thoracotomy in the evaluation of many pleuropulmonary disorders. Specific advantages of VATS over open thoracotomy include the use of smaller incisions, reduced operative morbidity, and optimal visualization of the entire lung and pleural space. In many centers it has become the procedure of choice for the biopsy of interstitial disease, indeterminate lung nodules, or pleural lesions. The role of VATS for staging of lung cancer patients is still under debate. VATS procedures have also been adopted for the treatment of a wide range of thoracic disorders. With increasing experience surgeons have become more skilled with this limited access technique and meanwhile lobectomies can be performed safely. The role of VATS in the management of lung metastases or lung cancer is still being investigated. It is a concern that there is a temptation to do less when a minimal access operation is performed that does not allow for palpation of the lung. In addition, lymph node dissection cannot be performed adequately and there continue to be reports of local recurrences in port sites. If the VATS approach is to be used, surgeons should always respect the oncological principles that have been developed over the past decades.

Biopsy↗
PubMed2003

Non-small-cell superior sulcus tumor: results of en bloc resection in fifty-six patients - non-small-cell pancoast.

BACKGROUND: Various multidisciplinary approaches are taken in the treatment of superior sulcus tumors. The purpose of this study was to determine the outcome, long-term results, and factors associated with prolonged survival after administering different combined radiosurgical regimens in a single institution. METHODS: Between 1986 and 2000, 56 patients (43 men, 13 women) with superior sulcus tumor and histology of non-small-cell lung cancer underwent surgical resection. There were four treatment groups: I - preoperative radiation and operation (n = 15); II - preoperative radiation, operation and postoperative radiation (n = 22); III - operation and postoperative radiation (n = 10) and IV - no radiotherapy (n = 9). Survival was calculated by the Kaplan-Meier method and prognostic factors were assessed for significance by log-rank test and Cox regression analysis. RESULTS: The five-year survival rate after complete resection and N0/1 was 34 %. Of the prognostic factors analyzed, the histology, type of irradiation regimen and Horner's syndrome did not influence survival. Completeness of resection and mediastinal lymph node involvement clearly influences survival in univariate analysis. Age, sex and TNM classification were found to be independent significant prognostic factors for survival following resection. CONCLUSION: With superior sulcus tumors, every attempt should be made to resect the tumor completely by en bloc chest-wall resection with lobectomy and systematic hilar and mediastinal lymph node dissection. Mediastinal exploration by routine mediastinoscopy is recommended for identification of patients with advanced nodal involvement. Long-term survival may be relative to care taken in patient selection and extent of the resection performed. No significant difference in survival of patients with different irradiation regimens could be demonstrated in this study.

Aged↗